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99-481: Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection , fluid coming from the nipple , a newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of the disease , there may be bone pain , swollen lymph nodes , shortness of breath , or yellow skin . Risk factors for developing breast cancer include obesity ,
198-484: A biopsy of the concerning tissue. Once the diagnosis is made, further tests are carried out to determine if the cancer has spread beyond the breast and which treatments are most likely to be effective. Breast cancer screening can be instrumental, given that the size of a breast cancer and its spread are among the most critical factors in predicting the prognosis of the disease. Breast cancers found during screening are typically smaller and less likely to have spread outside
297-482: A lack of physical exercise , alcohol consumption, hormone replacement therapy during menopause , ionizing radiation , an early age at first menstruation , having children late in life (or not at all), older age, having a prior history of breast cancer, and a family history of breast cancer. About five to ten percent of cases are the result of an inherited genetic predisposition, including BRCA mutations among others. Breast cancer most commonly develops in cells from
396-490: A " great imitator ". People may become anxious or depressed post-diagnosis. The risk of suicide in people with cancer is approximately double. Local symptoms may occur due to the mass of the tumor or its ulceration. For example, mass effects from lung cancer can block the bronchus resulting in cough or pneumonia ; esophageal cancer can cause narrowing of the esophagus , making it difficult or painful to swallow; and colorectal cancer may lead to narrowing or blockages in
495-402: A 30–50% increased risk of being diagnosed with breast cancer themselves. In those with zero, one or two affected relatives, the risk of breast cancer before the age of 80 is 7.8%, 13.3%, and 21.1% with a subsequent mortality from the disease of 2.3%, 4.2%, and 7.6% respectively. Women with certain genetic variants are at higher risk of developing breast cancer. The most well known are variants of
594-431: A biopsy reveals cells that are cancerous but have not yet spread beyond their original location. This condition, called carcinoma in situ , is often considered "precancerous" rather than a dangerous cancer itself. Those with ductal carcinoma in situ (in the mammary ducts) are at increased risk for developing true invasive breast cancer – around a third develop breast cancer within five years. Lobular carcinoma in situ (in
693-474: A concern. This includes that studies have not found a consistent link between mobile phone radiation and cancer risk. The vast majority of cancers are non-hereditary (sporadic). Hereditary cancers are primarily caused by an inherited genetic defect. Less than 0.3% of the population are carriers of a genetic mutation that has a large effect on cancer risk and these cause less than 3–10% of cancer. Some of these syndromes include: certain inherited mutations in
792-566: A persistent fever . Shortness of breath, called dyspnea , is a common symptom of cancer and its treatment. The causes of cancer-related dyspnea can include tumors in or around the lung, blocked airways, fluid in the lungs, pneumonia, or treatment reactions including an allergic response . Treatment for dyspnea in patients with advanced cancer can include fans , bilevel ventilation, acupressure / reflexology and multicomponent nonpharmacological interventions . Some systemic symptoms of cancer are caused by hormones or other molecules produced by
891-682: A person's age can also impact prognosis. Breast cancer before age 35 is rare, and is more likely to be associated with genetic predisposition to aggressive cancer. Conversely, breast cancer in those aged over 75 is associated with poorer prognosis. Up to 80% of the variation in breast cancer frequency across countries is due to differences in reproductive history that impact a woman's levels of female sex hormones ( estrogens ). Women who begin menstruating earlier (before age 12) or who undergo menopause later (after 51) are at increased risk of developing breast cancer. Women who give birth early in life are protected from breast cancer – someone who gives birth as
990-403: A role in the development of breast cancer. Smoking tobacco appears to increase the risk of breast cancer, with the greater the amount smoked and the earlier in life that smoking began, the higher the risk. In those who are long-term smokers, the relative risk is increased by 35% to 50%. A lack of physical activity has been linked to about 10% of cases. Sitting regularly for prolonged periods
1089-539: A role. Oncoviruses (viruses that can cause human cancer) include: Bacterial infection may also increase the risk of cancer, as seen in Parasitic infections associated with cancer include: Radiation exposure such as ultraviolet radiation and radioactive material is a risk factor for cancer. Many non-melanoma skin cancers are due to ultraviolet radiation, mostly from sunlight. Sources of ionizing radiation include medical imaging and radon gas. Ionizing radiation
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#17328591571611188-509: A second "diagnostic" mammogram and ultrasound – to confirm its presence and location. A biopsy is then taken of the suspected tumor. Breast biopsy is typically done by core needle biopsy , with a hollow needle used to collect tissue from the area of interest. Suspected tumors that appear to be filled with fluid are often instead sampled by fine-needle aspiration . Around 10–20% of breast biopsies are positive for cancer. Most biopsied breast masses are instead caused by fibrocystic breast changes ,
