Breast Cancer
Breast cancer is the most common cancer in women and the second leading cause of cancer death after lung cancer. It is a multifactorial disease caused by interactions between genetic background, lifestyle and environment, with risk increasing with age.
Symptoms of breast cancer
Breast cancer often presents as a palpable mass or nodule. Other atypical symptoms include breast swelling, skin irritation (peau d'orange appearance), pain, nipple retraction or discharge.
- Palpable lump or thickening in the breast or underarm area.
- Change in breast size, shape or appearance.
- Skin dimpling, puckering or redness resembling orange peel.
- Nipple changes: retraction, discharge (especially bloody), scaling or ulceration.
- Swelling of the entire breast or a specific area.
- Pain in the breast or nipple that persists.
- Swollen lymph nodes in the armpit or collarbone area.
When urgent evaluation is needed
Any new breast lump, change in breast appearance or persistent symptom requires prompt evaluation. Most breast lumps are benign, but early assessment is essential to rule out malignancy.
- New palpable lump or mass.
- Persistent breast pain not related to the menstrual cycle.
- Nipple discharge, especially if spontaneous or bloody.
- Skin changes such as dimpling, redness or thickening.
- Family history of breast or ovarian cancer.
Risk factors and genetics
About 5% of women with breast cancer have hereditary breast/ovarian cancer syndrome, and 10-20% have some familial predisposition. The BRCA1 and BRCA2 genes are the most well-known mutations, with BRCA1 conferring higher risk.
- Female gender and increasing age.
- BRCA1/BRCA2 gene mutations.
- Family history of breast or ovarian cancer in first-degree relatives.
- Personal history of breast cancer or certain benign breast conditions.
- Dense breast tissue on mammography.
- Early menarche or late menopause.
- Nulliparity or first pregnancy after age 30.
- Hormone therapy after menopause.
- Radiation exposure to the chest area.
- Obesity, alcohol consumption and smoking.
Screening and early detection
Regular screening is essential for early diagnosis. Mammography remains the gold standard, while ultrasound and MRI are used as supplementary tools depending on age, breast density and risk factors.
- Breast self-examination: Familiarity with your own breast tissue helps detect changes early.
- Clinical breast examination by a doctor during regular check-ups.
- Mammography: The primary screening tool, recommended every 1-2 years after age 40 or earlier for high-risk women.
- Breast ultrasound: Useful for evaluating specific findings and differentiating solid from cystic lesions.
- Breast MRI: Used for high-risk women or for further evaluation of suspicious findings.
Diagnosis of breast cancer
Diagnosis is based on clinical examination, imaging and histological confirmation through biopsy.
- Clinical breast examination: Inspection and palpation of both breasts, armpits and collarbone area.
- Mammography: X-ray imaging of the breast to detect suspicious findings.
- Ultrasound: Helps characterize breast masses as solid or cystic.
- MRI: Provides detailed images for high-risk screening or treatment planning.
- Core needle biopsy: Tissue sample is taken from a suspicious area for histological examination.
- Fine needle aspiration: Used for evaluating palpable lumps or lymph nodes.
- Sentinel lymph node biopsy: Determines whether cancer has spread to lymph nodes.
- Hormone receptor and HER2 testing: Guides targeted treatment decisions.
Staging and treatment planning
Staging after diagnosis helps design the optimal treatment plan. It includes evaluation of tumor size, lymph node involvement and presence of metastases.
- Tumor size and local extent assessed by imaging and pathology.
- Lymph node evaluation through sentinel biopsy or axillary dissection.
- CT scan, bone scan or PET/CT to detect distant metastases when indicated.
- Blood tests including tumor markers and organ function evaluation.
- Molecular profiling (Oncotype DX, MammaPrint) in selected cases to guide chemotherapy decisions.
Treatment options
Treatment is individualized based on stage, tumor characteristics, age and patient preference. It often combines local and systemic therapies.
- Surgery: Lumpectomy (breast-conserving) or mastectomy, with sentinel lymph node biopsy or axillary lymph node dissection.
- Radiotherapy: After lumpectomy or mastectomy to reduce local recurrence risk.
- Chemotherapy: Before (neoadjuvant) or after (adjuvant) surgery to shrink tumors or eliminate remaining cancer cells.
- Hormonal therapy: For hormone receptor-positive cancers, using tamoxifen or aromatase inhibitors.
- Targeted therapy: HER2-directed therapy (trastuzumab, pertuzumab) for HER2-positive cancers.
- Immunotherapy: For certain types, especially triple-negative breast cancer with PD-L1 expression.
- Reconstructive surgery: After mastectomy, immediate or delayed breast reconstruction.
Follow-up and survivorship
Regular follow-up after treatment is essential for monitoring recurrence, managing side effects and supporting overall health and quality of life.
- Regular clinical examinations and mammography according to the follow-up schedule.
- Management of treatment side effects: fatigue, lymphedema, neuropathy, menopausal symptoms.
- Bone health monitoring for women on hormonal therapy.
- Lifestyle counseling: exercise, nutrition, weight management.
- Psychological support and connection to support groups.
- Genetic counseling for women with hereditary risk factors.
Symptoms
Breast cancer often presents as a palpable mass or nodule. Other atypical symptoms include breast swelling, skin irritation (peau d'orange appearance), pain, nipple retraction or discharge.
- Palpable lump or thickening in the breast or underarm area.
- Change in breast size, shape or appearance.
- Skin dimpling, puckering or redness resembling orange peel.
- Nipple changes: retraction, discharge (especially bloody), scaling or ulceration.
- Swelling of the entire breast or a specific area.
- Pain in the breast or nipple that persists.
- Swollen lymph nodes in the armpit or collarbone area.
Any new breast lump, change in breast appearance or persistent symptom requires prompt evaluation. Most breast lumps are benign, but early assessment is essential to rule out malignancy.
- New palpable lump or mass.
- Persistent breast pain not related to the menstrual cycle.
- Nipple discharge, especially if spontaneous or bloody.
- Skin changes such as dimpling, redness or thickening.
- Family history of breast or ovarian cancer.
About 5% of women with breast cancer have hereditary breast/ovarian cancer syndrome, and 10-20% have some familial predisposition. The BRCA1 and BRCA2 genes are the most well-known mutations, with BRCA1 conferring higher risk.
- Female gender and increasing age.
- BRCA1/BRCA2 gene mutations.
- Family history of breast or ovarian cancer in first-degree relatives.
- Personal history of breast cancer or certain benign breast conditions.
- Dense breast tissue on mammography.
- Early menarche or late menopause.
- Nulliparity or first pregnancy after age 30.
- Hormone therapy after menopause.
- Radiation exposure to the chest area.
- Obesity, alcohol consumption and smoking.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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