For all official information and updates regarding COVID-19, visit the South African Department of Health's website at www.SAcoronavirus.co.za
A breast is the term commonly used for the tissue found on the front of the chest in human females, which contains glandular tissue (modified sudoriferous or sweat glands comprising lobules and ducts - mammary glands), which produce milk used for suckling the young, and stromal tissue (supportive tissue, such as Cooper’s ligaments, adipose tissue etc).
Two breasts are found on the front of the chest in men and women. When we are born the male and female breasts are largely the same, containing exactly the same tissue, but the breasts are seen to develop during puberty in females, while male breasts remain undeveloped.
Each breast has a nipple, surrounded by a pink to dark brown areola, which contains a number of fatty or sebaceous glands. The nipples of both sexes also contain a large concentration of blood vessels and nerves, and may become erect when sexually stimulated.
Larger mammary glands are distributed throughout the breast, but about two thirds of them are found very close to the nipple. The mammary glands produce milk, which is transported to the nipple through lactiferous ducts, which all have an opening in the nipple. There can be as few as 4 or as many as 18 lactiferous ducts in the breast. These ducts form a complex network in the breast, which looks like the root system of a plant.
Besides the mammary glands and lactiferous ducts, the breast is also made up of connective tissue (collagen and elastin), adipose (fat) tissue and Cooper’s ligaments – which are also part of the connective tissue and provide structural integrity to the breast (the terms “Cooper’s Droopers or “Cooper’s droop” refers to the breakdown of this structural integrity in aging women).
The percentage of fat tissue in the breast, when compared to the glands in the breast, is mostly the same when a woman is not producing milk, but the percentage of fat tissue almost doubles in women who are producing milk.
The top of the base of the breast is usually located at the same level as the 2nd rib in the ribcage and the bottom of the base of the breast at around about the 6th rib. The breast lies over the fan shaped pectoralis major muscle in the chest.
The breast is anchored by some mammary tissue, known as the “tail of Spense”, which extends diagonally from the breast to under the arm (where most of the lymph nodes that process the breast lymph fluid are located). Another thin layer of mammary tissue that extends from the collar bone at the base of the neck to about the 7th or 8th rib, and more tissue that connects to the back muscles, or the “latissimus dorsi posteriorly”.
The breast is supplied with oxygenated blood from the internal thoracic artery, the lateral thoracic artery, the thoracoacromial artery and the posterior intercostal arteries.
Blood is drained from the breast by mainly the axillary vein and also the internal thoracic vein and the intercostal veins.
Although most support to the breasts is thought to be supplied by the Cooper’s ligaments, the skin around the breast also gives support. This support structure gives the breasts their shape. The shape or size of a breast does not influence its lactation potential at all.
Most of the lymph fluid from the breast travels to the ipsilateral axillary lymph nodes (located in the armpit), the rest of the fluid flowing to the parasternal nodes (near the breastbone), the other breast and the abdominal lymph nodes.
It is important to note that cancer in the breast can therefore easily metasize (spread) to other body parts through the lymph fluid and early detection of this cancer is essential to prohibit this from occurring.
There are many different conditions that can occur in a woman’s breasts, and most of these are not cancerous.
While doing breast self-examination, you may feel changes in your breasts. Your age, the medicines you take as well as hormone levels may be responsible for lumps, bumps and discharges. Your menstrual cycle may also cause changes, or cause lumps to become larger.
Please Note: If you discover a lump, bump, or experience any pain or discharge – report this to your doctor as a matter of urgency, as severe breast problems may present the same symptoms as minor ones!
It is found very common for a woman to present with some changes in her breast tissue, especially if tissue is examined under a microscope, and while all changes should be reported to a doctor, most are not considered dangerous or life threatening, although some changes are linked to an increased risk of developing breast cancer.
Benign breast conditions include the following:
A fibrocystic change may affect at least half of all women at some stage in their life, and is therefore identified as a change and not as a disease. A fibrocystic change may occur in the glands or in the stromal (supportive) tissue of the breast, as the words “fibro” and “cystic” suggests.
These changes are usually noted when a woman reaches childbearing age, but changes are not uncommon outside this period either.
Monthly hormonal changes, caused by the menstrual cycle, may cause cysts to become larger, more noticeable or painful. Certain lumps may also appear firmer and may raise concern that cancer may be present.
