Breast Cancer is a malignant tumor that has developed from abnormally growing cells in the breast. Breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.
October every year has been designated for commemorating Breast Cancer Awareness in countries across the world. All efforts are devoted to increasing attention and support for the awareness, early detection and treatment as well as palliative care of this disease. The month-long campaign started in the United States as National Breast Cancer Awareness Month. However, it first started as a week-long event in the United States in October 1985, founded by the American Cancer Society and the Imperial Chemical Industries Pharmaceuticals (later part of AstraZeneca). Since then, campaigns to increase awareness of the disease, to educate people about methods of prevention and early detection, and to raise money to support research have extended to countries around the world. Today, nonprofit organizations, government agencies, and medical societies work together to promote breast cancer awareness.
In 2020, there were 2.3 million women diagnosed with breast cancer with 685,000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the previous 5 years, making it the world’s most prevalent cancer (World Health Organization, 2021). In Nigeria, there were 28,380 new cases of breast cancer with 14,274 deaths recorded (IARC Globocan, 2020).
There isn’t sufficient knowledge about exact causes of breast cancer, therefore, early detection of the disease and commencement of treatment remain cornerstones of breast cancer control. The underlisted have however been identified as risk factors:
- Age and gender
- Reproductive factors and steroid hormones
- Prior breast health history
- Lifestyle risk factors
- Obesity
- Environmental risk factors
- Radiation exposure
Early breast cancers may be asymptomatic, and pain and discomfort are typically not present. If a lump is discovered however, the following may indicate the possible presence of breast cancer:
- Change in breast size or shape
- Skin dimpling or skin changes
- Recent nipple inversion or skin change or nipple abnormalities
- Single-duct discharge, particularly if blood-stained
- Axillary (armpit) lump
Breast cancer is often first detected as an abnormality on a mammogram before it is felt by the patient or health care provider. However, other clinical steps to evaluating breast cancer includes the following:
- Self-breast examination
- Clinical breast examination
- Mammogram
- Ultrasonography: more sensitive in non-fatty breasts.
- Magnetic resonance imaging
- Needle biopsy
Aside the clinical features and diagnosis highlighted above, a major part of the management of breast cancer is the staging of the cancer. Staging is based on the various features of three important factors including the size of the Tumor, the presence of lymph Nodes and the Metastasis or spread of the cancer cells to other parts of the body (TNM Staging Method). Based on this, clinicians have come up with ten (10) different stages for breast cancer as described below:
- Stage 0: carcinoma in situ
- Stage IA: Cancer is 2 cm or smaller and has not spread outside the breast.
- Stage IB: Cancer has spread to the lymph node and is between 0.2 and 2 mm in size.
- Stage IIA: The tumor in the breast is still small. May or may not spread to the lymph nodes.
- Stage IIB: Tumor is the size of walnut/lime. May or may not spread to the lymph nodes.
- Stage III: Advanced stage. Cancer hasn’t spread to bones or organs.
- Stage IIIA: The tumor is found in up to 9 lymph nodes in the underarm to the collarbone.
- Stage IIIB: The tumor has grown into the chest wall or skin around the breast.
- Stage IIIC: The tumor is in >10 lymph nodes or has spread above or below the collarbone.
- Stage IV: breast cancer cells have spread far away from the breast and lymph nodes around it.
With the aid of the staging mechanism highlighted above, clinicians have been able to categorize different types of cancers as follows:
- Infiltrating (invasive) ductal carcinoma: starts in the milk ducts of the breast. Making up about 80% of all cases. it’s the most common type of breast cancer.
- Ductal carcinoma in situ: also called Stage 0 breast cancer (precancerous)
- Infiltrating (invasive) lobular carcinoma: it accounts for 10% to 15% of breast cancers.
- Lobular carcinoma in situ: a precancerous condition in which there are abnormal cells in the lobules of your breast. it isn’t a true cancer.
- Triple negative breast cancer (TNBC): making up about 15% of all cases.
- Inflammatory breast cancer: rare and aggressive, resembles an infection.
- Paget’s disease of the breast: this cancer affects the skin of your nipple and areola area.
Upon proper diagnosis breast cancers are typically treated and managed with a combination of the following methods:
- Surgical therapy: may consist of lumpectomy (removal of the tumor) or total mastectomy (removal of the breast).
- Radiation therapy: may follow surgery in an effort to eradicate residual disease while reducing recurrence rates.
- Adjuvant hormone or chemotherapy
- Surgical resection with or without radiation is the standard treatment for ductal carcinoma in situ.
In conclusion, increased public awareness and improved screening have led to earlier diagnosis at stages amenable to complete surgical resection and curative therapies. Improvements in therapy and screening have led to improved survival rates for women diagnosed with breast cancer. The majority of deaths occur in low- and middle-income countries, where most women with breast cancer are diagnosed at late stages mainly due to lack of awareness about early detection and barriers to health services.
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