Understanding Breast Cancer: Types, Causes, Treatment, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 16, 2024
What is breast cancer?
Breast cancer is a disease in which malignant (cancerous) cells form in the tissues of the breast. It starts when cells in the breast begin to grow uncontrollably. This uncontrolled growth forms a lump or mass, which can invade nearby tissues and spread to other parts of the body.
Anatomy of the breast
The breast is composed of several parts:
Lobules: Glandular tissues that produce milk.
Ducts: Tubes that carry milk from the lobules to the nipple.
Stroma: Connective tissue, including fat and blood vessels, that supports the lobules and ducts.
Nipple: The central projection through which milk is released.
How normal cells become cancerous
Breast cancer begins when normal cells in the breast undergo genetic changes or mutations. These changes cause cells to grow uncontrollably, bypassing normal growth regulation mechanisms. Mutated cells can form tumors and spread to surrounding tissues and distant parts of the body.
Stages of breast bancer development
Stage 0: The cancer is confined to the ducts or lobules and has not spread to nearby tissues (in situ).
Stage I: Tumor is small (less than 2 cm) and has not spread beyond the breast.
Stage II: Tumor size is larger (2-5 cm) or has spread to nearby lymph nodes.
Stage III: Tumor is larger than 5 cm and has spread extensively to lymph nodes and possibly to nearby tissues.
Stage IV: Cancer has spread to distant parts of the body (metastatic breast cancer).
Types of breast cancer
Invasive vs. non-invasive (In Situ) breast cancer
Invasive breast cancer: Cancer cells have spread beyond the ducts or lobules into surrounding breast tissue. This type includes:
Invasive ductal carcinoma (IDC): The most common type, starting in the milk ducts and spreading to surrounding tissues.
Invasive lobular carcinoma (ILC): Begins in the lobules and can spread to surrounding tissues.
Non-invasive breast cancer (In Situ): Cancer cells are confined to their original location and have not invaded nearby tissues. This type includes:
Ductal carcinoma In Situ (DCIS): Cancer cells are found in the ducts but have not spread to surrounding breast tissue.
Lobular carcinoma In Situ (LCIS): Abnormal cells are found in the lobules but have not invaded surrounding tissue.
Less common types
Inflammatory breast cancer (IBC): A rare and aggressive form that blocks lymph vessels in the breast, causing inflammation and redness.
Triple-negative breast cancer: Lacks three common receptors (estrogen, progesterone, and HER2), making it harder to treat with standard hormone therapies.
HER2-positive breast cancer: Overexpresses the HER2 protein, leading to more aggressive cancer growth.
Paget's disease of the breast: A rare type that starts in the nipple ducts and spreads to the skin and areola, often presenting as eczema-like changes.
Understanding these types helps in determining the appropriate treatment and management strategies for each individual case.
Causes and risk factors of breast cancer
Genetic factors
Certain genetic mutations can significantly increase the risk of breast cancer. The BRCA1 and BRCA2 genes, when mutated, are known to elevate the risk of developing breast cancer. Women with these mutations have a substantially higher risk compared to the general population. Additionally, having a family history of breast cancer can increase one's risk, as genetic predisposition often runs in families (Nebert et al., 2008).
Lifestyle factors
Lifestyle choices can also affect breast cancer risk. Obesity is linked to a higher risk of developing breast cancer, particularly in postmenopausal women (Vona-Davis et al., 2007). Alcohol consumption has been associated with an increased risk, with studies indicating that even moderate drinking can elevate the risk of breast cancer. Lack of physical activity is another risk factor, as regular exercise has been shown to reduce breast cancer risk (Ventura et al., 2013).
Environmental factors
Exposure to radiation, particularly during medical treatments like radiation therapy, can increase breast cancer risk (Ahn, E., 2003). Hormone replacement therapy (HRT) has also been associated with a higher risk of breast cancer, especially when used for extended periods (Writing Group for the Women's Health Initiative Investigators, 2002).
Other Risk factors
Several additional factors can influence breast cancer risk:
Age and gender: Breast cancer risk increases with age, and women are far more likely to develop breast cancer than men (American Cancer Society, 2022).
