DEFINITION

Breast cancer is one of the most common cancers that affects women and
people assigned female at birth (AFAB). It happens when cancerous cells in
your breasts multiply and become tumors. About 80% of breast cancer cases
are invasive, meaning a tumor may spread from your breast to other areas of
your body.

Breast cancer typically affects women age 50 and older, but it can also affect
women and people AFAB who are younger than 50. Men and people assigned
male at birth (AMAB) may also develop breast cancer.

TYPES OF BREAST CANCER

There are several types of breast cancer, which can be classified based on
their characteristics behavior and molecular features:

INVASIVE BREAST CANCERS:

• Invasive (infiltrating) ductal carcinoma (IDC): This cancer starts in your milk
ducts and spreads to nearby breast tissue. It’s the most common type of
breast cancer in the United States.

• Invasive Lobular breast cancer(ILC): This breast cancer starts in the milk-
producing glands (lobules) in your breast and often spreads to nearby breast
tissue. It’s the second most common breast cancer in the United States.

NON- INVASIVE BREAST CANCERS

• Ductal Carcinoma In Situ (DCIS): Cancer cells are confined to the milk ducts
and have not invaded surrounding tissue.

• Lobular Carcinoma In Situ (LCIS): Cancer cells are confined to the lobules
(milk- producing glands) and have not invaded surrounding tissue.

RARE TYPES OF BREAST CANCERS

• Inflammatory breast cancer (IBC): This rare, fast-growing cancer looks like
a rash on your breast. IBC is rare in the United States.

• Paget’s disease of the breast: This rare cancer affects the skin of your
nipple and may look like a rash. Less than 4% of all breast cancers are
Paget’s disease of the breast.
BREAST CANCER SUBTYPES BY RECEPTOR
CELL STATUS
Receptors are protein molecules in or on cells’ surfaces. They can attract or
attach to certain substances in your blood, including hormones like estrogen
and progesterone. Estrogen and progesterone help cancerous cells to grow.
Finding out if cancerous cells have estrogen or progesterone receptors helps
healthcare providers plan breast cancer treatment.

• Hormone Receptor- Positive (HR+): Breast cancer cells have receptors for
estrogen and/or progesterone

• Hormone Epidermal Growth Factor Receptor 2 (HER 2)-Positive: Breast

cancer cells have an over expression of the HER2 protein

• Triple- Negative Breath cancer (TNBC): Breast cancer cells lack estrogen
progesterone and HER2 receptors.

CAUSES OF BREAST CANCER

Experts know breast cancer happens when breast cells mutate and become
cancerous cells that divide and multiply to create tumors. They aren’t sure
what triggers that change. However, research shows there are several risk
factors that may increase your chances of developing breast cancer. These
include:

• Age: Being 55 or older.

•Sex: Women and people AFAB are much more likely to develop the condition
than men and people AMAB.

• Family history: If your parents, siblings, children or other close relatives

have breast cancer, you’re at risk of developing the disease.

• Genetics: Up to 15% of people with breast cancer develop the disease

because they have inherited genetic mutations. The most common genetic
mutations involve the BRCA1 and BRCA2 genes.

• Smoking: Tobacco use has been linked to many different types of cancer,
including breast cancer.

• Drinking beverages containing alcohol: Research shows that drinking

beverages containing alcohol may increase breast cancer risk.

• Having obesity.
• Radiation exposure: If you’ve had prior radiation therapy — especially to
your head, neck or chest — you’re more likely to develop breast cancer.

• Hormone replacement therapy: People who use hormone replacement

therapy (HRT) have a higher risk of being diagnosed with the condition.

SIGNS AND SYMPTOMS

The condition can affect your breasts in different ways. Some breast cancer
symptoms are very distinctive. Others may simply seem like areas of your
breast that look very different from any other area. Breast cancer may not
cause noticeable symptoms either. But when it does, symptoms may include:

• A change in the size, shape or contour of your breast.

• A mass or lump, which may feel as small as a pea.

• A lump or thickening in or near your breast or in your underarm that

persists through your menstrual cycle.

• A change in the look or feel of your skin on your breast or nipple. Your skin
may look by dimpled, puckered, scaly or inflamed. It may look red, purple or
darker than other parts of your breast.

• A marble-like hardened area under your skin.

• A blood-stained or clear fluid discharge from your nipple.

DIAGNOSIS AND TEST

Healthcare providers may do physical examinations or order mammograms
to check for signs of breast cancer. But they do the following tests to
diagnose the disease:

• Breast ultrasound.

• Breast magnetic resonance imaging (MRI) scan.

• Breast biopsy.

• Immunohistochemistry test to check for hormone receptors.

• Genetic tests to identify mutations that cause breast cancer.