1287-814: A second one. Some respond to a third sequential therapy as well. Adding an mTOR inhibitor , everolimus , can further slow the tumors' progression. Those with HER2-positive metastatic disease can benefit from continued use of trastuzumab, alone, in combination with pertuzumab, or in combination with chemotherapy. Those whose tumors continue to progress on trastuzumab benefit from HER2-targeted antibody drug conjugates (HER2 antibodies linked to chemotherapy drugs) trastuzumab emtansine or trastuzumab deruxtecan . The HER2-targeted antibody margetuximab can also prolong survival, as can HER2 inhibitors lapatinib , neratinib , or tucatinib . Certain therapies are targeted at those whose tumors have particular gene mutations: Alpelisib or capivasertib for those with mutations activating
1386-593: A teenager has around a 70% lower risk of developing breast cancer than someone who does not have children. That protection wanes with higher maternal age at first birth, and disappears completely by age 35. Breastfeeding also reduces one's chance of developing breast cancer, with an approximately 4% reduction in breast cancer risk for every 12 months of breastfeeding experience. Those who lack functioning ovaries have reduced levels of estrogens, and therefore greatly reduced breast cancer risk. Hormone replacement therapy for treatment of menopause symptoms can also increase
1485-402: A term that encompasses benign pockets of fluid, cell growth, or fibrous tissue . Breast cancers are classified by several grading systems, each of which assesses a tumor characteristic that impacts a person's prognosis. First, a tumor is classified by the tissue it arises from, or the appearance of the tumor tissue under a microscope. Most breast cancers (85%) are ductal carcinoma – derived from
1584-460: A woman's risk of developing breast cancer, though the effect depends on the type and duration of therapy. Combined progesterone /estrogen therapy increases breast cancer risk – approximately doubling one's risk after 6–7 years of treatment (though the same therapy decreases the risk of colorectal cancer ). Hormone treatment with estrogen alone has no effect on breast cancer risk, but increases one's risk of developing endometrial cancer , and therefore
1683-411: Is T3. Tumors that extend to the chest wall or to the skin are designated T4. N scores are based on whether the cancer has spread to nearby lymph nodes. N0 indicates no spread to the lymph nodes. N1 is for tumors that have spread to the closest axillary lymph nodes (called "level I" and "level II" axillary lymph nodes, in the armpit). N2 is for spread to the intramammary lymph nodes (on the other side of
1782-467: Is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors , which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements . While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans. Tobacco use
1881-416: Is about 2. The corresponding relative risk is 1.5 for lung cancer, and 1.9 for prostate cancer . For breast cancer, the relative risk is 1.8 with a first-degree relative having developed it at 50 years of age or older, and 3.3 when the relative developed it when being younger than 50 years of age. Taller people have an increased risk of cancer because they have more cells than shorter people. Since height
1980-407: Is another preventive measure in some high risk women. In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy , chemotherapy , hormonal therapy , and targeted therapy . Types of surgery vary from breast-conserving surgery to mastectomy . Breast reconstruction may take place at the time of surgery or at a later date. In those in whom
2079-399: Is assigned a grade based on how distinct it appears from healthy breast. Breast tumors are graded on three features: the proportion of cancer cells that form tubules, the appearance of the cell nucleus , and how many cells are actively replicating. Each feature is scored on a three-point scale, with a higher score indicating less healthy looking tissue. A grade is assigned based on the sum of
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#17328591571612178-790: Is associated with higher mortality from breast cancer. The risk is not negated by regular exercise, though it is lowered. Actions to prevent breast cancer include not drinking alcoholic beverages , maintaining a healthy body composition , avoiding smoking and eating healthy food . Combining all of these (leading the healthiest possible lifestyle) would make almost a quarter of breast cancer cases worldwide preventable. The remaining three-quarters of breast cancer cases cannot be prevented through lifestyle changes. Other risk factors include circadian disruptions related to shift-work and routine late-night eating. A number of chemicals have also been linked, including polychlorinated biphenyls , polycyclic aromatic hydrocarbons , and organic solvents . Although
2277-642: Is binary: M0 indicates no evidence metastases; M1 indicates metastases have been detected. TNM scores are then combined with tumor grades and ER/PR/HER2 status to calculate a cancer case's "prognostic stage group". Stage groups range from I (best prognosis ) to IV (worst prognosis), with groups I, II, and III further divided into subgroups IA, IB, IIA, IIB, IIIA, IIIB, and IIIC. In general, tumors of higher T and N scores and higher grades are assigned higher stage groups. Tumors that are ER, PR, and HER2 positive are slightly lower stage group than those that are negative. Tumors that have metastasized are stage IV, regardless of
2376-460: Is commonplace in most wealthy nations, but remains uncommon in the world's poorer countries. Still, mammography has its disadvantages. Overall, screening mammograms miss about 1 in 8 breast cancers, they can also give false-positive results, causing extra anxiety and making patients overgo unnecessary additional exams, such as bioposies . Those who have a suspected tumor from a mammogram or physical exam first undergo additional imaging – typically
2475-780: Is controversial. Chemotherapy drugs are typically given in two- to three-week cycles, with periods of drug treatment interspersed with rest periods to recover from the therapies' side effects. Four to six cycles are given in total. Many classes of chemotherapeutic agents are effective for breast cancer treatment, including the DNA alkylating drugs ( cyclophosphamide ), anthracyclines ( doxorubicin and epirubicin ), antimetabolites ( fluorouracil , capecitabine , and methotrexate ), taxanes ( docetaxel and paclitaxel ), and platinum-based chemotherapies ( cisplatin and carboplatin ). Chemotherapies from different classes are typically given in combination, with particular chemotherapy drugs selected based on
