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Breast Cancer: Risk Factors, Stages, And Management

  • Author by Raazi
  • Reviewed By Raazi
  • Last Edited : August 23, 2024
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Whether metastatic breast cancer is a first diagnosis or a recurrence, it’s common for patients to experience many emotions. These may include anger, fear, tension, outrage, depression, and calmness.

You can feel angry at your physicians, doubt the therapies you’ve had, or be ready to accept the diagnosis as it is. The process of accepting a diagnosis of metastatic breast cancer is not right or wrong, rather demands patience. 

Being informed that breast cancer has spread to other parts of the body can be unpleasant for you, your family, and any close one. However, there are ways to make sure that your quality of life is good.

Here are some tips on how to deal with emotions, get support, and determine how to diagnose and overcome the disease.

Ultimately, to shift into normal life after receiving a diagnosis.

  • Men can develop breast cancer too, though it’s about 100 times less common than in women.
  • Dense breast tissue can increase the risk of breast cancer and make it harder to detect tumors on mammograms.
  • Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of developing breast and ovarian cancers.
  • Breastfeeding for more than one year can lower the risk of breast cancer.
  • Regular exercise can reduce the risk of breast cancer by about 10-20%.
  • The majority of breast lumps are benign and not cancerous.
  • Breast cancer is the second most common cancer in women worldwide, after skin cancer.
  • Approximately 85% of breast cancers occur in women with no family history of the disease.
  • A diet high in fruits and vegetables may reduce the risk of breast cancer.

Is Breast Cancer Benign Or Malignant?

Breast cancer often develops when certain cells in the breast proliferate rapidly. These cells engulf the surrounding tissue and spread throughout the body. Large aggregates of these tissues are thus known as tumors.

Some tumors aren’t even considered cancer because they don’t threaten the patient’s life or spread throughout the body. “Benign tumors” are the name given to these kinds of tumors.

The term “malignant tumors” refers to certain types of tumors that are not confined to a certain area. They have the potential to infect the tissues around the breast spread throughout the body and cause malignant breast cancer.

According to some sources, each type of breast tissue has the potential to develop cancer. In contrast, ducts and glands are the regions where most cases occur. So, it can be declared that breast cancer is a type of malignant tumor that puts a person’s health at high risk.

What Breast Cancer Actually Is?

Breast cancer is a kind of malignant tumor developed from breast cells. It is one of the most common cancers affecting females. 

Breast cancer develops when cancerous tumors spread from the breast to other body tissues. The exact mechanism by which tumors develop is still unknown. It is increasingly acknowledged that malignant cells typically originate from ducts or glands.

Women’s health associations recommend frequent breast massages and checking for lumps. It may take a long time for a malignant cell to grow large enough for us to feel it. Thus, mammograms are preferably used by doctors to make the diagnosis.

Stages Of Developing Breast Cancer

Breast cancer is a disease of the cells, similar to other types of cancer. There are around fifteen distinct forms of breast cancer in total. Although some are more serious than others, they all have one thing in common. As neither the cause nor the solution has been discovered.

There are four primary stages in the development of breast cancer. It is important to understand the stages of breast cancer for proper breast cancer treatment by stage.

Stage 0

This is the initial stage of cancer. Here, the tumor may be found in the lining of milk glands called lobules or in the ducts that connect these glands to nipples. There is no tumor spread to the nearby fatty tissues.

Stage 1

This stage shows the spread of the tumor to the nearby fatty tissues of the breast. The size of the tumor at this stage is 1 or below. Moreover, no cancerous cells are present in the surrounding lymph nodes at this stage.

Stage 2

Here, the tumor size increases and reaches up to 2. This stage also shows the spread of the tumors surrounding lymph nodes.

Stage 3

This is a very advanced stage of tumor growth. Here, the size of the tumor becomes more significant than 2, and it prevails in lymph nodes of the underarm and breast. They might affect the upper or lower region of the collarbone.

Stage 4

This is the last stage and shows metastasis. Here, cancer prevails from lymph nodes to the other areas of the body.

Breast Conditions Associated With The Condition

Three conditions usually appear during breast cancer development. These are;

Galactorrhea

It stimulates milk production from the breasts without association with childbirth. Its major causes include nipple stimulation, prolactinoma, or the intake of drugs. Its best treatment advised is to avoid taking dopamine agonists.

Galactocele

It’s the most common benign breast lesion in lactating women. It’s the condition where milk retention containing cysts is found in the mammary glands. It usually occurs before or after breastfeeding, and surgical excision is advised for it.

