Breast Pathology 2019

The breast is highly complex. It goes through more changes than any other part of the human body – from birth, puberty, pregnancy and breastfeeding, right through to menopause. Breast tissue extends from the collarbone, to lower ribs, sternum (breastbone) and armpit. Each breast contains 15-20 glands called lobes, where milk is produced in women who are breastfeeding. These lobes are connected to the nipple by 6-8 tubes called ducts which carry milk to the nipple. The breast and armpit contain lymph nodes and vessels carrying lymph fluid and white blood cells. Much of the rest of the breast is fatty tissue. The breast, like any other part of the body, consists of billions of microscopic cells. These cells usually multiply in an orderly fashion – new healthy cells continue to divide and replace the ones that have died. However, sometimes cells develop abnormalities (mutations). This occurs when the genes that usually check that cells are replicating correctly fail to detect mutations. When this happens, abnormal cells continue to divide and multiply, sometimes growing quite rapidly.

Benign (not cancer) breast conditions are very common and most breast changes are not cancer. A benign breast condition refers to a lump, cyst, or nipple discharge (fluid) of the female or male breast that is not cancerous. There are numerous benign breast conditions. For women, the most common ones are: Fibrocystic breast changes, Fibro adenomas, Mastitis, Fat necrosis, Calcification, Nipple discharge. Less common types of benign breast conditions include: Hyperplasia, Adenosis, Intraductal papillomas, Lipoma. Benign breast conditions are generally caused by a number of factors. Those factors include the makeup of breasts (fatty tissue vs. dense or thick tissue), age, hormone problems, hormone therapy, birth control pills, pregnancy, menopause, being overweight, infection, and breastfeeding. The exact cause can often be traced back to your specific diagnosis. These are rare in men. Men do have undeveloped milk ducts. The most common benign breast condition in men is called gynecomastia this condition enlarges breast tissue. It is caused by a hormone imbalance. It also can be caused by hormone therapy, some diseases, and being severely overweight.

DCIS is an early form of breast cancer and accounts for about 12% of all breast cancers. When cancer cells have developed within the ducts of the breast but remain within the ducts (‘in situ’), it is called DCIS. The cancer cells have not yet developed the ability to spread outside these ducts into the surrounding breast tissue or to other parts of the body. As a result of being confined to the ducts, DCIS has a very good prognosis. If DCIS is left untreated, the cancer cells may develop the ability to spread outside the ducts, into the surrounding breast tissue. This is known as invasive breast cancer. Invasive cancer has the potential to also spread to other parts of the body. In some cases, DCIS will never develop further or grows so slowly that it would never cause harm during that person’s lifetime. Although the size and grade of the DCIS can help predict if it will become invasive, there is currently no way of knowing if this will happen. High-grade DCIS is more likely to become an invasive breast cancer than low-grade DCIS and do so more quickly. Although DCIS is an early form of breast cancer with a very good prognosis, people understandably may feel very anxious and frightened by the diagnosis. People can often struggle to come to terms with being offered treatments such as a mastectomy, at the same time as being told their DCIS may never do them any harm.

Lobular carcinoma in situ (LCIS) is an uncommon condition in which abnormal cells form in the milk glands (lobules) in the breast. LCIS isn't cancer. But being diagnosed with LCIS indicates that you have an increased risk of developing breast cancer. It begins when cells in a milk-producing gland of a breast develop genetic mutations that cause the cells to appear abnormal. The abnormal cells remain in the lobule and don't extend into, or invade, nearby breast tissue. LCIS is viewed as an uncommon condition, but we don’t know exactly how many people are affected. That’s because LCIS does not cause symptoms and usually does not show up on a mammogram. It tends to be diagnosed as a result of a biopsy performed on the breast for some other reason. It is usually diagnosed before menopause, most often between the ages of 40 and 50. Less than 10% of women diagnosed with LCIS have already gone through menopause. This is extremely uncommon in men. This is described as pleomorphic or if it has necrosis (areas of dead cells), in which case it might be more likely to grow quickly.

Atypical hyperplasia is a precancerous condition that affects cells in the breast. It describes an accumulation of abnormal cells in the breast which isn't cancer, but it can be a forerunner to the development of breast cancer. Over the course of your lifetime, if the atypical hyperplasia cells keep dividing and become more abnormal, this can transit into non-invasive breast cancer (carcinoma in situ) or invasive breast cancer. If you've been diagnosed with atypical hyperplasia, you have an increased risk of developing breast cancer in the future. For this reason, doctors often recommend intensive breast cancer screening and medications to reduce breast cancer risk. Atypical hyperplasia typically doesn't cause symptoms, but it may cause changes to appear on a mammogram. Atypical hyperplasia is usually discovered during a breast biopsy to investigate an abnormality found on a mammogram. Sometimes atypical hyperplasia is discovered on a biopsy done for a different condition.

Immune response get trigger due to the every cancer, this is the first line of defence against the progression of any cancer. Relationship is present in between the immune system and tumour evolution in case of breast cancer as well. Variety of immune cells present in the environment of tumour which can help in arresting the progression of breast cancer. Therapies used for the treatment of breast cancer can modulate these immune cells in case of breast cancer. B lymphocytes secrete antigen-specific immunoglobulin which might be having anticancer properties. Patient who is suffering from breast cancer have increase population of B lymphocytes in the bone marrow as compare to normal person, this can be noticeable point for the treatment of breast cancer.

