Breast cancer happens when cells in the breast begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. However, some tumors are not really cancer because they cannot spread or threaten someone's life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors. Theoretically, any of the types of tissue in the breast can form a cancer, but usually it comes from either the ducts or the glands. Because it may take months to years for a tumor to get large enough to feel in the breast, we screen for tumors with mammograms, which can sometimes see disease before we can feel it.

Signs and symptoms of Breast cancer

signs and symptoms of breast cancer may help save your life. When the disease is discovered early, you have more treatment options and a better chance for long-term recovery.

Most breast lumps are not cancerous. All breast lumps, however, need to be evaluated by a doctor.
Breast discharge is a common problem and is rarely a symptom of cancer. Discharge is most concerning if it is from only 1 breast or if it is bloody. In any case, all breast discharge should be evaluated.
Nipple inversion is a common variant of normal nipples, but nipple inversion that is a new development can be of concern.
Changes in the skin of the breast include redness, changes in texture, and puckering. These changes are usually caused by skin diseases but occasionally can be associated with breast cancer.

Causes of breast cancer

Hormonal causes - 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.

Environmental causes - Radiation treatment seems to increase the likelihood of developing breast cancer but only after a long delay. For example, women who received radiation therapy to the upper body for treatment of Hodgkin disease before age 15 years have a significantly higher rate of breast cancer than the general population.

Dietary causes - Breast cancer seems to occur more frequently in countries with high dietary intake of fat. This link is thought to be an environmental influence rather than genetic. For example, Japanese women, at low risk for breast cancer while in Japan, increase their risk of developing breast cancer after coming to the United States. Several studies comparing groups of women with high- and low-fat diets, however, have failed to show a difference in breast cancer rates.

Genetic causes -There is great interest in genes linked to breast cancer. BRCA1 is an abnormal gene that, when inherited, markedly increases the risk of breast cancer to a lifetime risk of almost 85%. Women with this abnormal gene also have an increased likelihood of developing ovarian cancer. Women who have the BRCA1 gene tend to develop breast cancer at an early age.
A second abnormal gene, BRCA2 , increases the risk of developing breast cancer but not ovarian cancer. Testing for these genes is expensive and frequently not covered by insurance. In addition, women who test positive may have trouble getting or keeping health insurance. The issues around testing are complicated, and women who are interested in testing should discuss this with their health care providers.

Treatment of breast cancer

Current convention means that breast cancer is usually treated surgically along with chemotherapy, radiotherapy and hormone therapy. Surgery used to involve the removal of the whole breast, but this is less common today.

Chemotherapy uses cytotoxic drugs to kill cancer cells both in the breast and elsewhere in the body. Hormone therapy may be used, as estrogen and progesterone influence all breast cells, including cancerous ones. However, many cancers are hormone-dependent. Estrogen promotes growth of cancer cells, so it may be advisable to stop the production of estrogen. This used to be done by surgically removing the ovaries, adrenal glands or pituitary gland, but today certain drugs are given instead.

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. This is not considered curative and should almost always be done in association with other therapy such as radiation therapy with or without chemotherapy or hormonal therapy.
Simple mastectomy removes the entire breast but no other structures. If the cancer is invasive, this surgery alone will not cure it. It is a common treatment for DCIS, a noninvasive type of breast cancer.
Modified radical mastectomy removes the breast and the axillary (underarm) lymph nodes but does not remove the underlying muscle of the chest wall. Although additional chemotherapy or hormonal therapy is almost always offered, surgery alone is considered adequate to control the disease if it has not metastasized.
Radical mastectomy involves removal of the breast and the underlying chest wall muscles, as well as the underarm contents. This surgery is no longer done because current therapies are less disfiguring and have fewer complications.

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