Breast cancer – how to prevent it?

Breast cancer in women

Of all cancers in women, 21% is breast cancer. In Poland, it is the second most common cause of their death.

However, not only Polish women face the risk of getting breast cancer. Worldwide, every year, breast cancer is detected in 1.5 million women. Unfortunately, in Poland, the cure rate for breast cancer is much lower than in other countries. Reason? We have check-ups too rarely and we go to see the doctor too late.

Breast cancer in men

Breast cancer is commonly considered to be a disease that occurs in women. And it is true – it is most common in women. But this does not mean that men are not affected at all. It is estimated that for every hundred new cases of breast cancer, one is diagnosed in a man.

Breast cancer – symptoms

Does breast cancer give any pain? No, and that is why you should watch for other symptoms.

Other symptoms of breast cancer include the following:The symptoms of breast cancer appear only at a certain stage of development of the disease. The first symptom is usually a hard lump in the breast, most often appearing in its outer upper quadrant. And although it does not have to be a sign of an advanced stage of cancer, it should make you alarmed.

• breast asymmetry;
• skin or nipple retraction;
• skin redness or ulcers;
• unilateral nipple discharge;
• swelling of the nearby lymph nodes on the tumour side;
• breast pain;
• change in the structure of the skin on the surface of the breast.

Inflammatory breast cancer

A rare type of breast cancer is inflammatory cancer.

Characteristics of inflammatory breast cancer are as follows:

• the lump is almost impalpable;
• the breast becomes swollen and red;
• pain occurs;
• the skin is excessively warm.

This type of breast cancer is more aggressive and, unfortunately, the prognosis is worse.

Causes of breast cancer

What causes breast cancer? This is not entirely clear. Undoubtedly, the risk of developing breast cancer increases with age. The disease occurs very rarely in women under 35 years of age, but the risk of getting it significantly increases after the age of 45. The highest incidence is recorded in women aged 50–65.

However, the fact that the disease occurs most often in older women does not exempt younger women from the obligation to perform breast self-exams and to regularly see their gynaecologist.

Factors increasing the risk of breast cancer include the following:

• breast cancer in close relatives, e.g. mother, grandmother, aunt or sister;
• a history of breast cancer, ovarian cancer, colorectal cancer or endometrial cancer;
• menopause late in life, i.e. after the age of 55;
• many years of hormone replacement therapy and hormonal contraception;
• being overweight and obese;
• unhealthy diet rich in fat;
• frequent consumption of alcohol;
• low level of physical activity;
• exposure to ionising radiation;
• childlessness;
• giving birth to the first child late in life, i.e. after 30 years of age;
• not breastfeeding children;
• high breast density, i.e. a large amount of glandular tissue in the breasts.

Is breast cancer hereditary?

Genes also affect the risk of developing breast cancer, which means that cancer can be hereditary.

In as many as 25% of cases, the disease occurs in family members, i.e. in grandmother, mother, daughter, etc. The most common cause of the disease are mutations of BRCA1 and BRCA2 genes – they cause from 5 to 10% of cases of breast cancer.

Breast cancer and BRCA1 gene mutation

The most important is the BRCA1 gene – if it is mutated, the risk of breast cancer is 80% and the risk of ovarian cancer, fallopian tube cancer and peritoneal cancer is 40%.

It is estimated that in Poland about 100 thousand women and the same number of men are carriers of the BRCA1 gene. In the case of men, however, the presence of mutations of this gene causes cancer much less frequently. But men, even if they do not get the disease themselves, can pass on the mutation of this gene to their children.

Breast cancer and BRCA2 gene mutation

The BRCA2 gene mutation is associated with a lower risk – 30–55% for breast cancer and 25% for ovarian cancer.

Breast cancer and mutations of other genes

The risk of developing breast cancer is also increased by mutations of other genes:

• ATP;
• BRIP1;
• TP3;
• CHEK;
• PTEN;

but it is less frequent.

In total, there are several dozen genes that can affect the risk of breast cancer being inherited. Moreover, scientists have not yet discovered all the genes whose mutations can cause this cancer. It is known, however, that the more cases of breast cancer in the family, the greater the risk of developing the disease.

Breast cancer and genetic predisposition

This does not mean, however, that a patient in whom mutations of any of these genes have been detected is sure to get breast cancer. It only means that they are much more likely to have it.

