What are breast cancer early warning signs and symptoms?
- The most common sign of breast cancer is a new lump or mass in the breast.
In addition, the following are possible signs of breast cancer:
- Thickening or lump in the breast that feels different from the surrounding area
- Inverting of the nipple (as a change from the previous appearance)
- Nipple discharge or redness (especially any bloody discharge)
- Breast or nipple pain
- Swelling in your armpit or collarbone could mean breast cancer has spread to lymph nodes in that area
- Swelling of part of the breast
- Changes in the skin of the breast
- Skin dimpling (peau d'orange)
- Lymph node changes
- Dimpling or Puckering of the Breast Skin
- Recent Breast Asymmetry
What causes breast cancer?
There are many risk factors that increase the chance of developing breast cancer. Although we know some of these risk factors, we don't know the cause of breast cancer or how these factors cause the development of a cancer cell.
- We know that normal breast cells become cancerous because of mutations in the DNA, and although some of these are inherited, most DNA changes related to breast cells are acquired during one's life.
- Proto-oncogenes help cells grow. If these cells mutate, they can increase the growth of cells without any control. Such mutations are referred to as oncogenes. Such uncontrolled cell growth can lead to cancer.
What are breast cancer risk factors?
Some of the breast cancer risk factors can be modified (such as alcohol consumption) while others cannot be influenced (such as age). It is important to discuss these risks with a health care provider when starting new therapies (for example, postmenopausal hormone therapy).
Several risk factors are inconclusive (such as deodorants), while in other areas, the risk is being even more clearly defined (such as alcohol use).
The following are risk factors for breast cancer:
- Age: The chances of breast cancer increase as one gets older.
- Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, daughter) doubles a woman's risk.
- Personal history: Having a breast cancer diagnosis in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast.
- Women diagnosed with certain benign (non-cancerous) breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.
- Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.
- Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.
- Race: White women have a higher risk of developing breast cancer, but African-American women tend to have more tumors that are aggressive when they do develop breast cancer.
- Exposure to previous chest radiation or use of diethylstilbestrol (DES) increases the risk of breast cancer.
- Having no children or the first child after age 30 increases the risk of breast cancer.
- Breastfeeding for 1½ to 2 years might slightly lower the risk of breast cancer.
- Being overweight or obese increases the risk of breast cancer both in pre- and postmenopausal women but at different rates.
- Use of oral contraceptives in the last 10 years increases the risk of breast cancer slightly.
- Using combined hormone therapy after menopause increases the risk of breast cancer.
- Alcohol consumption increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used. A recent meta-analysis reviewing the research on alcohol use and breast cancer concluded that all levels of alcohol use are associated with an increased risk for breast cancer. This includes even light drinking.
- Exercise seems to lower the risk of breast cancer.
- Genetic risk factors: The most common causes are mutations in the BRCA1 and BRCA2 genes (breast cancer and ovarian cancer genes). Inheriting a mutated gene from a parent means that one has a significantly higher risk of developing breast cancer.
Are there any other questions I should ask my doctor about breast cancer?
Yes. There are surely other questions you will wish to ask. Do not hesitate to be very open about your concerns with your doctor. There is constantly new information and new research available about breast cancer, whether BRCA-related new treatments or drugs (for example, olaparib [Lynparza]) or new treatment regiments and recommendations. The foregoing questions and comments should demonstrate that the diagnosis and treatment of breast cancer may not be a simple process. Even when all the information is available, there may be difficulties in deciding a proper course of action. However, this decision-making process has a better chance of success when you and the doctor are well informed and communicating effectively. Although the information here cannot be all-inclusive, we hope it will help you work through this process.
What tests do physicians use to diagnose breast cancer?
The American Cancer Society (ACS) has the following recommendations for breast cancer screenings:
- Women should have the choice to begin annual screening between 40-44 years of age.
- Women age 45 and older should have a screening mammogram every year until age 54.
- Women 55 years of age and older should have biennial screening or have the opportunity to continue screening annually.
- Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
Mammograms are a very good tool for breast cancer screening. As with any test, mammograms have limitations and will miss some cancers. Patients should discuss their family history and mammogram and breast exam results with their health care provider.
The ACS does not recommend clinical screening exams in women of any age.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderate risk (15%-20%) should talk to their doctor about the benefits and limitations of adding MRI screening to their yearly mammogram.
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Salerno, K.E. "NCCN Guidelines Update: Evolving Radiation Therapy Recommendations for Breast Cancer." J Natl Compr Canc Netw 15(5S) May 2017: 682-684.
Shield, Kevin D., et al. "Alcohol Use and Breast Cancer: A Critical Review." Alcoholism: Clinical and Experimental Research Apr. 30, 2016.
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