Breast Cancer: Causes, Risk Factors, Symptoms, Types, & Treatment
Breast Cancer Introduction
Cancer is a disease that can affect any person – whether they are a child, a teenager, an adult or a senior citizen.
It is an invasive disease that has led to the death of millions.
Even today, the diagnosis of cancer remains relatively high, and the current treatment measures that are available to treat these cancers are not always effective enough to treat cancer that has advanced or spread to other parts of the body.
Table of Contents [Show]
- An Overview of The Breasts
- An Overview of Breast Cancer
- Types of Breast Cancer
- Noninvasive Breast Cancer
- Invasive Breast Cancer
- Inflammatory Breast Cancer
- Paget Disease
- Triple Negative Breast Cancer
- Metaplastic Breast Cancer
- Metastatic Breast Cancer
- Breast Cancer In Women Versus Breast Cancer In Men
- Outlook For Patients Diagnosed With Breast Cancer
- Signs and the Most Common Symptoms of Breast Cancer
- Breast Cancer Causes And Risk Factors
- Breast Cancer Diagnosis
- Breast Cancer Treatment
- Breast Cancer Awareness Month
There are, however, many people that have conquered their battle against cancer and are living normal lives today.
Cancer is not a single disease, but rather a group of diseases.
More than 200 different cancers have been identified by medical experts and these all affect different parts of the human body.
Apart from their location, cancers are also categorized based on their structure, advancement, and, of course, on the rate at which the cancer is growing and possibly spreading throughout an affected patient’s body.
Some cancers are more common than others.
There are also certain cancers that account for less than 1% of all diagnosed cases – in such a case, the cancer is classified as extremely rare.
Certain cancers are also more dangerous than others, while some are considerably easy to treat and have a high survival rate.
Today, we would like to focus on cancer that is classified amongst the more common types of these diseases – breast cancer.
Breast cancer is also one of those that can develop in any person and, even though it is more commonly found in and associated with women, some men also tend to develop cancer in their breast tissue.
We would like to focus on all factors related to breast cancer.
We are going to start by discussing how the breasts are the structure, as well as how cancer forms in the breasts.
We will also be looking at the symptoms that a patient should look out for, how breast cancer can be prevented, how doctors diagnosed this type of cancer, and, of course, what type of treatments a patient can expect to undergo should they be diagnosed with breast cancer.
Finally, we are also going to discuss breast cancer awareness month and tell you how you can become involved in this movement for patients who are battling against this commonly diagnosed cancer.
An Overview of the Breasts
Prior to discussing breast cancer and all factors related to this cancer, we should really start out by discussing the anatomy of the breasts.
By knowing how the breasts are structured, it will be considerably easier to know how to identify the possibility of a tumor, and it will be easier to understand how tumors develop in the breasts.
Firstly, it is important to state that the breasts of the male and female bodies are structured in similar ways, even though they appear significantly different.
According to John Hopkins Medicine, the factor that causes the difference that can be observed between the breasts of a man and the breasts of a woman are the fact that a man’s breasts do not contain developed lobules like a woman’s breasts.
Note that some men do not have any lobules contained within their breast tissue.
Lobules are the components that are responsible for producing milk in the female body, which is then used to breastfeed a baby.
They also report that the breasts are often categorized as an organ due to their particular function – which is for lactation.
It is already common knowledge that the breasts are located in the chest and rib area, above the pectoralis muscle.
Each breast expands from the sternum, which is a term used to describe the flat bone found in the middle of a patient’s chest, towards the midaxillary line, which is a term used to describe the underarm, which is also often called the axilla.
Some breast tissue also flows into this particular area, which is why some types of cancers may be diagnosed with breast cancer even if it seems like the tumor is not contained within the breast itself.
As we have already discussed in this section, the breast usually contains lobules, which are the particular part of the breast that is responsible for the production of milk.
Attached to these lobules is a series of ducts.
These ducts are responsible for transporting milk that has been produced by the lobules towards the nipples, where it can be excreted when a woman is breastfeeding a baby.
There are also lymphatic vessels and blood vessels inside the breast.
These vessels, along with the lobules and ducts, are covered with a type of fatty tissue known as the stroma.
Muscles are also present in the breasts, which is responsible for making the nipple enter an “erect” state when a woman is breastfeeding a child.