Personal history of breast conditions: A history of benign breast conditions or previous breast cancer can elevate the risk of developing new cancer
Dense breast tissue: Women with dense breast tissue have a higher risk of breast cancer and may also have more difficulty detecting tumors through mammography (Tran et al., 2022).
Signs and symptoms of breast cancer
Early warning signs
Early detection is crucial for effective treatment. Common early warning signs of breast cancer include:
Lumps or thickening in the breast: A new lump or mass is one of the most common signs (Saslow et al., 2007).
Changes in breast size or shape: Noticeable changes in the breast's size or shape can be a warning sign (American Cancer Society, 2022).
Skin changes: dimpling, redness, or puckering of the breast skin may indicate breast cancer
Nipple changes or discharge: Changes in the nipple, including discharge or inversion, can be signs of breast cancer (Smith et al., 2003).
When to see a doctor
If you notice any of these symptoms or changes in your breast, it is essential to consult a healthcare provider promptly. Early diagnosis and treatment are crucial for the best outcomes.
Importance of self-examinations
Regular self-examinations can help in early detection of breast cancer. By becoming familiar with the normal look and feel of your breasts, you can more easily notice any changes that may require medical attention (American Cancer Society, 2022).
Breast cancer prevention
Lifestyle modifications
Maintaining a healthy weight: Being overweight or obese increases the risk of breast cancer. Achieving and maintaining a healthy weight through balanced diet and regular exercise can help reduce this risk
Regular rxercise: Engaging in physical activity has been shown to lower breast cancer risk. Aim for at least 150 minutes of moderate-intensity exercise per week (Ventura et al., 2013).
Limiting alcohol intake: Alcohol consumption is linked to an increased risk of breast cancer. Limiting intake to no more than one drink per day may reduce this risk (Key et al., 2006).
Breastfeeding: Breastfeeding may slightly reduce the risk of breast cancer. It also has other health benefits for both mother and baby (Ip et al., 2009).
Screening and early detection
Mammograms: Regular mammograms are essential for early detection of breast cancer. They can identify tumors before they are palpable (American Cancer Society, 2022).
Clinical breast exams: Healthcare providers perform these exams to check for any abnormalities in the breast tissue (Smith et al., 2003).
Breast self-exams: Regular self-exams can help individuals become familiar with their breast tissue and detect any changes early (American Cancer Society, 2022).
Genetic counseling and testing
For individuals with a family history of breast cancer or known genetic mutations (like BRCA1 and BRCA2), genetic counseling and testing can provide information about personal risk and help guide preventive measures (Easton et al., 2007).
Preventive medications
For high-risk individuals, medications like tamoxifen or aromatase inhibitors may be recommended to reduce the risk of developing breast cancer (Cuzick et al., 2015).
Diagnosis of breast cancer
Mammography and other imaging techniques
Ultrasound: Often used to evaluate breast abnormalities found on mammograms or to guide biopsies (Duct, 2010).
MRI: Provides detailed images and is useful for assessing the extent of disease, particularly in high-risk patients or those with dense breast tissue (Sickles, 2012).
3D Mammography (Tomosynthesis): Offers clearer images and can improve the detection of small cancers and reduce false positives (Houssami et al., 2013).
Biopsy procedures
Fine-needle aspiration: Uses a thin needle to extract a small sample of tissue (Ghafoor et al., 2010).
Core needle biopsy: Provides a larger tissue sample for more accurate diagnosis (Azzopardi & Lakhani, 2004).
Surgical biopsy: Involves removing part or all of the suspicious tissue for examination (Ghafoor et al., 2010).
Staging process
TNM system: Stages breast cancer based on Tumor size (T), Node involvement (N), and Metastasis (M) (American Joint Committee on Cancer, 2010).
Stage 0 to Stage IV:
Stage 0: Non-invasive (in situ) cancer.
Stage I: Early stage, small tumor without lymph node involvement.
Stage II: Larger tumor or spread to nearby lymph nodes.
Stage III: Extensive spread to lymph nodes and nearby tissues.
Stage IV: Metastasis to distant organs.
Treatment options for breast cancer
Surgery
Lumpectomy: Removal of the tumor and a small margin of surrounding tissue (Puts et al., 2005).
Mastectomy: Removal of one or both breasts, depending on the extent of cancer (Puts et al., 2005).
Lymph node removal: Often done to check for cancer spread (Whelan et al., 2004).