PATHOPHYSIOLOGY OF BREAST CANCER

Breast cancer develops due to a complex series of genetic, environmental,
and hormonal factors that lead to abnormal cell growth in the breast tissue.
The pathophysiology of breast cancer can be broken down into several key
stages:

• Genetic Mutations: The development of breast cancer often benigns with

mutations in the DNA of normal breast cells. These mutations may occur
oncogenes (genes that promote cell growth) or tumor suppressor genes that
inhibit cell growth and promote apoptosis.

BRCA1/BRCA2 mutations: Mutations in these tumor suppressor genes

significantly increase the risk of breast cancer.

HER2 amplification: Overexpression of the HER2 gene (human epidermal

growth factor receptor 2) leads to aggressive tumor growth.

TP53 mutations: Mutations in the TP53 gene, a tumor suppressor, are

commonly found in breast cancer.

• Cellular Transformation: The mutation of key genes causes the normal

epithelial cells in the breast to divide uncontrollably. This results in the
formation of a mass of abnormal cells, known as a tumor. In some cases,
these cells may remain localized (in situ), while in others they may invade
surrounding tissues (invasive carcinoma).

• Tumor Microenvironment: The tumor develops within a complex

microenvironment that includes immune cells, fibroblasts, blood vessels, and
extracellular matrix components. This microenvironment supports tumor
growth and may contribute to metastasis (spread to distant sites). Tumors
often secrete growth factors like VEGF (vascular endothelial growth factor) to
promote angiogenesis (formation of new blood vessels).

• Hormonal Influence: Many breast cancers are hormone-sensitive,

particularly estrogen and progesterone receptor-positive cancers. Estrogen
stimulates the growth of these cancer cells, so the presence of estrogen or
progesterone can drive the progression of the disease. These cancers are
often treated with hormonal therapies, like tamoxifen or aromatase
inhibitors, to block hormone signaling.

• Invasion and Metastasis: As the tumor grows, it may invade surrounding

tissues, including muscle, skin, and lymphatic vessels. The cancer cells can
also travel through the bloodstream or lymphatic system to distant organs,
such as the lungs, liver, and bones, leading to metastasis. The ability to
invade and spread is one of the most important characteristics of malignant
tumors.

• Immunological Evasion: Tumor cells often develop mechanisms to evade

detection by the immune system. They may express immune checkpoint
proteins (like PD-L1) that inhibit immune responses, or they may alter the
immune microenvironment to suppress the activity of immune cells.

STAGES OF BREAST CANCER

Healthcare providers use cancer staging systems to plan treatment. Staging
cancer also helps providers set a prognosis, or what you can expect after
treatment. Breast cancer staging depends on factors like breast cancer type,
tumor size and location, and whether cancer has spread to other areas of
your body. Breast cancer stages are:

• Stage 0: The disease is noninvasive, meaning it hasn’t spread from your

breast ducts to other parts of your breast.

• Stage I: There are cancerous cells in nearby breast tissue.

• Stage II: The cancerous cells have formed a tumor or tumors. The tumor is
either smaller than 2 centimeters across and has spread to underarm lymph
nodes or larger than 5 centimeters across but hasn’t spread to underarm
lymph nodes. Tumors at this stage can measure anywhere between 2 and 5
centimeters across, and may or may not affect the nearby lymph nodes.

• Stage III: There’s breast cancer in nearby tissue and lymph nodes. Stage III
is usually referred to as locally advanced breast cancer.

• Stage IV: Cancer has spread from your breast to areas like your bones,
liver, lungs or brain.

MANAGEMENT AND TREATMENT

Surgery is the primary breast cancer treatment, but healthcare providers
may use other treatments. Breast cancer surgeries include:

• Mastectomy.

• Lumpectomy.

•Breast reconstruction.

Providers may combine surgery with one or more of the following treatments:
• Chemotherapy.

• Radiation therapy, including intraoperative radiation therapy (IORT).

• Immunotherapy.

• Hormone therapy, including selective estrogen receptor modulator (SERM)

therapy.

COMPLICATION OF BREAST CANCER

The most significant complication is metastatic breast cancer — breast
cancer that spreads to other areas of your body, including your brain, bones,
liver and lungs. Studies show about 1 in 3 women and people AFAB who have
early-stage cancer later develop metastatic breast cancer.

What are treatment side effects?

Common chemotherapy and radiation therapy side effects include fatigue,
nausea and vomiting. Targeted therapy, immunotherapy and hormone
therapy have similar side effects, including gastrointestinal issues like
constipation and diarrhea.

People react differently to breast cancer treatments. If you’re receiving

treatment. Palliative care helps manage breast cancer symptoms and
treatment side effects so you’re as comfortable as possible as you go
through treatment.

Complications of breast cancer surgery

All surgeries have potential complications, and breast cancer surgery is no
exception.

If you’re having breast cancer surgery, ask your healthcare provider to

explain potential complications, which may include:

• Infection at the surgical site.

• Blood clots that can happen after surgery.

• Nerve damage.

• Lymphedema.