Overview of Breasts

Structure of Breasts

Here's an overview of its key parts of the breasts and their functions:

- Mammary glands: These are the milk-producing glands that contain lobes, lobules and alveoli or milk sacs.

- Lobules: They are small milk-producing glands within the breast. They are composed of glandular tissue and are arranged in clusters throughout the breast.

- Ducts: They are narrow tubes responsible for transportation of milk produced by the lobules to the nipple for breastfeeding. They form a branching network throughout the breast tissue.

- Nipple: The nipple is a raised area in the center of the breast through which milk is expelled during breastfeeding.

- Areola: Surrounding the nipple is the areola, a darker pigmented area of skin that contains sebaceous glands and Montgomery's glands, which produce an oily substance that lubricates the nipple.

- Adipose or Fatty Tissue: Adipose tissues or fat make up a significant portion of the breast and provide cushioning and protection for the glandular tissue. The varying levels of fatty tissue or adipose tissue among women determines their breast size and shape.

- Cooper's ligaments: These are supportive connective tissue bands that extend from the skin to the chest wall, giving breasts their shape and structure.

- Blood and Lymphatic Vessels: The breast is supplied with blood vessels that deliver nutrients and oxygen to the tissue and lymphatic vessels that drain excess fluid and waste products. Lymph nodes located in the armpit (axilla) and around the collarbone play a crucial role in filtering lymph fluid and detecting abnormal cells, including cancer cells.

Functions of Breasts:

In females, the primary functions of breasts are:

Lactation: Milk production to nourish a newborn baby is the predominant function. This process is triggered by hormonal changes following childbirth.

Sexual development and function: Breasts play a crucial role in sexual development and can be a source of erotic stimulation.

In males, breasts have very little to no function. They may develop some tissue during puberty but typically remain small and flat.

Breast Diseases and Breast Disorders:

Several conditions can affect the breasts causing a diverse range of symptoms and complications. Some common breast diseases and disorders include::

Breast cancer: It is the most common cancer among women which arises due to the uncontrolled growth of malignant cells in breast tissue.

Fibrocystic breasts: Fibrocystic breasts, also known as fibrocystic breast disease or chronic cystic mastalgia, are a common, noncancerous condition that affects breast tissue. It causes changes in the breasts, such as lumps and tenderness, that fluctuate with hormonal changes throughout the menstrual cycle.

Mastitis: It is the inflammation and infection of the breast tissue which often occurs due to bacterial infections or milk stasis (ineffective removal of milk from the breasts) in breastfeeding women during the first few months after giving birth.

Benign breast lumps: These are non cancerous growths or benign lumps in the breast that are usually harmless.

What causes breast cancer?

The exact cause of breast cancer isn't fully understood. However, there are numerous factors that can elevate your breast cancer risk. Some of the causes of the breast cancer or breast cancer risk factors include:

- Age: Although breast cancer is more commonly diagnosed in women aged 50 and above, it is not exclusive to this age group, as younger women can also be affected. The risk of developing breast cancer rises significantly in women older than 50 years of age.

- Genetic Factors: Inherited mutations in specific genes, such as BRCA1 and BRCA2, significantly increase the risk of developing breast cancer. However, most breast cancers occur in individuals without a family history of the disease.

- Hormonal Factors: The risk of breast cancer can be influenced by estrogen and progesterone, hormones pivotal in regulating the menstrual cycle and crucial during pregnancy. Extended exposure to estrogen whether due to HRT or hormone replacement therapy, early onset of menstruation or delayed menopause might substantially heighten the risk of breast cancer.

- Family History: A family history of breast cancer, particularly in first-degree relatives (mother, sister, daughter), can increase an individual's risk, especially if the relative was diagnosed at a young age.

- Reproductive Factors: Early onset of menstruation, late onset of menopause, never having children or having the first child after age 30, and not breastfeeding may increase breast cancer risk.

- Radiation Exposure: Previous radiation therapy to the chest, especially during childhood or adolescence, increases the risk of developing breast cancer later in life.

- Environmental Factors: Exposure to environmental pollutants and chemicals may put women at a higher risk of developing breast cancer

- Lifestyle choices: Certain lifestyle choices can significantly increase breast cancer risk. Alcohol consumption, lack of physical activity, smoking and being overweight or obese have been linked with an increased risk of developing breast cancer.

Although very uncommon, men can also develop breast cancer but it is much more common in women due to the presence of breast tissue.

What are the steps for Preventive Care?

