Breast cancer

Breast cancer
Mammo breast cancer wArrows.jpg
Mammograms showing a normal breast (left) and a breast with cancer (right, white arrows).
Specialty Oncology
Symptoms Lump in a breast, change in breast shape, dimpling of the skin, fluid coming from the nipple, red scaly patch of skin [1]
Risk factors Female, obesity, lack of exercise, alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, older age, family history, Klinefelter syndrome [1] [2] [3]
Diagnostic method Tissue biopsy [1]
Treatment Surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy [1]
Prognosis Five-year survival rate ~85% (US, UK) [4] [5]
Frequency 2.1 million affected as of 2015 [6]
Deaths 533,600 (2015) [7]

Breast cancer is cancer that develops from breast tissue. [8] Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin. [1] In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin. [9]

Risk factors for developing breast cancer include being female, obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, older age, and family history. [1] [2] About 5–10% of cases are due to genes inherited from a person's parents, [1] including BRCA1 and BRCA2 among others. [1] Breast cancer most commonly develops in cells from the lining of milk ducts and the lobules that supply the ducts with milk. [1] Cancers developing from the ducts are known as ductal carcinomas, while those developing from lobules are known as lobular carcinomas. [1] In addition, there are more than 18 other sub-types of breast cancer. [2] Some cancers, such as ductal carcinoma in situ, develop from pre-invasive lesions. [2] The diagnosis of breast cancer is confirmed by taking a biopsy of the concerning lump. [1] Once the diagnosis is made, further tests are done to determine if the cancer has spread beyond the breast and which treatments it may respond to. [1]

The balance of benefits versus harms of breast cancer screening is controversial. A 2013 Cochrane review stated that it is unclear if mammographic screening does more good or harm. [10] A 2009 review for the US Preventive Services Task Force found evidence of benefit in those 40 to 70 years of age, [11] and the organization recommends screening every two years in women 50 to 74 years old. [12] The medications tamoxifen or raloxifene may be used in an effort to prevent breast cancer in those who are at high risk of developing it. [2] Surgical removal of both breasts is another preventative measure in some high risk women. [2] In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy, chemotherapy, hormonal therapy and targeted therapy. [1] Types of surgery vary from breast-conserving surgery to mastectomy. [13] [14] Breast reconstruction may take place at the time of surgery or at a later date. [14] In those in whom the cancer has spread to other parts of the body, treatments are mostly aimed at improving quality of life and comfort. [14]

Outcomes for breast cancer vary depending on the cancer type, extent of disease, and person's age. [14] Survival rates in the developed world are high, [15] with between 80% and 90% of those in England and the United States alive for at least 5 years. [5] [4] In developing countries survival rates are poorer. [2] Worldwide, breast cancer is the leading type of cancer in women, accounting for 25% of all cases. [16] In 2012 it resulted in 1.68 million new cases and 522,000 deaths. [16] It is more common in developed countries [2] and is more than 100 times more common in women than in men. [15] [17]

Signs and symptoms

Breast cancer
Breast cancer showing an inverted nipple, lump, and skin dimpling.

The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump. [18] The earliest breast cancers are detected by a mammogram. [19] Lumps found in lymph nodes located in the armpits [18] can also indicate breast cancer.

Indications of breast cancer other than a lump may include thickening different from the other breast tissue, one breast becoming larger or lower, a nipple changing position or shape or becoming inverted, skin puckering or dimpling, a rash on or around a nipple, discharge from nipple/s, constant pain in part of the breast or armpit, and swelling beneath the armpit or around the collarbone. [20] Pain (" mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues. [18] [19] [21]

Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange. [18] As inflammatory breast cancer does not present as a lump there can sometimes be a delay in diagnosis.

Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as skin changes resembling eczema, such as redness, discoloration, or mild flaking of the nipple skin. As Paget's disease of the breast advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's disease of the breast also have a lump in the breast. [22]

In rare cases, what initially appears as a fibroadenoma (hard, movable non-cancerous lump) could in fact be a phyllodes tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant. [23]

Occasionally, breast cancer presents as metastatic disease—that is, cancer that has spread beyond the original organ. The symptoms caused by metastatic breast cancer will depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain. [24] Unexplained weight loss can occasionally signal breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are called non-specific, meaning they could be manifestations of many other illnesses. [25]

Most symptoms of breast disorders, including most lumps, do not turn out to represent underlying breast cancer. Fewer than 20% of lumps, for example, are cancerous, [26] and benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. Nevertheless, the appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age. [27]

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Afrikaans: Borskanker
العربية: سرطان الثدي
azərbaycanca: Süd vəzi xərçəngi
български: Рак на гърдата
bosanski: Tumori dojke
čeština: Karcinom prsu
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日本語: 乳癌
norsk: Brystkreft
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Simple English: Breast cancer
slovenčina: Rakovina prsníka
slovenščina: Rak dojke
српски / srpski: Rak dojke
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