Breast Cancer: Early Symptoms, Causes, and Recent Treatments

October, the Pink Month, is dedicated to raising awareness about breast cancer, a disease that creeps in gradually over time, especially after women reach the age of 50. It often manifests as a lump in the breast or changes in the skin or nipple, signaling a potential health issue.

Not all breast lumps are necessarily cancerous, but knowing the symptoms of breast cancer and how to diagnose and detect it is crucial for early detection and prompt treatment. So, what are the early symptoms of breast cancer? Why do some women develop it? And what are the latest available treatments?

What is breast cancer?

Breast cancer involves the abnormal multiplication and growth of breast cells, leading to the formation of a malignant tumor that may spread to other parts of the body. Breast cancer primarily affects women over the age of 50, though men can also be diagnosed.

Early symptoms of breast cancer

Initially, breast cancer may not present any symptoms in women, and symptoms may vary depending on the type of breast cancer. However, some of the early signs include:

1. Breast lumps

Breast lumps are often the first sign of breast cancer. They are typically hard with irregular edges, though some cancers may present as soft, round lumps. These lumps are often too small to be felt by either the woman or her doctor, making regular mammograms necessary, especially if you're over 40 or have a family history of breast cancer.

However, not all lumps are cancerous. Most are benign, caused by cysts, benign tumors, breast infections, or blocked milk ducts.

2. Swelling

Some women may notice breast swelling before feeling any lump. While not all breast swelling is a sign of cancer, it’s essential to consult a doctor to rule out other causes like thickened areas of the breast or swollen lymph nodes under the arm or near the collarbone.

General breast cancer symptoms in women

General symptoms of breast cancer in women include:

1. Skin changes

Breast cancer can cause inflammation or changes in the skin cells, leading to peeling around the nipple or areola, extreme dryness, or thickening of the skin in parts of the breast. Some types of breast cancer may cause itching, though this is uncommon.

Other potential causes of these symptoms, like dermatitis or eczema, should be ruled out first.

2. Nipple discharge

Abnormal nipple discharge, which may be milky, yellow, green, or even bloody, could be a sign of breast cancer. Discharge typically comes from one breast but can occur in both if both are affected. During breastfeeding, milk secretion is natural, but any other discharge warrants a doctor’s visit. Nipple discharge is often not cancer-related and could be due to birth control pills, certain medications, or infections.

3. Skin dimpling

Dimpling of the breast skin is a significant indicator of breast cancer and can be a sign of inflammatory breast cancer, an aggressive form of the disease. It results from the buildup of lymph fluid in the breast due to cancer cells, causing swelling and dimpling.

4. Breast or nipple pain

Breast cancer can sometimes cause pain or discomfort, though it is often painless.

5. Nipple inversion or retraction

Changes in the cells behind the nipple caused by breast cancer can lead to nipple inversion or retraction.

It’s important to note that nipples may change during ovulation or other parts of the menstrual cycle. Any new changes should be discussed with a doctor.

Advanced breast cancer symptoms

The symptoms of advanced breast cancer vary depending on the stage and where the cancer has spread. Late-stage signs can include breast swelling and nipple discharge, along with general symptoms such as:

• Fatigue: Common in cancer patients, likely due to chemotherapy or radiation. It becomes more prominent in stage four breast cancer.
• Insomnia: Breast cancer can cause pain and discomfort, disrupting sleep. It is also one of the cancers that increase the risk of insomnia.
• Weight loss: Cancer can cause nausea and vomiting, making it hard to maintain a healthy diet, leading to malnutrition and weight loss. Patients may also lose their appetite over time.
• Shortness of breath: In stage four breast cancer, patients may experience difficulty breathing, especially if accompanied by a chronic or dry cough, which could indicate cancer has spread to the lungs.

Breast cancer during pregnancy

It can be challenging to detect breast cancer during pregnancy due to changes in the breasts, such as enlargement, lumps, or tenderness, making it harder to identify a cancerous lump until it’s quite large.

Mammograms may not be as helpful during pregnancy because breast tissue becomes denser, making it difficult to see cancer through X-rays.

