October is Breast Cancer Awareness Month, one of the most frequent tumors in women. This cancer develops when the cells of the glands that make up the breast become altered and begin to reproduce uncontrollably and very rapidly, giving rise to a tumor.
Dr. García Álvarez of GenesisCare, a member of Top Doctors, is a specialist in its treatment and offers us several clues about the symptoms, causes and prevention.
Causes of breast cancer
In approximately 50% of cases, the causes of breast cancer are unknown, however, a series of factors have been identified that can predispose to the appearance of this tumor:
- Age: when women get older the risk of breast cancer increases. As with other tumors it is the main risk factor.
- Hormonal factors: the time of exposure to endogenous estrogens may influence the risk of occurrence:
- Early menarche (first period at an early age).
- Late menopause.
- Hormone replacement therapy after menopause increases the risk of breast cancer.
- Nulliparous women (never having given birth) seems to increase the risk of this tumor.
- Not breastfeeding.
- Hereditary factors: 5 to 10% of breast tumors are hereditary.
- Women with a family history of breast cancer are more at risk, especially if the family member is a mother, sister or daughter.
- History of breast cancer: women who have had breast cancer are more likely to have contralateral breast cancer.
- Ionizing radiation: exposure to this type of radiation, especially during puberty, increases the possibility of breast cancer.
- Lifestyle: Women with obesity, a sedentary lifestyle, or habitual alcohol consumption are at increased risk for breast cancer.
Symptoms of Breast Cancer
Most breast tumors do not show any symptoms and are usually detected during a routine examination with mammography and ultrasound.
However, when it does give symptoms the most frequent is the appearance of a palpable nodule, of different size, which usually does not cause pain. Other frequent symptoms are:
- Alterations of the skin of the breast (orange peel).
- Nipple retraction.
- Appearance of a painless nodule in the armpit.
- Alterations in the contour of the breast.
If you are concerned about any breast symptom, it is recommended to see a specialist to perform the necessary examination and evaluation.
Can breast cancer be prevented?
There are a series of modifiable factors, such as diet, physical exercise, alcohol consumption, the administration of hormone replacement therapy in menopause and the prevention of obesity and overweight. Controlling these could have an effect on the risk of breast cancer and, over the course of a lifetime, have an effect in reducing the incidence of breast cancer.
However, strategies aimed at healthy living may achieve some reduction in risk, but not prevent most breast tumors. That is why early detection continues to be the fundamental tool in the reduction of mortality from this cancer, since it improves the prognosis and survival of breast cancer, by achieving earlier diagnoses.
Treatments for Breast Cancer
The assessment and decision to carry out one treatment or another in breast cancer is made by a multidisciplinary committee in which different specialists such as radiologists, anatomopathologists, gynecologists, surgeons, medical oncologists and radiation oncologists participate.
This decision is based on multiple biological (size, lymph node or other organ involvement) and molecular (hormone receptor status, HER 2 and proliferation index) factors obtained from a biopsy of the lesion.
Depending on the molecular factors (essential at present to decide the treatment) breast cancer is divided into different subtypes: luminal A, B, Her2 positive and Triple negative.
In luminal A and B tumors the initial treatment is surgery followed by radiotherapy and hormonal treatment. In Her2+ and triple negative tumors, treatment with chemotherapy is usually administered before surgery (neoadjuvant chemotherapy), generally followed by treatment with external radiotherapy.
In triple-negative tumors, hormonal treatment is not administered, since the hormone receptors are negative, this treatment is not effective.
How does radiation oncology work in the treatment of breast cancer?
Radiotherapy is a local treatment (treatment of the breast) and a regional treatment (treatment of ganglion chains), with two fundamental objectives: on the one hand it reduces the risk of the appearance of the disease, both in the breast or in the mastectomy scar and in the ganglions to which the breast drains, and on the other hand it increases the patient’s survival.
At present, new shorter treatment schedules (hypofractionation) and new techniques (intensity-modulated radiotherapy) drastically reduce the side effects of radiotherapy and increase the therapeutic ratio, which makes radiotherapy a safe and effective treatment.
What percentage of patients are cured?
The percentage of cure depends on the stage of the tumor. In the earliest stages, in which the tumor is not invasive (carcinoma in situ), survival at 5 years is practically 100%.
Globally in Spain, 5-year survival for breast cancer is over 80%, being one of the highest in Europe (eurocare-4 study).