Gynecomastia

It’s the enlargement of mammary glands in males. Its causes may include the increased production of estrogen or testosterone. Meanwhile, its treatment involves Tamoxifen intake. It is known as one of the testosterone replacement estrogen receptor modulators. Surgery is applied as the last treatment option. 

Prevalence of Breast Cancer

Breast cancer has emerged from relative obscurity into becoming the top killer of women worldwide. In 2001, about 2 lac cases of breast cancer were reported in the United States, declaring it as the second major cause of cancer death in the country.

It is the most prevalent malignancy issue plaguing women in North America and Europe currently.

Risk Factors Associated With Breast Cancer

All women are at risk of developing breast cancer. The risk can be aggravated by the presence of risk factors that are already a part of the natural cycle, like aging. 

There are two categories of risk factors for breast cancer. One is that you cannot control, and the other is under your control. 

Genders, growing older, and having a history of the disease in your family are all risk factors for breast cancer that you cannot control. Delayed menopause, childbearing after the age of 30, or acquiring a genetic mutation also comes under this category.

However, smoking, poor diet, and unhealthy lifestyle are those which are controllable. Though the exact breast cancer causes are still unknown, some risk factors are related to an increased likelihood of the disease. Some of these include:

Age

Recent studies have shown that there is a significant prevalence of breast cancer in the age group over 50. However, the incidence is relatively low in the age group under 25. It is crucial to note that this condition is more prevalent in patients between the ages of 25 and 50.

Menstrual Cycle

The menstrual cycle is another aspect to consider. Breast cancer occurrence has a close association with menstruation onset and cessation. For example, it is typical among women who have longer menstrual cycles. Such as those with earlier menarche and later menopause.

Smoking

Smoking is another risk factor for breast cancer. Smoking increases the risk of breast cancer in younger, premenopausal women and is associated with a variety of disorders. Not only active smoking but passive smoking also triggers the chances of developing breast cancer. So, ideally, women should avoid complete exposure to smoking.

Marital Status

Breast cancer onset is associated with the marital status of a woman. For example, the chances of developing breast cancer are higher among women who have not breastfed kids after birth. The probability is equal among those who have not given birth to a child. Those women who are involved in intense physical activities also have more chances of developing breast cancer. Sprinting is an example.

Family History

Family history is another major indicator of breast cancer. For example, if any family members like the mother, sister, or daughter of a woman had breast cancer in the past. There will be a higher possibility of developing breast cancer. Breast cancer or any kind of cancer runs in families. So, if any family member has breast cancer, you will be affected by it too.

Obesity

Obesity is another primary risk factor associated with breast cancer. The risk of breast cancer is very high among those women who have higher weight than the ones who are normal, especially after menopause. 

This increased risk is synchronized with a higher number of fat cells in the body. More fat cells synthesize more estrogen. These increased estrogen levels allow hormone-receptors-positive breast cancers to develop and prevail. 

Obesity increases the formation of fat cells. An increased number of fat cells produces a special form of estrogen known as ‘Estradiol’ that stimulates the division of cells. These dividing cells increase the probability of random genetic errors, which leads to cancer. 

The location of extra weight is also associated with the probability of developing breast cancer. For example, if a woman has excessive fat cells around her belly, she is prone to develop breast cancer. Fat centered on the abdomen increases the synthesis of insulin and insulin-like growth factors. It ultimately gives rise to breast cancer development. 

Meanwhile, the chances are slightly lower in the woman who has excessive weight in the thighs and hips region.

Poor Diet

Intake of saturated fatty acids is associated with increased chances of getting breast cancer. Saturated fats lead to extra fat deposition, leading to obesity. Obesity increases the chances of developing cancer.

Hormonal Therapies

Undergoing combined estrogen plus progestin hormone therapy increases the chances of breast cancer. Moreover, those women who continue taking oral anti-contraceptives for over 10 years are prone to develop the disease.

Gender

One of the frequent causes of breast cancer in women is being a woman. Even though males can still get this disease, being a woman puts you at a far higher risk.

Protections Relevant to the Risks

Breast cancer is the leading cause of mortality for women despite increased awareness and the availability of ways to detect it. The risks of developing breast cancer can be reduced by taking certain precautionary measures. Some of them include;

Early Detection of Breast Cancer

Breast cancer develops when tumor-like cells, which are found in our breasts, grow out of control and harm neighboring tissues. This cancerous cell proliferation damages health greatly.  

All women should begin performing breast self-examination (BSE) by the age of 20. The reason is that it is one of the quickest and most straightforward ways to detect cancer. This examination should be performed at least once every month or at least once a year.

