How is the breast designed?

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.
The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.

Our body is made up of cells. All cancers begin in the cells. These cells grow and divide in to well controlled manner to produce more cells as they are needed to keep the body healthy. As cells become older or damaged, they die and are replaced with the new cells.
However due to certain reasons this normal functioning of our body cells in interrupted and leads to an abnormal behavior of the cells, typically in one part / organ of the body. When the cells continue to multiply and live beyond their lifespan, these are referred to as the “cancerous cells”
Cancer starts when the genetic material of a cell becomes damaged or goes through the production changes which effect the normal cell growth and division. Many a times these changes are inherited, due to the effect of our diet or may be caused due to exposure to the environmental factors like some chemicals, tobacco, cigarette, smoke etc. When this happens, the body does not obey the normal life cycle resulting in to the new cells are continuously forming and old/damaged cells not dying resulting in to a formation of a mass of tissue which is called as “tumor”. All these tumors may not be cancerous.

The non cancerous tumor is called as “Benign Tumor” and the cancerous tumor is called as” Malignant”

The Benign Tumor (Non Cancerous) can be:

• Surgically removed
• Reoccurrence is very rare after it has been removed surgically.
• It remains contained within its organ and does not spread to other parts of the body.

The Malignant tumors are “cancerous” as:

• The cells in these tumors can spread to the other parts of the body.

The extent of growth of cells in the originating tissue and its spread to the distant organs determines the seriousness, the impact and the line of treatment of the disease.
This assessment also determines the stage of cancer.

Breast Cancer Overview
Breast cancer is cancer arising in breast tissue. Cancer is simply a group of abnormal cells that have abnormal growth patterns.

• Although breast cancer is primarily a disease of women, about 1% of breast cancers occur in men.
• Breast cancer is the most common type of cancer in women and is the second leading cause of death by cancer in women, following only lung cancer.
• In 2007, the American Cancer Society estimated that 284,200 new cases of breast cancer were diagnosed in the United States.

Breast Cancer Causes

• About 50% of women who develop breast cancer have no risk factors other than age and sex.
• Sex is the biggest risk because breast cancer occurs mostly in women.
• Age is another critical factor. Breast cancer may occur at any age, though the risk of breast cancer increases with age.
• The average woman at age 30 years has 1 chance in 280 of developing breast cancer in the next 10 years. This chance increases to 1 in 70 for a woman aged 40 years, and to 1 in 40 at age 50 years. A 60-year-old woman has a 1 in 30 chance of developing breast cancer in the next 10 years.

Genetic causes
Family history has long been known to be a risk factor for breast cancer. The risk is highest if the affected relative developed breast cancer at a young age or if she is a close relative such as a mother, sister, daughter, or aunt.
Hormonal influences play a role in the development of breast cancer.

• Women who start their periods at an early age or experience a late menopause have a higher risk of developing breast cancer.
• Conversely, being older at your first menstrual period and early menopause tend to protect one from breast cancer.
• Having a child before age 30 years may provide some protection, and having no children may increase your risk for developing breast cancer.

Dietary causes
Breast cancer seems to occur more frequently in countries with high dietary intake of fat.
Breast Cancer Symptoms and seeking Medical Care
Early breast cancer has no symptoms. It is not painful.

When to Seek Medical Care
Breast cancer develops over months or years. Once it is identified, however, a certain sense of urgency is felt about the treatment, because breast cancer is much more difficult to treat as it spreads from the breast.
You should see your physician if you experience any of the following:

• Finding a breast lump
• Finding a lump in your armpit or above your collarbone that does not go away in a week or so
• Developing breast discharge
• Noticing new nipple inversion or skin changes over the breast

Redness or swelling in the breast may suggest an infection of the breast.

• You should see your physician within the next 24 hours because infection should be treated promptly.
• If you have redness, swelling, or severe pain in the breast and are unable to reach your health care provider, a trip to the nearest emergency department is warranted.

If an abnormality is found on your mammogram, you should right away to make a plan for further evaluation.

Exams and Tests
Diagnosis of breast cancer usually comprises several steps, including examination of the breast, mammography, possibly ultrasonography, and finally biopsy. Biopsy is the only definitive way to diagnose breast cancer.

Examination of the breast

• A complete breast examination includes visual inspection and careful palpation (feeling) of the breasts, the armpits, and the areas around your collarbone.
• During that exam, your physician  may palpate a lump or just feel a thickening.

Mammography

• Mammograms are x-rays of the breast that may help define the nature of a lump.
• Usually, it is possible to tell from the mammogram whether a lump in the breast is breast cancer, but no test is 100% reliable.
• All breast lumps need to be clearly defined as benign or should be biopsied. .