Breast cancer preventive care involves multiple steps aimed at mitigating the risk of developing breast cancer or diagnosing it at an early stage when treatment is most effective. Here are a few pointers for preventive breast cancer:

- Healthy Lifestyle Choices:

Maintaining optimal weight and getting at least 150 minutes of moderate intensity exercise every week can positively impact your breast health. Eat a balanced diet and refrain from consuming red meat, processed foods, unhealthy fats, excessive alcohol or smoking.

- Breast Self-Awareness and Breast Exams: Perform Breast Self Exams or BSE on a monthly basis and become familiar with the normal look and feel of your breasts. If you notice any changes or abnormalities then report them to your doctor immediately. Get regular clinical breast exams or CBE as advised by your doctor.

Common Breast Cancer Symptoms include (but aren’t limited to):

- Lumps or swellings in your breast(s) or near your armpits

- Unusual changes in breast size or shape

- Persistent and unexplained breast pain or discomfort

- Leaky discharge from the nipple discharge other than breastmilk (especially if the discharge is bloody)

- Irritation, dimpling or puckering of your breast skin

- Flaking or nipple pain

- Nipple retraction or nipple(s) turning inward)

If you experience one or more of these breast cancer warning signs then you should consult a doctor right away.

- Mammograms: Follow breast cancer screening guidelines for mammograms based on age, familial history of breast cancer and other risk factors. For most women, this means getting a mammogram once every year or once in two years starting from the age of 40. Discuss with your doctor to understand when to begin and how often to have mammograms and other breast cancer screening tests.

- Genetic Counseling and Testing: Women with a known or strong familial history of breast cancer or women who carry genetic mutations like BRCA1 or BRCA2 should consider genetic counseling and testing. This can help assess your risk and guide preventive measures.

- Breastfeeding: Breastfeeding or nursing for a minimum duration of one year has been correlated with a decreased likelihood of breast cancer occurence. So, women should breastfeed if they can to lower their risk of breast cancer.

- Medications: Women at a higher risk of developing breast cancer can be administered certain medications such as aromatase inhibitors such as Exemestane & Letrozole and SERMS or selective estrogen receptor modulators to lower their risk of breast cancer. Talk to your doctor to understand your breast cancer risk and if you need any prophylactic medications.

- Hormone Replacement Therapy (HRT):

Women considering hormone replacement therapy should discuss the potential risks and benefits with their doctor as Hormone Replacement Therapy has a high correlation with breast cancer occurrence.

Dense Breast Tissue: Please be wary of the fact that women with more glandular tissue and less fatty tissue in their breasts may greatly increase the probability of breast cancer occurrence as such breasts can be harder to screen for abnormalities.

How is breast cancer diagnosed?

Diagnosis of breast cancer involves several sequential steps and diagnostic procedures. Some of the key diagnostic tests for breast cancer screening are:

The first step is a clinical examination or a physical examination by your doctor. Your doctor will examine and assess your breasts and surrounding lymph nodes for any irregularities like changes in size or shape or other signs of breast cancer.

Imaging Procedures:

- Mammography: X-ray images of the breast are taken to detect any suspicious areas such as masses, lumps and calcifications.

- Ultrasound: High frequency sound waves (above the audible range of humans) are used to generate detailed and intricate images of the breast tissue, which can help differentiate between solid masses and fluid-filled cysts.

- Magnetic Resonance Imaging (MRI): This imaging technique comes in handy especially for women with dense breast tissue or to further evaluate suspicious findings.

Biopsies: If imaging tests reveal suspicious areas, a tissue sample (biopsy) is taken for analysis under a microscope to confirm or rule out cancer. There are different types of biopsies, including:

• Fine-needle aspiration biopsy
• Vacuum-assisted biopsy
• Core needle biopsy
• Surgical biopsy (excisional biopsy or incisional biopsy)

A pathologist then examines the tissue sample procured during the biopsy to determine if cancerous cells are present. This pathological examination can help classNameify the type of breast cancer, its aggressiveness and other characteristics of the cancer that guide treatment decisions.

If breast cancer is diagnosed, additional tests such as CT scans, bone scans, PET scans, or other imaging studies may be performed to determine the stage of the disease and whether it has spread to other parts of the body.