This “erect” state can also be achieved through stimulation.
In addition to the muscle tissue found in the region where the nipple is located, there is also muscle tissue that surrounds the lobules in the breasts.
This particular type of muscle tissue assists with squeezing milk from the lobules to the ducts, where it is then transferred towards the nipple.
An Overview of Breast Cancer
You should now have a better understanding of how the breasts are structure and know how they function.
The overview we provided about the breast is an important step to take if you want to thoroughly understand how breast cancer works.
Now, let’s move on to a quick overview of breast cancer.
Hereafter, we will look at more specific details about every aspect of breast cancer, including where these tumors most often develop and more.
Breast cancer essentially works the same way as other types of cancer, like lung cancer, stomach cancer or brain cancer.
A tumor starts to form when cells that are contained within the breast start to grow uncontrollably.
In addition to grow larger than they should, these cells often also tend to multiply at a relatively fast rate; thus adding more cells that continue to grow at an out-of-control rate.
The accumulation of these cells then forms a lump, which is classified as a tumor.
While it may be unpleasant and quite worrisome for a patient to identify a lump in their own breasts, or even in the breast of a loved one, it is important to know that not all lumps are life-threatening.
While breast cancer, which involves the development of a tumor that contains cancerous cells, is a more common kind of cancer, the majority of lumps that are found in the breasts of both men and women often turn out to be benign tumors.
Benign tumors are growths that develop in the breast tissue that does not invade the tissue it surrounds.
These tumors often have a “lining”, while a cancerous tumor does not have such a lining, which causes the cancerous cells to invade the “healthy” cells in the surrounding area – this also gives the cancerous tumor opportunity not only to grow but also to spread to other areas.
A non-cancerous tumor, or a benign tumor, does not spread to other parts of the body, the cells of such a tumor do not enter the lymph system in the breasts, and they grow at a significantly slower rate, especially when compared to a cancerous, or malignant, tumor.
Types Of Breast Cancer
Apart from understanding the structure of the breast and breast cancer in general, we also need to discuss the most common locations where tumors often form in the breasts, as well as the particular types of cancer that can develop in the breasts.
This will offer the patient valuable education and help them determine where they should often examine to identify the possibility of a developing tumor.
As with any other type of cancer, the earlier breast cancer is detected, the more successful the treatment can be; thus early detection can eventually lead to a saved life.
To thoroughly discuss the locations of breast tumors, we really need to consider the different types of breast cancers that have been identified by medical doctors.
Each type of breast cancer affects a different area of the breast, which is why it is such an important feat to be acknowledged with these terms.
When a patient is diagnosed with a type of breast cancer and understands these terms, they will also be able to understand better their particular condition, where their cancer is located and the severity of their particular condition.
The Canadian Cancer Society reports that breast cancer is often divided into four main categories, each with its own set of characteristics that help a doctor or specialists identify the particular type of breast cancer that affects a patient that is being examined.
These four primary categories of breast cancer include noninvasive breast cancer, invasive breast cancer, Paget’s disease, and inflammatory breast cancer.
In addition to these four main types, another term that can also be used to diagnose a very specific kind of cancer in the breast is “triple-negative breast cancer”.
An extremely rare type of breast cancer has also been detected in some patients and is known as metaplastic breast cancer.
Let’s discuss each of these categories separately and take a look at where tumors are most often located when a patient is diagnosed with a particular type of breast cancer.
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Noninvasive Breast Cancer
Since noninvasive breast cancer is the most common kind of breast cancer, we should start out with this particular type.
Some medical reports or medical professionals may also refer to noninvasive breast cancer as in situ breast cancer.
Noninvasive breast cancer refers to a tumor that has formed in the lobules of the breast tissue.
This type of tumor can also develop in the ducts that carry the milk that the lobules produce towards the nipples.
Note that noninvasive breast cancer can be divided into two different types:
Ductal Carcinoma In Situ – Ductal carcinoma in situ is not only known as the most common kind of in situ breast cancer but is generally the most commonly diagnosed form of breast cancer.
It is often abbreviated as DCIS.
This type of cancer is diagnosed when the cancerous cells that have formed are only found in the lining of the ducts that are connected to the lobules and the nipples.
When a patient is diagnosed with this type of breast cancer, it also means the cancerous cells have not spread into breast tissue through the walls of the particular ducts that have been affected by cancer.
This is good news as cancer that doesn’t spread towards other breast tissue can also not enter the lymph nodes that are found in the breasts, which means the cancer is not likely to spread throughout the body and affect other parts of the patient’s body.
This is also the particular type of breast cancer that has the highest success rates.
Note that in situ does not cause any symptoms to develop and there is usually no lump that can be felt when the breast is physically examined.
This is why frequent checkups with a mammogram are often recommended to women like this type of scan can identify ductal carcinoma in situ.
Lobular Carcinoma In Situ – Lobular carcinoma in situ is also a non-invasive type of breast cancer.
It is in some ways similar to the other type of noninvasive breast cancer.
While ductal carcinoma in situ develops in the duct’s lining of the breasts, lobular carcinoma in situ develops in the lobules – the parts of the breast tissue that is responsible for the production of milk.
This type of breast cancer is not considered life-threatening cancer, and in many cases, it is not even considered a real type of cancer.
This is mostly due to the fact that this particular cancer is diagnosed when an abnormality is detected in cells that are present in the lobules of the patient’s breasts, but the changes do not necessarily cause a tumor to form and do not necessarily exhibit the same behavior of cancerous cells.
Even though not considered life-threatening, patients should be advised that being diagnosed with lobular carcinoma in situ increases their risk of developing a more invasive type of breast cancer later in life.
In most cases, lobular carcinoma in situ can only be diagnosed after a biopsy has been taken from the breast to analyze other particular changes that were noticed during a scan or physical examination.
Invasive Breast Cancer
Invasive breast cancer is considered as a significantly more life-threatening type of cancer that can spread towards other parts of breast tissue and also affect other parts of the body, apart from the breasts.
Breast cancer is diagnosed as invasive when the abnormal cells that are found in the lobules or ducts break through these linings or “walls” and invade other parts of the breast.
When these cells break through the ducts or lobules, they can also enter the lymphatic vessels and blood vessels, and spread throughout the body.
Similar to noninvasive breast cancer, invasive breast cancer is also divided into two different types, each based on the initial part of the breast tissue that was affected by the abnormal cells.
These two different types of invasive breast cancer include:
- Invasive Ductal Carcinoma – In some cases, this particular type of breast cancer is also named infiltrating ductal carcinoma. Similar to ductal carcinoma in situ, this particular type of breast cancer also starts in the ducts of the breast tissue. Unlike ductal carcinoma in situ, however, this type of breast cancer is more invasive and spreads to other parts of breast tissue by breaking through the walls of these ducts. Invasive ductal carcinoma is the most prevalent type of invasive breast cancer.
- Invasive Lobular Carcinoma – This type of invasive breast cancer is quite similar to lobular carcinoma in situ in the fact that it starts to develop in the lobules of the breast tissue. Like the name suggests, however, this particular type of breast cancer breaks through the walls of the lobules and spreads to other parts of the breast.
Inflammatory Breast Cancer
Inflammatory breast cancer is technically also classified as an invasive type of breast cancer but is often placed into its own category due to the particular characteristics that this cancer has.
This type of breast cancer is less common than the other types we have discussed thus far in this report. According to the BreastCancer.Org, accounts for approximately 1% of all diagnosed cases of breast cancer.
It is also important to note that inflammatory breast cancer is much more aggressive than the other types of invasive breast cancers we have discussed, including both invasive ductal carcinoma and invasive lobular carcinoma.
In some cases, this particular type of cancer may become worse within as little as just a few hours.
While most breast cancers can be detected by feeling a lump in the breast, this type of cancer rather causes inflammation, as the name suggests, within the breast’s tissue.
Redness is also another common symptom that is caused by inflammatory breast cancer.
While the name might make it sound like a particular type of disease, Paget disease is a very rare kind of breast cancer that most often affects the nipples.
It is important to not confuse this particular type of breast cancer with the other type of Paget disease that affects the bones.
This is why you will often see medical reports refer to this type of cancer as “Paget Disease of the Breast” or, more commonly, as “Paget Disease of the Nipple” since it primarily affects the nipple or nipples.
This particular type of breast cancer can affect the nipple, as well as the areola, which refers to the darker skin that surrounds the nipple.
The National Cancer Institute in the United States reports that, in the majority of cases where a patient is diagnosed with Paget disease, an accommodating cancer type are often also found in the breast tissue.