Ultrasound

• Ultrasound of the breast may be done in addition to the mammogram.
• Ultrasound waves create a "picture" of the inside of the breast.
• It can demonstrate whether a mass is filled with fluid (cystic) or solid. Cancers are usually solid, but many cysts are benign.
• Ultrasound might also be used to guide a biopsy or the removal of fluid.

Biopsy
The only way to diagnose breast cancer with certainty is to biopsy the tissue in question. Biopsy means to take a very small piece of tissue from the body for examination and testing by a pathologist. These are physicians who are specially trained in diagnosing diseases by looking at cells and tissues under a microscope.
If the cells are cancerous, the person will undergo an operation for removal of the tumor.

• Additional tissue around the tumor will also be removed to check for microscopic (invisible) spread of the cancer.
• How much tissue has to be removed depends on the individual situation.
• Sometimes the whole breast is removed (mastectomy).
• Some lymph nodes under the arm are removed and tested for cancer.

After these tissues are removed, the cancer is staged. Staging is a classification that implies which treatment is best and also the prognosis for recovery.

• Staging in breast cancer is based on the size of the tumor, which parts of the breast are involved, how many and which lymph nodes are affected, and whether the cancer has metastasized to another part of the body.
• Cancers may be referred to as invasive if they have spread to other tissues. Those that do not spread to other tissues are called noninvasive. Carcinoma in situ is a noninvasive cancer.

Breast cancer is staged from 0 to IV.

• Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no affected lymph nodes or metastasis. This is the most favorable stage of breast cancer.
• Stage I is breast cancer that is less than three quarters of an inch in diameter and has not spread from the breast.
• Stage II is breast cancer that is fairly small in size but has spread to lymph nodes in the armpit OR cancer that is somewhat larger but has not spread to the lymph nodes.
• Stage III is breast cancer of a larger size (greater than 2 inches in diameter), with greater lymph node involvement, or of the inflammatory type.
• Stage IV is metastatic breast cancer: a tumor of any size or type that has metastasized to another part of the body. This is the least favorable stage.

Breast Cancer Treatment

Medical Treatment
In this disease, patient preference plays a major role in decisions regarding treatment. Treatment depends on a large number of factors, including the type of breast cancer, the hormone receptor status of the tumor, the stage of the tumor, the size of the breast, and the person's general health, age, and menstrual status (has or has not been through menopause).
Radiation therapy is used to kill tumor cells if there are any left after surgery.

• Radiation is a local treatment and therefore works only on tumor cells that are directly in its beam.
• Radiation therapy is usually given 5 days a week over 5-6 weeks. Each treatment takes only a few minutes.
• Radiation therapy is painless and has relatively few side effects. However, it can irritate the skin or cause a burn similar to bad sunburn in the area.

Chemotherapy consists of the administration of medications that kill cancer cells or stop them from growing.

• Most chemotherapy agents are given through an IV line, but some are given as pills.
• Chemotherapy is usually given in "cycles." Each cycle includes a period of intensive treatment lasting a few days or weeks followed by a few weeks of recovery. Most people with breast cancer receive at least 2, more often 4, cycles of chemotherapy to begin with. Tests are then repeated to see what effect the therapy has had on the cancer.
• Chemotherapy differs from radiation in that it treats the entire body and thus may find stray tumor cells that may have migrated from the breast area.
• The temporary side effects of chemotherapy include loss of hair, nausea and vomiting, loss of appetite, fatigue, to feel sick and tired easily than usual.

Hormone therapy
This treatment will be only suggested by your doctor if the cancer is hormone positive. Also, your doctor might recommend it in the following situations:

• As an add-on therapy with or without chemotherapy to kill any remaining breast cancer
• cells after surgery
• As the main therapy, if cancer is present even after the surgery or when cancer strikes back, months or years after surgery

Surgery
Surgery is the mainstay of therapy for breast cancer. The choice as to which type of surgery is based on a number of factors, including the size and location of the tumor, the type of tumor, and the person's overall health and personal wishes. Breast-sparing surgery is often possible.

• Lumpectomy involves removal of the cancerous tissue and a surrounding area of normal tissue. Generally the lymph nodes in the armpit are sampled at the same time.
• Simple mastectomy removes the entire breast but no other structures.
• Modified radical mastectomy removes the breast and the axillary (underarm) lymph nodes but does not remove the underlying muscle of the chest wall.
• Radical mastectomy involves removal of the breast and the underlying chest wall muscles, as well as the underarm contents.

Next Steps - Follow-up
People who have been diagnosed with breast cancer need careful follow-up care for life.

• Initial follow-up care after treatment is usually every 3-6 months for the first 2-3 years.
• This most often includes careful breast examination, yearly mammography, blood work, and, possibly, a chest x-ray.
• Other tests, such as bone scans or CT scans, are done as needed.

Any woman with a mother, daughter, or sister with breast cancer should be screened for breast cancer at least yearly.

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