A major protection that a woman can do against breast cancer development is its early detection. Daily self-examinations, yearly checkups, and mammograms are all effective ways to do this. It’s crucial for women to understand how breast cancer develops. They should be on the lookout for the following warning indicators.

  • Lump presence in breast or underarm
  • Scaling of skin, both of the nipple and breast
  • Changing in the nipple and breast size, texture, and shape
  • Any discharge from the nipple
  • Redness of breast or nipple
  • Thickening of breast

When cancer is discovered, fighting it off becomes simpler for you and the physicians. If you find any of these changes in the breast, make sure to consult a physician to verify the presence of breast cancer. It will help you move ahead to the treatment strategies.

Decreased Alcohol Consumption

If you are a smoker or alcohol consumer, avoid their use to minimize the risk of developing cancer.

Exercise

We are more inclined to form routines around the things we love doing. This way, we can keep doing the activities we often enjoy. Additionally, it is beneficial to incorporate physical exercise into daily life, so we should not neglect it at any moment. 

Taking exercise regularly decreases the probability of developing cancer. Always try to maintain a good metabolism through regular physical activity. A minimum of 30 minutes of exercise is essential daily. It might include a 30-minute brisk walk or any other physical work. 

There are common things that you are supposed to do to reduce the risk of developing cancer. For example, use the stairs at work rather than the escalator or elevator. Park your car in the parking space farthest from the supermarket, and avoid changing the TV station using the remote.

Breastfeeding

Breastfeeding decreases the risk of developing breast cancer. Moreover, avoid the use of taking birth control pills to ensure early protection.

Medications

Certain drugs are advised for a woman who is already at risk of developing breast cancer. Doctors often recommend a drug called ‘Tamoxifen’ to cure. It decreases the risk by 50% when taken in 5 years. Like all medications, excessive or consistent intake of Tamoxifen can be hazardous as it induces side effects like; 

  • Hot Flashes
  • Vaginal Discharge
  • Blood Clot
  • Stroke
  • Uterine Cancer
  • Pulmonary Embolus

Dietary Recommendations

Match your diet to what your body needs. You will gain weight if you consume more calories than your body needs. Make recipes healthier, learn to manage your portion sizes, and avoid eating fast foods regularly. Moreover, choose healthy snacks. 

Intake of vitamin A decreases the risk of cancer. Phytoestrogen is also effective in fighting breast cancer. It is found in soy, vitamin C, and vitamin E. 

Every meal should include lean protein. Protein sends a solid signal to the brain that prolongs the feeling of fullness. The correct protein source is vital to maintain your lean muscle mass. It also helps you regulate your appetite while consuming fewer calories. 

The white flesh of chicken seafood, like shrimp, prawns, scallops, and lobster, should all be considered as options for protein. Vegans may also choose soy-based meat replacements.

Keep Checking your Body Mass Index

Check your BMI to see whether your weight has posed a health problem. This body mass index is the measure of a person’s weight about height.

According to the Centers for Disease Control and Prevention, 60% of Americans or those with a BMI are overweight. Of those, 27% have a body mass index of 30 or more and are considered obese.

Preventive Strategies

  • Shift your eating patterns to a vegetarian. Ensure to eat organic foods and coloured vegetables like cabbage, carrot, celery, parsley, and parsnip. Eat at least 5 to 9 servings of fresh fruits and vegetables daily. 
  • Avoid eating red meat and processed food items.
  • Avoid carbonated beverages like cola. Preferably, take herb stevia, which is an excellent alternative to all other toxic artificial sweeteners.
  • Prefer whole grains rather than refined grains. Oatmeal, wheat, bran, Kamut, and psyllium are the best whole grain and fiber sources. 
  • Garlic and ginger are the best cancer-fighting nutrients. Try to include them in your daily diet.

What Should A Woman Do?

Early detection of breast cancer always proves the best chance of survival. All women should make use of all available resources so that they can enjoy the best results. 

Some of the things a woman should do include:

  • Getting complete awareness about the risk factors associated with breast cancer
  • Getting complete knowledge about the stages, symptoms, and types of breast cancer
  • Learn the proper way to do a self-examination test and perform it routinely

Women Above Age 40 Should

  • Have annual mammography screening for breast cancer care or prevention
  • Become aware of the risk of breast cancer associated with increasing age

Recurrence of Breast Cancer

A woman may be more likely to die from the disease if her breast cancer recurs or spreads to other body areas.

Breast cancer recurrence is thought to be more likely in women whose breast cancer was initially confined to lymph nodes. And in those who underwent chemotherapy after surgery.

