By Christos Markopoulos, MD, PhD, FEBS, Professor of Surgery at the Medical School of Athens, President of the Hellenic Breast Surgical Society, Director of the Breast Clinic at Athens Medical Center
What is breast cancer and how does it develop?
Breast cancer is an uncontrolled, abnormal development of mammary gland cells. Over time, cancer cells infiltrate the healthy breast and then move towards the axillary lymph nodes. Subsequently, they are gradually transported to other parts of the body, where they settle and develop what is called "a metastasis".
How common is Breast Cancer?
Breast cancer is the most common cancer that occurs in women and accounts for almost 30% of all malignant tumors. Approximately half a million women are diagnosed with breast cancer every year in Europe and about 5,000 of them are Greek.
Can Men Have Breast Cancer?
Breast cancer can also occur in men, but the likelihood is very small. For every 100 women with breast cancer, there is one man. Therefore, screening is not recommended for men, but when they detect a lump or a hardening of the tissue in the breast, they should be examined by a breast surgeon.
Are there any factors that increase the likelihood of developing breast cancer and how can a woman protect herself?
Indeed, there are factors associated with breast cancer. Some of them, such as gender (female), age, positive family history (mainly mother or sister with breast cancer) and hereditary history, cannot be changed. However, others, such as lack of exercise, excess weight, smoking, excessive consumption of alcohol and long-term use of hormones after menopause, may be modified to reduce the risk of a woman developing breast cancer.
What do we mean when we say "hereditary" breast cancer?
In hereditary breast cancer, we have identified genes (BRCA1 & 2), which are responsible for its occurrence. The existence of a defect (mutation) in such a gene increases significantly the likelihood of disease, reaching a 75 to 80% probability during a woman's life, while accompanied by a high probability of about 50-60% for the development of ovarian cancer. Hereditary, however, is only a small portion of breast cancers. In every 100 women with breast cancer, only 5 – 7 women have hereditary cancer.
Screening for hereditary cancer is not generally recommended, except in women with a strong family history of breast cancer and therefore a high probability of heredity (e.g. occurring in at least two or more relatives, cancer at a young age or appearance of both breast and ovarian cancer in the same family). However, it is important to know that, even if the genetic tests prove negative, women should continue with their screening normally. A negative genetic test simply rules out the small percentage of "hereditary cancer" while there is still a risk of "random" breast cancer. Therefore, women should normally continue the proactive examination of their breasts.
Are older women at risk of breast cancer?
Breast cancer may occur at any age. The likelihood of it occurring in young women under the age of 40 is small and increases with the age. An 80-year-old woman has a five-fold risk of developing the disease compared to a 50-year-old woman.
What are the "tools" for the early diagnosis of breast cancer?
Mammography is the most important tool for detecting breast cancer. Any woman with an average risk of developing breast cancer should have an annual mammogram beginning at the age of 40. High-risk women may be advised by their doctor for more intensive monitoring, which could include both ultrasound and MRI (magnetic mammography). Clinical examination of breasts by a breast specialist is also very important and should always be carried out along with mammography. Younger women, who are at lower risk as a result of their age, should check their breasts regularly in their check-ups, preferably every 2-3 years.
What are the "first signs" of breast cancer?
In the early stages, breast cancer shows no signs or symptoms and is only detected by mammogram. Later, there may appear a palpable form on the breast (tumor), a pulling of the skin or the nipple of the breast. If the woman does not give importance to the above, there may follow signs of an advanced disease, such as a hot and red breast (inflammatory cancer), pain in the bones, large swelling (block) of the lymph nodes in the armpit.
What is the benefit of the "early" detection of breast cancer?
Finding a small breast cancer (e.g. <1 cm) during a mammogram could have many advantages. Surgical treatment of a tumor small in size usually does not require mastectomy, and removal of the armpit lymph nodes can be avoided by performing only the technique of the lymph node sentinel biopsy, which has no effect on the arm. Most importantly, the patient's prognosis is excellent (very low risk of metastasis) and sometimes cure is 100% achieved (DCIS cases - non-invasive cancer).