How Can Breast Cancer Be Detected? Symptoms & Treatment

By (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 12/13/2019

Breast cancer is one of the most common types of cancer in women. Nonetheless, it can be detected early if the woman attends all the annual gyaecological check-ups, which has allowed breast cancer to have a high chance of being cured today.

One of the drawbacks of cancer treatment is that it causes female infertility because both chemotherapy and radiation therapy affect the ovarian reserve.

Therefore, the main objective of specialists and associations against cancer is to increase attention to this pathology, to support research and early diagnosis and, in the case of women, to inform about options for preserving fertility.

What is breast cancer?

Breast cancer is the uncontrolled growth of cells found in the mammary gland. This type of cancer is also known as adenocarcinoma.

Normally, breast cancer causes the appearance of a lump in the breast that may be palpable by the woman, so it is important to examine yourself regularly to detect any change in the breasts.

Types

There are many ways to classify breast cancer. In the next section, we are going to look into the area of the breast where breast cancer may originate:

Ductal carcinoma
when the cancer originates inside in cells that line the ducts, which carry breast milk to the nipple.
Lobular carcinoma
when the cancer originates in the milk-producing glands.

Apart from this, breast cancer may take place in situ or be invasive. A carcinoma in situ is one that grows inside the milk or lobule ducts, but will not spread to other parts of the body.

However, in an invasive carcinoma, cancer cells can move and invade surrounding tissues. This type of breast cancer is the most common and may also be called infiltrating cancer.

At last, the term metastasisrefers to the spread of cancer cells to other organs and parts of the body when they reach the blood or lymphatic system.

Symptoms

Most women with breast cancer show no obvious signs and/or symptoms that could alarm her about this situation. It is also possible that symptoms differ from woman to woman.

However, we are going to comment on the symptoms of breast cancer that occurr more frequently:

  • Changes in breast size
  • Irregularities in the contour of the breasts
  • Appearance of a lump in the breast or armpit
  • Scaling in the nipple area or retraction of the nipple
  • Irritation, roughness, color changes, or ulcers on the skin of the breasts
  • Decreased mobility of one breast when raising the arms
  • Breast pain with palpation
  • Nipple discharge

It should be noted that these symptoms may be due to other alterations and have nothing to do with breast cancer, but for greater safety it is advisable to go to the gynecologist if the woman presents any of these discomforts.

Diagnosis of breast cancer

The most important thing to win the battle against breast cancer is early diagnosis. The earlier breast cancer is detected, the higher the chance of cure.

For this reason, it is essential to go to all annual gynecological check-ups at the moment the woman begins her sexual life or from the age of 25, where the specialist will do a gynecological examination, a pap smear and an exploration of the breasts and armpits.

Additionally, it is also advisable for women to know how to self-explore their breasts in order to be able to see if any suspicious lumps or masses appear.

However, Mammography is still the most effective technique to diagnose breast cancer, as it can detect abnormalities in the breasts up to 2 years before they are palpable or other symptoms appear.

A mammography is an x-ray of the breasts using a low dose of radiation. Other diagnostic tests for breast cancer include breast ultrasound and magnetic resonance imaging, which are only performed to confirm the result of the mammography.

Medicare, Medicaid and most of the insurance companies take over the costs of mammographies. Breast screenings are recommended at 45 years of age and should be done yearly.

In short, thanks to mammographies and regular gynecological check-ups, it is possible to detect breast cancer early and treat it before it becomes more serious.

Risk Factors

Currently, the exact causes of breast cancer are unknown, but it is known that there are risk factors that increase a woman's chance of developing breast cancer. We will discuss them below:

  • Being a woman over 45 years
  • Having dense breasts
  • Suffering from obesity and not following a healthy and balanced diet
  • Drinking alcohol
  • Having had their first period at a very early age, before age 12
  • Never having been pregnant or having had her first child after age 35
  • Hormone therapy for menopause
  • Having a personal history of breast cancer or benign breast disease
  • Having a personal history of breast cancer or benign breast disease
  • Having received chest radiaton therapy between the age of 10 and 30
  • Presenting a known mutation of the BRCA1 gene or the BRCA2 gene
  • Suffering from Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome

Women at high risk for breast cancer may even decide to have preventive surgery to remove healthy breasts in order to prevent cancer. This is what is known as a prophylactic mastectomy.

