Genetics and Family History

Some people inherit gene changes (mutations) that increase their risk of breast cancer. The most well-known genes linked to breast cancer are BRCA1 and BRCA2. If these genes have mutations, it raises the risk for breast and ovarian cancer.

Having close relatives (like a mother, sister, or daughter) with breast cancer, especially if they were diagnosed at a young age, also increases your risk.

Hormones and Reproductive History

Hormones, especially estrogen, play a big role in breast cancer. Certain factors that affect hormone levels over time can raise the risk:

• Early Periods: Starting periods before age 12 slightly raises the risk due to longer exposure to hormones.
• Late Menopause: Going through menopause after age 55 also increases risk because of longer hormone exposure.
• Pregnancy and Childbirth: Having your first child after age 30 or not having children can increase risk because pregnancy reduces the number of menstrual cycles over a lifetime.
• Hormone Therapy: Taking hormone replacement therapy (HRT) during menopause, especially combined estrogen and progesterone, can raise the risk of breast cancer. Birth control pills may also have a slight effect on breast cancer risk, but this risk decreases when you stop taking them.
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Lifestyle Choices

Certain lifestyle habits can raise the risk of breast cancer:

• Alcohol: Drinking alcohol regularly can increase the risk of breast cancer, even in small amounts.
• Being Overweight: After menopause, being overweight raises the risk because extra body fat increases estrogen levels.
• Lack of Exercise: Not being physically active is linked to a higher risk of breast cancer.
• Diet: Eating a balanced diet with lots of fruits and vegetables may help lower cancer risk, while a diet high in processed foods and unhealthy fats may increase it.
• Smoking: Although more strongly linked to other cancers, heavy smoking may slightly raise the risk of breast cancer, especially in younger women.
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Age and Gender

• Age: The risk of breast cancer increases as you get older, especially after age 50. Cancer tends to be more common in older people due to changes in cells over time.
• Gender: Women are much more likely to develop breast cancer than men, but men can still get breast cancer, too.
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Exposure to Radiation

If you had radiation treatment to your chest area, especially at a young age (for example, to treat another type of cancer), it can raise your risk of breast cancer later in life.

Environmental Factors

Certain chemicals and substances can mimic hormones and may increase the risk of breast cancer. For example:

• Plastics and Chemicals: Substances like BPA, used in some plastics, and certain pesticides might act like estrogen in the body and raise cancer risk, although research is still ongoing.

Breast Tissue Density

Women with dense breast tissue have more glandular tissue and less fat in their breasts. This not only increases the risk of breast cancer but can also make it harder to see tumors on a mammogram, potentially delaying diagnosis.

Breastfeeding

Breastfeeding may slightly lower the risk of breast cancer, especially if done for a year or longer. Breastfeeding reduces the number of menstrual cycles over a woman’s lifetime, which lowers hormone exposure.

Race and Ethnicity

Breast cancer rates and types can vary by race and ethnicity:

• White women

  tend to have a slightly higher overall risk of breast cancer.

• Black women have a higher risk of aggressive types of breast cancer, like triple-negative breast cancer.
• Asian, Hispanic, and Native American women generally have a lower risk compared to white women.
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Summary of Breast Cancer Risk Factors

In simple terms, the main factors that raise the risk of breast cancer include having a family history of breast cancer, certain inherited gene changes, exposure to hormones over time (like early periods or late menopause), lifestyle choices (like alcohol use and being inactive), age, gender, and environmental exposures. While you can’t control some of these factors, making healthy lifestyle choices, staying active, and getting regular screenings can help lower your risk and detect any changes early.

Regular breast screenings and being aware of changes in your breast health can make a big difference in catching breast cancer early when it’s easier to treat.

TREATMENT

Surgery

Surgery is often the first treatment for breast cancer, aiming to remove as much of the cancer as possible. There are a few types of surgeries:

• Lumpectomy (Breast-Conserving Surgery): Only the tumor and a small amount of surrounding tissue are removed. This surgery keeps most of the breast intact and is usually followed by radiation to lower the risk of cancer coming back.
• Mastectomy: The entire breast is removed. Sometimes, the nearby lymph nodes are removed as well, especially if the cancer has spread to them. In some cases, both breasts are removed if there is a high risk of cancer developing in the other breast.
• Lymph Node Removal: If cancer has spread to nearby lymph nodes (usually under the arm), some or all of these lymph nodes may be removed during surgery to prevent further spread.

After a mastectomy, some people choose to have breast reconstruction surgery to rebuild the breast’s shape. This can be done during the mastectomy or at a later time.

Radiation Therapy

Radiation therapy uses high-energy rays to kill any remaining cancer cells in the breast or surrounding area. It’s often used after a lumpectomy to target any leftover cancer cells and reduce the risk of recurrence.