There are three general types of breast implant devices, defined by their filler material saline solution silicone, silicone gel and composite filler. The saline implant has an elastomer silicones shell filled with sterile saline  solution during surgery the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel and the alternative composition implant featured miscellaneous fillers such as soy oil, polypropylene string etc. Saline implants, Silicone gel implants, Post-surgical recovery, Implant rupture. Breast implant emplacement is performed with five types of surgical incisions

Most women with breast cancer have some type of surgery as part of their treatment. There are different types of breast surgery, and it may be done for different reasons, depending on the situation. surgery may be done to Remove as much of the cancer as possible, to Find out whether the cancer has spread to the lymph nodes under the arm, to Restore the breast’s shape after the cancer is removed, to Relieve symptoms of advanced cancer. There are two main types of surgery to remove breast cancer:  Breast-conserving surgery and Mastectomy. Many women with early-stage cancers can choose between breast-conserving surgeries (BCS) and mastectomy. The main advantage of BCS is that a woman keeps most of her breast. But in most cases she will also need radiation. Women who have mastectomy for early stage cancers are less likely to need radiation. For some women, mastectomy may be a better option, because of the type of breast cancer, the large size of the tumour, previous treatment history, or certain other factors.

There are several categories of breast diseases which may cause infections, cysts and lumps with or without pain. Some of the breast diseases are benign (harmless) and some are malignant (which can spread). Most common breast diseases are mastitis (a bacterial infection), cysts, benign lumps and cancer. Women mostly are affected by the breast diseases where they are encouraged to start breast self-examination early in the life and to have regular mammography, if found suspicious they are generally offered with a combination of ultrasound and needle biopsy to work out the cause. Men are affected by breast diseases too, although not as often.

 It is estimated that one in eight women, or approximately 12%, will be diagnosed with breast cancer in her lifetime. However, women with certain genetic mutations have a higher lifetime risk of the disease. It’s estimated that 55 – 65% of women with the BRCA1 mutation will develop breast cancer before age 70. Approximately 45% of women with a BRCA2 mutation will develop breast cancer by age 70. Women with a BRCA1 or BRCA2 mutation who overcome their breast cancer with treatment appear to have a higher-than-average chance of developing a second cancer. This is called a recurrence. Cancers related to a BRCA1 mutation are also more likely to be triple negative breast cancer, which can be more aggressive and difficult to treat. You may find these statistics alarming. However, it’s important to note that less than 10% of women diagnosed with breast cancer have a BRCA mutation. Also, with early detection, the vast majority of breast cancer cases can be successfully treated—and that’s true even for people who have a BRCA1 or BRCA2 mutation.

Breast cancer is often thought of as something that only affects women, but men can get it in rare cases. It develops in the small amount of breast tissue men have behind their nipples. It usually occurs in men over 60, but can very occasionally affect younger men. The outlook for breast cancer in men varies depending on how far it has spread by the time it's diagnosed. It may be possible to cure breast cancer it it's caught at an early stage. A cure is much less likely if the cancer isn't found until it has spread beyond the breast. In these cases, treatment can relieve your symptoms and help you live longer. The exact cause of breast cancer in men isn't known, but there are some things that increase your risk of getting it. These include: genes and family history – inheriting faulty versions of genes called BRCA1 or BRCA2 increases your risk of breast cancer, Conditions that can increase the level of oestrogen in the body – including obesity, Klinefelter syndrome and scarring of the liver, previous radiotherapy to the chest area. It's not certain if you can do anything to reduce your risk, but eating a balanced diet, losing weight if you're overweight and not drinking too much alcohol may help.

Breast microcalcifications are small calcium deposits in the soft tissue of the breast. Indeed, breast microcalcifications are extremely common in women and are almost always a benign (non-cancerous) breast condition. So many different factors are taken into account when deciding if a potential lesion is malignant or not.  Radiologists consider breast microcalcifications as a possible very early indicator for breast cancer.  However, this may or may not be the case and only histological findings will confirm the suspicion. When evaluating microcalcifications, if there are combinations of findings that tend to lead to the same outcome (benign or malignant), it is generally true that those predictions carry even more weight. It can be said that as a general rule, when the microcalcifications are distributed in diffuse or bilateral arrangements, or with a round or punctuate shape, or scattered in dense breast tissue, the situation is usually benign.

 Raising general public awareness on the breast cancer problem and the mechanisms to control as well as advocating for appropriate policies and programmes are key strategies of population-based breast cancer control. Many low- and middle-income countries face now a double burden of breast and cervical cancer which represent top cancer killers in women over 30 years old. These countries need to implement combined strategies that address both public health problems in an effective and efficient way. Control of specific modifiable breast cancer risk factors as well as effective integrated prevention of non-communicable diseases which promotes healthy diet, physical activity and control of alcohol intake, overweight and obesity, could eventually have an impact in reducing the incidence of breast cancer in the long term. Treatment plan to achieve good outcome is affected by the biology of breast cancer. Breast Therapy includes Mastectomy, Breast-sparing surgery, and Radiation therapy, Chemotherapy, Stereotactic Radiosurgery, Hormone Therapy and Targeted Therapy.

If the breast cancer detection and treatment done at early stage it increase the survival rate. Life after breast cancer treatment gets changed like returning to some familiar things and new choices to make. After the last steps of treatment like radiation or diagnostic procedure is not the end of fighting against breast cancer. Instead person has to take care of lots of things like eating habits and exercise. Person has to eat which will help to prevent the recurrence of breast cancer. It also affects the sex life as well. Person will observe hair growth started again. Physical energy and functioning can also be getting affected after the breast cancer treatment. Level of oestrogen may also get lowered after the treatment which leads to the decrease in bone density. Bone density can be increased as well recurrence of breast cancer can be prevented with the help of exercise. Oncology rehabilitation helps to build strength as well as to overcome the physical defects. During oncology rehabilitation physical functioning as well as sense of well-being can be improved.