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BREAST CANCER

A breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs mainly in women, but men can get it, too. Many people do not realize that men have breast tissue and that they can develop breast cancer.

Normal breast structure

Here is some basic knowledge about the normal structure of the breasts.

The breast is made up mainly of lobules (milk-producing glands in women), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).

Until puberty (usually around 13 or 14), young boys and girls have a small amount of breast tissue consisting of a few ducts located under the nipple and areola (area around the nipple). At puberty, a girl's ovaries make female hormones, causing breast ducts to grow, lobules to form at the ends of ducts, and the amount of stroma to increase. In boys, hormones made by the testicles keep breast tissue from growing much. Men's breast tissue has ducts, but only a few if any lobules.

Like all cells of the body, a man's breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because their breast cells are not constantly exposed to the growth-promoting effects of female hormones.



What are the key statistics about breast cancer in men?

- About 1,970 new cases of invasive breast cancer will be diagnosed among men
- About 390 men will die from breast cancer
- Breast cancer is about 100 times less common among men than among women.
- For men, the lifetime risk of getting breast cancer is about 1 in 1,000.

What are the key statistics about breast cancer in women?
- Increase in incidence; 205,000 new patients annually
- Annual mortality (death) 40,000
- Women with BRCA-1 or BRCA-2 genes have a lifetime risk as high as 85%

Contributing factors

- Family history
- Smoking
- Obesity
- Alcohol
- Radiation exposure
- Not having children or having them later in life (more exposure to estrogen and progesterone hormones)
- Lack of exercise

Signs and Symptoms

The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded. So it's important to have anything unusual checked by a doctor.

Other signs of breast cancer include the following:

- Swelling of all or part of the breast
- Skin irritation or dimpling
- Breast pain
- Nipple pain or the nipple turning inward
- Redness, scaliness, or thickening of the nipple or breast skin
- A nipple discharge other than breast milk

Sometimes breast cancer can spread to lymph nodes under the arm and cause a lump or swelling there, even before the tumor in the breast tissue is large enough to be felt.

Prevention

Mammogram: Women age 40 and older should have a screening mammogram every year and should keep on doing so for as long as they are in good health.

Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert at least every 3 years. After age 40, women should have a breast exam by a health expert every year.

Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should report any changes in how their breasts look or feel to a health expert right away.

A woman can notice changes by knowing how her breasts normally look and feel and feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach and using a specific schedule to examine her breasts.

Women with breast implants can do BSE. It may be useful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may make it easier to examine. Women who are pregnant or breast-feeding can also choose to examine their breasts regularly.

The following information provides a step-by-step approach for the exam. The best time for a woman to examine her breasts is when the breasts are not tender or swollen or 5-7 days after her period. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.

How to examine your breasts

Lie down on your back and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.

Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. Use each pressure level to feel the breast tissue before moving on to the next spot. 

     

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).

Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)

Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

The goal, with or without BSE, is to see a doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.



Resources:

2011 Ferri’s Clinical Advisor

American Cancer Society website: www.cancer.org





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