Breast Cancer Markers:

Breast cancer markers, alternatively referred to as tumor markers, are compounds generated either by breast cancer cells themselves or by the body in reaction to cancer. Detectable via blood tests, tissue examination, or imaging techniques, these markers offer significant insights into the existence, characteristics, or advancement of breast cancer. Below are several prevalent breast cancer markers:

- Estrogen Receptor or ER: The presence of estrogen receptors is a critical marker in breast cancer, indicating whether cancer cells possess receptors for the hormone estrogen. Breast cancers classNameified as estrogen receptor-positive (ER+) can be treated with hormone therapy aimed at inhibiting estrogen's impact on cancer cells.

- Progesterone Receptor or PR: The status of progesterone receptors indicates whether cancer cells carry receptors for the hormone progesterone. Breast cancers categorized as progesterone receptor-positive (PR+) may also benefit from hormone therapy.

- Human Epidermal Growth Factor Receptor 2 or HER2/neu: HER2/neu is a protein that fosters the proliferation of cancer cells. Breast cancers that are HER2/neu-positive exhibit elevated levels of this protein and may respond to targeted therapies designed to obstruct its effects.

- Ki-67: Ki-67 serves as a protein marker indicating the rate of cell proliferation within breast cancer tissue, reflecting how rapidly cells are dividing. Elevated levels of Ki-67 may suggest more aggressive tumors and an increased risk of recurrence.

- BRCA1 and BRCA2: BRCA1 and BRCA2 are genes that, when mutated, raise the likelihood of developing breast cancer and ovarian cancer. Testing for mutations in these genes aids in identifying individuals with heightened breast cancer risk and assists in treatment decision-making.

- CA 15-3: CA 15-3 functions as a tumor marker that can be heightened in the blood of certain breast cancer patients, particularly those with advanced or metastatic disease. Its measurement is often employed to monitor treatment response and track disease progression.

- CA 27.29: Similarly, CA 27.29 is another tumor marker that might be elevated in the blood of some breast cancer patients. Like CA 15-3, it is utilized for monitoring treatment response and disease advancement.

- Circulating Tumor Cells or CTCs: CTCs are cancer cells that have detached from the primary tumor and circulated into the bloodstream. Analyzing and detecting CTCs in blood samples can offer insights into cancer presence, response to treatment, and prognosis.

These breast cancer markers play pivotal roles in diagnosing, planning treatment, and monitoring breast cancer patients. However, it's essential to recognize that these markers constitute just one aspect of a comprehensive breast cancer assessment. Their interpretation should be conducted within the broader context of clinical and pathological factors. Treatment decisions typically involve a combination of considerations, including tumor characteristics, disease stage, overall health condition, and patient preferences.

Following a breast cancer diagnosis, doctors work with patients to develop a treatment plan tailored to their specific situation which may include surgery, chemotherapy, radiation therapy, hormone therapy, targeted therapy or a combination of these treatments.

Regular follow-ups and monitoring are critical to evaluate treatment effectiveness and detect any recurrence, progression or complications.

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Frequently Asked Questions

1. What are the common signs of breast cancer?

Ans) Common Signs of Breast Cancer include:

- Changes in breast size or shape

- Persistent breast pain or discomfort

- Lumps or masses in your breasts or underarm area

- Nipple discharge (especially if the discharge is bloody)

- redness, puckering or dimpling of your breast skin

- Nipple retraction (turning inward)

2. How often should a woman perform a breast self-exam (BSE)?

Ans) Women are encouraged to perform a breast self-exam once every month, ideally a few days after their menstrual period ends. It is important to note that self breast exams are not a substitute for clinical breast exams performed by your doctor. Please talk to your doctor to understand how frequently you need to perform a Self Breast Exam and discuss if it's right for you.

3. What role does hormone replacement therapy (HRT) play in breast cancer risk?

Ans) Hormone Replacement Therapy or HRT, especially when combined estrogen-progestin therapy, has been linked to an increased risk of breast cancer. Women considering Hormone Replacement Therapy should discuss the risks and benefits with their doctor.

4. Are there any specific exercises or activities that promote breast health?

Ans) There's no specific exercise proven to prevent breast cancer, but staying active is beneficial. Regular physical activity, including aerobic exercises and strength training, is beneficial for overall health and can indirectly contribute to breast health. Women should ideally aim for at least 150 minutes of moderate intensity physical exercise every week.

5. What are the potential side effects of breast cancer treatment?

Ans) Breast cancer treatment options such as Chemotherapy, radiation therapy, surgery and hormone therapy can all have specific side effects. Side effects vary depending on the type of treatment. Common side effects of breast cancer treatment include:

- Fatigue

- Nausea

- Weight loss or abnormal changes in weight

- menopausal symptoms (especially if ovaries are affected)

- emotional distress

- Hair loss

- nerve pain