2574-537: Is generally not a transmissible disease . Exceptions include rare transmissions that occur with pregnancies and occasional organ donors . However, transmissible infectious diseases such as hepatitis B , Epstein-Barr virus , Human Papilloma Virus and HIV , can contribute to the development of cancer. Exposure to particular substances have been linked to specific types of cancer. These substances are called carcinogens . Tobacco smoke , for example, causes 90% of lung cancer. Tobacco use can cause cancer throughout
2673-413: Is genetically determined to a large extent, taller people have a heritable increase of cancer risk. Some substances cause cancer primarily through their physical, rather than chemical, effects. A prominent example of this is prolonged exposure to asbestos , naturally occurring mineral fibers that are a major cause of mesothelioma (cancer of the serous membrane ) usually the serous membrane surrounding
2772-420: Is highest among heavy drinkers. Globally, about one in ten cases of breast cancer is caused by women drinking alcoholic beverages. Alcohol use is among the most common modifiable risk factors. Obesity and diabetes increase the risk of breast cancer. A high body mass index (BMI) causes 7% of breast cancers while diabetes is responsible for 2%. At the same time the correlation between obesity and breast cancer
2871-439: Is injected near the tumor site, and several hours later the lymph node the dye accumulates in is removed. After surgery, many undergo radiotherapy to decrease the chance of cancer recurrence . Those who had lumpectomies receive radiation to the whole breast. Those who had a mastectomy and are at elevated risk of tumor spread – tumor greater than five centimeters wide, or cancerous cells in nearby lymph nodes – receive radiation to
2970-411: Is low-dose X-ray imaging of the breast, called mammography . Each breast is pressed between two plates and imaged. Tumors can appear unusually dense within the breast, distort the shape of surrounding tissue, or cause small dense flecks called microcalcifications . Radiologists generally report mammogram results on a standardized scale – the six-point Breast Imaging-Reporting and Data System (BI-RADS)
3069-637: Is more common in Japan due to its high-salt diet while colon cancer is more common in the United States. Immigrant cancer profiles mirror those of their new country, often within one generation. Worldwide, approximately 18% of cancer deaths are related to infectious diseases . This proportion ranges from a high of 25% in Africa to less than 10% in the developed world. Viruses are the usual infectious agents that cause cancer but bacteria and parasites may also play
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3168-403: Is not inherited , such as lifestyle, economic, and behavioral factors and not merely pollution. Common environmental factors that contribute to cancer death include tobacco use (25–30%), diet and obesity (30–35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to 10%), lack of physical activity , and pollution. Psychological stress does not appear to be a risk factor for
3267-474: Is not a particularly strong mutagen . Residential exposure to radon gas, for example, has similar cancer risks as passive smoking . Radiation is a more potent source of cancer when combined with other cancer-causing agents, such as radon plus tobacco smoke. Radiation can cause cancer in most parts of the body, in all animals and at any age. Children are twice as likely to develop radiation-induced leukemia as adults; radiation exposure before birth has ten times
3366-420: Is not at all linear. Studies show that those who rapidly gain weight in adulthood are at higher risk than those who have been overweight since childhood. Likewise, excess fat in the midriff seems to induce a higher risk than excess weight carried in the lower body. Dietary factors that may increase risk include a high-fat diet and obesity-related high cholesterol levels. Dietary iodine deficiency may also play
3465-482: Is only given to women who have undergone hysterectomies . In the 1980s, the abortion–breast cancer hypothesis posited that induced abortion increased the risk of developing breast cancer. This hypothesis was the subject of extensive scientific inquiry, which concluded that neither miscarriages nor abortions are associated with a heightened risk for breast cancer. The use of hormonal birth control does not cause breast cancer for most women; if it has an effect, it
3564-468: Is placed into a device inserted at the surgical site the tumor was removed from. Fresh radioactive material is added twice a day for five days, then the device is removed. Surgery plus radiation typically eliminates a person's breast tumor. Less than 5% of those treated have their breast tumor grow back. After surgery and radiation, the breast can be surgically reconstructed , either by adding a breast implant or transferring excess tissue from another part of
3663-427: Is predominantly used in the production of Teflon , is known to cause two kinds of cancer. Chemotherapy drugs such as platinum-based compounds are carcinogens that increase the risk of secondary cancers Azathioprine , an immunosuppressive medication , is a carcinogen that can cause primary tumors to develop. Diet, physical inactivity , and obesity are related to up to 30–35% of cancer deaths. In
3762-459: Is small (on the order of 0.01% per user–year), temporary, and offset by the users' significantly reduced risk of ovarian and endometrial cancers. Among those with a family history of breast cancer, use of modern oral contraceptives does not appear to affect the risk of breast cancer. Drinking alcoholic beverages increases the risk of breast cancer, even among very light drinkers (women drinking less than half of one alcoholic drink per day). The risk
