Breast cancer is second to lung cancer as a cause of cancer deaths. Because of this, most women are afraid of breast cancer, not knowing that they are far more likely to die of cardiovascular diseases than they are of all forms of cancer combined. And, while most breast cancer cases occur in women, men could also be afflicted of the disease.

Signs and symptoms

Knowing the signs and symptoms of breast cancer may help save a life. When the disease is discovered early, there are more treatment options and a better chance for long-term recovery. When breast cancer is diagnosed and treated in its early stages, the five-year survival rate is 95 percent.

Most breast lumps aren't cancerous. Still, everyone is encouraged to be watchful of lumps or thickening in the breasts as this is the most common sign of breast cancer for both men and women. Often, the lump is painless. The other signs of breast cancer include:

• A spontaneous clear or bloody discharge from the nipple
• Retraction or indentation of the nipple
• A change in the size or contours of the breast
• Any flattening or indentation of the skin over the breast
• Redness or pitting of the skin over the breast, like the skin of an orange
• A number of factors other than breast cancer can cause the breasts to change 
in size or feel.

In addition to the natural changes that occur during pregnancy and menstrual cycle, other common non-cancerous (benign) breast conditions include:

• Fibrocystic changes. This condition can cause the breasts to feel ropy or granular. Fibrocystic changes are extremely common, occurring in at least half of all women. In most cases the changes are harmless. If the breasts are very lumpy, performing a breast self-exam is more challenging. Becoming familiar with what's normal through self-exams will help make detecting any new lumps or changes easier.

• Cysts. These are fluid-filled sacs that frequently occur in the breasts of women ages 35 to 50. Cysts can range from very tiny to about the size of an egg. They can increase in size or become more tender just before your menstrual period, and may disappear completely after it. Cysts are less common in postmenopausal women.

• Fibroadenomas. These are solid, non-cancerous tumors that often occur in women during their reproductive years. A fibroadenoma is a firm, smooth, rubbery lump with a well-defined shape. It will move under the skin when touched. It is also usually painless.

• Infections. Breast infections (mastitis) are common among women who are breast-feeding or who recently have stopped breast-feeding, although they can also develop mastitis that's not related to breast-feeding. The breast will likely be red, warm, tender and lumpy, and the lymph nodes under the arm may swell. The person may also feel slightly ill and have a low-grade fever.

• Trauma. Sometimes a blow to the breast or a person’s mid-section or a bruise also can cause a lump, but this doesn’t affect one’s risk of having breast cancer.

• Calcium deposits (microcalcifications). These tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram. Most women have one or more areas of microcalcifications of various sizes. These may be caused by secretions from cells, cellular debris, inflammation, trauma or prior radiation. They're not the result of calcium supplements you take. The majority of calcium deposits are harmless; but a small percentage may be pre-cancerous or cancer.

If a lump or other change in the breast is discovered even before menopause, women may want to wait through one menstrual cycle before seeing their doctor. If the change hasn't gone away after a month, the lump has to be evaluated immediately.

Causes

Cancer affects cells, the basic units of life. Normally, cells grow and divide in an orderly way. But sometimes this growth gets out of control — cells continue dividing even when new cells aren't needed. These extra cells may form a mass of tissue called a tumor.

Tumors may be either non-cancerous (benign) or cancerous (malignant). Cells from malignant tumors can invade and damage nearby tissues and organs. They may also travel through your bloodstream or lymph system to other parts of your body.

In most cases, it isn't clear what triggers abnormal cell growth in breast tissue. It is known that between 5 percent and 10 percent of breast cancers are inherited. Defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), put you at greater risk of developing the disease. In fact, women who have variations in these genes have a much higher chance of developing breast cancer and a higher chance of developing ovarian cancer. Both men and women can inherit these genes from either parent.

Although the discovery of these genes is important, it's only the first step. Breast cancer is a complex disease that could come from a number of causes.

