What everyone should know about breast cancer

When was the last time you had a breast exam? If you’re drawing a blank, it may be a good idea to start making it a habit—it’s recommended that you start talking to your doctor about mammograms every year at age 40. Breast cancer is the most common cancer for women worldwide, affecting as many as 1 in 8 according to the World Cancer Research Fund (WCRF). Maven OB-GYN Jackie Stone, MD, explains what you need to know about breast cancer and the preventative measures we should all take to stay healthy and safe.

What is breast cancer? 

Breast cancer is when the cells in the breast tissue grow abnormally and the excess cells cause tissue masses (or tumors) to develop. “If our bodies are functioning normally, old cells die off and new ones develop in their place,” Stone says. “When someone has cancer of any kind, this process isn’t working properly. Instead of the old cells dying off, they keep growing, forming abnormal cells at an uncontrollable rate.”

In most cases of breast cancer, carcinomas are the cause. Carcinomas are a type of cancer that begin in the cells of the skin or tissue lining. Breasts are made up mainly of fat, glandular tissue, connective tissue and ducts. With breast cancer, abnormal and rapid cell growth occurs in the breast tissue, leading to masses or lumps and can spread to other parts of the body through blood vessels and lymph vessels. Breast cancer most commonly develops in the epithelial tissue that lines the breast ducts (the intricate pathways where milk travels to the nipple when breastfeeding).

Hormones play a big role in breast cancer. The tissue in our breasts respond directly to our hormones, which is why they get tender or swollen before your period, for example. Cancer cells can be receptive to the hormones that our bodies naturally produce, such as estrogen and progesterone. In some instances the cancer cells can also produce their own hormones that stimulate tumor growth.

What are the risk factors for breast cancer? 

Research has found that there are some factors that increase your chances of developing breast cancer. Some can be avoided, like drinking less alcohol, and others can’t, like genetics. That said, we know it can be scary and frustrating to hear, but some people without any known risks will still develop breast cancer, and some with many risk factors won’t. In fact, according to the National Breast Cancer Foundation, 60-70% of breast cancer patients have no known risk factors and only 30-40% do. “The main risk factors are age and sex, so even if you don’t have any others, you should familiarize yourself with your breasts and alert your doctor if you notice anything abnormal,” Stone says. Though guidelines vary a bit by organization, it’s generally recommended that you begin talking with your doctor about annual mammograms at age 40 and start getting them no later than age 50.

The top risk factors for breast cancer are:

• Being female: Breast cancer can occur in men but it’s rare.
• Advanced age: Most breast cancers are found in women who are age 55 and older.

Some additional risk factors include:

• Family history of breast cancer: Having a first-degree relative with breast cancer (i.e., a mother or sister) can double your risk.
• Hereditary gene mutations: Most commonly associated with BRCA1 and BRCA2
• Having had breast cancer before: In the same or other breast
• Having benign breast disease: Such as fibroadenomas, ductal hyperplasia, and intraductal papillomas
• Having dense breast tissue: Your doctor can help you determine if you have dense breast tissue (usually by performing a mammogram).
• Getting your period early: Before the age of 12
• Going through menopause late: After the age of 55

What are the symptoms? 

Cancer may not have any symptoms until it’s advanced, but there are some possible warning signs to be aware of, including:

• A lump in the breast or armpits
• Breast swelling. Irritation or dimpling on the skin of the breast
• Newly inverted nipple (when the nipple sinks inward instead of pointing outward)
• Red or flaky breast or nipple skin
• Nipple discharge (other than breast milk)
• A change in the size or shape of the breast
• Pain in any area of the breast or nipple

Keep in mind that these symptoms can be related to other conditions so if you experience any of the above, tell your doctor so they can examine you.

What are the different stages of breast cancer? 

Breast cancer is diagnosed according to stages. “The stages refer to the size of the tumors and the growth of the cancer, if it’s local (in one area) or has spread to other areas of the body,” Stone says.

Stage 0: Limited to inside the milk duct. Non-invasive

Stage I: Small tumors. Have either not spread to the lymph nodes or very limited spread

Stage II: Larger than Stage I tumors. And/or have spread to nearby lymph nodes

Stage III: Larger than Stage II tumors. And/or have spread to nearby tissue or nearby lymph nodes

Stage IV:Tumors that have spread beyond the breast and nearby lymph nodes to other parts of the body (commonly the bones, liver, or lungs, sometimes the brain)

“Catching breast cancer at its earliest stage provides the best possible outcomes,” Stone says. Survival rates for breast cancer vary widely, but thanks to access to medical care and better screening, as well as more awareness in general about breast cancer, survival rates have generally been improving. According to WCFR, in many countries the 5-year survival rate for women who are diagnosed with breast cancer is:

Stage I/II: 80-90% 5-year survival rate

Stage III/IV: 24% 5-year survival rate

What can I do to lower my risk? 

While breast cancer can occur in individuals without risk factors, strong evidence has been found that being physically active and breastfeeding can both lower your risk. Though not as strong, there’s also some evidence that your risk of breast cancer can be lowered by eating healthy: specifically non-starchy vegetables (ex. asparagus, broccoli, cauliflower), foods with carotenoids (ex. carrots, oranges, tomatoes, spinach), and calcium-rich foods (cheese, yogurt, milk, dark leafy greens).

“There’s some evidence that decreasing red and processed meat and increasing fruits/vegetables, phytoestrogens (soy), or eating a Mediterranean diet can lower your risk for a number of health conditions, including breast cancer,” Stone says. “However the evidence isn't conclusive. That said, you can be a very healthy person and still get breast cancer due to genetics or other factors which aren’t entirely understood. So in addition to a healthy lifestyle, I recommend that you stay familiar with your breasts to note if anything changes.”

How often should I get a mammogram? 

Because the recommendations vary, it’s best to ask your doctor about your personal risk. Here are some general guidelines according to ACOG:

Below age 40: Mammograms are recommended every 1-2 years if you’re high risk

Age 40-49: The decision to get a mammogram should be shared between doctor and patient

Age 50-75: Most national professional societies recommend annual or once every other year mammograms if you are low-risk

After age 75: Shared decision making is recommended regarding whether or not to continue screening

“There’s little evidence that clinical breast exams (at your doctor’s office) are helpful in addition to mammography for detection of breast cancer in average risk individuals, but it’s usually performed as part of a complete physical examination every 1-3 years for those age 25-39 and annually in those 40 and over and is recommended in higher risk individuals,” Stone says.

How is breast cancer treated? 

Treatment for breast cancer usually depends on the type of breast cancer and the stage. Your doctor will recommend the treatment options they believe will be most effective based on your condition. “If cancer is caught in a very early stage, removal of the cancerous tumor, called lumpectomy, can be curative,” Stone says. “Other times, removal of the entire breast, called mastectomy is necessary. These surgeries may be performed with or without chemotherapy or radiation to treat the cancer or prevent recurrence. Hormonal therapies are also often given depending on many factors to prevent recurrence. If the cancer has spread to distant organs (stage IV) chemotherapy or hormonal therapy is often used, but it can be difficult to cure.”

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