• How It Works: Radiation damages the DNA of cancer cells, making it impossible for them to grow and divide. Healthy cells may also be affected but can usually recover.
• Types of Radiation Therapy:
  • External Beam Radiation: The most common form of radiation for breast cancer, where a machine outside the body directs radiation to the breast area.
  • Internal Radiation (Brachytherapy): Sometimes, small radioactive “seeds” are placed inside the breast near the cancer site to deliver targeted radiation.

Radiation therapy usually involves daily sessions over several weeks. Side effects can include skin irritation, fatigue, and, occasionally, swelling or discomfort in the treated area.

Chemotherapy

Chemotherapy (or “chemo”) uses drugs to kill cancer cells throughout the body. It’s often used if the cancer has a higher risk of spreading or if it has already spread to other parts of the body.

• How It Works: Chemotherapy drugs target and kill fast-growing cells, which includes cancer cells. Since these drugs travel through the bloodstream, they can reach cancer cells throughout the body.
• When It’s Used:
  • Before Surgery (Neoadjuvant Therapy): To shrink large tumors so they’re easier to remove with surgery.
  • After Surgery (Adjuvant Therapy): To kill any remaining cancer cells that might have spread beyond the breast.

Chemo is usually given in cycles, with a period of treatment followed by a rest period. Common side effects include nausea, fatigue, hair loss, and a weakened immune system, but these effects often go away after treatment ends.

Hormone (Endocrine) Therapy

Hormone therapy is used to treat breast cancers that are hormone receptor-positive, meaning they rely on hormones like estrogen to grow. This therapy blocks the body’s natural hormones from fueling the cancer.

• Types of Hormone Therapy:
  • Tamoxifen: Often used for premenopausal women. Tamoxifen blocks estrogen from attaching to cancer cells, slowing or stopping their growth.
  • Aromatase Inhibitors (AIs): Often used for postmenopausal women. AIs (like anastrozole and letrozole) lower estrogen levels in the body, starving hormone-dependent cancer cells.
  • Ovarian Suppression: In premenopausal women, stopping the ovaries from making estrogen (through drugs or surgery) can be part of hormone therapy.

Hormone therapy is usually taken as a daily pill for several years. Side effects can include hot flashes, mood changes, and joint pain.

Targeted Therapy

Targeted therapy drugs are designed to specifically attack cancer cells with certain features, like specific genes or proteins, without harming most normal cells. They’re usually given to patients whose cancer cells have certain targets, like HER2, a protein that promotes cancer growth.

• HER2-Targeted Therapy: For HER2-positive breast cancers, drugs like trastuzumab (Herceptin) and pertuzumab are used to block HER2, slowing or stopping cancer growth.
• CDK4/6 Inhibitors: These drugs, like palbociclib, help control cell growth and are often used for advanced hormone receptor-positive, HER2-negative breast cancer.
• PARP Inhibitors: Used in patients with BRCA mutations, these drugs interfere with cancer cells’ ability to repair DNA, causing them to die.

Targeted therapy is often combined with other treatments, like chemotherapy or hormone therapy, and can help improve the effectiveness of these treatments. Side effects vary depending on the drug but can include fatigue, nausea, and skin rashes.

Immunotherapy

Immunotherapy helps the body’s immune system recognize and attack cancer cells. It’s still a newer option in breast cancer treatment and is usually used in specific cases, like advanced triple-negative breast cancer.

• How It Works: Immunotherapy drugs, like checkpoint inhibitors, block proteins that stop the immune system from attacking cancer cells, allowing the immune cells to target and kill the cancer.
• Example: Pembrolizumab is an immunotherapy drug that can be used for some advanced triple-negative breast cancers.

Side effects of immunotherapy can include fatigue, skin rash, and flu-like symptoms. In some cases, the immune system can attack normal organs, leading to other side effects.

Treatment Plans: Combining Different Therapies

Often, breast cancer treatment involves a combination of these therapies, depending on the cancer’s type, stage, and specific characteristics:

• Early-Stage Breast Cancer: Surgery is usually the first step, followed by radiation therapy and, if needed, hormone therapy or targeted therapy to prevent recurrence.
• Locally Advanced Breast Cancer: Treatment might start with chemotherapy or targeted therapy to shrink the tumor, followed by surgery and possibly radiation.
• Advanced or Metastatic Breast Cancer: Treatment focuses on managing the cancer and improving quality of life. Options can include hormone therapy, chemotherapy, targeted therapy, or immunotherapy, based on the cancer’s specific traits.

Each patient’s treatment plan is unique, and doctors work with patients to decide on the best approach based on the latest medical research, the patient’s preferences, and overall health.

