Breast Cancer — the Psychopath Within the Breast

6 min readOct 16, 2021

Cancer cells are psychopaths, having no respect for the rights of other cells. They spread violently and rapidly, destroying the cells around them.

On this breast cancer awareness month, let us get armed with awareness to prevent this deadly disease in ourselves and our loved ones.

The name ‘cancer’ derives from the Greek and Latin words for a crab. Breast cancer is a tumor that forms in the cells of the breasts.

How serious is the threat?

According to WHO statistics 2020, breast cancer is the commonest cancer among women in Sri Lanka (25.7%), also the commonest cancer in Sri Lanka (13.4%) [1]. It is the 3rd leading cause of cancer death in Sri Lanka, and the most common cause of death in middle-aged women in Western countries [2].

Figure 1: Breast cancer statistics Sri Lanka_____________________________________________________Figure 2: Cancer statistics Sri Lanka

What causes breast cancer?

Similar to all other cancers, breast cancer occurs from the clonal proliferation of mutated cancer cells. These mutations arise due to exposure to risk factors (environmental), inherited susceptibility (genetic), or most frequently, a combination of both!

Familial breast cancer

There is a special type of gene called tumor suppressor genes which suppress the emergence of tumors by physiologically inhibiting cell proliferation. What will happen if these genes are mutated already? The cells will grow endlessly, and the occurrence of other mutations will be increased in such a person!

Some such tumor suppressor genes that cause breast cancer upon mutation are BRCA1, BRCA2, TP53, and CHEK2. The commonest single-gene mutations are BRCA1 and 2 mutations (80–90%), and the penetrance varies from 30%-90% [3].

BRCA1 and BRCA2 are both large genes, and there are hundreds of possible different mutations distributed throughout their coding regions, associated with familial breast cancers.

Sporadic breast cancer

Sporadic breast cancer occurs due to risk factors such as being a female, prolonged use of oral contraceptives, hormone exposure, age at menarche and menopause, prevention from breastfeeding, diet, obesity, exposure to radiation, and chemicals.

Estrogen is a promoter of breast cancer, which is why breast cancer is more common in women, however, males can get breast cancer too!

Protective factors such as having given birth to a child, having the first child at an early age, breastfeeding, menarche at advanced age and menopause at a younger age are also important factors protecting from breast cancers related to this hormone estrogen.

Molecular mechanisms of carcinogenesis… Is it important?

Yes, it is!

Resident breast tissue stem cells are the cells of origin for all breast cancers [3].

· Estrogen receptor(ER) positive breast cancers need female hormones (mainly estrogen) to grow and reproduce. Most people with hormone-positive breast cancer will be recommended hormone-blocking therapy [4]

· Human epidermal growth factor receptor 2 (HER2) positive breast cancer expresses excess HER2 receptors on its cell surface, thereby increasing sensitivity to growth factors, and promoting the growth of these cancer cells.

Once the process is initiated by a driver mutation, carcinogenesis can occur through three major genetic pathways

o ER-positive, HER2-negative cancers- 50–60%
o HER2-positive cancers
o ER-negative, HER2-negative cancers

Types of breast cancer

· Classification according to spread

· Carcinoma in situ- The malignant clonal proliferation of epithelial cells, limited to the ducts and lobules by the basement membrane. It is confined to the epithelial cells and has not invaded beyond the basement membrane[3]. Two subtypes

o Ductal carcinoma in situ (DCIS) -
o LCIS — lobular carcinoma in situ

· Invasive carcinoma- Cancer that has spread to the surrounding breast tissue, invading the basement membrane of the site of origin. Few subtypes

o Lobular carcinoma
o Medullary carcinoma
o Micropapillary carcinoma
o Mucinous carcinoma

Figure 2: Difference between Carcinoma in situ and invasive cancer

· Paget’s disease of the nipple

Is rare and is a sign of breast cancer in the tissue behind the nipple. It causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola).

Staging of breast cancer

Staging is a way of describing how extensive breast cancer is, including the size of the tumor, whether it has spread to lymph nodes, whether it has spread to distant parts of the body, and what its biomarkers are. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer[5].

• Tumor– node–metastasis (TNM) staging

◦ A tumor (T): How large is the tumor? and its biomarkers

◦ Node (N): Has the tumor spread to the adjacent lymph nodes? If so, where, what size, and how many?

◦ Metastasis (M): Has cancer spread to other parts of the body?

The letters T, N, or M plus a number are used to describe the relevant feature. X is used when the feature cannot be evaluated. Numbers indicate the severity. (Eg: T3N1Mx)

• Cancer stage grouping

The stage of the cancer is determined by combining the T, N, M classification, the tumor grade, and the results of ER/PR and HER2 testing. It is useful to determine the prognosis. The possible stages include stage 0, IA, IB, IIA, IIB, IIIA, IIIB, IIIC, and IV, stage 0 being the best and IV being the worst.

When to see a doctor?

If you have any kind of lump in your breast, see a doctor!

The prognosis of breast cancer is closely related to the stage at diagnosis. Therefore, if you have the slightest doubt, it is always better to have a doctor’s opinion.

The risk is increased if,

• The lump feels firm or fixed
• The lump lasts longer than 4–6 weeks
• There are skin changes on your breast, such as redness, crusting, dimpling, or puckering
• There is a discharge from the nipple
• The nipple is turned inward and isn’t normally positioned that way
• There is a lump in the armpit

If you have close relatives with breast cancer

As we discussed earlier, single-gene mutations run in families. Therefore, screening is highly recommended for such persons. If identified as a person with an increased risk from genetic and pedigree studies, they can decide with the help of the doctor, whether to go for prophylactic surgery, increase surveillance, or commence medications.

· Peau d’orange (orange peel appearance)

When there is an inflammatory type of carcinoma, the breast gets swollen and red, with burying of hair follicles which gives it a characteristic orange peel appearance. These cancers may be confused with breast infection, making them difficult to detect in the early stages.

How to prevent breast cancer?

You can prevent breast cancer via,

Becoming familiar with your breasts through breast self-examination
• Knowing your risks and family history
• Minimizing alcohol consumption
• Choosing to breastfeed
• Exercising regularly
• Maintaining a healthy weight
• Consuming a healthy diet
• Limiting postmenopausal hormone therapy
• Discussing with your doctor when to begin breast cancer screening tests

Written by- Anagi Kottahachchi