Stages of breast cancer

After performing all the necessary diagnostic tests, it is possible to classify breast cancer into different stages, which is very useful in determining the most appropriate treatment, as well as knowing the prognosis and the possibility of survival of the patient.

The system used to classify breast tumours is the TNM system, which refers to the size and infiltration of the tumour, the involvement of lymph nodes and the existence of metastasis.

According to these criteria, breast cancer is classified into the following stages:

Stage 0
these are premalignant lesions, such as carcinoma in situ.
Stage I
the size of the tumor is equal to or less than 2 cm, there is no lymph node infiltration or metastasis.
Stage II
the size of the tumour is between 2 and 5 cm, with or without lymph node involvement. There's no metastasis.
Stage III
the tumor does affect the axillary nodes and may be larger than 5 cm or expand into the skin or chest wall.
Stage IV
the cancer has spread, that is, there is metastasis. This includes all tumor sizes, whether or not the lymph nodes are involved.

In general, patients with stage I breast cancer have a 100% 5-year survival rate, while in patients diagnosed with stage IV this rate is about 20%.

Treatment

The most appropriate treatment to combat breast cancer is established on the basis of multiple factors related to the patient and the tumour, such as the age of the woman, her general state of health, the state of the menopause, the location and stage of the tumour, the hormonal receptors of the tumour, the degree of differentiation of the tumour cells, and so on.

Although there are many types of treatments and possible combinations, below we are going to talk about the most common ones for breast cancer:

Surgical treatment
is the removal of the tumor from the breast that can be of two types. On the one hand, there is conservative surgery in which the woman keeps her breasts with the healthy tissue she has left. On the other hand, there is a mastectomy in which the entire breast is removed.
Radiotherapy
is the application of high-energy ionising radiation to destroy tumour cells.
Chemotherapy
is a pharmacological treatment aimed at the whole body that destroys tumour cells. To its disadvantage it also affects healthy cells and has therefore multiple side effects.
Hormone Therapy
is the administration of anti-estrogen medications that block the action of these hormones on the malignant cells of the breast, so they manage to reduce their proliferation and the size of the tumor. The best-known drug is Tamoxifen, although aromatase inhibitor drugs may also be used.
Directed Therapy
these are drugs that target the genes or proteins specific to cancer, so that they block the growth of cancer cells without affecting healthy cells as in the case of chemotherapy. One of the best-known treatments is directed at HER2, a cell membrane receptor for growth factors that is overexpressed in tumor cells.

Most of the anti-cancer therapies used today, chemotherapy and radiotherapy, affect women's fertility to a large extent, so it is advisable to preserve fertility with a vitrification treatment of the eggs before facing this tough disease.

FAQs from users

What is triple negative breast cancer?

By Dra. Lydia Pilar Suárez (gynecologist).

A classification of breast cancers is based on the receptors it expresses. Three main receptors are studied: ER or estrogen receptor; RP or progesterone receptor; and HER2.

Triple negative breast cancer is cancer in which the hormone receptors, estrogen and progesterone receptors, and HER2 are negative.

Consequently, this type of cancer is more resistant to pharmacological treatment as it does not respond to hormone therapy (such as tamoxifen or aromatase inhibitors) or to therapies aimed at HER2 receptors, such as Herceptin (generic name: trastuzumab), with other treatments such as surgery (lumpectomy or mastectomy), radiotherapy and other chemotherapies other than Herceptin taking on special importance.

About 10-20% of breast cancer cases are triple negative, and due to their resistance to treatment they are also more aggressive.

When is a breast biopsy necessary?

By Zaira Salvador BSc, MSc (embryologist).