Fibrosis is defined as the development of fibrous tissue, the same tissue that scars and ligaments are made of. Fibrous tissue in the breast will feel rubbery, firm and hard. Luckily, it seems that fibrosis may not increase the risk of breast cancer and may not require special treatment.
The cause of breast cysts is not known, although injury is thought to be a cause. Cysts are spaces filled with fluid lined by breast glandular cells, which can be small (microcysts), or may become rather large macrocysts, which can be easily felt as a round movable lump, which is usually tender to the touch.
As a cyst swells it can stretch the surrounding tissue, which may cause pain.
When diagnosing a cyst, a doctor may ask for a breast ultrasound to confirm this. A fine needle aspiration may also confirm the diagnosis of a cyst, where a needle is inserted into the cyst and a certain amount of fluid is drawn off. Fine needle aspiration may also be used to drain the cyst, which most commonly relieves the pressure and the pain. Fluid may return after the aspiration, and many aspirations may be required. Developing a cyst, or many cysts, is not seen to affect your risk of developing breast cancer.
Epithelial Hyperplasia (Proliferative Breast Disease)
This is a condition where there is an over proliferation of cells in either the lobules or the ducts of the mammary glands. Ductal hyperplasia is the term used for when this occurs in the ducts of the mammary glands and lobular hyperplasia, when this occurs in the lobules. Hyperplasia may also be defined as typical for a more common form or atypical for a form that is not common.
It is found that the risk of cancer is slightly higher in a woman presenting with typical hyperplasia and moderately higher in a woman presenting with atypical hyperplasia. REFERENCE 17
Epithelial hyperplasia is usually diagnosed with a core needle biopsy or a surgical biopsy.
If you are diagnosed with hyperplasia, specifically atypical hyperplasia, you should have more frequent breast examinations and most definitely a mammogram at least once a year, but please remember that your doctor should be able to advise you on this.
An enlargement of the breast lobules, which contain more glands then usual, is known as adenosis. This is usually identified during a biopsy, but if many of these enlarged lobules occur in the same place it may be felt.
There are various types of adenosis, known as aggregate adenosis, tumoral adenosis or adenosis tumor, although this tumor is usually found to be non-cancerous or benign.
Sclerosing adenosis is a unique form of adenosis, in which the lobules are distorted by the abnormal growth of scar-like fibrous tissue or deposits of mineral material (calcification).
Adenosis, particularly sclerosing adenosis, may make it difficult for a doctor to identify cancerous lumps during a physical breast examination, which will result in the doctor requesting a biopsy to clarify a diagnosis.
Fine needle aspiration of the adenosis will most usually show whether the lump is benign, but a core needle biopsy will usually show if the mass is benign or not. However sometimes a surgical biopsy may be required to rule out cancer.
It is found that women presenting with this condition have a heightened risk of breast cancer, which should result in more intense and regular breast examinations and mammograms. REFERENCE 18
Much research has been conducted into treating the symptoms of fibrocystic breast changes, but there seems to be little that is effective.
In some cases, aspiration of breast cysts does relieve the pain, as reducing the fluid causing the swelling relieves pressure on the surrounding tissue.
It is suggested that minimizing the intake of caffeine (found in coffee, tea, cocoa, chocolate and cola drinks) may minimize symptoms, but there are many conflicting studies in this regard. It is recommended in some reports that restricting the intake of dietary fat may also relieve symptoms. Other reports suggest various herbal supplements, vitamin E and evening primrose oil to have a positive effect, but we have found no substantiating evidence of this.
Hormone treatment (usually a synthetic androgen) is sometimes prescribed in severe cases when the benefits seem to outweigh the side effects of the treatment.
These are benign tumors made up of glandular and stromal breast tissue. These are found to occur often in young woman, aged 20 to 30, but may occur at any age.
Fibroadenomas are usually round, with distinct borders, and vary in size – from microscopically small to several inches across. A woman may develop one or many of them. These are usually diagnosed by fine needle aspiration or core needle biopsy.
Fibroadenomas may change the shape of the breast and most doctors recommend that they be surgically removed in these cases, but if they are not identified as cancerous and are not growing, they may be left as they are.
