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# What Is Breast Cancer? Types, Symptoms, Causes, Stages And More

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Dr. Culwell is a fellowship-trained OB-GYN who has specialized in women’s reproductive health for over 20 years.

Updated: Jun 22, 2023, 5:11am

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What Is Breast Cancer? Types, Symptoms, Causes, Stages And More

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## Table of Contents

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Breast cancer is the most frequently diagnosed cancer in women and the second leading cause of cancer deaths in women[1]Breast Cancer Facts and Figures. American Cancer Society. Accessed 5/15/2023. . When it comes to treating breast cancer, the earlier you’re diagnosed, the better your odds of eliminating the disease. That’s why following the United States Preventive Services Task Force’s guidelines for breast cancer screening–mammograms every two years in women ages 40-74—is so important[2]Breast Cancer Screening. U.S. Preventive Services Task Force. Accessed 5/12/2023. .

It’s also important to be aware of the signs of breast cancer. Here’s an in-depth look at breast cancer symptoms, types, causes, stages and more.

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## What Is Breast Cancer?

Breast cancer occurs when abnormal cells accumulate in the breast, forming a malignant (cancerous) mass, lump or growth (tumor), says Erika P. Hamilton, M.D., a board-certified oncologist and director of breast cancer and gynecologic cancer research at Sarah Cannon Research Institute in Nashville.

According to Johns Hopkins Medicine, breast cancer is most likely to occur in the ducts (tubes in the breast that transport milk to the nipple) and lobules (structures that contain milk glands), but it can also form in the breast’s connective tissue, though this is rare, accounting for less than 1% of breast cancers[3]Types of Breast Cancer. Johns Hopkins Medicine. Accessed 5/23/2023. . From its primary site, breast cancer typically spreads to nearby lymph nodes in the armpit, says Arif Kamal, M.D., a medical oncologist and board-certified palliative medicine specialist at Duke Cancer Institute in Durham, North Carolina and chief patient officer at the American Cancer Society.

This spread, or metastasis, occurs when cancer cells break away from the breast tissue and travel through the blood vessels or lymph vessels, gaining access to other areas and tissues of your body and forming new tumors, explains Dr. Hamilton.

## What Causes Breast Cancer?

For about 5-10% of women, breast cancer arises from an increased risk due to family history and genetic abnormalities passed down within families, says Dr. Kamal[4]Breast Cancer Risk Factors You Cannot Change. American Cancer Society. Accessed 5/12/2023. . Hereditary breast cancer is usually caused by an inherited mutation in the BRCA1 or BRCA2 gene, protein-forming genes that repair damaged DNA in normal cells. When these genes mutate, abnormal cell growth may occur, leading to cancer.

Most of the time, the exact cause of breast cancer is not known, says Raquel Prati, M.D., chief of surgical services and breast surgeon at City of Hope Phoenix in Goodyear, Arizona. However, certain factors can increase the risk of breast cancer, she says.

### Breast Cancer Risk Factors

The biggest risk factor for breast cancer is being a woman, says Eric Winer, M.D., director of Yale Cancer Center and physician-in-chief of Smilow Cancer Network in New Haven, Connecticut. While some risk factors can be minimized by lifestyle changes, others cannot, including:

- Age: Breast cancer risk rises with age, with most cases being diagnosed in individuals over the age of 55.
- Genetics: Your risk increases if you have certain genetic mutations like BRCA1 and BRCA2. According to Dr. Winer, people who are of Ashkenazi Jewish background have a higher chance of having a BRCA1 or BRCA2 mutation than the rest of the population.
- Personal or family history: If you have had breast cancer or other disease of the breasts, your risk increases. If a first-degree relative (like a mother or sister) has a history of breast or ovarian cancer, risk is also higher.
- Reproductive history: Women who start menstruating prior to the age of 12 and women who begin menopause after the age of 55 are at increased risk.
- Breast density: Having a greater amount of fibrous connective tissue than fatty tissue in the breast increases risk.
- Radiation therapy: If you had radiation therapy to your chest or breasts at a young age, your risk of developing breast cancer increases.
- Diethylstilbestrol (DES): Exposure to this drug, used to prevent miscarriage between 1940-1971, raises breast cancer risk.