Every year, more than 215,000 women receive a breast cancer diagnosis. Radiation and chemotherapy are frequently used in conjunction with surgery for many of them as their first line of defence.

Later, these women may need to discuss with their doctor whether to have “adjuvant treatment”. This entails medicine to help reduce the chance of their cancer returning.

Treatment Options For Early-Stage Breast Cancer

Various treatment options are available after the detection of breast cancer. Some of them include the following;

Surgery

This aims to remove a tumor from the breasts indicated by imaging. Surgery is performed in two ways;

  • Lumpectomy
  • Mastectomy

A lumpectomy is applied for the smaller tumors that are confined to the breast region only. It has no prevalence in the skin or chest wall. The candidate undergoes radiation therapy for tumor removal. 

Mastectomy is applied to the tumors that are spread to different quadrants of the breast. It is also known as inflammatory breast cancer, and the candidate is ineligible for radiation therapy here. 

After these basic procedures, a Sentinel Lymph node biopsy is performed. It’s a procedure where tracer material is injected into the breast through a needle. It helps to find out the sentinel nodes during surgery. These sentinel nodes are then analyzed in the laboratory.

If they give negative tumor presence, it does not require further nodal dissection. Meanwhile, if they give positive tumor presence, further nodal dissection is indicated. It is also performed to verify if the tumor has spread to axillary lymph nodes.

Adjuvant Chemotherapy

Adjuvant Chemotherapy

It is performed to minimize the risk of breast cancer occurring again in the future. This procedure focuses on two women groups primarily;

  1. Premenopausal Women where show a recurrence score of 20 or above
  2. Postmenopausal Women where show a recurrence score of more than 25

Generally, chemotherapy is the name of treating disease through drugs. And the drugs here are mainly Cyclophosphamide, Methotrexate, and 5FU.

Radiation Therapy

It reduces the risk of local recurrence of breast cancer. It covers three areas, including the breast, chest wall, and lymph nodes. Some side effects of the therapy include;

  • Fatigue
  • Breast Swelling
  • Formation of scar tissues in the breast
  • Nerve damage
  • Lymphedema
  • Lungs inflammation

Adjuvant Systemic Therapy

It is also performed to reduce the risk of local and distant recurrence of cancer. It is performed along with hormonal therapy and shows two possibilities;

If Lymph node-positive with the presence of tumor k1-67 proliferation index greater than 20%, Abemaciclib is advised to be taken for two years. It is recommended to take it orally two times a day.  If germline BRCA1 and BRCA2 mutation is found and requires chemotherapy then OLAPARIB is advised. These are also oral pills that are advised to take two times a day, for one year. 

Some common side effects of both medications include;

  • Fatigue
  • Nausea, vomiting, diarrhea
  • Decreased appetite
  • Low blood count
  • Headache

Hormonal Therapy

Appropriate hormonal therapy reduces the chances of recurrence by 50%. It uses two parameters. Like;

Aromatase inhibitors

Aromatase is an enzyme produced by the kidney. It acts on adrenal glands and blocks the conversion of testosterone into estrogen. 

Femara is a well-known therapy for breast cancer. It is currently the only drug in the class of drugs known as aromatase inhibitors. And, is authorized for use both after surgery and after five years on Tamoxifen. It is FDA-approved and offers significant benefits compared to other medications on the market. 

According to experts from the American Society of Clinical Oncology, Femara should be a part of adjuvant therapy. It should particularly be implied in postmenopausal women. 

Women who have had treatment for early breast cancer often worry that the disease may return. However, with Femara, we now have a choice that can assist all patients—even those with the highest recurrence risk. It specifically proves effective at an early stage of cancer. 

Researchers examined the efficacy of Femara and Tamoxifen in a significant clinical study. A twenty-six-month experimental study on post-surgical breast cancer treatment declared that Femara reduces the risk of breast cancer recurrence by 21%. Patients using Femara demonstrated a 27% decrease in the likelihood of cancer spreading to unaffected areas of the body. 

Women in this trial who had a higher chance of recurrence benefited most from Femara. Femara reduced this risk by 30% in women who had previously undergone chemotherapy. The reduction was 29% in women whose breast cancer had already progressed to the lymph nodes at the time of diagnosis. 

The findings also showed that Femara decreased the probability of cancer metastasizing to distant sites on the body. The ratios were 33 and 31%, respectively, in these high-risk women. It proved more efficacious than Tamoxifen.

Femara showed mild to moderate side effects in an adjuvant setting. The most frequent adverse effects of Femara in this trial were hot flashes, joint discomfort, nocturnal sweats, and nausea. Weight gain also appeared as a side effect. However, Femara seemed well tolerated. Bone fractures and osteoporosis were also observed in some women. 