Risk factors

Seventy-five percent of breast cancer cases occur in women with no known risk factors. At the same time, having one or even several risk factors doesn't mean you'll develop the disease. The following factors may increase your risk of breast cancer:

• Sex. Being a woman is the greatest risk factor in developing breast cancer. Although men can develop breast cancer, it's 100 times more common in women.

• Age. The chances of developing breast cancer increase as a person grows old. The disease rarely affects women under 25 years of age, whereas close to 80 percent of breast cancers occur in women over age 50. At age 40, a woman has a one in 252 chance of developing breast cancer. By age 85, the chance is one in eight.

• A personal history of breast cancer. If a person has had breast cancer in one breast, she/he has an increased risk of developing cancer in the other breast.

• Family history. If a person has relatives with breast cancer, she/he has a greater chance of developing breast cancer. In general, the more relatives a woman has with pre-menopausal diagnosed breast cancer, the higher the woman’s risk of developing the disease. If a woman has one close relative with breast cancer, her risk is doubled.

• Genetic predisposition. Between 5 percent and 10 percent of breast cancers are inherited. Defects in one of several genes, especially BRCA1 or BRCA2, put men and women at greater risk of developing the disease. Usually these genes help prevent cancer by making proteins that keep cells from growing abnormally. But if these genes mutate, the genes aren't as effective at protecting a person from cancer.

Molecular biology of breast cancer also shows that patients with Her-2-neu antigens on the breast cancer lesion denotes an aggressive type of cancer, non-responsiveness to methotrexate therapy but responsiveness to doxorubicin and anti-Her2-neu antibody therapy (e.g., trastuzumab).

• Excess weight. Weighing more than what is healthy for one’s age range and height increases the risk especially if she/he had gained the weight as an adult, or for women, more so after menopause. Although women usually have more fat in their thighs and buttocks, they tend to gain weight in their abdomens starting in their 30s, and this weight gain can increase their risk.

• Exposure to estrogen. The longer exposure to estrogen, the breast cancer risk is greater. If a woman has late menopause (after age 55) or she began menstruating before age 12, she has a higher risk of developing breast cancer. The same is true for women who never had children, or whose first pregnancy occurred when they were age 35 or older.

• Hormone therapy. In 2002, international studies proved that hormone therapy actually poses more health risks than benefits. Among these was a slightly higher risk of breast cancer for women taking the estrogen plus progestin hormone therapy. Combination hormone therapy can make malignant tumors harder to detect on mammograms. Thus, the cancer is diagnosed at more advanced stages.

Women who undergo breast surgery for treatment of cancer must always be test for Estrogen-Receptor Assay and Progesterone Receptor Assay.  ERA/PRA positivity denotes favorable response to anti-estrogen hormonotherapy.

• Birth control pills. Because of the recent information on hormone therapy, many younger women are concerned about the relationship between birth control pills and breast cancer. Unfortunately, there's no clear answer. If a woman’s on the pill, better to consult with a gynecologist or physician on the risks involved.

• Exposure to certain carcinogens. Polycyclic aromatic hydrocarbons (PAHs) are chemicals found mainly in cigarette smoke and charred red meat. Studies have shown that exposure to these chemicals can significantly increase chances of developing breast cancer. Exposure to certain pesticides also may increase risks, but more research needs to be done to establish a clear link.

• Excessive use of alcohol. Women who consume more than one alcoholic drink a day have a 20 percent greater risk of breast cancer than women who don't drink. Like all simple pleasures in life, everything must be taken in moderation. 

• Unusual sleep patterns. Women may have an increased risk of breast cancer if they work the graveyard shift or are up often during the night. The risk seems to be greatest if they don't sleep between 1 a.m. and 2 a.m., when levels of melatonin — a sleep-regulating hormone — are highest. Researchers speculate that suppression of melatonin by exposure to light may increase the release of estrogen by the ovaries.

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