3861-770: Is the cause of about 22% of cancer deaths. Another 10% are due to obesity , poor diet , lack of physical activity or excessive alcohol consumption . Other factors include certain infections, exposure to ionizing radiation , and environmental pollutants. Infection with specific viruses, bacteria and parasites is an environmental factor causing approximately 16–18% of cancers worldwide. These infectious agents include Helicobacter pylori , hepatitis B , hepatitis C , human papillomavirus infection , Epstein–Barr virus , Human T-lymphotropic virus 1 , Kaposi's sarcoma-associated herpesvirus and Merkel cell polyomavirus . Human immunodeficiency virus (HIV) does not directly cause cancer but it causes immune deficiency that can magnify
3960-520: Is the leading type of cancer in women, accounting for 25% of all cases. In 2018, it resulted in two million new cases and 627,000 deaths. It is more common in developed countries, and is more than 100 times more common in women than in men . For transgender individuals on gender-affirming hormone therapy , breast cancer is 5 times more common in cisgender women than in transgender men , and 46 times more common in transgender women than in cisgender men. Most people with breast cancer have no symptoms at
4059-1069: Is the most common globally – where a higher number corresponds to a greater risk of a cancerous tumor. A mammogram also reveals breast density; dense breast tissue appears opaque on a mammogram and can obscure tumors. BI-RADS categorizes breast density into four categories. Mammography can detect around 90% of breast tumors in the least dense breasts (called "fatty" breasts), but just 60% in the most dense breasts (called "extremely dense"). Women with particularly dense breasts can instead be screened by ultrasound , magnetic resonance imaging (MRI), or tomosynthesis , all of which more sensitively detect breast tumors. Regular screening mammography reduces breast cancer deaths by at least 20%. Most medical guidelines recommend annual screening mammograms for women aged 50–70. Screening also reduces breast cancer mortality in women aged 40–49, and some guidelines recommend annual screening in this age group as well. For women at high risk for developing breast cancer, most guidelines recommend adding MRI screening to mammography, to increase
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4158-457: Is then typically further investigated by medical imaging and confirmed by biopsy . The risk of developing certain cancers can be reduced by not smoking, maintaining a healthy weight, limiting alcohol intake, eating plenty of vegetables, fruits, and whole grains , vaccination against certain infectious diseases, limiting consumption of processed meat and red meat , and limiting exposure to direct sunlight. Early detection through screening
4257-408: Is typically recommended for at least five years after surgery and chemotherapy, and is sometimes continued for 10 years or longer. Women with breast cancer who had a lumpectomy or a mastectomy and kept their other breast have similar survival rates to those who had a double mastectomy. There seems to be no survival advantage to removing the other breast, with only a 7% chance of cancer occurring in
4356-409: Is useful for cervical and colorectal cancer . The benefits of screening for breast cancer are controversial. Cancer is often treated with some combination of radiation therapy , surgery, chemotherapy and targeted therapy . Pain and symptom management are an important part of care. Palliative care is particularly important in people with advanced disease. The chance of survival depends on
4455-959: The BRCA genes BRCA1 and BRCA2 . Women with pathogenic variants in either gene have around a 70% chance of developing breast cancer in their lifetime, as well as an approximately 33% chance of developing ovarian cancer . Pathogenic variants in PALB2 – a gene whose product directly interacts with that of BRCA2 – also increase breast cancer risk; a woman with such a variant has around a 50% increased risk of developing breast cancer. Variants in other tumor suppressor genes can also increase one's risk of developing breast cancer, namely p53 (causes Li–Fraumeni syndrome ), PTEN (causes Cowden syndrome ), and PALB1 . Breast changes like atypical ductal hyperplasia found in benign breast conditions such as fibrocystic breast changes , are correlated with an increased breast cancer risk. Diabetes mellitus might also increase
4554-480: The HER2 -targeted antibody trastuzumab to chemotherapy reduces the chance of cancer recurrence and death by at least a third. Trastuzumab is given weekly or every three weeks for twelve months. Adding a second HER2-targeted antibody, pertuzumab slightly enhances treatment efficacy. In rare cases, trastuzumab can disrupt heart function, and so it is typically not given in conjunction with anthracyclines, which can also damage
4653-402: The bowel , affecting bowel habits. Masses in breasts or testicles may produce observable lumps. Ulceration can cause bleeding that can lead to symptoms such as coughing up blood (lung cancer), anemia or rectal bleeding (colon cancer), blood in the urine (bladder cancer), or abnormal vaginal bleeding (endometrial or cervical cancer). Although localized pain may occur in advanced cancer,
4752-584: The immune system and endocrine system . More than half of the effect from the diet is due to overnutrition (eating too much), rather than from eating too few vegetables or other healthful foods. Some specific foods are linked to specific cancers. A high-salt diet is linked to gastric cancer . Aflatoxin B1 , a frequent food contaminant, causes liver cancer. Betel nut chewing can cause oral cancer. National differences in dietary practices may partly explain differences in cancer incidence. For example, gastric cancer
4851-452: The lungs , liver , brain, and the bones . While some cancers can be cured if detected early, metastatic cancer is more difficult to treat and control. Nevertheless, some recent treatments are demonstrating encouraging results. The majority of cancers, some 90–95% of cases, are due to genetic mutations from environmental and lifestyle factors. The remaining 5–10% are due to inherited genetics . Environmental refers to any cause that