Radiation therapy
External beam radiation: Targets the breast or chest wall from outside the body (Henson & Brierley, 2016).
Brachytherapy: Involves placing radioactive material inside or near the tumor (Wallner et al., 2012).
Chemotherapy
Neoadjuvant vs. adjuvant chemotherapy: Neoadjuvant is given before surgery to shrink tumors, while adjuvant is given after surgery to kill remaining cancer cells (Kaufman et al., 2006).
Common drugs and side effects: Drugs like doxorubicin and cyclophosphamide are used, with side effects including nausea and hair loss (Hershman et al., 2010).
Hormone therapy
Tamoxifen: Blocks estrogen receptors on cancer cells (Early Breast Cancer Trialists' Collaborative Group, 2005).
Aromatase inhibitors: Reduce estrogen levels in postmenopausal women (Goss et al., 2016).
Targeted therapy
HER2-targeted drugs: Drugs like trastuzumab target HER2-positive breast cancer cells (Slamon et al., 2001).
PARP inhibitors: Used for cancers with BRCA mutations to prevent cancer cell repair
Physiotherapy's role in breast cancer treatment
Benefits of physiotherapy
Improving range of motion: Physiotherapy helps restore movement in the shoulder and arm, which can be affected by surgery or radiation
Managing Lymphedema: Specialized techniques help manage and reduce swelling caused by lymphedema, a common side effect of breast cancer treatment
Enhancing overall physical function: Physiotherapy aids in regaining strength and endurance, improving overall physical function during and after treatment
Specific techniques and exercises
Shoulder and arm exercises: Exercises help maintain or improve flexibility and strength in the affected areas (Baxter et al., 2008).
Manual lymph drainage: A technique used to help reduce lymphedema by improving lymphatic flow (Leduc et al., 2012).
Scar tissue mobilization: Techniques to reduce stiffness and improve movement in areas affected by surgery.
Managing treatment side effects
Fatigue management: Physiotherapy can help manage fatigue through tailored exercise programs that boost energy levels
Pain control techniques: Methods such as heat/cold therapy, massage, and specific exercises help alleviate pain (Fogel, 2015).
Strategies for chemotherapy-induced peripheral neuropathy: Physiotherapists can provide exercises and techniques to manage symptoms like numbness and tingling
Improving quality of life
Individualized Exercise Programs: Tailored exercise plans help patients maintain physical health and manage side effects
Body Awareness and Posture Training: Enhances body awareness and corrects posture, which can be affected by changes in body structure
Stress Reduction Techniques: Techniques such as relaxation exercises and breathing practices help manage stress and improve emotional well-being
Living with breast cancer
Coping strategies
Emotional and psychological support: Seeking support from mental health professionals or support groups helps address emotional challenges
Nutrition and diet during treatment: A balanced diet supports overall health and can help manage treatment side effects (Chajes & Romieu, 2014).
Managing body image concerns: Support from counselors and support groups can help address body image issues resulting from treatment
Support resources
Support groups: Joining support groups provides emotional support and practical advice (Kroemeke et al., 2019)
Online communities: Online forums and communities offer a platform for sharing experiences and receiving support (Bender et al., 2011).
Breast cancer organizations: Organizations provide resources, advocacy, and information on treatment options and support (American Cancer Society, 2022).
Long-term care and follow-up
Survivorship care plans: Personalized plans help manage long-term health and monitor for recurrence (Hewitt et al., 2006).
Monitoring for recurrence: Regular follow-up appointments help detect any return of cancer early (Stearns et al., 2015).
Managing long-term side effects: Ongoing care helps address and manage any long-term side effects from treatment (Bower, 2014).
Conclusion
Recap of key points
Breast cancer is a complex condition requiring comprehensive care. Physiotherapy plays a crucial role in improving range of motion, managing lymphedema, and enhancing overall physical function.
Importance of early detection and comprehensive care. Early detection through screening and comprehensive care, including physiotherapy, is vital for effective treatment and improved outcomes.
Encouragement for seeking professional help. Patients are encouraged to seek professional help, including physiotherapy, to manage symptoms and improve quality of life.
Positive outlook on advancements. Advancements in breast cancer treatment and care continue to improve survival rates and quality of life for patients.
References:
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.