Coping with Breast Cancer Treatment

Treatment can be physically and emotionally challenging, and support is essential. Patients may experience side effects like fatigue, hair loss, nausea, and changes in mood, but there are ways to manage these issues. Some options include:

• Support Groups: Talking to others who are going through similar experiences can provide comfort.
• Counseling: A counselor or psychologist can help with the emotional impact of cancer and its treatment.
• Nutrition and Exercise: Eating a healthy diet and staying active can improve energy levels and overall well-being.
• Self-Care: Practicing relaxation techniques, hobbies, or other activities that bring joy can help reduce stress.
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Summary

Breast cancer treatment is personalized and may involve one or a combination of the following approaches:

Surgery: Removes the cancer from the breast.

Radiation Therapy: Uses high-energy rays to kill remaining cancer cells.

Chemotherapy: Uses drugs to kill cancer cells throughout the body.

Hormone Therapy: Blocks hormones that help some breast cancers grow.

Targeted Therapy: Attacks specific molecules in cancer cells.

Immunotherapy: Boosts the immune system to fight cancer.

Treatment decisions are made based on the type and stage of breast cancer, and doctors work with patients to find the most effective plan. With advances in treatment, many people with breast cancer can live healthy, fulfilling lives.

Prevention of Breast Cancer

While some risk factors for breast cancer can’t be changed (like age or family history), making certain lifestyle choices may help reduce the risk:

Maintain a Healthy Weight

• • Being overweight, especially after menopause, increases the risk of breast cancer because fat tissue can produce estrogen, which fuels some types of breast cancer.
  • Maintaining a balanced diet and staying active can help keep your weight in a healthy range.
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Stay Physically Active

• • Regular exercise (about 150 minutes of moderate activity each week, like walking or cycling) can lower the risk of breast cancer.
  • Exercise helps control weight, reduces hormone levels, and boosts the immune system, all of which may reduce cancer risk.
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Limit Alcohol Consumption

• • Drinking alcohol, even in small amounts, can increase breast cancer risk. Aim to limit alcohol to no more than one drink per day, or avoid it altogether if possible.
  • Alcohol raises estrogen levels and can damage DNA in cells, both of which increase cancer risk.
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Quit Smoking

• • Smoking is linked to many cancers, including breast cancer, especially in younger women. Avoiding smoking or quitting if you already smoke can reduce the risk.
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Breastfeed, If Possible

• • Breastfeeding for several months can lower the risk of breast cancer. The longer you breastfeed, the greater the protective effect.
  • Breastfeeding reduces the number of menstrual cycles, which lowers hormone exposure over a lifetime.
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Limit Hormone Replacement Therapy (HRT)

• • HRT used for menopause symptoms (especially combined estrogen and progesterone therapy) can raise breast cancer risk. If you need HRT, talk to your doctor about the lowest dose for the shortest time, or consider non-hormonal options for managing symptoms.
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Follow a Healthy Diet

• • Eating a diet rich in fruits, vegetables, whole grains, and lean proteins may help lower breast cancer risk by providing nutrients that support overall health and reduce inflammation.
  • Avoiding processed foods and limiting sugar can also help keep weight and inflammation under control.
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Consider Genetic Testing if You Have a Family History

• • If you have a strong family history of breast cancer, consider genetic counseling and testing to check for mutations in genes like BRCA1 and BRCA2, which increase breast cancer risk.
  • Women with high-risk gene mutations may consider additional preventive measures, like enhanced screening, preventive medications, or even preventive surgery.
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Early Screening for Breast Cancer

Early detection is one of the most effective ways to improve breast cancer outcomes. Regular screening can help find breast cancer at an early stage, when it is often easier to treat. There are a few key ways to screen for breast cancer:

Mammograms

What It Is: A mammogram is an X-ray of the breast that can detect tumors that are too small to feel. It’s currently the best screening tool for breast cancer.

Who Should Get It: Women are generally advised to start getting mammograms around age 40 to 50, depending on personal and family risk factors. Screenings are usually done every 1-2 years.

Why It Helps: Mammograms can detect breast cancer early, sometimes up to three years before it can be felt as a lump. Early detection greatly increases the chance of successful treatment.

Breast MRI (Magnetic Resonance Imaging)

What It Is: An MRI uses magnets and radio waves to create detailed images of the breast. It’s often used for women at higher risk of breast cancer (like those with a BRCA gene mutation).

Who Should Get It: Breast MRI is not used for general screening but may be recommended for high-risk women, often in addition to a yearly mammogram.

Why It Helps: An MRI is more sensitive than a mammogram and can detect cancers that might not show up on a mammogram, especially in women with dense breast tissue.

Clinical Breast Exams

What It Is: A healthcare provider checks the breasts and underarms for lumps or other changes. This is usually done during a regular check-up.