Some risk factors may be reduced through lifestyle changes, says Dr. Prati. They include:

- Alcohol consumption: The more alcohol you drink, the greater your odds of developing breast cancer. According to the American Cancer Society, drinking one alcoholic beverage daily increases your risk by 7-10%; drinking two to three alcoholic beverages daily raises your risk by 20%[5]Lifestyle-related Breast Cancer Risk Factors. American Cancer Society. Accessed 5/12/23. .
- Overweight or obesity: Although the link between weight and breast cancer is complex, having more fat tissue, which produces estrogen, can increase your risk of breast cancer. Women with excess body fat often have increased insulin levels, which is also a risk factor.
- Activity level: It’s not clear why regular physical activity reduces the risk of breast cancer, but a 2016 meta-analysis including 38 studies found that the most physically active women were at a 12–21% lower risk of developing breast cancer than the least physically active women[6]Physical Activity and Cancer. National Cancer Institute. Accessed 5/12/23. .
- Reproductive history: The risk of breast cancer is lower in women who have given birth as well as in those who have breastfed for a year or longer.
- Birth control: Studies are conflicting as to whether hormonal contraceptives like the birth control pill, birth control shot, birth control implants, intrauterine devices (IUDs), skin patches and vaginal rings may increase breast cancer risk. However, any increase in risk seems to go away within two to five years of stopping hormonal birth control.
- Hormone therapy (HT): Combination HT (containing both estrogen and progesterone, a synthetic form of progestin) is linked to a small increased risk in breast cancer after an average of about five years of use.
- Breast implants: While breast implants have not been linked explicitly to breast cancer, the Food and Drug Administration (FDA) has reported cases of squamous cell carcinoma (SCC) and lymphomas in the scar tissue that the body forms around breast implants[7]Breast Implants: Reports of Squamous Cell Carcinoma and Various Lymphomas in Capsule Around Implants: FDA Safety Communication. U.S. Food and Drug Administration. Accessed 5/12/23. . More research is needed to determine the frequency at which this may occur.

## Symptoms of Breast Cancer

Early on, breast cancer is usually asymptomatic, says Jane Mendez, M.D., a board-certified surgical oncologist and chief of breast surgery at Miami Cancer Institute in Miami. “By the time somebody develops symptoms, the cancer is usually at a later stage,” says Dr. Mendez. That’s why it’s important to pay attention to any changes or signs that something’s off, she explains. Below are changes to watch for:

- Changes to the nipple (such as turning inward or pain)
- Skin dimpling (has the appearance of an orange peel)
- Nipple discharge
- Areas of thickening in the breast
- Breast and/or nipple pain
- Breast and/or nipple skin changes (dryness, flakiness, redness or thickened skin)
- Changes in breast size or symmetry
- A new lump or mass in the breast or armpit
- Swollen lymph nodes in the armpit/collarbone region

Late-stage symptoms can include joint pain, hip pain, unrelenting headaches, visual changes, changes in the appetite, unintentional weight loss, abdominal discomfort or distention, difficulty breathing and skin breakdowns, says Dr. Mendez. If the cancer has metastasized to the lung, symptoms can include a bloody phlegm, she adds.

## Types of Breast Cancer

Breast cancer is almost always a type of carcinoma (cancer that forms in the epithelial tissue) because it typically starts in the lining of the breast, says Dr. Hamilton. There are two types of non-invasive carcinomas, she says.

- Ductal carcinoma in situ means that the cancer cells are in the breast ducts.
- Lobular carcinoma in situ means that the cancer cells are in the breast lobules.

These may be called pre-cancers, or Stage 0 cancers, because they have not progressed to the point of forming a mass or tumor or becoming invasive, explains Dr. Hamilton, adding that this is the earliest breast cancer can be caught.

### Invasive Ductal Carcinoma

Invasive ductal carcinoma (IDC) starts in the milk ducts and accounts for about 80% of all breast cancers, says Dr. Mendez[8]Invasive Breast Cancer (IDC/ILC). American Cancer Society. Accessed 5/15/2023. . IDC spreads to tissue outside of the milk duct, potentially metastasizing to other parts of the body, she explains.

### Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC), accounting for 10% of all breast cancer cases, begins in the lobules or milk glands of the breast and spreads to surrounding tissues and other areas of the body, says Dr. Mendez[8]Invasive Breast Cancer (IDC/ILC). American Cancer Society. Accessed 5/15/2023. . ILC is more likely to occur in both breasts than other types of breast cancers, adds Dr. Prati.

### Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare and aggressive type of cancer, says Dr. Mendez. According to the American Cancer Society, it accounts for 1-5% of breast cancers[9]Inflammatory Breast Cancer. American Cancer Society. Accessed 5/15/23. .  IBC cells block lymph vessels in the breast, which may cause the skin to become red and swollen, she says, adding that IBC tends to affect younger people and can progress quickly.

### Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) occurs in 10-15% of all breast cancer cases, according to the American Cancer Society[10]Triple-negative Breast Cancer. American Cancer Society. Accessed 5/15/23. . TNBC tests negative for three of the receptors that drive other forms of breast cancer—the hormones estrogen and progesterone, and a protein monoclonal antibody called HER-2, says Dr. Mendez.

Hormone receptors are proteins found in and on breast cells that pick-up hormone signals telling the cells to grow, says Dr. Mendez. Because the tumor cells in TNBC lack the necessary receptors, common treatments are ineffective, making it the hardest breast cancer to beat, she says. What’s more, TNBC is more aggressive than other forms of breast cancer.

### Rare Forms of Breast Cancer

- Paget disease of the breast is a rare form of breast cancer that starts on the nipple and extends to the dark circle of skin (areola) around the nipple, says Dr. Hamilton.
- Phyllodes tumors of the breast are rare breast tumors that start in the connective tissue of the breast, says Dr. Hamilton. Most are benign, but can be difficult to remove completely, she says.
- Angiosarcoma is rare, developing in the blood or lymphatic vessels of the breast, says Dr. Hamilton. It occurs in the breast and skin of the arms and spreads rapidly, she says.
- Male breast cancer is rare, occurring in 1% of breast cancer cases, according to the Centers for Disease Control and Prevention (CDC)[11]Breast Cancer in Men. Centers for Disease Control and Prevention. Accessed 5/15/2023. . Because men don’t get mammograms and may not be aware of their risk of developing breast cancer, they are usually diagnosed at a later stage, says Dr. Mendez.

## Diagnosing Breast Cancer

There are numerous tests used to find or diagnose breast cancer, including breast ultrasound, diagnostic mammogram, breast MRI and biopsy, says Dr. Hamilton.

- Breast ultrasound uses a machine that takes pictures, called sonograms, of areas inside the breast.
- Diagnostic mammogram, a more detailed x-ray of the breast, is performed if you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal during a routine screening mammogram, says Dr. Hamilton. It’s similar to screening mammography used to screen for breast cancer.
- Breast MRI is a body scan that uses a magnet linked to a computer to provide a detailed picture of areas inside the breast.
- Biopsy is a procedure to remove tissue or fluid from the breast to be examined under a microscope; further analysis is conducted by a pathologist to determine if breast cancer is present. It is the only test that can provide a definitive diagnosis of breast cancer.

## Breast Cancer Stage

According to the TNM system (tumor, node, metastasis), breast cancer has five stages, says Dr. Prati. They include:

- Stage 0 breast cancer, or carcinoma in situ, means that cancer cells are present but have not spread.
- Stage 1 breast cancer means the tumor is very small and either has not spread or has a tiny amount of spread to a nearby lymph node. A cancer that has spread into the surrounding breast tissue, beyond the milk ducts and lobules, is referred to as invasive breast cancer. There can also be minor spread to the lymph nodes.
- Stage 2 breast cancer means the tumor is larger than at stage 1 and may have spread to a few nearby lymph nodes.
- Stage 3 breast cancer means the tumor is larger than at stage 2 and/or has spread to several lymph nodes and/or tissue around the breast or breast bone.
- Stage 4 breast cancer, or metastatic breast cancer, means the cancer has spread to distant parts of the body, typically the bones, lungs or liver. This is an advanced stage of cancer.

Since the most recent updates in 2018, staging categories have become more complex, with the status of biomarkers (estrogen, progesterone and HER-2) now being incorporated into the equation, says Dr. Prati. So although a cancer might be smaller than others, it might belong to a higher stage category based on these biomarkers, she explains.

Each stage category is also subdivided, depending on all the factors in the equation–tumor size in the breast, the extent of lymph node disease and the presence of distant metastasis and biomarkers status, says Dr. Prati.