4950-576: The six hallmarks of cancer . These characteristics are required to produce a malignant tumor. They include: The progression from normal cells to cells that can form a detectable mass to cancer involves multiple steps known as malignant progression. When cancer begins, it produces no symptoms. Signs and symptoms appear as the mass grows or ulcerates . The findings that result depend on cancer's type and location. Few symptoms are specific . Many frequently occur in individuals who have other conditions. Cancer can be difficult to diagnose and can be considered
5049-460: The tumor microenvironment . Oncogenes build up an inflammatory pro-tumorigenic microenvironment. Hormones also play a role in the development of cancer by promoting cell proliferation . Insulin-like growth factors and their binding proteins play a key role in cancer cell proliferation, differentiation and apoptosis , suggesting possible involvement in carcinogenesis. Hormones are important agents in sex-related cancers, such as cancer of
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#17328591571615148-745: The United States have mirrored smoking patterns, with increases in smoking followed by dramatic increases in lung cancer death rates and, more recently, decreases in smoking rates since the 1950s followed by decreases in lung cancer death rates in men since 1990. In Western Europe, 10% of cancers in males and 3% of cancers in females are attributed to alcohol exposure, especially liver and digestive tract cancers. Cancer from work-related substance exposures may cause between 2 and 20% of cases, causing at least 200,000 deaths. Cancers such as lung cancer and mesothelioma can come from inhaling tobacco smoke or asbestos fibers, or leukemia from exposure to benzene . Exposure to perfluorooctanoic acid (PFOA), which
5247-479: The United States, excess body weight is associated with the development of many types of cancer and is a factor in 14–20% of cancer deaths. A UK study including data on over 5 million people showed higher body mass index to be related to at least 10 types of cancer and responsible for around 12,000 cases each year in that country. Physical inactivity is believed to contribute to cancer risk, not only through its effect on body weight but also through negative effects on
5346-533: The affected person's health and the different chemotherapeutics' side effects. Anthrocyclines and cyclophosphamide cause leukemia in up to 1% of those treated. Anthrocyclines also cause congestive heart failure in around 1% of people treated. Taxanes cause peripheral neuropathy , which is permanent in up to 5% of those treated. The same chemotherapy agents can be given before surgery – called neoadjuvant therapy – to shrink tumors, making them easier to safely remove. For those whose tumors are HER2-positive, adding
5445-414: The body (such as through inhalation) and require years of exposure to produce cancer. Physical trauma resulting in cancer is relatively rare. Claims that breaking bones resulted in bone cancer, for example, have not been proven. Similarly, physical trauma is not accepted as a cause for cervical cancer, breast cancer or brain cancer. One accepted source is frequent, long-term application of hot objects to
5544-404: The body including in the mouth and throat, larynx , esophagus , stomach, bladder, kidney, cervix, colon/rectum, liver and pancreas . Tobacco smoke contains over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons . Tobacco is responsible for about one in five cancer deaths worldwide and about one in three in the developed world. Lung cancer death rates in
5643-427: The body. Chemotherapy reduces the chance of cancer recurring in the next ten years by around a third. However, 1-2% of those on chemotherapy experience life-threatening or permanent side effects. To balance these benefits and risks, chemotherapy is typically offered to those with a higher risk of cancer recurrence. There is no established risk cutoff for offering chemotherapy; determining who should receive chemotherapy
5742-401: The body. It is possible that repeated burns on the same part of the body, such as those produced by kanger and kairo heaters (charcoal hand warmers ), may produce skin cancer, especially if carcinogenic chemicals are also present. Frequent consumption of scalding hot tea may produce esophageal cancer. Generally, it is believed that cancer arises, or a pre-existing cancer is encouraged, during
5841-549: The breast (nearly two thirds of cases) have the best prognoses – over 99% survive at least five years. Those whose tumors have metastasized to distant sites have relatively poor prognoses – 31% survive at least five years from the time of diagnosis. Triple-negative breast cancer (up to 15% of cases) and inflammatory breast cancer (up to 5% of cases) are particularly aggressive and have relatively poor prognoses. Those with triple-negative breast cancer have an overall five-year survival rate of 77% – 91% for those whose tumors are confined to
5940-428: The breast , with eczema -like red, scaly irritation on the nipple and areola . Advanced tumors can spread (metastasize) beyond the breast, most commonly to the bones, liver, lungs, and brain. Bone metastases can cause swelling, progressive bone pain , and weakening of the bones that leads to fractures . Liver metastases can cause abdominal pain, nausea, vomiting, and skin problems – rash , itchy skin, or yellowing of
6039-527: The breast, endometrium , prostate, ovary and testis and also of thyroid cancer and bone cancer . For example, the daughters of women who have breast cancer have significantly higher levels of estrogen and progesterone than the daughters of women without breast cancer. These higher hormone levels may explain their higher risk of breast cancer, even in the absence of a breast-cancer gene. Similarly, men of African ancestry have significantly higher levels of testosterone than men of European ancestry and have
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#17328591571616138-442: The breast, near the chest center), or for axillary lymph nodes that appear attached to each other or to the tissue around them (a sign of more severely affected tissue). N3 designates tumors that have spread to the highest axillary lymph nodes (called "level 3" axillary lymph nodes, above the armpit near the shoulder), to the supraclavicular lymph nodes (along the neck), or to both the axillary and intramammary lymph nodes. The M score