A Fibroadenoma may be removed, but this doesn’t mean that another one or a few will not form again, and this must be continually monitored.
Removing a Fibroadenoma may also cause the formation of scar tissue, making further physical examination of the breast and mammograms difficult to interpret, which may lead to the need of more invasive methods of diagnosis in these cases.
These are rare but are very alike Fibroadenoma, as they also occur in the stromal and glandular breast tissue. The difference, however, is that there is an abnormal growth in the stromal, or connective tissue, when a phyllodes tumor is present.
Carcinomas are the normal type of breast cancer, which are found in the ducts or/and lobules of the glandular tissue of the breast.
Depending on the diagnosis of a biopsy, a phyllodes tumor may be benign, cancerous, or the chance of such a tumor being cancerous may be uncertain.
These tumors are treated by removing the tumor and about an inch of the surrounding healthy tissue, if they are benign. If they are cancerous, more healthy tissue is removed, together with the tumor. The entire breast may be removed through a mastectomy, in a worst-case scenario.
Malignant phyllodes tumors are not commonly known to respond well to radiation therapy, hormone therapy or chemotherapy, although surgical removal is considered to influence a favorable prognosis. REFERENCE 19
Although these are not often found in the breast, but more commonly in the mouth or on the skin, they do sometimes present and are mostly non-cancerous.
They are most often felt as a movable, firm lumps from ½ an inch to an inch across and are usually diagnosed through a fine needle or core needle biopsy, which will also be able to identify if the specimen is malignant or not.
The tumor is usually treated by being surgically removed, along with some healthy tissue and the prognosis is usually considered very good.
Wart-like growths of gland tissue, blood vessels and fibrous tissue are known as Intraductal Papilloma. These growths are often found to involve the large milk ducts near the nipple, and mostly result in a bloody discharge from the nipple, but can also be found on other small ducts further away from the nipple.
When found further from the nipple, these cases usually also present with epithelial hyperplasia.
Treatment usually comprises the removal of the Papilloma/s and a part of the duct that it is found in, usually through the areola, which surrounds the nipple. A biopsy will most probably be done on the excised tissue, to ensure that cancer is not present.
The cause of this is not currently known, but the prognosis for people with solitary tumors (growths) is thought to be very good. Patients with multiple tumors or who have a family history of cancer are thought to be more at risk of developing cancer.
This usually occurs through damage to the fatty tissue of the breast and is the result of the body’s response to injury. The injury can occur through surgery or radiation treatment, as well as through other harm done to the breast.
The body will repair the damage by forming firm scar tissue, which may be felt as a firm lump. Sometimes injury will cause the fat cells to die and release their contents, which will form a sac-like collection of fluid – an oil cyst. This cyst may be diagnosed and removed through a fine needle aspiration.
Because fat necrosis may feel the same as a lump that may contain cancer, a doctor may feel that a needle biopsy is called for.
This usually occurs in women who are breast feeding or have a crack in the skin of their breast. The cracking of the skin around the nipple lets bacteria into the area, which may result in inflammation, tissue swelling and increased blood flow to the area. Sometimes mastitis may lead to an abscess, containing a collection of pus, which has to be surgically drained.
This condition is usually treated by a course of antibiotics.
Inflammatory breast cancer may be misdiagnosed as mastitis, which causes delays in the correct treatment of the condition.
Usually found to occur in women in their 40s and 50s. Symptoms are usually a green or black sticky discharge and the nipple area is usually red and sore. Sometimes there may be some scar tissue around the breast, which may give rise to a fear of cancer.
Treatment usually involves antibiotics and warm compresses, but sometimes the condition clears up on its own.
If it seems to be permanent or to re-occur often, the abnormal duct is usually removed through a surgical incision.
Stages of Breast Cancer
Breast cancer has been classed into 5 stages, according to a combination of parameters, as detailed below:
The most common types of breast cancer start in the mammary glands of the breasts, either in the ducts or in the lobules of the glands and are known as ductal carcinoma and lobular carcinoma.
Originating in the cells of the ducts of the mammary glands, divided into 2 types:
This type of breast cancer may also be identified as or include medullary carcinoma, colloid or mucinous carcinoma and papillary carcinoma.
