6 March 2019 Author: José Luís Passos Coelho The mammary gland is made up of vesicles (lobules), where the milk is produced, and channels (ducts) that transport the milk to the nipple. When the cells in the ducts or lobules of the breast become malignant, this leads to ductal carcinoma or lobular carcinoma. These are the 2 most common types of breast cancer. Breast cancer usually appears after the menopause, but it can occur in younger women, although this is less common. In rare cases, in families in which there is a high incidence of breast cancer (or ovarian cancer), the disease may affect very young women (under 30 years of age). What are the risk factors for breast cancer? Risk factors are the characteristics that increase the probability of a person developing a given disease. There are several risk factors for breast cancer, although not all of them are of equal significance: Advanced age; Early age at first menstruation; Late first pregnancy; Never having been pregnant; Family history of breast cancer; Use of hormone replacement therapy after menopause; Being overweight; Lack of physical activity; Alcohol and tobacco consumption. How is breast cancer diagnosed? Breast cancer should be suspected if a nodule is detected in the breast or the armpit. However, there are other warning symptoms, such as: Changes in breast size; Changes in the appearance of the skin of the breast or the nipple; Discharge from the breast, especially if there is blood. Breast cancer may also be suspected after a routine mammogram and/or breast ultrasound shows changes suggestive of the disease. Ideally, all breast cancers should be detected by these routine tests before they are palpable. If so, there is a greater probability of cure. There are international recommendations that a routine mammogram should be performed every year or every two years starting at the age of 50 (or before this in certain circumstances). What is the procedure when breast cancer is suspected? When breast cancer is suspected, a biopsy to confirm or exclude the diagnosis is indicated. Breast biopsy involves taking a small sample of the mammary gland from the suspected area (and sometimes also from an axillary lymph node), after administration of local anaesthesia. It is a rapid procedure that does not cause significant discomfort and is carried out by a radiologist, anatomical pathologist or surgeon. If malignant cells are identified when the sample obtained from the biopsy is analysed, a diagnosis of breast cancer will be made. Additional examinations of the breast and other parts of the body may also be necessary, such as: Magnetic resonance; Ultrasound; Radiography; Bone scan; Computerised tomography (CT). What is the treatment for breast cancer? Treatment of breast cancer can involve various forms of therapy: Surgery; Radiotherapy; Chemotherapy and hormone therapy, among others. The decision on the type of treatment to be carried out or on the sequence of treatment may depend on the results of the examinations described above. Most breast cancers have hormone receptors (oestrogens and/or progesterone). In these cases, the patient may benefit from treatment with medicines blocking these receptors (hormone therapy). Chemotherapy , on the other hand, can be used to treat all types of breast cancer, with or without hormone receptors Currently, with early diagnosis and indicated treatment, breast cancer is curable in most patients. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