Regardless, if you notice lumps or changes in your breasts that concern you, don't ignore them, tell your doctor right away.

Breast cancer in breastfeeding women

Breast cancer is rare during breastfeeding. However, changes in the breast during lactation can make detecting cancer challenging. Early signs include breast lumps, nipple discharge, persistent breast pain, changes in breast size, shape, or appearance, and redness or darkening of the breast.

Some may experience itching or a rash around the nipple, or swelling or warmth in the breast.

It’s important to note that most breast lumps during breastfeeding aren’t cancerous. They may be caused by:

• Breast abscesses
• Mastitis
• Benign breast tumors
• Milk cysts (galactoceles)

Signs of breast cancer spreading to the lungs

If breast cancer spreads to the lungs, symptoms may include:

• Shortness of breath or difficulty breathing
• Chronic cough
• Chest pain
• Hoarseness
• Fatigue

Signs of breast cancer spreading to the bones

In later stages, breast cancer can reach the bones, causing bone pain and increased fracture risk. This pain may occur in the vertebrae, pelvis, or hips, and walking may become uncomfortable or painful.

Breast cancer in men

Breast cancer is much rarer in men than in women. Symptoms include:

• A firm, painless lump in the breast, behind the nipple, or in the armpit
• Dimpling of the chest skin, similar to orange peel
• Red or scaly skin on the chest or near the nipple
• Pain in the chest or armpit
• Clear or bloody nipple discharge, or nipple inversion

Causes of breast cancer in women

The exact cause of breast cancer is unclear, but several factors increase a woman's risk, most commonly affecting women over 50. Risk factors include:

• Genetic mutations: BRCA1 and BRCA2 gene mutations raise the risk of breast cancer.
• Early menstruation or late menopause: Beginning menstruation before age 12 or menopause after 55 exposes women to hormones for longer periods, increasing breast cancer risk.
• Dense breast tissue: Women with dense breasts are at higher risk of breast cancer and it’s harder to detect tumors with mammograms.
• Personal or family history of breast cancer or breast diseases: Women with a personal history of breast cancer are more likely to develop it again, and certain benign breast conditions may also increase risk.
• Previous ovarian cancer: Women who have had ovarian cancer or have a family history of it are at higher risk of breast cancer.
• Lack of physical activity: Inactivity may increase breast cancer risk.
• Obesity or being overweight after menopause: Older women with excess weight are more likely to develop breast cancer compared to those with a healthy weight.
• Hormone therapy: Taking estrogen and progesterone, such as after menopause, may increase the risk, particularly when used for more than five years, as can certain birth control pills.
• Reproductive history: Pregnancy after age 30 and not breastfeeding can increase breast cancer risk.

Do deodorants cause cancer?

The American Cancer Society has indicated that there are no strong studies or scientific evidence linking breast cancer to the use of deodorants.

In a 2002 study published in the Journal of the National Cancer Institute, researchers found no connection between the use of deodorants and breast cancer.

Meanwhile, a small 2004 study in the Journal of Applied Toxicology found that some breast tumor samples contained small amounts of parabens, preservatives used in many underarm products, including deodorants.

A 2017 study in The Lancet found that women who used underarm cosmetics multiple times a day before the age of 30 had an increased risk of breast cancer, and tissue samples also showed that women with breast cancer had aluminum in their breast tissue.

The study did not suggest that deodorant or antiperspirants could increase the risk of breast cancer, but the researchers recommended using underarm cosmetics with caution.

It’s preferable to choose deodorants or antiperspirants that are free from aluminum or parabens, as some studies have pointed to these substances as potential risks, while others have denied this.

Breast cancer diagnosis

If a lump is found in the breast or a woman is suspected of having breast cancer, doctors will conduct several tests, including:

• Ultrasound: This test can detect minor abnormalities in dense breast tissue. It also helps determine whether a tumor is a fluid-filled cyst or a solid mass and is used to guide the doctor during a biopsy.
• Mammogram: A mammogram can provide images of breast tissue, though it may not be accurate in detecting cancer in dense breasts.
• Magnetic resonance imaging (MRI): Provides detailed cross-sectional images of the breast, helping in cancer detection.
• Breast biopsy: If cancer is suspected, a doctor may use a fine needle to take a sample of breast tissue to determine whether the tumor is benign or malignant.