If you are allergic to Femara or any of its constituents, speak with your doctor. Femara may damage the fetus; thus should not be taken during conception. However, it can be safely taken during the postmenopausal stage. 

With Femara, some women experienced tiredness and drowsiness. Patients using Femara experienced higher cholesterol levels than those taking Tamoxifen (5.4% vs. 1.2%). So, it should be taken wisely and in the recommended range.

Tamoxifen

It’s a prime estrogen receptor and gives both stimulatory and inhibitory effects. It has stimulatory effects on bone, endometrium, and blood vessels. Meanwhile, the inhibitory effects can be observed in breast cells, vaginal cells, and the hypothalamus. 

Both collectively reduce the production of tumors and minimize the chances of their recurrence if already there. 

Surveillance

Its goal is to check the recurrence of breast cancer. It’s a long-term treatment that involves lab testing and mammograms. It advises lab testing after every 3 months in the first two years, and every 6 months in the 5 years. And, after every 12 months in the 6th year of cancer.  Moreover, it advises mammograms once every year or every 6 months.

Treatment Options For Metastatic Breast Cancer

Management of metastatic breast cancer is done under three primary stages. These include;

  • Management of Oligometastatic disease
  • Management of bone, visceral, or CNS disorder
  • Management of Visceral Crisis

Management of Oligometastatic disease

This is also known as endocrine therapy and comes under the first-line treatment of breast cancer. Certain medications used in this stage are;

  • Anastrozole
  • Exemestane
  • Letrozole
  • Tamoxifen

 Moreover, the combination of Fulvestrant with either Anastrozole or Letrozole is given sometimes.

Management of Bone, Visceral, or CNS disorder

It’s a combination of endocrine therapy and CDK4/6 inhibitor and comes under the first line of defence against breast cancer. Medications given in this stage include;

  • Anastrozole
  • Exemestane 
  • Letrozole
  • Tamoxifen 

 These come under endocrine therapy. While the ones counted in the CDK4/6 inhibitors group include the following; 

  • Palbociclib
  • Ribociclib
  • Abemaciclib (explicitly known as CNS activator)

Management of Visceral Crisis

It is also known as chemotherapy, doublet, or monotherapy and comes under first-line defence. Some prime medications included in this category are;

  • Doxorubicin
  • Liposomal Doxorubicin
  • Paclitaxel
  • NAB-Paclitaxel
  • Docetaxel
  • Capecitabine
  • Gemcitabine
  • Vinorelbine
  • Eribulin
  • Epirubicin
  • Carboplatin
  • Cisplatin
  • Cyclophosphamide

All three stages come under the first line of defence against breast cancer.

Second Line of Defence

In this stage, molecular testing of the tumor is done. It is done in three steps, and the mutations are detected respectively. 

  1. If a P1K3CA mutation is found, ALPELISIB+FULVESTRANT is given.
  2. If an ESR1 mutation is found, EVEROLIMUS+FULVESTRANT is given. Note that the P1K3CA mutation is absent in this case.
  3. If no mutation is found, then the combination of EVEROLIMUS+FULVESTRANT is given. Or, Tamoxifen is given alone.

Third Line of Defence

This is the last stage which continues the molecular testing of the tumor. Some possibilities for this stage include;

  • BRCA1/2 mutation where OLAPARIB and TALAZOPARIB are given
  • High mutational burden where PEMBROLIZUMAB and DOSTARLIMAB Dxly are given
  • Microsatellite instability where PEMBROLIZUMAB is given
  • NTRK1/2/3 fusions where LAROTRECTINIB and ENTRECTINIB are given
  • No mutations where chemotherapy or monotherapy is applied
  • Improper androgen receptor expression where BICALUTAMIDE, ENZALUTAMIDE, and ABIRATERONE are given

 These procedures are performed for the efficient cure of metastatic breast cancer.

Practice Healthy Living

Options for postoperative care should be discussed with an oncologist. Taking care of your general health and well-being lowers your chance of cancer recurring and gives you the energy to do the activities you enjoy. Whether it’s one, five, or ten years after your first diagnosis.

Takeaway

There was a time when breast cancer was seen as a terrifying illness. But today, things have changed completely. Now, this might be effectively cured if diagnosed early. Its treatment is less radical and more effective today than in the past.

One of the unpleasant procedures you may need to undergo as part of your breast cancer therapy is the excision of one or both breasts. But it’s not the same for all patients.

Breast cancer may now be treated because of advancements in medical science and breast cancer treatment options available.

Breast Cancer: Risk Factors, Stages, And Management

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