6237-666: The breast. A 2013 Cochrane review found that it was unclear whether mammographic screening does more harm than good, in that a large proportion of women who test positive turn out not to have the disease. A 2009 review for the US Preventive Services Task Force found evidence of benefit in those 40 to 70 years of age, and the organization recommends screening every two years in women 50 to 74 years of age. The medications tamoxifen or raloxifene may be used in an effort to prevent breast cancer in those who are at high risk of developing it. Surgical removal of both breasts
6336-403: The breast; 12% for those with metastases. Those with inflammatory breast cancer are diagnosed after the cancer has already spread to the skin of the breast. They have an overall five-year survival rate of 39%; 19% for those with metastases. The relatively rare tumors with tubular, mucinous, or medullary growth tend to have better prognoses. In addition to the factors that influence cancer staging,
6435-454: The cancer has spread to other parts of the body, treatments are mostly aimed at improving quality of life and comfort. Outcomes for breast cancer vary depending on the cancer type, the extent of disease , and the person's age. The five-year survival rates in England and the United States are between 80 and 90%. In developing countries, five-year survival rates are lower. Worldwide, breast cancer
6534-786: The cancer, another is started. In addition to the chemotherapeutic drugs used for localized cancer, gemcitabine , vinorelbine , etoposide , and epothilones are sometimes effective. Those with bone metastases benefit from regular infusion of the bone-strengthening agents denosumab and the bisphosphonates ; infusion every three months reduces the chance of bone pain, fractures, and bone hypercalcemia . Up to 70% of those with ER-positive metastatic breast cancer benefit from additional endocrine therapy. Therapy options include those used in localized cancer, plus toremifene and fulvestrant , often used in combination with CDK4/6 inhibitors ( palbociclib , ribociclib , or abemaciclib ). When one endocrine therapy fails, most will benefit from transitioning to
6633-423: The chance of detecting potentially dangerous tumors. Regularly feeling one's own breasts for lumps or other abnormalities, called breast self-examination , does not reduce a person's chance of dying from breast cancer. Clinical breast exams, where a health professional feels the breasts for abnormalities, are common; whether they reduce the risk of dying from breast cancer is not known. Regular breast cancer screening
6732-457: The developing world. The global total economic costs of cancer were estimated at US$ 1.16 trillion (equivalent to $ 1.62 trillion in 2023) per year as of 2010 . The word comes from the ancient Greek [καρκίνος] Error: {{Transliteration}}: transliteration text not Latin script ( help ) , meaning 'crab' and 'tumor'. Greek physicians Hippocrates and Galen , among others, noted the similarity of crabs to some tumors with swollen veins. The word
6831-455: The effect. Medical use of ionizing radiation is a small but growing source of radiation-induced cancers. Ionizing radiation may be used to treat other cancers, but this may, in some cases, induce a second form of cancer. It is also used in some kinds of medical imaging . Prolonged exposure to ultraviolet radiation from the sun can lead to melanoma and other skin malignancies. Clear evidence establishes ultraviolet radiation, especially
6930-445: The genes BRCA1 and BRCA2 with a more than 75% risk of breast cancer and ovarian cancer , and hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome), which is present in about 3% of people with colorectal cancer , among others. Statistically for cancers causing most mortality, the relative risk of developing colorectal cancer when a first-degree relative (parent, sibling or child) has been diagnosed with it
7029-828: The heart. After their chemotherapy course, those whose tumors are ER-positive or PR-positive benefit from endocrine therapy , which reduces the levels of estrogens and progesterones that hormone receptor-positive breast cancers require to survive. Tamoxifen treatment blocks the ER in the breast and some other tissues, and reduces the risk of breast cancer death by around 40% over the next ten years. Chemically blocking estrogen production with GnRH -targeted drugs ( goserelin , leuprolide , or triptorelin ) and aromatase inhibitors ( anastrozole , letrozole , or exemestane ) slightly improves survival, but has more severe side effects. Side effects of estrogen depletion include hot flashes , vaginal discomfort, and muscle and joint pain. Endocrine therapy
7128-479: The initial tumor is usually painless. Some cancers can cause a buildup of fluid within the chest or abdomen . Systemic symptoms may occur due to the body's response to the cancer. This may include fatigue, unintentional weight loss, or skin changes. Some cancers can cause a systemic inflammatory state that leads to ongoing muscle loss and weakness, known as cachexia . Some cancers, such as Hodgkin's disease , leukemias , and liver or kidney cancers , can cause
7227-408: The lining of milk ducts and the lobules that supply these ducts with milk. Cancers developing from the ducts are known as ductal carcinomas , while those developing from lobules are known as lobular carcinomas . There are more than 18 other sub-types of breast cancer. Some, such as ductal carcinoma in situ , develop from pre-invasive lesions . The diagnosis of breast cancer is confirmed by taking
7326-441: The lining of the mammary ducts . 10% are lobular carcinoma – derived from the mammary lobes – or mixed ductal/lobular carcinoma. Rarer types include mucinous carcinoma (around 2.5% of cases; surrounded by mucin ), tubular carcinoma (1.5%; full of small tubes of epithelial cells ), medullary carcinoma (1%; resembling "medullary" or middle-layer tissue), and papillary carcinoma (1%; covered in finger-like growths). Oftentimes
