Breast cancer is a malignant tumor arising from the cells of the glandular tissue of the breast. It begins in the ducts or lobules and in its early stage may cause no noticeable changes. Below are the risk factors, signs, mammography by age, and heredity.
What it is
The tumor begins inside the milk ducts and lobules that produce milk. The earliest form (in situ) is not yet life-threatening. Later, cells grow into nearby tissue, and lumps and thickenings appear; invasive cancer can spread to the axillary lymph nodes and later to the lungs, liver, brain, and bones, at which point new symptoms arise, including bone pain or headache.
In 2024, about 2.4 million cases in women and 694 thousand deaths were recorded worldwide; in 164 of 186 countries it is the most common cancer among women. Almost 99% of cases occur in women, 0.5–1% in men.
Breast cancer occurs in every country in the world, in women of any age after puberty, but more often at an older age. According to WHO, in countries with a very high level of human development, one woman in 12 will receive the diagnosis during her lifetime; in low-development countries, one in 27.
Who is at risk
The strongest risk factor is female sex; risk increases with age. About 80% of cases occur in women with no other known factors besides sex and age over 40.
Risk is increased by obesity, alcohol abuse, smoking, a history of chest radiation, type 2 diabetes, reproductive history — the age at onset of menstruation and the age at first pregnancy — as well as hormone therapy prescribed during menopause. Some of these factors are not a person's choice; others can be controlled.
Signs
Symptoms vary and more often appear at later stages. Warning changes:
- a lump or thickening in the breast, often painless;
- a change in the size, shape, or appearance of the breast;
- retraction, redness, "orange-peel" skin, or other skin changes;
- a change in the appearance of the nipple or the skin around it;
- unusual nipple discharge, including discharge containing blood.
Most breast lumps are not cancer. A formation still requires examination, even without pain: the smaller the tumor and the less it has spread to the lymph nodes, the more successful the treatment. Axillary lymph nodes may be affected and not noticeable to the touch.
Early detection consists of two parts: early diagnosis — awareness of signs and symptoms and timely consultation with a doctor — and screening. A routine preventive gynecological and breast examination with breast examination is recommended every six months after puberty, and a mammogram once a year after age 45, unless there are other indications.
Mammography: who and when
Screening is mammography for the outwardly healthy population, usually in women aged 50–69: this is how changes are found before complaints appear. According to WHO, mortality decreases when cases are detected and treated early.
To confirm the diagnosis, mammography and breast ultrasound are performed, and for suspicious formations, a biopsy — fine-needle or core-needle — with examination of a tissue sample. The diagnosis consists of two parts: the stage (T — tumor size, N — status of regional lymph nodes, M — distant metastases, G — degree of cell differentiation) and the biological characteristics of the tumor — estrogen and progesterone receptors, the Ki67 proliferation index, and HER2/neu overexpression.
Heredity: BRCA and other genes
Most breast cancer cases are sporadic; 5–10% are considered hereditary. The most significant hereditary factors are mutations in the BRCA1 and BRCA2 genes: such mutations lead to the development of cancer in 60–80% of cases. PALB-2 also belongs to this group.
Most women with a diagnosis have no known family history, and its absence does not mean a low risk. To assess risk, testing for mutations in the BRCA1 and BRCA2 genes is possible.
Who to contact
The first step is a preventive gynecological and breast examination with breast examination. If there is a wound or ulcer on the breast that does not heal, this is a reason to see a doctor so that a biopsy can be performed.
At the appointment, it is appropriate to ask: whether the formation is suspicious and on what basis; what examination is being prescribed and what it will show; when the results will be available; whether a geneticist consultation is needed; when to come next time if the changes remain.
Breast cancer by itself is not a reason to call an ambulance; 103/112 — if there is a suspicion of stroke or heart attack or a severe injury.
This material is for reference: it does not replace consultation with a doctor who sees your specific situation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer