Nothing should be taken for granted when it comes to healthy living, for early detection of breast cancer is often linked to recovery and/or survival.
Introduction
Breast cancer arises in the lining cells (epithelium) of the ducts (85%) or lobules (15%) in the glandular tissue of the breast. Initially, the cancerous growth is confined to the duct or lobule (“in situ”) where it generally causes no symptoms and has minimal potential for spread (metastasis).
Over time, these in situ (stage 0) cancers may progress and invade the surrounding breast tissue (invasive breast cancer) then spread to the nearby lymph nodes (regional metastasis) or to other organs in the body (distant metastasis). If a woman dies from breast cancer, it is because of widespread metastasis.
Breast cancer treatment can be highly effective, especially when the disease is identified early. Treatment of breast cancer often consists of a combination of surgical removal, radiation therapy and medication (hormonal therapy, chemotherapy and/or targeted biological therapy) to treat the microscopic cancer that has spread from the breast tumor through the blood. Such treatment, which can prevent cancer growth and spread, thereby saves lives.
Scope of the problem
In 2020, there were 2.3 million women diagnosed with breast cancer and 685 000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. There are more lost disability-adjusted life years (DALYs) by women to breast cancer globally than any other type of cancer. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life.
Breast cancer mortality changed little from the 1930s through to the 1970s. Improvements in survival began in the 1980s in countries with early detection programmes combined with different modes of treatment to eradicate invasive disease.
Who is at risk?
Breast cancer is not a transmissible or infectious disease. Unlike some cancers that have infection-related causes, such as human papillomavirus (HPV) infection and cervical cancer, there are no known viral or bacterial infections linked to the development of breast cancer.
Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years). Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy.
Behavioural choices and related interventions that reduce the risk of breast cancer include:
prolonged breastfeeding;
regular physical activity;
weight control;
avoidance of harmful use of alcohol;
avoidance of exposure to tobacco smoke;
avoidance of prolonged use of hormones; and
avoidance of excessive radiation exposure.
Unfortunately, even if all of the potentially modifiable risk factors could be controlled, this would only reduce the risk of developing breast cancer by at most 30%.
Female gender is the strongest breast cancer risk factor. Approximately 0.5-1% of breast cancers occur in men. The treatment of breast cancer in men follows the same principles of management as for women.
Family history of breast cancer increases the risk of breast cancer, but the majority of women diagnosed with breast cancer do not have a known family history of the disease. Lack of a known family history does not necessarily mean that a woman is at reduced risk.
Signs and symptoms
Breast cancer most commonly presents as a painless lump or thickening in the breast. It is important that women finding an abnormal lump in the breast consult a health practitioner without a delay of more than 1-2 months even when there is no pain associated with it. Seeking medical attention at the first sign of a potential symptom allows for more successful treatment.
Generally, symptoms of breast cancer include:
a breast lump or thickening;
alteration in size, shape or appearance of a breast;
dimpling, redness, pitting or other alteration in the skin;
change in nipple appearance or alteration in the skin surrounding the nipple (areola); and/or
abnormal nipple discharge.
There are many reasons for lumps to develop in the breast, most of which are not cancer. As many as 90% of breast masses are not cancerous. Non-cancerous breast abnormalities include benign masses like fibroadenomas and cysts as well as infections.
Breast cancer can present in a wide variety of ways, which is why a complete medical examination is important. Women with persistent abnormalities (generally lasting more than one month) should undergo tests including imaging of the breast and in some cases tissue sampling (biopsy) to determine if a mass is malignant (cancerous) or benign.
Breast cancer arises in the lining cells (epithelium) of the ducts (85%) or lobules (15%) in the glandular tissue of the breast. Initially, the cancerous growth is confined to the duct or lobule (“in situ”) where it generally causes no symptoms and has minimal potential for spread (metastasis).
Over time, these in situ (stage 0) cancers may progress and invade the surrounding breast tissue (invasive breast cancer) then spread to the nearby lymph nodes (regional metastasis) or to other organs in the body (distant metastasis). If a woman dies from breast cancer, it is because of widespread metastasis.
Breast cancer treatment can be highly effective, especially when the disease is identified early. Treatment of breast cancer often consists of a combination of surgical removal, radiation therapy and medication (hormonal therapy, chemotherapy and/or targeted biological therapy) to treat the microscopic cancer that has spread from the breast tumor through the blood. Such treatment, which can prevent cancer growth and spread, thereby saves lives.
Scope of the problem
In 2020, there were 2.3 million women diagnosed with breast cancer and 685 000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. There are more lost disability-adjusted life years (DALYs) by women to breast cancer globally than any other type of cancer. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life.
Breast cancer mortality changed little from the 1930s through to the 1970s. Improvements in survival began in the 1980s in countries with early detection programmes combined with different modes of treatment to eradicate invasive disease.
Who is at risk?
Breast cancer is not a transmissible or infectious disease. Unlike some cancers that have infection-related causes, such as human papillomavirus (HPV) infection and cervical cancer, there are no known viral or bacterial infections linked to the development of breast cancer.
Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years). Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy.
Behavioural choices and related interventions that reduce the risk of breast cancer include:
prolonged breastfeeding;
regular physical activity;
weight control;
avoidance of harmful use of alcohol;
avoidance of exposure to tobacco smoke;
avoidance of prolonged use of hormones; and
avoidance of excessive radiation exposure.
Unfortunately, even if all of the potentially modifiable risk factors could be controlled, this would only reduce the risk of developing breast cancer by at most 30%.
Female gender is the strongest breast cancer risk factor. Approximately 0.5-1% of breast cancers occur in men. The treatment of breast cancer in men follows the same principles of management as for women.
Family history of breast cancer increases the risk of breast cancer, but the majority of women diagnosed with breast cancer do not have a known family history of the disease. Lack of a known family history does not necessarily mean that a woman is at reduced risk.
Signs and symptoms
Breast cancer most commonly presents as a painless lump or thickening in the breast. It is important that women finding an abnormal lump in the breast consult a health practitioner without a delay of more than 1-2 months even when there is no pain associated with it. Seeking medical attention at the first sign of a potential symptom allows for more successful treatment.
Generally, symptoms of breast cancer include:
a breast lump or thickening;
alteration in size, shape or appearance of a breast;
dimpling, redness, pitting or other alteration in the skin;
change in nipple appearance or alteration in the skin surrounding the nipple (areola); and/or
abnormal nipple discharge.
There are many reasons for lumps to develop in the breast, most of which are not cancer. As many as 90% of breast masses are not cancerous. Non-cancerous breast abnormalities include benign masses like fibroadenomas and cysts as well as infections.
Breast cancer can present in a wide variety of ways, which is why a complete medical examination is important. Women with persistent abnormalities (generally lasting more than one month) should undergo tests including imaging of the breast and in some cases tissue sampling (biopsy) to determine if a mass is malignant (cancerous) or benign.
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