7425-441: The lungs. Other substances in this category, including both naturally occurring and synthetic asbestos-like fibers, such as wollastonite , attapulgite , glass wool and rock wool , are believed to have similar effects. Non-fibrous particulate materials that cause cancer include powdered metallic cobalt and nickel and crystalline silica ( quartz , cristobalite and tridymite ). Usually, physical carcinogens must get inside
7524-420: The mammary lobes) rarely causes a noticeable lump, and is often found incidentally during a biopsy for another reason. It is commonly spread throughout both breasts. Those with lobular carcinoma in situ also have an increased risk of developing breast cancer – around 1% develop breast cancer each year. However, their risk of dying of breast cancer is no higher than the rest of the population. Invasive tumor tissue
7623-437: The mastectomy scar and chest wall. If cancerous cells have spread to nearby lymph nodes, those lymph nodes will be irradiated as well. Radiation is typically given five days per week, for up to seven weeks. Radiotherapy for breast cancer is typically delivered via external beam radiotherapy , where a device focuses radiation beams onto the targeted parts of the body. Instead, some undergo brachytherapy , where radioactive material
7722-486: The nipple. Some may experience unusual discharge from the breasts, or swelling of the lymph nodes under the arms or along the collar bone . Some less common forms of breast cancer cause distinctive symptoms. Up to 5% of people with breast cancer have inflammatory breast cancer , where cancer cells block the lymph vessels of one breast, causing the breast to substantially swell and redden over three to six months. Up to 3% of people with breast cancer have Paget's disease of
7821-496: The non-ionizing medium wave UVB , as the cause of most non-melanoma skin cancers , which are the most common forms of cancer in the world. Non-ionizing radio frequency radiation from mobile phones, electric power transmission and other similar sources has been described as a possible carcinogen by the World Health Organization 's International Agency for Research on Cancer . Evidence, however, has not supported
7920-462: The onset of cancer, though it may worsen outcomes in those who already have cancer. Environmental or lifestyle factors that caused cancer to develop in an individual can be identified by analyzing mutational signatures from genomic sequencing of tumor DNA. For example, this can reveal if lung cancer was caused by tobacco smoke, if skin cancer was caused by UV radiation, or if secondary cancers were caused by previous chemotherapy treatment. Cancer
8019-425: The original is called the primary tumor. Almost all cancers can metastasize. Most cancer deaths are due to cancer that has metastasized. Metastasis is common in the late stages of cancer and it can occur via the blood or the lymphatic system or both. The typical steps in metastasis are: Different types of cancers tend to metastasize to particular organs. Overall, the most common places for metastases to occur are
8118-435: The other breast over 20 years. For around 1 in 5 people treated for localized breast cancer, their tumors eventually spread to distant body sites – most commonly the nearby bones (67% of cases), liver (41%), lungs (37%), brain (13%), and peritoneum (10%). Those with metastatic disease can receive further chemotherapy, typically starting with capecitabine, an anthracycline, or a taxane. As one chemotherapy drug fails to control
8217-450: The other scored characteristics. The management of breast cancer depends on the affected person's health, the cancer case's molecular characteristics, and how far the tumor has spread at the time of diagnosis. Those whose tumors have not spread beyond the breast often undergo surgery to remove the tumor and some surrounding breast tissue. The surgery method is typically chosen to spare as much healthy breast tissue as possible, removing just
8316-869: The previous decade increases of 26% and 21%, respectively. The most common types of cancer in males are lung cancer , prostate cancer , colorectal cancer , and stomach cancer . In females, the most common types are breast cancer , colorectal cancer, lung cancer, and cervical cancer . If skin cancer other than melanoma were included in total new cancer cases each year, it would account for around 40% of cases. In children, acute lymphoblastic leukemia and brain tumors are most common, except in Africa, where non-Hodgkin lymphoma occurs more often. In 2012, about 165,000 children under 15 years of age were diagnosed with cancer. The risk of cancer increases significantly with age, and many cancers occur more commonly in developed countries. Rates are increasing as more people live to an old age and as lifestyle changes occur in
8415-403: The process of healing, rather than directly by the trauma. However, repeated injuries to the same tissues might promote excessive cell proliferation, which could then increase the odds of a cancerous mutation. Chronic inflammation has been hypothesized to directly cause mutation. Inflammation can contribute to proliferation, survival, angiogenesis and migration of cancer cells by influencing
8514-657: The protein PIK3CA . PARP inhibitors ( olaparib and talazoparib ) for those with mutations that inactivate BRCA1 or BRCA2 . The immune checkpoint inhibitor antibody atezolizumab for those whose tumors express PD-L1 . And the similar immunotherapy pembrolizumab for those whose tumors have mutations in various DNA repair pathways. Many breast cancer therapies have side effects that can be alleviated with appropriate supportive care. Chemotherapy causes hair loss , nausea , and vomiting in nearly everyone who receives it. Antiemetic drugs can alleviate nausea and vomiting; cooling
8613-511: The quality of life. Physical activity interventions, yoga and meditation may also have beneficial effects on health related quality of life, cognitive impairment, anxiety, fitness and physical activity in women with breast cancer following adjuvant therapy. Breast cancer prognosis varies widely depending on how far the tumor has spread at the time of diagnosis. Overall, 91% of women diagnosed with breast cancer survive at least five years from diagnosis. Those whose tumor(s) are completely confined to