A breast biopsy is done to confirm breast cancer when diagnostic tests such as mammography or magnetic resonance imaging (MRI) indicate a suspicion.

With breast biopsy, cells can be removed from the area of the breast where cancer is suspected with a needle and viewed directly under a microscope. The specialist in pathological anatomy will be able to determine whether these are malignant cancer cells and establish a definitive diagnosis.

What is the most common type of breast cancer?

By Zaira Salvador BSc, MSc (embryologist).

The most common type of breast cancer in women is invasive ductal carcinoma, which originates within the milk ducts and expands into surrounding tissues. This tumor accounts for 80% of infiltrating breast cancers.

What is Paget's disease of the breast?

By Zaira Salvador BSc, MSc (embryologist).

Paget's disease of the breast is a rare type of cancer that affects the skin of the nipple or areola. The most common symptoms are redness, itching, and scaling of the nipple and areola skin. The nipple may also be flattened and have strange yellow or bloody secretions.

Normally, women with this type of cancer usually have one or two tumors already in the breast.

How is breast cancer detected?

By Zaira Salvador BSc, MSc (embryologist).

The most common test used to detect breast cancer is mammography, since it can locate suspicious changes in the breasts up to 2 years before a palpable lump appears by the woman or the specialist.

For early diagnosis, it is recommended that women have regular mammograms every 1 or 2 years from age 40 to 69.

It is also not too much to ask a woman to do breast self-examinations in order to detect possible suspicious lumps and to have an annual gynecological check-up.

Can men also get breast cancer?

By Zaira Salvador BSc, MSc (embryologist).

Yes, although the vast majority of people who get breast cancer are women, there is a very small percentage of men who can also get breast cancer.

Breast cancer in men is associated with hereditary factors, exposure to ionising radiation and situations of hyperestrogenism. For example, men with Klinefelter syndrome have an increased risk of breast cancer due to high estrogen levels.

Suggested for you

As we have said, cancer therapies cause sterility in both men and women. If you want to find out about this and find out what preventive measures are in place, you can continue reading here: How does cancer affect fertility?

You can also inform yourself about the options to preserve fertility before undergoing an oncological treatment. For more details, have a look at the following post: Preserving fertility in women with cancer.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

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M Braden A, V Stankowski R, M Engel J, A Onitilo A. Breast cancer biomarkers: risk assessment, diagnosis, prognosis, prediction of treatment efficacy and toxicity, and recurrence. Curr Pharm Des. 2014;20(30):4879-98.

McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. Clinical Diagnosis and Management of Breast Cancer. J Nucl Med. 2016 Feb;57 Suppl 1:9S-16S.

Menen RS, Hunt KK. Considerations for the Treatment of Young Patients with Breast Cancer. Breast J. 2016 Nov;22(6):667-672.

Merino Bonilla JA, Torres Tabanera M, Ros Mendoza LH. Breast cancer in the 21st century: from early detection to new therapies. Radiologia. 2017 Sep - Oct;59(5):368-379.

Weigelt B, Reis-Filho JS. Histological and molecular types of breast cancer: is there a unifying taxonomy? Nat Rev Clin Oncol. 2009 Dec;6(12):718-30.

FAQs from users: 'What is triple negative breast cancer?', 'When is a breast biopsy necessary?', 'What is the most common type of breast cancer?', 'What is Paget's disease of the breast?', 'How is breast cancer detected?' and 'Can men also get breast cancer?'.

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Authors and contributors

Dra. Lydia Pilar Suárez
Dra. Lydia Pilar Suárez
Gynecologist
Bachelor degree in Medicine and Surgery at the Universidad de Oviedo in Asturias. Specialization in Obstetrics and Gynecology at the University Hospital of San Carlos de Madrid. Master in Assisted Reproduction at the University of Rey Juan Carlos in collaboration with the Valencian Fertility Clinic IVI. More information about Dra. Lydia Pilar Suárez
Zulassungsnummer: 64136
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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