What is breast cancer?
The breast is a gland comprised of breast tissue itself (which is formed by lobes) and support a called connective tissue and fat. Milk is produced in the lobules of the breast tissue and ducts driven to its exit from the nipple.
Breast cancer is a malignant tumor that develops in the breast tissue (although there may be tumors in the supporting tissues, but are not true breast cancers). If the tumor is contained in the lobes and ducts, it is called "in situ" or non-invasive. If tumor cells run off ducts and lobules be invasive tumor.
Frequency of breast cancer
It is the most common cancer among women and affects approximately one million women worldwide. It is the malignant tumor that causes more deaths among women in Spain. Its incidence in our country is about 46 cases per 100,000 inhabitants and more than 15,000 cases / year ( it is estimated that one of every 11 to 12 women will develop breast cancer). Despite these figures, Spain is the second country in the European Union with the lowest incidence of breast cancer. In males can also occur this tumor, although its effects are much lower (it is a rare cancer in males): less than 1%. The cure rate is around 60%.
The incidence increases with age and doubles every 10 years until the menopause . With the highest incidence ages: 45-60 years. 75% of breast cancers occur in women over 40 years. It is estimated as a risk factor greater than 50 years old. This does not mean that breast cancer do not give in young women, but is much less common.
Geographic variation
It is less common in Asian countries (China, Japan), and more common in Western industrialized countries. Within the latter, it is less common in Latin or Mediterranean countries (Spain, Italy, Greece), which in Anglo-Saxon or Nordic countries.
Studies in Japanese women who emigrated to the United States show that the frequency of breast cancer in these women is raised to approach the American country in one or two generations. This indicates a possible relationship between environmental factors and the type of life with breast cancer.
Reproductive factors, pregnancy
Women with a first menstruation at an early age and late menopause are at increased risk of breast cancer. A menopause after age 55 gives twice as likely to develop breast cancer than women with menopause before 45 years of age.
The incidence of this disease is higher in women who have not had children and where the first pregnancy occurs late. It is estimated that the risk of breast cancer in women who had their first child after age 30 is almost twice those that were before age 20. The highest risk group is that of women who had their first child after 35 years.
Heritage
It is estimated that up to 10% of breast cancers are hereditary. This hereditary factor can be transmitted by both parents, and some family members can pass the altered gene without themselves develop cancer. They are not known accurately set of genes involved in breast cancer, but some have been identified that play important role in these tumors as the BRCA gene.
previous breast diseases
Only the so-called atypical epithelial hyperplasia of the breast appears to increase the risk of breast cancer in women who have previously had.
Radiations
Called ionizing radiation are known cause of development of breast cancer. This relationship is based on studies by mid-century with women or teenage girls who had received radiation to the chest by repeated exposures to X - rays as a diagnostic method or treatment. The risk of developing the tumor depends on the age at which received radiation dose received at each ray exposure and the number of times they were exposed (total dose).
Lifestyle
Are ongoing studies are performed on breast cancer and the acquisition of fats in the diet of people. Some suggest that olive oil (the Mediterranean diet) helps reduce the risk of developing the tumor; however, are factors that still need further study and longer term. Lately, the way research is focusing on soy intake as protective against breast cancer.
The overweight
The overweight is associated with increased risk in postmenopausal women (up to twice the risk than non - obese).
The alcohol
The spirit does not seem to be a clear factor in the development of breast cancer, although some studies relate it so inconsistent. It can have more influence on snuff , especially in cases of younger women in whom not usually frequent breast cancer, and yet present.
Hormones
There is great controversy over whether consumption of oral contraceptives increases the risk of breast cancer. Large studies fail to agree on a definitive form. As a guide, we can say that described a somewhat higher risk in people taking these medications, but that the risk is very small.
Hormone Replacement Therapy
Other hormone preparations taking women make up what is called hormone replacement therapy (HRT) . These are hormones which are administered to menopausal women to relieve symptoms which occur in this period. With these hormones we are in the same situation as with oral contraceptives: studies give very different data arise, and do not allow to clarify in one hundred percent if this treatment is a risk factor for breast cancer or not.
We can say as a general rule that the evidence we have now suggest that HRT does not increase mortality from breast cancer, although we can not rule exhaustively for all women a slightly increased risk of disease treatment.
What are the risk factors for developing breast cancer? Breast lump
In some cases, the first symptom is the appearance of a lump in the breast . The first thing to consider, not scare us is that not all lumps or nodules that appear in the breast are breast cancer. The woman grooming note, in the shower, or get some clothes that rub on the package.
Skin changes
Sometimes women notice a change in the skin of the chest area, dimpled or wrinkled, that changes over time. In advanced cases, it can take on the appearance of the skin of an orange. Sometimes this area or the entire breast may redden, become enlarged (swollen).
Changes in the nipple skin
You may also notice changes in the skin of the nipple , which is inserted into the breast, which erodes or flakes (lose skin peeling), or have secretions by it, both milky, watery, or blood.
Nodal involvement armpit
Another sign that may appear is the one that leaves the involvement of lymph in the armpit, usually the affected breast: may receive one or more packages, which are only the nodes that have been thickened by tumor effect.
What are the symptoms of breast cancer?
In the early stages of the disease, women do not experience any symptoms or apparent discomfort. So many breast cancers currently diagnosed, they are in women attending routine medical checkups or screening programs for breast cancer.
Physical exam
It consists of a first exploration, both general and both breasts, armpits and neck. This is achieved determine a lump in the breast or underarm lymph nodes.
