Breast cancer is a disease that arises when cells in one or both breasts grow uncontrollably. As these cells divide more rapidly than they should, they can accumulate into a tumor.

Breast cancer can begin in any of the three main parts of the breast:

The lobules (glands that produce milk)
The ducts (tubes that transport milk to the nipple)
The connective tissue that surrounds them
According to the World Health Organization, about 85% of breast cancers start in the cells lining the ducts and 15% begin in the cells lining the lobules.3 At stage 0, the beginning of breast cancer, the disease is usually symptomless and contained within the lobule or duct. Breast cancer may then invade nearby breast tissue, lymph nodes, and then other organs. This spreading, or metastasis, can make breast cancer fatal.

When breast cancer is diagnosed early, treatment options like surgery, radiation, chemotherapy, and hormonal therapy can help reduce the risk of death.

Prevalence of Breast Cancer

Breast cancer is the second most common cancer among people assigned female at birth in the United States. Each year, it’s responsible for nearly 30% of all cancers among this demographic.

The American Cancer Society estimates that there are about 287,850 new cases of invasive breast cancer and around 51,400 cases of ductal carcinoma in situ (DCIS) annually among those assigned female at birth. The disease tends to be more prevalent among people who are middle-aged and older. The median age of diagnosis is 62.

Tragically, breast cancer is a leading cause of cancer death among people assigned female at birth, killing approximately 43,250 each year.

Overall, the incidence of breast cancers has grown by .5% per year in recent years. However, the death rate has declined: 43% through 2020. Experts attribute this change to early detection, awareness campaigns, and treatment improvements. Now, there are more than 3.8 million breast cancer survivors in the United States.

Causes and Risk Factors

What Causes Breast Cancer?
Scientists still do not fully understand the causes of breast cancer. Research has shown that certain risk factors increase the likelihood of developing breast cancer. And while gene mutations can cause healthy breast cells to become cancerous, many of those gene changes have not yet been pinpointed by researchers.

Breast Cancer and Genetics
Genes influence how cells work.The proto-oncogenes contained by normal cells regulate cell growth, and genes called tumor-suppressor genes, which determine how often cells divide. If proto-oncogenes or tumor suppressor genes mutate, cells can become cancerous.

Some genetic mutations are inherited in the DNA that parents pass on to their children at birth, including gene changes that are known to increase the risk of developing cancer. Notably, mutations in the BRCA tumor-suppressor genes can be inherited. Yet only around 10% of breast cancer diagnoses are linked to known inherited gene abnormalities. Other cases may develop from still unknown hereditary mutations. About 90% of breast cancers are thought to arise from unidentified acquired gene changes that happen after birth, stemming from factors like radiation, exposure to cancer-causing chemicals, or random cellular changes.

Breast Cancer Risk Factors

Certain hormonal, environmental, and lifestyle factors may increase the risk for breast cancer, including6:

Aging
Menstrual cycle history
Reproductive history
Dense breasts
Personal and family history
Previous radiation therapy
Diethylstilbestrol (DES) usage
Inactive lifestyle and obesity
Hormones
Drinking alcohol and smoking
Male Breast Cancer
Breast cancer in people assigned male at birth can also occur, but it’s much less common than it is for those assigned female at birth.3 Before puberty, all children have some breast tissue, including a few ducts under their nipples.7 At puberty, estrogen causes ducts to grow and lobules to form.7,8 When levels of these hormones are low, the breast tissue typically doesn’t grow much. And while people assigned male at birth still have breast ducts, they have few, if any, lobules.

How Common Is Male Breast Cancer?

Roughly 1% of all breast cancers occur in people assigned male at birth.3 In 2022, experts expect the U.S. to see 2,710 new diagnoses of invasive breast cancer and 530 deaths from the disease in this demographic.

Male Breast Cancer Causes and Risk Factors
Researchers don’t fully understand what causes male breast cancer, but several known risk factors include:1

Aging
Family history
Klinefelter syndrome
Radiation therapy
Alcohol and liver disease
Estrogen therapy
Obesity
Testicular conditions
Male breast cancer treatment is similar to other breast cancer treatments, but researchers are currently exploring whether different therapies would elicit a better response.

Breast Cancer Prevention

Exercising regularly, maintaining a healthy weight, moderating alcohol consumption, and breastfeeding your children, if possible, are some ways to reduce the risk of breast cancer.

Having risk factors does not mean that breast cancer will develop. Some people with several risk factors never develop breast cancer, while others with no known risk factors get the disease. Discussing one’s individual health with a healthcare provider can help with understanding personal risks.