A sub-type of infiltrating ductal carcinoma. The breast appears infected, red and sore.
This may occur anywhere in the breast tissue, originating in the lobules of the mammary glands.
This is a rare form of tumor, where the cell mutates into another form of cell. In the breast this may mean that the tumor starts in the glands and mutates into the cells of the connective tissue.
The following can be an indication of breast cancer.
Please note: Most of the following symptoms may be signs of another type of problem and may not be evidence of cancer, but you should still report these symptoms to your doctor.
Breast examination by a doctor is recommended every 12 months, as you may have cancer, but do not show any of the above-mentioned symptoms.
Cancer is caused by the replication of mutant cells, but the reason why the cells mutate is considered to be very complex and has not as yet really been established.
One theory explains that cancer develops when abnormal mutations, which naturally occur during stem cell multiplication, manage to pass through a corrupted defense system and carry on multiplying, instead of being destroyed.
Breast cancer is thought to be the end product of a multitude of different hereditary and environmental factors and it is known that the chances of developing breast cancer are increased in certain situations. REFERENCE 20
The chance of getting breast cancer is increased as a woman ages. It is considered that the risks of getting breast cancer is high amongst women who have had their first child after the age of 30 or have never had children, have an early first menstrual period or a late menopause.
Men are less at risk of developing breast cancer than women. REFERENCE 21
Having a close relative, who developed breast cancer before menopause, is considered to double the risk of getting breast cancer.
A significant environmental effect is reported in studies concerning the incidence of breast cancer in various countries, which seems to indicate that diet has an effect on breast cancer. Other studies report conflicting findings as to the influence of diet on the incidence of breast cancer.
According to a study done by the Harvard Medical School, obesity raises the risks of breast cancer. REFERENCE 22
High alcohol consumption is linked to an increased risk of breast cancer. REFERENCE 22
Constant elevated levels of estrogen in the blood are linked to an increased risk of cancer.
Many women take replacement hormone therapy during menopause, and if this is used for several years, this could also increase risk of breast cancer.
An article suggests a minimal risk of breast cancer from the use of hormonal contraceptives.
Most studies find no relation between smoking and breast cancer, but it is suggested that the parameters for such studies are difficult to set.
A study done by the National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA concluded that the sensitivity of the female breast to tobacco carcinogens is increased during adolescence and childhood, which may raise the risk of breast cancer. REFERENCE 23
High dose ionizing radiation is suggested as being a possible cause of breast cancer.
The most useful tool of breast cancer diagnosis is self-examination. A doctor may send you for one or more of the following tests if a physical examination shows any lumps or abnormalities.
Some of the diagnostic tools used for identifying breast cancer are the following:
Most cancer associations strongly recommend that women over the age of 20 perform a monthly self examination of the breasts. This is because early detection of cancer is the single most important factor in surviving breast cancer.
Although most of the lumps or abnormalities found by self examination are benign, breast cancer is discovered through self examination in most of the reported cases.
Doing a regular self examination of your breasts will help you notice any abnormality, as you will acquaint yourself with the normal feel of your breasts and will then notice if something feels wrong quickly. A breast self examination should not be regarded as a substitute for other types of screening methods and you should also schedule visits to your doctor for a regular check-up.
If you still get your monthly period, this self-examination should be done during the same stage of the period every month, to minimize changes in the breast tissue. The best time recommended is just following the end of the last period. The breasts should also be less swollen and tender at this time. Pregnant women or women in their menopause should simply choose a day every 30 days to do their examination. If breastfeeding, an examination should be done once a month, just after feeding.
An excellent method of self-examination is called the “seven P’s” method, which helps you to remember all the steps.
The steps are:
This treatment is used to destroy any cancer cells that have not been removed during surgery. Radiation is routinely administered after a simple mastectomy or lumpectomy, or if various lymph nodes have been affected. This treatment is also used to treat inoperable cancer or to relieve pain experienced during advanced cancer.
Radiation treatment may start about 2 to 3 weeks after surgery, when the scar has healed and the patient has regained use of her arm.
Skin blistering and fatigue are reported almost immediately. After continued exposure, the skin may darken, thicken and lose sensitivity due to nerve endings being damaged. In the long term, lung function may be impaired due to the formation of scar tissue. The ribs may fracture easily and there is an increased risk of heart disease.