In many cases, physicians will find that the patient also has ductal carcinoma in situ tumor, but there are some patients that are also diagnosed with an invasive type of breast cancer when a physician finds that they have developed Paget disease.
Triple Negative Breast Cancer
During the diagnosis of a tumor in breast tissue, tests are performed to determine the particular receptors that are responsible for the growth of the tumor.
These tests are performed to see whether progesterone, the HER-2/neu gene or estrogen are causing tumor growth.
When all three of these tests come back with negative results, the cancer is diagnosed as triple-negative breast cancer.
The National Breast Cancer Foundation reports that up to 20% of breast cancer patients are diagnosed with triple-negative breast cancer.
When this type of breast cancer is diagnosed at an early stage, it can sometimes be treated more effectively than other types of cancers that affect the breasts.
Unfortunately, in many cases, cancer that is diagnosed as triple-negative is hard to treat successfully and also poses as an aggressive type of cancer.
Medical professionals have also found that triple-negative breast cancer is more likely to return after successful treatment, and this type of cancer is also more likely to spread when compared to breast cancers that are not diagnosed as triple-negative.
Metaplastic Breast Cancer
Apart from the types of breast cancer we have discussed thus far, we also need to mention another type of breast cancer that is extremely rare, harder to diagnose, and often larger than other types of breast cancer.
We are referring to a condition known as metaplastic breast cancer.
Metaplastic breast cancer affects less than 1% of all patients that have been diagnosed with breast cancer. Breast Cancer Care UK reports that metaplastic breast cancer is considered invasive and often spreads to the breast tissue surrounding the initial site of development.
This cancer type also has the potential to spread to other sites in the patient’s body through the bloodstream.
The reason it is often difficult to accurately diagnose this cancer is due to the fact that the cancerous cells tend to transform into different types of cells.
Note that this cancer type can be diagnosed as either mixed epithelial or purely epithelial.
Metastatic Breast Cancer
Finally, we also need to discuss metastatic breast cancer, a particular type of cancer that can be significantly more life-threatening that other types of breast cancer.
It is important that patients understand that metastatic breast cancer does not refer to a particular type of breast cancer, such as the ones we have discussed in this section, but is rather a term used to describe breast cancer that has spread to parts of the body other than the breasts.
When breast cancer reaches this point, it is diagnosed as advanced breast cancer. In some cases, it may also be referred to as stage IV breast cancer.
The National Breast Cancer Foundation reports that breast cancer often spreads to the bones, brain, liver, and lungs, but may also spread to other parts of the patient’s body.
Breast Cancer In Women Versus Breast Cancer In Men
As we have already noted, there is a common associated between women and breast cancer.
If you search for information about breast cancer on the internet, then you’ll notice that all of the top results only talk about breast cancer in women.
Even the majority of breast cancer associations solely focuses on bringing about awareness for women that have been diagnosed with breast cancer.
Yes, women are much more likely to be diagnosed with breast cancer due to the fact that several cells and parts of their breasts develop more thoroughly than a man’s, but this does not mean that women are the only patients that can develop this type of cancer.
There are also some men that have developed breast cancer in the past and this type of cancer still poses a risk to both women and men.
Breast cancer reports that at least 12% of all women will be diagnosed with an invasive type of breast cancer at some point in their lives.
According to the National Breast Cancer Foundation in the United States, approximately one in every 1000 men will ever be diagnosed with breast cancer – this accounts for around 0.1% of all men – or even less.
The 11.9% difference in the prevalence of breast cancer when men and women are compared is the primary influencing factor that causes organizations, foundations, and awareness events to mostly focus on raising awareness for breast cancer amongst women.
It is also important to state that the prevalence of breast cancer has been decreasing steadily over the past few years.
Between the 1980s and the year 2000, a worrisome increase was observed when medical experts inspected the diagnostic rates of this cancer amongst patients.
By the year 2000, however, medical experts noted that the diagnostic rates started to decrease, fortunately.
It is expected that this decrease was most likely due to a reduction in the utilization of hormone replacement therapy amongst women.
This decrease in HRT treatments among women was observed after a particular study, conducted by the Women’s Health Initiative, linked hormone replacement therapy in women to an increased risk of breast cancer – the results were published in numerous publications in 2002.
