The incidence of breast cancer is increasing worldwide: Until a few years ago, these were one in nine women, but in recent years, at least one in eight women has developed breast cancer. As part of the disease awareness month that will be celebrated in October, we have put together a detailed guide for you with the most frequent questions that patients ask, with the assistance of Dr. Gabi Haran, director of gynecology and gynecology oncology of the Assuta network, and advisor to the “Good Genes” association.
What is the incidence of breast cancer for its types?
Breast cancer is the most common cancer among women worldwide and accounts for about a quarter of new cancer cases each year. In Israel, one in eight women will be diagnosed with breast cancer during her lifetime. There are different types of breast cancer, the most common being invasive ductal carcinoma, but there are also other types such as non-invasive breast cancer (DCIS) and inflammatory breast cancer, which is considered rare but more aggressive.
How does breast cancer form?
Breast cancer develops as a result of genetic changes in the breast cells, leading to uncontrolled division of the cells. These changes can be the result of hereditary factors, such as mutations in the BRCA1 or BRCA2 gene, but in most cases they result from environmental factors, such as the influence of lifestyle, diet, exposure to radiation or the influence of hormones. As the cells continue to divide uncontrollably, they can form a lump or tumor, which may also spread to other areas of the body in more advanced cases of the disease.
Is breast cancer hereditary?
Around 5-10% of breast cancer cases are hereditary, and result from genetic mutations that run in the family, such as mutations in BRCA1 and BRCA2. BRCA1 and BRCA2 are called “tumor suppressor genes” that are part of the maintenance and control system of cell growth as well as repair of acquired DNA damage. When there is a mutation in these two genes, a reduced activity of the proteins is caused, which creates failures in the repair of the DNA defects leading to a significant increase in the development of several types of cancer. When a family member carries the gene, the chance is 50% to pass it on to the children.
When a woman carries one of the mutations in the BRCA gene she is in danger of getting cancer. The data in Israel and around the world speak of the estimate of 60-80% of getting breast cancer during her lifetime, where the risk of a woman who is not a carrier is about 13%. There is also an estimated 20-60% risk of getting ovarian cancer, while the risk of a woman who is not a carrier is estimated at about one and a half percent. Women with these mutations are also at increased risk of developing other cancers such as ovarian cancer, endometrial cancer and pancreatic cancer. However, most cases of breast cancer are not directly related to hereditary factors, but to other risk factors.
Who is at increased risk of having the disease?
There are several risk factors for breast cancer, such as family history of the disease, genetic mutations (such as BRCA1 and BRCA2), advanced age, personal history of breast cancer or other cancer, exposure to hormones (hormonal therapy or long-term birth control pills), and lifestyle which includes smoking, drinking alcohol and obesity. In addition, women who started menstruating at a young age or entered menopause at a late age are at increased risk.
What tests and at what age should women at increased risk undergo?
Women who are at an increased risk of breast cancer should start performing mammograms from an earlier age, sometimes as early as age 30-35, according to the doctor’s recommendation. In addition to mammography, there are other tests such as breast MRI, which is used as a screening test for women with a high hereditary risk. Doctors may also recommend genetic testing for women with a significant family history of breast or ovarian cancer.
What are the stages of breast cancer and how serious are they?
Breast cancer is divided into four main stages, determined by the size of the tumor and the extent of its spread to the lymph nodes or other organs.
at the stage the firstthe tumor is small and located in the breast only. This is the easiest stage, with high chances of healing.
at the stage the second, The tumor is slightly larger or there is involvement of the lymph nodes in the area. At this stage the disease can still be treated very effectively.
at the stage the third, The cancer has spread further and also includes the lymph nodes, and sometimes even the walls of the chest.
at the stage the fourth, The cancer has metastasized and spread to distant organs such as the lungs, liver and bones, and the treatment is mainly focused on prolonging life and improving its quality.
How is the self-test performed, how often and how effective is it?
The self-examination involves regular palpation of the breasts and armpit area to detect changes in the size, texture or structure of the breast. It is recommended to perform the test once a month, a few days after the end of the menstrual cycle, when the breasts are not swollen. However, it should be remembered that the self-examination is not an alternative to a medical examination, and its effectiveness in early detection of breast cancer is limited compared to mammography.
Which review test should be performed and how often?
A mammogram is the recommended screening test for women over the age of 50, and it is performed once every two years. For women with a family history or other risk factors, it may be necessary to start mammograms or MRIs as early as age 40 or even earlier. It is important to maintain regular check-ups, as early detection significantly improves the chances of recovery.
What do the mammogram results mean?
Mammography detects changes in tissue density in the breasts, and can detect tumors in very early stages. If the mammogram shows a normal result, there is no abnormal finding. However, if there is a suspicious finding, further testing, such as ultrasound or biopsy, is required. It is important to note that a mammogram does not definitively diagnose the disease, but only provides an indication of the need for additional tests.
Who should undergo a biopsy and what does it mean?
A biopsy is performed when there is a suspicious finding in imaging tests such as mammography or ultrasound. During the biopsy, a small sample of the suspicious tissue is taken and sent for testing in a laboratory to determine if it is a cancerous tumor. The biopsy is usually performed under local anesthesia and does not require hospitalization, although there may be minor side effects such as local pain.
What are the possible treatments for breast cancer and who are they suitable for?
There are several treatment options, and the choice between them depends on the type of tumor, the stage of the disease, the general state of health and the preferences of the patient. Surgery is one of the most common treatments, and includes partial or complete excision of the breast (lumpectomy or mastectomy). The surgery is usually performed in a hospital, and you can usually be discharged within a day or two.
Chemotherapy is a drug treatment designed to kill the cancer cells, and it is usually given through the vein in cycles that last several weeks to months. There may be side effects such as nausea, weakness and hair loss, but the treatment improves the chances of recovery and reduces the risk of the disease returning.
Radiation is used to destroy cancer cells that remain after surgery, or in cases where it is not possible to operate. The treatment is done in a dedicated clinic and lasts several weeks, with side effects such as fatigue and skin irritations.
Hormonal therapy is suitable for women with hormone-sensitive cancer (positive cancer for estrogen or progesterone receptors). This treatment includes taking drugs that prevent the effect of hormones on cancer cells. Targeted therapy is a biological treatment that aims to damage specific mechanisms in the cancer cells, such as the HER2 protein.
When should you see a doctor for an examination?
You should see a doctor if you notice any changes in the breasts, such as lumps, changes in the shape of the breast, depressions in the skin, discharge from the nipple or unexplained pain. Also, women in increased risk groups should be tested more frequently and be routinely monitored by a specialist.