Okay everybody welcome back to another week. In honor of Breast Cancer Month we will be doing a two part episode on the basics about breast cancer. It's an important topic because after skin cancer, breast cancer is the second most common cancer diagnosed in the United States. There’s a lot of science behind this so we will try to keep it brief by explaining what breast cancer is, how it is diagnosed, the different types, treatment options and screening as well as, prevention in a two part special!
As you know it can occur in both sexes but is obviously much more commonly seen in women. Prevention is important and is done by appropriate screening and spreading awareness. These key points have really changed the game in terms of how many people get diagnosed and if they do early on they may even be be cured. There have been many advances in the field of breast cancer and we couldn’t have been more proud.
There are different subtypes of breast cancer and just to list them there are ductal cancers (occur in the ducts of the breast), lobular (occurring in the lobules), either of which may become invasive. Furthermore, there is a condition known as paget’s disease of the breast, inflammatory breast cancer, angiosarcoma, male breast cancer and recurrent breast cancer.
Symptoms include usually a lump or some tissue thickening that you feel is different than usual or normal or simply different from the rest of the breast or the other breast. Also, new onset is an important thing to note. We mention this because some individuals have sort of a lump before their period but that goes away soon after your period ends.
You should also look for changes in the size of the breast or with its appearance or shape. A warning sign for example, can be visible if there are changes to the skin overlying the breast such as dimpling or a retraction of the nipple that was not present before. Others can present with peeling or crusting over the areola, redness or pitting of the skin (something in medicine we call (peau d-orange) which literally means skin of an orange.
If you see any of these concerning symptoms see your doctor no matter when your last check up or mammogram was. Additionally, look out for any alarm symptoms like fatigue, weight loss, headache, or new onset symptoms in other parts of the body (we can get into the specifics later if you'd like).
As with most other types of cancers this occurs due to mutations when some of your cells start to grow erratically particularly these cancer cells and they tend to form a mass. These cells can also spread to other sites of the body or to the lymph nodes near the original cancer site. With breast cancer in particular, it usually begins in the ducts (which is the area that produces milk) but as mentioned it can also occur in the lobules (which is the glandular tissue). There are other cell and tissue types that can be affected which we will discuss later.
There are certain risk factors that are associated with the development of breast cancer. But please note that you can still get any type of cancer even if you have no risk factors. Currently, it is believed to occur due to multiple things mainly in combination with genetic and environmental factors. Five to ten percent of patients are estimated to be from a familial gene mutation as you may have heard of was the case with Angelina Jolie! The genes are known as the BRCA1 and BRCA2 which literally stands for breast cancer gene 1 and 2. These two genes have a relationship with increasing the risk of both breast and ovarian cancer. You can be tested for these mutations if you have a strong family history and be offered prophylactic treatment to remove your breasts and ovaries as a means to stop the cancer from ever occurring.
Other risk factors to note include obviously being a woman, increasing age, alcohol, personal history of a breast condition already like a carcinoma in situ or atypical hyperplasia, personal history of breast cancer (so if you have had it in one breast you’re at increased risk of developing it in the other breast), family history and inherited genes as mentioned earlier particularly if they were at a young age. You can also be at risk if you have had radiation exposure (over the chest as a child or young adult), obesity, early onset of your period specifically those who have their periods before twelve years old and on the opposite spectrum if you had your periods stop at an older age, having your first child at an older age (after age thirty), postmenopausal hormone therapy (usually seen with combined estrogen and progesterone), as well as, individuals who were never pregnant when compared to those who had one or more pregnancies.
It should be noted that for those on hormone replacement therapy (HRT) their risk will decrease once they stop the HRT.
For those who have these risk factors and even in the general population there are things you can do for prevention which are so crucial that we can’t stress it enough!
First if you go to your physician annually they should automatically ask you about breast cancer screening based on your sex, age, family history and additional medical conditions. This will involve clinical breast exams and mammograms.
Of course number two is you want to become familiar with your breasts so you can assess for any changes and do self inspections! This “awareness” won’t prevent breast cancer (as this has been studied) but it helps you become more in tune with your body and the ability to go see your doctor if you do notice a difference which may potentially help with early detection.
Number three: Drink alcohol in moderation like everything else we say everything in moderation (for women this is usually a limit of one drink per day).
Number four: Exercise most days of the week and really this means at least 30 minutes a day of activity. Maintain a well balanced lifestyle like being at a healthy weight and choosing a healthy diet. The Mediterranean diet is one of the most popular ones specifically extra virgin olive oil, mixed nuts, plant-based foods in general like fruits or vegetables and healthy fats like fish.
Number five: Avoid HRT if possible (in some circumstances it really makes a difference to use it for those who have menopause with serious symptoms and if needed you can use it for a shorter time period).
For those at high risk breast cancer reduction can be utilized by using certain preventive medications like SERMs and aromatase inhibitors which basically are estrogen blocking medications. In other cases you can undergo preventive surgery via prophylactic mastectomy where you remove your breasts and also oophorectomy to remove the ovaries!
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