One year after this publication, the prevalence of breast cancer diagnosis was reduced by 7% in just 12 months.
Outlook For Patients Diagnosed With Breast Cancer
Patients that have been diagnosed with breast cancer often wonder what their outlook will be.
The prognosis of breast cancer is not specific and really depends on a variety of factors, such as whether the cancer is invasive or noninvasive, how advanced the cancer is, and whether or not it has spread to surrounding tissues or other parts of the patient’s body.
There are some statistics that are helpful for determining the average outcome of certain breast cancers.
Note that survival rates are usually given for a five-year rate following the initial diagnosis of breast cancer and, even though the survival rate of certain types of this cancer may seem low, it does not, in any way, mean that a particular patient will not be able to survive their battle against breast cancer.
The American Cancer Society reports that almost all patients that are diagnosed with stage zero or stage one breast cancer are able to survive for at least the first five years after their initial diagnosis.
The five-year survival rate reduces to approximately 93% amongst patients that are diagnosed with stage two breast cancer and the five-year survival rate for patients with stage three breast cancer is 72%.
More advanced types of breast cancers do have a significantly lower survival rate; thus the outlook for many patients may be unpleasant.
When breast cancer has spread, which means the patient has been diagnosed with metastatic breast cancer, the five-year survival rate is 22%.
Even though the survival rate may drop as the stage of breast cancer advances, it is still important to consider the fact that many patients have been successfully treated for their breast cancer, even when cancer has started to spread.
The key to successful treatment is recognizing the symptoms and acting upon those symptoms appropriately and quickly.
Signs and the Most Common Symptoms of Breast Cancer
When breast cancer is detected and diagnosed at an early stage, it can be treated with a high success rate.
Thus, patients – especially women – are advised to educate themselves about the potential signs and symptoms that may indicate the development of tumors to ensure the development of breast cancer, should it be present, can be detected before cancer becomes invasive and aggressive, or starts to spread throughout their body.
According to the American Cancer Society, the most important step a woman can take is to acknowledge themselves with the normal appearance of their look, as well as to thoroughly study how their breasts feel.
When changes in the appearance or feeling of their breast can be noticed, then an appointment with a professional healthcare provider should be made to investigate the changes.
When a tumor develops in the breast tissue, the most obvious symptom is most often a lump that can be noticed in the breasts.
In some cases, a woman may be able to see the lump when they look at their breasts.
Sometimes, however, the lump cannot be seen at the surface level of the breast but can be felt when the breast is examined.
Note that lumps that are hard and do not cause any pain are most often the ones that contain cancerous cells.
Cancerous tumors also usually have edges that are not smooth or round. There are some tumors that can cause pain.
A lump is not the only symptom that may be experienced when breast cancer is developing.
In addition to a lump, inflammation may also be experienced in the affected breast.
In some cases, the breast may be inflamed without the appearance of a lump.
This can still be caused by cancer; thus a visit to a healthcare provider is essential.
Furthermore, some women experience pain in their nipples and breasts, as well as a retracting nipple.
The skin of the breast may also become thicker and red.
In some cases, discharge that does not look like breast milk may also be present.
Furthermore, some patients have also reported that the skin of their breasts is somewhat irritated.
Since breast cancer can spread, it is also important to look out for symptoms that may accompany the primary symptoms in the breast.
This type of cancer most often spreads through lymph nodes, which means, should the cancer spread, symptoms, such as inflammation and a lump, may also be experienced in the area where the collar bone is located, as well as under the patient’s arm.
There are some cases where these symptoms of metastatic breast cancer are experienced prior to the initial tumor in the breast becoming obvious to the touch or sight.
Breast Cancer Causes And Risk Factors
Breast cancer does not have a specific cause. There is quite a lot of research being conducted on the development of breast cancer, but, at the moment, only a series of risk factors that contributes to the development of a cancerous tumor in the breast is available to help patients understand when they are at a higher risk of developing this particular type of cancer.
The most obvious risk factor is being of the female gender, of course. While breast cancer affects about 12% of all women, it affects less than 0.1% of all men.
Thus, if a patient is a woman, they should automatically be more aware of their breasts and obtain regular checkups to ensure lumps are not developing in their breast tissue and, should any lumps develop, to take care of the problem before it grows into a metastatic breast tumor.