If the mutation is not detected in the patient, there is also no certainty that breast cancer or ovarian cancer will not develop. It should be kept in mind that only about 20% of cancers are caused by genetic predisposition.

But what if a woman learns that she is genetically predisposed to get breast cancer? Awareness of the increased risk of breast cancer gives a chance to include additional preventive measures or to modify the frequency of their implementation. Thanks to this, we increase the chance of detecting the disease at an early stage.

We can also change our lifestyle or reduce additional risk factors:

• obesity;
• smoking. 

Genetic testing for breast cancer

Genetic tests for the presence of a mutation increasing the risk of breast cancer should be done primarily by women who:

• had at least two cases of breast or ovarian cancer in the family up to three generations back. A special indication is if breast cancer or ovarian cancer occurred in the family before the age of 50;
• have a history of breast cancer or ovarian cancer, especially if the disease occurred before the age of 40;
• have in their family a man who had breast cancer;
• have a family history of prostate cancer, laryngeal cancer or melanoma in addition to breast cancer;
• have been diagnosed with benign breast or ovarian lesions, e.g. cysts;
• have family members with BRCA1 or BRCA2 gene mutations;
• take hormone replacement therapy.

Genetic tests are painless. A blood sample is taken and analysed in a laboratory. The results of the genetic test are ready in about 7 weeks.

Breast cancer – preventive check-ups and examinations

Every woman should get preventive check-ups. If the patient knows that she is genetically predisposed and therefore the risk of breast cancer is much higher, she should get check-ups as often as recommended by a specialist, who, having taken medical history and based on the results of tests (including genetic tests), decides to change the frequency of examinations.

First of all, women should once a month, preferably at the beginning of the cycle, perform breast self-exams.

Other breast cancer examinations

• mammography (recommended in women over 50 years of age every two years unless the doctor decides otherwise);
• breast ultrasound;
• MRI mammography.

If the doctor finds any changes in the breast or discovers lumps, a biopsy will be necessary. If the patient experiences nipple discharge, the doctor may also recommend an examination.

Breast cancer – prognosis

Cancer is not the death sentence. If detected early, it can in many cases be completely cured. If breast cancer is diagnosed in the first stage, 95% of patients survive 5 years after the diagnosis. However, much depends on the stage of the disease.

Stage 1

The risk that breast cancer will result in death is very low when the tumour has a diameter of no more than 0.5 cm. The tumour then grows to two centimetres. These sizes correspond to the first stage of the disease.

Stage 2

In the second stage of cancer development, the tumour measures between 2 and 5 cm. Cancer cells are already present in the lymph nodes in the armpits and surgery is necessary. Cancer development is also described as the second stage when the tumour is smaller than 2 cm, but lymph nodes are affected, or when lymph nodes are not attacked, but the tumour is larger than 5 cm.

Stage 3

In the third stage the tumour is of any size and the cancer has attacked lymph nodes and surrounding tissues – breast skin or muscles.

Stage 4

In the fourth stage of the disease the tumour is very large. The cancer has spread to other distant organs, such as bones, liver or lungs (metastasis).

Metastatic breast cancer

In further stages of development of breast cancer the cancer spreads to other parts of the body. Cancer is detected at this stage in 5–10% of patients.

Breast cancer most frequently spreads to the following:

• axillary lymph nodes;
• slightly less frequently to retrosternal, supraclavicular and subclavicular lymph nodes.

Metastases may also appear in other internal organs such as the following:

• lungs;
• liver;
• bones;
• brain.

However, breast cancer may not only cause metastases, but may also be the result of metastases from gastrointestinal cancer, reproductive organ cancer or melanoma.

Breast cancer – treatment

The treatment of breast cancer depends on the stage of the disease and the decision about treatment is always taken by a team of doctors.

Local treatment for breast cancer

The treatment may be local. Then, it involves the following:

• removal of the tumour;
• removal of the whole breast (mastectomy) – if necessary;
• possibly the removal of the axillary lymph nodes.

Radiotherapy is also the local treatment – it can be used at any stage of the disease, including after surgery, which reduces the risk of relapse, and when surgery is not possible, radiotherapy replaces surgical treatment.

Systemic treatment of breast cancer

Treatment of breast cancer may also be systemic, which means that it affects all cells of the body, not only those attacked by cancer. Such treatment methods include the following:

• chemotherapy;
• hormone therapy;
• targeted therapy which involves intravenous or oral administration of drugs chosen depending on the severity of the disease.