Breast cancer treatment

Treatment for breast cancer depends on several factors, and the doctor will choose the most appropriate treatment option based on the patient’s condition. The main treatment options for breast cancer include:

• Surgery.
• Chemotherapy.
• Radiation therapy.
• Hormonal therapy.
• Immunotherapy.

Often, the patient receives a combination of these treatments depending on how widespread or invasive the cancer is. The choice of treatment depends on factors like:

• The location of the cancer.
• The size and spread of the cancer.
• The type of cancer.
• The appearance of abnormal cells under a microscope.
• Whether the patient is postmenopausal.
• The patient’s overall health.

Surgical treatment for breast cancer

Most breast cancer cases begin with surgery. Some patients may receive hormonal or chemotherapy before surgery. There are different types of breast cancer surgeries:

• Lumpectomy: The doctor may be able to remove the tumor while preserving breast tissue, depending on the size and location of the lump.
• Mastectomy: The surgeon may recommend the removal of the entire breast to eliminate cancer, followed by breast reconstruction surgery to restore the breast’s appearance.
• Lymph node surgery: Cancer cells may spread to the lymph nodes near the breast, particularly those in the armpit, which are closest to the breast. The surgeon may remove some or all of the lymph nodes if cancer cells are detected in them.

Hormonal therapy for breast cancer

Some breast cancers require estrogen to grow, so hormonal therapy works by lowering estrogen levels in the body or blocking its effects.

Hormonal therapy is only effective if breast cancer cells have estrogen receptors. Some breast cancers do not respond to estrogen. Patients usually receive hormonal therapy after breast cancer surgery.

In some cases, women may receive hormonal therapy before surgery to help shrink the cancer.

Duration of hormonal therapy for breast cancer

The duration of hormonal therapy for breast cancer may last five years or more, depending on the type of drug used and any side effects experienced.

Radiation therapy for breast cancer

Radiation therapy uses high-energy X-rays to kill cancer cells. Patients typically undergo radiation therapy after breast surgery, and they may require 5 to 15 sessions of radiation treatment.

Some women may receive radiation therapy after a mastectomy, particularly if the tumor is larger than 5 cm or has spread to the lymph nodes.

Chemotherapy for breast cancer

Chemotherapy is used to destroy cancer cells by circulating the drug throughout the body via the bloodstream. Patients may receive chemotherapy before or after surgery, or both.

Chemotherapy before surgery aims to shrink the cancer and reduce the risk of future recurrence, while chemotherapy after surgery helps reduce the risk of the cancer returning.

Number of chemotherapy sessions for breast cancer

Chemotherapy for breast cancer is given in cycles, with sessions ranging from once a week to once every three weeks. Chemotherapy treatments may last 3 to 6 months. If the cancer is in advanced stages, chemotherapy may continue for more than six weeks.

Immunotherapy for breast cancer

Immunotherapy is a treatment that helps the immune system attack and kill cancer cells. It assists the body in producing cancer-killing immune cells such as pembrolizumab and dostarlimab. Immunotherapy is used for early-stage high-risk cases or for triple-negative metastatic breast cancer.

Biological therapy for breast cancer

Biological therapy, also known as targeted therapy, is a method of treating breast cancer by using the immune system or hormone system to fight cancer cells without harming healthy cells. Therefore, it has fewer side effects compared to chemotherapy.

One type of biological therapy uses antibodies to kill or prevent the growth of cancer cells, while another type involves small molecules that block signals necessary for cancer cells to grow. The type of biological therapy used depends on the patient’s condition.

Side effects of biological therapy for breast cancer

Despite its benefits, biological therapy may still have some side effects, which can vary depending on the medication, such as:

• Swelling.
• Difficulty breathing.
• Nausea.
• Diarrhea.
• Skin rash.
• Dizziness.
• Weakness.