NHS Choices report that women who have gone through menopause are at a much higher risk than women who are not yet at that point in their lives.
They continue to report that as much as 80% of all breast cancer diagnoses occur in women who have reached the age of 50.
Furthermore, women who have family members who were diagnosed with ovarian cancer or breast cancer in the past also seem to be at a higher risk of developing this type of cancer themselves.
Even though breast cancer is often not related to genetics, it has been found that containing the particular genes BRCA1 and BRCA2 does have a significant impact on a woman’s risk of developing a tumor in their breast tissue.
Apart from the already-mentioned risk factors, the following also seems to play a part in contributing to a higher risk of developing breast cancer:
- Excessive alcohol use.
- Having a body mass index that exceeds 25. In other words, being either overweight or obese.
- Having a high breast density.
- The use of hormone replacement therapy, including oestrogen-only hormone replacement therapy and combined hormone replacement therapy.
- Using a contraceptive drug.
- Prior exposure to X-rays, CT scans and other types of radiation.
Breast Cancer Diagnosis
When a lump is detected in the breast of a patient, the first step is to identify what the lump is. In some cases, it may be benign and not considered a life-threatening condition.
Even though the majority of lumps seem to be benign, it is still important to get any lumps examined to ensure they do not contain cancerous cells.
Mammograms are one of the most effective ways of detecting lumps.
This is why women should obtain regular mammograms to check for any changes in the cellular function and structure in their breast tissue.
Apart from mammograms, other types of scans, including breast imaging, MRI scans, and ultrasound scans can also be used.
These scans cannot provide accurate data on the particular type of tumor that has been detected; thus a biopsy will be needed, should a lump be detected during these scans.
During a biopsy, a piece of tissue is removed from the tumor and sent for examination.
A biopsy is the only method for determining whether a particular lump is benign or malignant.
Breast Cancer Treatment
Once breast cancer has been diagnosed, an appropriate treatment plan needs to be compiled by the patient’s healthcare provider.
The particular treatment options that will be utilized to treat breast cancer depend on the patient’s current wellbeing, as well as numerous aspects of the tumor that has been found.
The stage of breast cancer has quite a significant impact on the treatment options that can be utilized to treat the patient’s condition.
According to the Cancer Treatment Centers of America, stage zero breast cancer rarely requires treatment as it is often considered a precancerous condition. Still, in some cases, treatment may be administered.
A treatment provided to patients with breast cancer in this stage is usually successful.
The American Cancer Society reports that cancer that is diagnosed as stage one to three are most often treated through radiation therapy and, in some cases, surgery may also be used to remove the tumor.
When cancer has advanced to stage four, however, systemic therapies are usually provided to the patient due to the fact that cancer has spread.
Patients diagnosed with inflammatory breast cancer may receive a combination of treatment measures, depending on the stage of their condition.
In many cases, chemotherapy, radiation therapy, and surgery are combined for the best results.
When breast cancer returns after successful treatment, other treatment measures may be executed to avoid a further recurrence of breast cancer.
Breast Cancer Awareness Month
Breast cancer affects a lot of women and the condition can be unpleasant and devastating on the affected patient’s life.
While the survival rates of breast cancer are relatively high, quite a large number of women had to go through invasive surgeries where pieces of their breast had to be removed to effectively get rid of the tumor that developed in their breast.
Every year, an entire month is dedicated to these women that are going through tough times battling against breast cancer, as well as to remember those that were not able to survive their struggle.
This month has been dubbed Breast Cancer Awareness Month and millions of people are participating in these events every year to show their support.
There are events being held in every country; thus we encourage patients – those with breast cancer, those who know someone with breast cancer, and even those who simply want to show their support – to look up local events and to participate.
Remember that every person who participates in these events to make a real change when it comes to effectively treating breast cancer as the funds that are being raised at these events often go towards further research into methods that can be used to successfully treat breast cancer, as well as charities that have been founded for women who are struggling with breast cancer.
Breast cancer is one of the most common cancer types in women and can be devastating when it has advanced to a stage where a part of the breast has to be removed through surgery.
Therefore, being acknowledged about the particular symptoms that may be caused by breast cancer is an important step for women to take in order to detect breast cancer at an early stage, which may lead to a more successful treatment.
Being aware of their own breasts is another important step women need to take to ensure they are able to detect any noticeable changes that may point out the development of a tumor.
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