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## Treating Breast Cancer

Dr. Winer emphasizes that breast cancer isn’t one disease; rather, it’s a family of diseases. Different subtypes of breast cancer behave differently, and treatment is based on how much cancer there is, the stage of the cancer and other features, he says.

Treatment options include the following:

- Surgery to remove the cancerous tissue can be breast-conserving, like a lumpectomy (where only the tumor is removed) or a mastectomy, where the entire breast is removed.
- Chemotherapy is medication that is used to shrink or kill the cancer cells. It also decreases the likelihood of metastasis.
- Hormonal therapy blocks the hormones estrogen and progesterone, which are needed for cancer cells to grow.
- Targeted therapy such as tyrosine kinase inhibitors or monoclonal antibodies work with your body’s immune system to help it attack specific types of cancer cells.
- Immunotherapy, such as immune checkpoint inhibitors, is a treatment that helps your immune system in fighting off cancer.
- Radiation therapy uses high-energy rays, like x-rays, to kill the cancer cells in the breast to decrease the local recurrence rate.

## Can Breast Cancer Be Prevented?

The best way to prevent breast cancer is through lifestyle changes like minimizing alcohol use and maintaining a healthy weight, says Dr. Kamal. Eating a healthy diet full of fruits and vegetables, drinking plenty of water and getting regular exercise are important too, says Dr. Mendez. She also recommends avoiding smoking, which has been linked to an increased risk of breast cancer in premenopausal women.

It’s also important to discuss the right frequency of mammograms with your doctor, says Dr. Winer. The goal of mammograms is to identify breast cancer in an earlier stage and treat it effectively before it becomes metastatic, he says. And though it hasn’t been shown conclusively that doing monthly breast self exams is useful, being aware of changes is key–so if you feel a lump in your breast or notice something abnormal, you should talk to your health care provider, adds Dr. Winer.

## Breast Cancer Prognosis

According to the American Society of Clinical Oncology, in the U. S., the five-year relative survival rate for non-metastatic invasive breast cancer is 91%; the 10-year relative survival rate is 85%. The five-year relative survival rate for cancer that has metastasized to the lymph nodes is 86%; for metastasis in distant parts of the body, the five-year relative survival rate is 30%[12]Breast Cancer: Statistics. American Society of Clinical Oncology. Accessed 5/15/2023. .

But even if you have metastatic breast cancer, don’t lose hope. Dr. Winer says it’s possible to live for many, many years. That’s because new treatments are being developed all of the time, he says.

## When to See a Doctor

If you notice any symptoms of breast cancer, like a painless lump in the breast or surrounding area, it’s vital to see a health care provider as soon as possible to be examined, says Dr. Hamilton. Women should also speak to their health care provider about their individualized risk, as higher risk women may benefit from genetic counseling or early screening, she recommends.

Review your family history and risk for breast cancer with your health care provider each year, discussing the benefits of annual mammograms after the age of 40, urges Dr. Kamal. For information on breast cancer screening, including current guidelines, options if you don’t have insurance coverage and suggestions on how to safely plan your routine cancer screenings, visit www.cancerscreenweek.org, he advises.

## Sources

### Footnotes

### References

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Forbes Health adheres to strict editorial integrity standards. To the best of our knowledge, all content is accurate as of the date posted, though offers contained herein may no longer be available. The opinions expressed are the author’s alone and have not been provided, approved or otherwise endorsed by our advertisers.

Heidi Borst is a freelance journalist, healthcare content writer and certified nutrition coach with a love of all things health and wellness. Her work has appeared in The New York Times, The Washington Post, National Geographic, Good Housekeeping, MSN, Yahoo and more. Based in Wilmington, North Carolina, Borst is a lifelong runner and general fitness enthusiast who is passionate about the physical and mental benefits of sleep and self-care.

Known professionally as “Dr. Lady Doctor,” Dr. Culwell is a fellowship-trained OB-GYN who has specialized in women’s reproductive health for over 20 years. She has served as a medical officer for the World Health Organization in Geneva, Switzerland and as senior medical advisor for the International Planned Parenthood Federation in London.

Dr. Culwell currently serves as the senior vice president and chief medical officer at Afaxys, Inc. She maintains an active medical license and continues to regularly see patients in need of outpatient gynecologic care.

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