Breast cancer is the most common malignancy in women globally. While it primarily affects females, men can also develop the disease. Early diagnosis and prompt treatment drastically improve the prognosis. With increased awareness, breast self-examinations, and modern treatments, survival rates have improved significantly in recent decades.
Key Facts & Global Impact
- 1 in 9 women develop breast cancer in their lifetime.
- Female to male ratio: 100:1
- Breast cancer is curable in early stages.
- Late-stage breast cancer is managed palliatively.
- HER2+ cancers require targeted therapy like trastuzumab (Herceptin®).
Causes and Risk Factors
Breast cancer arises due to a combination of genetic, hormonal, lifestyle, and environmental factors.
Common Risk Factors
- Gender: Female
- Age: >50 years
- Family history of breast/ovarian cancer
- Early menarche or late menopause
- Nulliparity (never giving birth)
- Hormone Replacement Therapy (HRT)
- Obesity and alcohol use
- Smoking
- Sedentary lifestyle
Genetic & Hormonal Predispositions
Genetic Factors
- BRCA1 and BRCA2 gene mutations
- Family history (Fhx)
- Caucasian ethnicity has a slightly higher risk
Hormonal Factors
- Delayed childbearing or no childbirth
- Anovulatory cycles
- Postmenopausal estrogen exposure
Early Signs and Cardinal Symptoms
Understanding the early signs is key to early detection.
Cardinal Signs
- Hard, fixed, painless breast lump
- Skin dimpling or nipple retraction
- Nipple discharge (especially bloody)
- Changes in breast contour or symmetry
- Lymph node enlargement in axilla
- Eczematous nipple changes (Paget’s disease)
Breast Cancer Staging Explained
Staging helps guide treatment and assess prognosis. The TNM classification is used:
Stage 0 (In Situ)
- No residual disease
- No nodes/metastasis
Stage I–III
Size and nodal involvement varyExample:
- Ia: Tumor <2 cm + no nodes
- IIa: Tumor 2–5 cm or mobile nodes
- IIIa: Fixed nodes
- IIIb: Local skin/chest wall involvement
- IIIc: Extensive node involvement
Stage IV
- Distant metastasis (lungs, liver, bones, brain)
How Breast Cancer Spreads (Metastasis)
Pathways of Spread
- Lymphatic: Axillary and internal mammary nodes
- Haematogenous: Bones, lungs, liver, brain
- Direct Extension: To overlying skin or chest wall
Metastases are common in late-stage disease and indicate a need for palliative care.
Types and Molecular Subtypes
Histological Types
- Invasive ductal carcinoma (80%)
- Invasive lobular carcinoma (15%)
- Paget’s disease of the nipple
Molecular Subtypes
- Luminal A: ER+/PR+/HER2− (best prognosis)
- Luminal B: ER+/PR+/HER2+ or high Ki67
- HER2-enriched: ER−/PR−/HER2+
- Triple negative/basal-like: ER−/PR−/HER2− (worst prognosis)
Diagnostic Process: Triple Assessment and More
Triple Assessment
1. Clinical Examination – Lump characteristics2. Imaging
- Mammography (for women >35 years)
- Ultrasound (for women <35 years)
3. Tissue Sampling
- FNAC or core needle biopsy
Additional Investigations
- MRI: Axillary or lobular cancers
- PET/CT: Metastatic workup
- Receptor Testing: ER/PR and HER2 status
- Genetic Testing: BRCA1/2 mutations
Screening Guidelines
- Age 50–70: Mammogram every 3 years
- High-risk individuals: Begin screening at age 40
- Self-exams: Monthly after age 20
- Clinical exams: Every 3 years (20–39), yearly after 40
- Participation in screening programs can reduce mortality by 35%.
Treatment Options Based on Stage
Early Breast Cancer (Stages I–II)
- Surgery: Lumpectomy or mastectomy
- Radiation therapy
- Hormonal therapy (if ER/PR+)
- HER2+ cancers: Trastuzumab (Herceptin®)
- Chemotherapy (based on tumor grade, receptor status)
Locally Advanced (Stage III)
- Neoadjuvant chemotherapy
- Mastectomy ± radiation
- Hormone or targeted therapy
Advanced Breast Cancer (Stage IV)
- Palliative chemotherapy
- Hormone therapy (ER/PR+)
- Trastuzumab for HER2+
- Bone metastasis: Bisphosphonates
- Pain relief and quality-of-life support
Breast Cancer Prognosis and Survival Rates
10-Year Survival
- Stage I: 85%
- Stage II: 60%
- Stage III: 40%
- Stage IV: 10%
Prognosis depends on:
- Stage at diagnosis
- Tumor biology and receptor status
- Response to treatment
- Lymph node involvement
Breast Cancer in Men
Although rare (1 in 100 cases), men can develop breast cancer, usually presenting with:
- Hard retroareolar lump
- Nipple changes
- Axillary lymphadenopathy
FAQs
Q1. Is breast cancer hereditary?
Yes, especially with BRCA1/BRCA2 mutations. Family history increases risk.
Q2. Can men get breast cancer?
Yes, though rare, men can get breast cancer.
Q3. What is the survival rate for breast cancer?
It ranges from 85% (early stage) to 10% (late stage), depending on many factors.
Q4. Are all breast lumps cancerous?
No. Many are benign, but all lumps should be evaluated via triple assessment.
Q5. How is HER2+ breast cancer treated?
With Trastuzumab (Herceptin®), chemotherapy, and sometimes hormone therapy.