Breast Cancer Types

Most breast cancers begin in the cells lining the milk ducts or lobules.13 There are other types of cancer that can be found in the breast, but they are rare. This includes:

Sarcomas, which can begin in the connective breast tissue cells.14 Sarcomas account for less than 1% of breast cancers.
Angiosarcomas, which begin in cells that line blood vessels or lymph vessels and can involve breast tissue or skin.
Paget’s disease of the breast, which starts in the breast ducts and spreads to the skin of the nipple (accounting for 1% to 3% of breast cancers).

Phyllodes tumor of the breast, which is usually a benign growth in the connective tissue of the breast. It can sometimes be cancerous. Phyllodes tumors of the breast are rare.
Breast Cancer Hormone Receptors and HER2 Status
HER2-positive (HER2+)
Triple-negative breast cancer
“In Situ” vs Invasive Breast Cancer
Breast Cancer Stages
In addition to identifying the type of breast cancer a patient has, doctors will classify the cancer’s stage. This helps to determine treatment and the prognosis for survival.

Breast cancers are classified from stage 0 through stage 4, based on these characteristics:

The size of the tumor
Whether or not lymph nodes have cancer cells in them and how many lymph nodes are involved.
Whether it has involved the tissue of the chest wall outside of the breast
Whether the cancer has spread to organs distant from the breast (metastasized)
ER, PR, and HER2 status
Grade of differentiation of the cancer cells, based on how much they look like normal cells

Metastatic Breast Cancer

In 2017, researchers projected that more than 150,000 people with XX chromosomes in the U.S. would have metastatic breast cancer.23 Otherwise known as stage 4 breast cancer, metastatic cancer is cancer that has reached other parts of the body, such as the liver,brain lungs or bones.

Metastatic disease can arise as “distant recurrence” months or years after initial diagnosis at an earlier stage.

Initial diagnoses of metastatic breast cancer are called de novo metastatic breast cancer. This designation indicates that the cancer has already reached other parts of the body by the time it is first detected.

Metastatic breast cancer is incurable. But some treatments may prolong life, alleviate symptoms, reduce tumor size, or slow tumor growth. Patients will often continue a specific treatment if it controls the cancer and if side effects are manageable. If the treatment stops working or the patient can no longer tolerate specific treatments, patients may try other treatment options.

Breast Cancer Symptoms

While experts highlight the benefits of regular breast cancer screening, they also caution that mammograms don’t always find every instance of breast cancer.26 It’s important to know how your breasts normally look and feel so you can spot early signs of breast cancer.

A new lump or mass is the most common presentation that a person can detect. Although cancerous masses are typically painless and hard with irregular edges, they can also be tender (or even painful) with soft or rounded edges. Thus, any new lump should be checked by an experienced health care provider.

Other breast cancer symptoms might include:

Swelling or any change in the size or shape of the breast
Swollen or tender lymph nodes under the arm or around the collar bone
Skin dimpling on the breast (possibly resembling an orange peel)
Pain or tenderness in the breast or nipple
Nipple retraction (inverting inward)
Red, dry, flaky, or thickened skin on the nipple or breast skin
Nipple discharge other than breast milk
Many of these symptoms can be caused by other conditions, but they should be reported to healthcare professionals for evaluation.26

Breast Cancer Treatment

After diagnosing patients with breast cancer, doctors will explain options and work with patients to create treatment plans specific to their types of cancer and goals of treatment.21,22 Some breast cancer treatment can be highly effective, with a survival rate of 90% or higher if the disease is discovered early.

Treatment options typically differ depending on whether breast cancer is detected early, or whether it has reached metastatic stage.

Early-Stage Breast Cancer Treatment
Neoadjuvant Treatment
Surgery
Radiation
Chemotherapy
Endocrine therapy
Targeted therapy
Targeted therapy for HER2-positive breast cancer
Targeted therapy for hormone receptor-positive breast cancer
Targeted therapy for BRCA gene mutations
Targeted therapy for triple-negative breast cancer
Immunotherapy for breast cancer
Metastatic Breast Cancer Treatment
Global Impact of Breast Cancer
Global Impact of Breast Cancer
At the close of 2020, an estimated 7.8 million people remained alive following a breast-cancer diagnosis within the past 5 years, according to the World Health Organization.3 In 2020, 2.3 million people worldwide were diagnosed with breast cancer, and 685,000 lost their lives to the disease.

Innovations in breast cancer research have contributed to a five-year survival rate for cancer that is detected early to more than 90% in high-income countries. But the rate dips in other countries. In India and South Africa, the survival rates are 66% and 40%, respectively.

Not only is the disease a burden on breast cancer patients and their families, but there’s also a high global economic cost for cancer in general—including healthcare spending and productivity losses.

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