This treatment is found to increase long term survival. Chemotherapy is usually used a few weeks after surgery to kill off any cancer cells that may still be present. Chemotherapy seems to prevent a return of cancer among young women who have not entered menopause.
Severe side effects may occur, such as nausea, hair loss, mouth sores, fatigue, bleeding problems and breakdown of the immune system. Some of these symptoms are temporary however, and in most cases ease after cessation of treatment.
Some tumors are stimulated by estrogen or progesterone, but cancer specialists consider that all breast cancer patients may benefit from this type of treatment. Medication is prescribed to block the production of these hormones, which may cause menopausal symptoms, such as hot flushes in younger women.
A more radical type of hormone therapy involves the removal of the ovaries. This is called ovarian oblation, where the ovaries are removed through surgery, or destroyed by radiation or chemicals. This may also involve the removal or destruction of other glands, which produce hormones.
A woman who is at high risk of breast cancer may request an ovarian oblation, but due to the side effects of this procedure, thorough consultation is necessary before this is done.
If your doctor or oncologist has no other alternative but to recommend a mastectomy, the least radical procedure will be performed, based on the diagnosis of your condition. Many advances have been made in this field of surgery, and the psychological effects of a mastectomy are taken into account, which will cause the surgeon to operate as carefully as possible. Many advances have also been made in cosmetic surgery techniques, which will enable the surgeon to achieve good cosmetic results, balancing this with safety.
The following types of surgery may be done, depending on the treatment plan discussed with you:
This surgery involves removal of the breast, underlying chest muscles and lymph nodes under the arm and in some cases deep within the chest. The words “extended” and “radical” describe the surgery, as it is extended surgery into the underlying muscles and lymph nodes and is definitely radical, causing the removal of the breast and a lot of surrounding tissue.
This surgery also involves the removal of the breast and the lymph nodes under the arm, and may include the removal of some of the chest muscle. The amount of tissue removed depends on the spread of the tumor.
Removal of the entire breast, including its extensions into the armpit, sometimes also tissue near the collarbone. The lymph nodes are usually left intact, which may cause your oncologist or doctor to recommend radiotherapy or chemotherapy after the operation, to kill off any cancer cells in the lymph nodes.
A surgeon will remove the breast tissue, but leave the skin and nipple intact. A prosthesis may be inserted under the skin to restore the appearance of the breast.
This is surgery to remove a cancerous lump, which includes part of the surrounding normal tissue. Some lymph nodes may also be taken out to examine the spread of the cancer. Your oncologist or doctor may recommend radiotherapy or chemotherapy after the operation to kill off any remaining cancer cells.
The breast may be removed if a woman is at high risk of breast cancer, and if this worries her so much that she cannot live a normal life.
Suspected cancer, or cancer should always be referred to a medical professional, but the following complementary therapies may be found to be of benefit:
Madagascar Periwinkle, or Tropical Periwinkle (Catharanthus roseus) is used to make an extract containing isolated alkoloids, called vincristine, which is used in chemotherapy. Self-medication with this herb is strongly discouraged, but may be an option if discussed with a medical professional.
Cancer Tree or Happy Tree (Campotheca acuminate) is also used to treat various forms of cancer, as the camptothecine and related compounds in the plant inhibit a DNA enzyme that causes an interruption in the replication of cancer cells. This herb is toxic and professional medical guidance is necessary when considering this herb as an alternative treatment.
Lapacho or Pau d’arco (Tabebuia impetiginosa) is used in modern herbal medicine as a supportive treatment in cancer. Studies have shown conflicting results as to the anti-cancer activity of the extract from the bark of this tree, called lapachol. Teas containing this herb are said not to contain the correct amount of anti-cancer compounds, and it is also reported that the correct amounts could have very negative side effects.
Studies show the positive effects Maitake, Shiitake and Reishi mushrooms have on promoting the growth of natural killer cells in the body, boosting the immune system and attacking cancer cells. A Chinese study showed that maitake mushrooms inhibited the growth of breast cancer cells. Shiitake mushroom contains lentinan, which activates lymphokine activated killer cells, which attack carcinomas. The quantities of mushrooms that have to be ingested are not known to us, as well as if there are any major side effects.