Who Should Get It: Clinical breast exams are recommended every 1-3 years for women in their 20s and 30s and annually for women over 40.

Why It Helps: These exams can help identify any unusual changes in the breast that may need further testing.

Breast Self-Awareness

What It Is: Breast self-awareness means knowing how your breasts normally look and feel so you can notice any changes, such as lumps, thickening, pain, or changes in size or shape.

Who Should Practice It: All women should practice breast self-awareness. Self-exams are optional, but many women find them helpful for becoming familiar with their breasts.

Why It Helps: Knowing what’s normal for your breasts makes it easier to detect any changes that may need medical attention.

Understanding Risk Levels and Screening Recommendations

• Average Risk: Women without a family history of breast cancer or known genetic mutations generally begin mammogram screenings between ages 40-50 and continue every 1-2 years until age 74.
• High Risk: Women with a higher risk (such as those with BRCA gene mutations, a family history of breast cancer, or previous chest radiation therapy) may start screening earlier and use additional methods, like MRI, alongside mammograms.
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Benefits of Early Screening

• Improves Survival Rates: Breast cancer is much easier to treat when found early. Early-stage cancers often require less aggressive treatment and have higher survival rates.
• Detects Cancer Before Symptoms Appear: Screening can catch cancer when it’s still small and hasn’t spread, which usually means a better prognosis.

Allows for More Treatment Options: Early detection can lead to more treatment options, including less invasive surgeries and targeted therapies.

Common Signs to Watch For Between Screenings

Even with regular screenings, it’s important to be aware of changes in your breasts. Common signs that may require a doctor’s attention include:

• A new lump in the breast or underarm
• Swelling in part of the breast
• Skin irritation or dimpling (like an orange peel texture)
• Pain in the breast or nipple area
• Nipple discharge (especially if it’s bloody)
• Nipple turning inward or changes in size, shape, or color

Summary

Preventing breast cancer involves a healthy lifestyle, including maintaining a balanced diet, exercising, limiting alcohol, avoiding smoking, and managing hormone use. For those at high genetic risk, preventive options like genetic testing and extra screenings may be helpful.

Early screening for breast cancer typically involves mammograms, clinical exams, and, for those at high risk, MRIs. Knowing your own breasts and recognizing any changes is also crucial for early detection. With early screening, breast cancer can often be found at an early stage, leading to simpler treatment, higher survival rates, and a better quality of life. Regular check-ups and screenings based on age and risk level are important steps toward managing breast cancer risk effectively.

NEWER ADVANCEMENTS OR RESEARCHES IN BREAST CANCER

Breast cancer research has made significant strides in recent years, leading to improved detection, treatment, and prevention strategies. Here are some notable advancements:

Experimental Vaccine for Triple-Negative Breast Cancer

An experimental vaccine targeting triple-negative breast cancer—a particularly aggressive form—has shown promising results. In an early trial, 16 out of 18 patients remained cancer-free three years after treatment, compared to the expected half with standard care. The vaccine works by training the immune system to recognize and attack cancer cells.

Genetic Screening to Reduce Early Disease Deaths

A study by Stanford University and Genomics suggests that genetic screening could prevent nearly 25% of premature deaths from common diseases, including breast cancer. By utilizing polygenic risk scores (PRS) from large genetic databases, researchers can identify individuals at high genetic risk, allowing for earlier and more personalized interventions. 

Liquid Biopsy for Early Detection

Researchers have developed a blood test capable of predicting the return of breast cancer, potentially years before it would be detectable by conventional methods like mammograms. This ‘liquid biopsy’ identifies mutations from cancer cells in the blood, enabling earlier and more effective treatment. 

Cryoablation: A Less Invasive Treatment

Cryoablation, a procedure that freezes and destroys cancer cells, is emerging as a less invasive alternative to surgery for certain breast cancer patients. This method, combined with hormonal therapy and radiation, has shown potential in completely eradicating tumors, offering hope to patients unable to undergo traditional surgery. 

Targeting Dormant Tumor Cells

Scientists have discovered a method to eliminate ‘hibernating’ tumor cells in estrogen receptor-positive (ER+) breast cancer, which accounts for a significant portion of cases. By inhibiting the enzyme G9a, researchers can prevent cancer cells from entering dormancy and eliminate those already in a dormant state, potentially reducing cancer recurrence. 

Role of Selenium in Cancer Spread

A study funded by Cancer Research UK suggests that the essential mineral selenium, commonly found in foods like Brazil nuts and cereals, may contribute to the spread of triple-negative breast cancer. Restricting selenium could prevent the spread of this aggressive cancer type, offering new avenues for treatment. 

These advancements reflect the ongoing efforts to improve breast cancer outcomes through innovative research and personalized medicine approaches.