8712-423: The radiation from mammography is a low dose, it is estimated that yearly screening from 40 to 80 years of age will cause approximately 225 cases of fatal breast cancer per million women screened. Around 10% of those with breast cancer have a family history of the disease or genetic factors that put them at higher risk. Women who have had a first-degree relative (mother or sister) diagnosed with breast cancer are at
8811-618: The risk due to other infections, sometimes up to several thousand fold (in the case of Kaposi's sarcoma ). Importantly, vaccination against hepatitis B and human papillomavirus have been shown to nearly eliminate risk of cancers caused by these viruses in persons successfully vaccinated prior to infection. These environmental factors act, at least partly, by changing the genes of a cell. Typically, many genetic changes are required before cancer develops. Approximately 5–10% of cancers are due to inherited genetic defects. Cancer can be detected by certain signs and symptoms or screening tests. It
8910-547: The risk of breast cancer. Autoimmune diseases such as lupus erythematosus seem also to increase the risk for the acquisition of breast cancer. Women whose breasts have been exposed to substantial radiation doses before the age of 30 – typically due to repeated chest fluoroscopies or treatment for Hodgkin lymphoma – are at increased risk for developing breast cancer. Radioactive iodine therapy (used to treat thyroid disease) and radiation exposures after age 30 are not associated with breast cancer risk. Cancer Cancer
9009-862: The scalp with a cold cap during chemotherapy treatments may reduce hair loss. Many complain of cognitive issues during chemotherapy treatment . These usually resolve within a few months of the end of chemotherapy treatment. Those on endocrine therapy often experience hot flashes , muscle and joint pain, and vaginal dryness/discomfort that can lead to issues having sex. Around half of women have their hot flashes alleviated by taking antidepressants ; pain can be treated with physical therapy and nonsteroidal anti-inflammatory drugs ; counseling and use of personal lubricants can improve sexual issues. In women with non-metastatic breast cancer, psychological interventions such as cognitive behavioral therapy can have positive effects on outcomes such as cognitive impairment, anxiety, depression and mood disturbance, and can also improve
9108-511: The skin ( jaundice ). Those with lung metastases experience chest pain , shortness of breath, and regular coughing . Metastases in the brain can cause persistent headache , seizures , nausea, vomiting, and disruptions to the affected person's speech, vision, memory, and regular behavior. Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to diagnose breast tumors early when treatments are more successful. The most common screening test for breast cancer
9207-860: The three scores. Combined scores of 3, 4, or 5 represent grade 1, a slower-growing cancer. Scores of 6 or 7 represent grade 2. Scores of 8 or 9 represent grade 3, a faster-growing, more aggressive cancer. In addition to grading, tumor biopsy samples are tested by immunohistochemistry to determine if the tissue contains the proteins estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2). Tumors containing either ER or PR are called "hormone receptor-positive" and can be treated with hormone therapies. Around 15 to 20% of tumors contain HER2; these can be treated with HER2-targeted therapies. The remainder that do not contain ER, PR, or HER2 are called "triple-negative" tumors, and tend to grow more quickly than other breast cancer types. After
9306-429: The time of diagnosis; their tumor is detected by a breast cancer screening test. For those who do have symptoms, a new lump in the breast is most common. Most breast lumps are not cancer, though lumps that are painless, hard, and with irregular edges are more likely to be cancerous. Other symptoms include swelling or pain in the breast; dimpling, thickening, redness, or dryness of the breast skin; and pain, or inversion of
9405-433: The tumor ( lumpectomy ) or a larger part of the breast (partial mastectomy ). Those with large or multiple tumors, high genetic risk of subsequent cancers, or who are unable to receive radiation therapy may instead opt for full removal of the affected breast(s) (full mastectomy). To reduce the risk of cancer spreading, women will often have the nearest lymph node removed in a procedure called sentinel lymph node biopsy. Dye
9504-545: The tumor is evaluated, the breast cancer case is staged using the American Joint Committee on Cancer and Union for International Cancer Control 's TNM staging system . Scores are assigned based on characteristics of the tumor (T), lymph nodes (N), and any metastases (M). T scores are determine by the size and extent of the tumor. Tumors less than 2 centimeters (cm) across are designated T1. Tumors 2–5 cm across are T2. A tumor greater than 5 cm across
9603-400: The tumor, known as paraneoplastic syndromes . Common paraneoplastic syndromes include hypercalcemia , which can cause altered mental state , constipation and dehydration, or hyponatremia , which can also cause altered mental status, vomiting, headaches, or seizures. Metastasis is the spread of cancer to other locations in the body. The dispersed tumors are called metastatic tumors, while
9702-461: The type of cancer and extent of disease at the start of treatment. In children under 15 at diagnosis, the five-year survival rate in the developed world is on average 80%. For cancer in the United States, the average five-year survival rate is 66% for all ages. In 2015, about 90.5 million people worldwide had cancer. In 2019, annual cancer cases grew by 23.6 million people, and there were 10 million deaths worldwide, representing over
9801-477: Was introduced in English in the modern medical sense around 1600. Cancers comprise a large family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. They form a subset of neoplasms . A neoplasm or tumor is a group of cells that have undergone unregulated growth and will often form a mass or lump, but may be distributed diffusely. All tumor cells show
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