Studies show that women with advanced breast cancer that participates in groups that practice meditation; self-hypnosis and visualization have significantly longer survival rates. This may be due to the fact that these methods may stimulate the immune system.
Restrictive diets should only be followed under the supervision of your oncologist or doctor.
Any foods high in antioxidants and which boost the immune system are thought to be effective in helping to prevent the spread of cancer, such as orange and dark green vegetables and yellow and orange fruits.
Vitamin supplements should only be taken under the strict supervision of an oncologist or doctor.
Yoga boosts relaxation, alleviates stress and anxiety, which may boost the immune system.
Most doctors cannot say why one person develops breast cancer, but another person does not, and until the reason is discovered breast cancer will not be able to be prevented. However, most cancer associations recognize the following to be helpful in minimizing the risks of developing breast cancer:
One of the major preventative measures is breast self examination once a month. This will enable you to acquaint yourself with the feel of your breast and any differences that you may feel in the tissue.
Breast self examination is discussed in more depth above.
Discuss with your doctor and find out what risk category you fall into.
Find out if your genes will influence the risk of you getting breast cancer.
Our surroundings and the air we breathe, or the food we eat may be filled with pollutants, or may contain carcinogenic substances.
Obesity and a high alcohol intake are known to increase the risk of developing breast cancer, which logically leads one to conclude that a healthy lifestyle, including a balanced diet with a high intake of fresh fruits and vegetables, moderate exercise and a low consumption of alcohol, will minimize the risk of breast cancer. This type of lifestyle will also help us maintain our ideal body weight and prevent a huge amount of other health problems.
There are also so many carcinogenic and toxic substances in cigarettes, that stopping smoking would be a very good idea, even though we have not discovered any studies that link smoking directly to causing breast cancer.
There are so many different types of pollutants and toxins in the world today that it is impossible for us to avoid all of them, and very little research has been conducted into the harm that these do to humans.
Living as healthy a lifestyle as possible, trying to moderate risks and keeping ourselves informed may go a long way to preventing the development of cancer.
The shock of finding out that you have breast cancer can be very severe. This is one of the major fears that all women have and lots of women rather ignore doing breast self-examination for this reason, which can delay early treatment and an effective cure.
After diagnosis, treatment can be started very swiftly, as the sooner cancer is treated the better. This can place unbelievable stress on one as you feel swept away and do not feel in control of your own life anymore. Remember that you are the patient and have a right to be fully informed. If you don’t understand anything about the treatment program, call a halt and ask your doctor or oncologist questions. Being fully informed is one way of regaining control of your life and being able to plan ahead.
If treatment requires a mastectomy, the psychological effects have to be faced and dealt with, and having a good idea of precisely what the surgery will entail will help greatly in what to expect when you examine the wound afterwards.
Ask your surgeon precisely what will be cut away, what the common after effects are and how long will the scar take to heal. Also find out about the surgery and the after effects by contacting your nearest cancer association, or government health organization, for information on your nearest support group. Remember to talk to your loved ones and if you want to talk to a psychologist or psychiatrist, please do so, as cancer can be beaten, but the shock, denial, anger and fear have to be dealt with and resolved.
This is a time in your life when you need to be informed to make the right decision about treatment. To do so you need to be positive and to be in full control, so use or create a support system for yourself, using all the options available and remember that proper communication and understanding is vital. It is a good idea to make notes when talking to a doctor, so you can take them home to make an informed decision. A good idea would be to discuss your decisions, anger and fears with your loved ones or trusted friends.
Sample questions to ask your doctor, before considering a mastectomy (please feel free to add more if you wish):
Dealing with breast cancer most commonly involves coming to terms with the after effects of surgery, dealing with the pain and healing process and dealing with the side effects of radiation or/and chemotherapy, hormone therapy or other forms of treatment.
Swift and early detection of breast cancer is by far the most important reason for a better survival rate with breast cancer. Early detection of cancer may also minimize invasive surgery and widen the treatment options.
Great strides forward have been made in treating breast cancer, and research is constantly being conducted in curbing the side effects of the various treatment methods. New techniques are also constantly being developed regarding cosmetic surgery on scars and breast replacement, with this sometimes being incorporated into the mastectomy procedure, with amazing cosmetic results.