Mammograms
We can say that are x - rays of the breasts. Possibly the best evidence for the study of these glands. Identify abnormal areas in the breast, but not always have to be breast cancer. You can give guidance on benign or malignant of these abnormal areas, but not complete security. In young women mammograms are not very aclarativas, due to the different breast density of these women compared to other older; for this reason it is not necessary or useful to practice routine mammograms this group of young women.
Ultrasounds
The ultrasound can help in the study, determining whether a nodule is solid or liquid, size, etc. They are not useful as definitive evidence, but they are to rule out other diseases, such as cysts.
Puncture-fine needle aspiration (FNA)
It involves inserting a needle into a nodule previously detected. This needle allows the collection of samples with cells of said node to be analyzed microscopically. Sometimes there are changes on mammograms but can not feel nodules, so it is necessary to perform this puncture mammographic or sonographic control.
Biopsy
It may be that as many abnormal cells for diagnosis necessary area. Then the doctor will use taking biopsy . It involves taking a sample of breast tissue for observation under the microscope. This process can be done under local or general anesthesia, depending on the situation of each patient and each case. There are times when it is decided to surgically remove the suspicious nodule, and analyze during the same surgery, so that whether to expand the surgical site, it can be done all at once, without having to return the patient to the operating room another moment.
How is breast cancer diagnosed?
If any of the changes just mentioned, it is important that women see your doctor. This can start a case study, to further tests then may have the specialist. In other cases, the doctor directly refers the patient to the specialist to be he who initiated the study.
Non-invasive carcinomas
Non-invasive carcinomas are those who have not exceeded some of the microscopic structures of the breast. Depending on where they originate, can be duct (intraductal) or lobular (Intralobular). In turn, ductal may have different microscopic varieties. This type of non-invasive carcinomas is rare that generate metastases, but can get to be invasive (exceeding those breast structures).
Invasive carcinomas
Are invasive tumors that have exceeded a kind of barrier in the structure of the breast. Among them we are:
The so-called invasive ductal, which is the most common type of all breast cancers (70-80%).
There is also lobular, much less frequent.
Medullary, mucinous, tubular, etc.: Other special types They are now less common.
Other malignant tumors
Other malignancies may occur in the breast, for example, those arising in the tissue that gives support to the mammary gland (connective tissue), and we call sarcomas. They are rare, and we can not say it properly breast cancer.
What types of breast cancer are there?
We can find different classifications of breast cancer, catering to different characteristics of the same. To avoid confuse us, we will discuss what are the most common types are in the Spanish population, leaving aside other more rare cases.
Early breast cancer
It is the one that is confined to the breast and / or underarm nodes on the same side of the body.
Locally advanced breast cancer
It affects areas of skin or chest wall near the breast ill, but has not spread beyond the breast and / or armpit. Their outlook is worse than the early type, and skin appearance is directly affected by the tumor, red, swollen. It is due to obstruction by cancer cells of liquid drainage channels chest (lymphatics), causing this inflammation can not drain area.
Advanced Breast Cancer
It is has spread beyond the breast and armpit, ie, it has spread to other areas or organs of the body. For example: neck nodes, bones, liver, lungs, or brain.
How is breast cancer treated?
The treatment depends on the type of tumor and the stage of the disease is: involvement of lymph nodes, spread to other organs, etc. For this reason, there are classifications of tumors depending on their length. To understand more easily, we can classify them into three groups:
Development of breast cancer
Initially, tumor cells are confined to the mammary ducts or lobules, which as we know denominate allow noninvasive or "in situ".
The two main types, the ductal and lobular, are different when examined microscopically, and also will be treated somewhat differently. Ductal complete treatment usually requires surgery and radiation or hormone treatment, whereas non-invasive lobular, only usually requires surgical removal, and some authors recommend only monitoring, without intervening.
The DCIS, if left untreated, gets to become invasive, spreading to the surrounding breast tissue. The period of time when this does occur, it seems from months to years, that is, it does not in days or weeks.
When has developed an invasive cancer is when there is risk that cancer cells spread to nearby lymph glands, being the first to be affected nodes in the armpit on the same side of the body. Another area in which the tumor can spread through the blood vessels: cells invade the small vessels that supply cancer, and from there can move to other body organs, causing so - called metastasis. The most frequent location areas of these metastases are: bone , lung, liver and brain.
Can cancer be prevented?
The fact of not knowing a single common cause for all breast cancers, causes can not avoid certainly acquiring this disease. However, there are a number of facts or factors that may help reduce the risk of acquiring, or even as they say vulgarly "catch him in time."
The breast examination selective (programs of early diagnosis or screening of breast cancer) can reduce mortality, but not the incidence of breast cancer, and only in the group of people with specific age when programs are made screening.
These screening programs, also called breast cancer screening, usually made frequently in Spain. His intention is to diagnose as early breast cancer, to allow treatment as quickly and efficiently as possible, thus attempting to reduce the risk of death from cancer female carrier. The age at which women should attend these programs is still being debated, and varies across countries. For example, the American Cancer Society recommends that women come from forty. In other countries, the recommendation is made from 45 or 50. There is also controversy about how often repeat the screening test (usually a mammogram), recommending each year, although depending on the age of the woman and the economic costs of screening programs in some areas are repeated every 2 or 3 years.
Women under 40 generally do not need to undergo such programs, since breast cancer below this age is rare (although we must not forget that cases occur in young girls), and also mammography in young women it does not provide as good information as in older women, due to the higher density of breast tissue in young women, and can lead to unclear diagnoses.
From here we recommend to women that are cited in these screening programs that come to get tested because they constitute a benefit for themselves.