Grace Starr
Breast Cancer: Treatments and Prevention.
Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is called ductal carcinoma.The vast majority of breast cancer cases occur in females. This article focuses on breast cancer in women. We also have an article about male breast cancer.
Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.
Breast cancer rates are much higher in developed nations compared to developing ones. There are several reasons for this, with possibly life-expectancy being one of the key factors - breast cancer is more common in elderly women; women in the richest countries live much longer than those in the poorest nations. The different lifestyles and eating habits of females in rich and poor countries are also contributory factors, experts believe.
According to the National Cancer Institute, 232,340 female breast cancers and 2,240 male breast cancers are reported in the USA each year, as well as about 39,620 deaths caused by the disease.
Causes of breast cancer
Experts are not definitively sure what causes breast cancer. It is hard to say why one person develops the disease while another does not. We know that some risk factors can impact on a woman's likelihood of developing breast cancer. These are:
1) Getting older
The older a woman gets, the higher is her risk of developing breast cancer; age is a risk factor. Over 80% of all female breast cancers occur among women aged 50+ years (after the menopause).
2) Genetics
Women who have a close relative who has/had breast or ovarian cancer are more likely to develop breast cancer. If two close family members develop the disease, it does not necessarily mean they shared the genes that make them more vulnerable, because breast cancer is a relatively common cancer.
The majority of breast cancers are not hereditary.
Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast and/or ovarian cancer. These genes can be inherited. TP53, another gene, is also linked to greater breast cancer risk.
3) A history of breast cancer
Women who have had breast cancer, even non-invasive cancer, are more likely to develop the disease again, compared to women who have no history of the disease.
4) Having had certain types of breast lumps
Women who have had some types of benign (non-cancerous) breast lumps are more likely to develop cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.
5) Dense breast tissue
Women with more dense breast tissue have a greater chance of developing breast cancer.
6) Estrogen exposure
Women who started having periods earlier or entered menopause later than usual have a higher risk of developing breast cancer. This is because their bodies have been exposed to estrogen for longer. Estrogen exposure begins when periods start, and drops dramatically during the menopause.
7) Obesity
Post-menopausal obese and overweight women may have a higher risk of developing breast cancer. Experts say that there are higher levels of estrogen in obese menopausal women, which may be the cause of the higher risk.
8) Height
Taller-than-average women have a slightly greater likelihood of developing breast cancer than shorter-than-average women. Experts are not sure why.
9) Alcohol consumption
The more alcohol a woman regularly drinks, the higher her risk of developing breast cancer is. The Mayo Clinic says that if a woman wants to drink, she should not exceed one alcoholic beverage per day.
10) Radiation exposure
Undergoing X-rays and CT scans may raise a woman's risk of developing breast cancer slightly. Scientists at the Memorial Sloan-Kettering Cancer Center found that women who had been treated with radiation to the chest for a childhood cancer have a higher risk of developing breast cancer.
11) HRT (hormone replacement therapy)
Both forms, combined and estrogen-only HRT therapies may increase a woman's risk of developing breast cancer slightly. Combined HRT causes a higher risk.
12) Certain jobs
French researchers found that women who worked at night prior to a first pregnancy had a higher risk of eventually developing breast cancer.
Canadian researchers found that certain jobs, especially those that bring the human body into contact with possible carcinogens and endocrine disruptors are linked to a higher risk of developing breast cancer. Examples include bar/gambling, automotive plastics manufacturing, metal-working, food canning and agriculture. They reported their findings in the November 2012 issue of Environmental Health.
Cosmetic implants may undermine breast cancer survival
Women who have cosmetic breast implants and develop breast cancer may have a higher risk of dying prematurely form the disease compared to other females, researchers from Canada reported in the BMJ (British Medical Journal) (May 2013 issue).
The team looked at twelve peer-reviewed articles on observational studies which had been carried out in Europe, the USA and Canada.
Experts had long-wondered whether cosmetic breast implants might make it harder to spot malignancy at an early stage, because they produce shadows on mammograms.
In this latest study, the authors found that a woman with a cosmetic breast implant has a 25% higher risk of being diagnosed with breast cancer when the disease has already advanced, compared to those with no implants.
Women with cosmetic breast implants who are diagnosed with breast cancer have a 38% higher risk of death from the disease, compared to other patients diagnosed with the same disease who have no implants, the researchers wrote.
After warning that there were some limitations in the twelve studies they looked at, the authors concluded "Further investigations are warranted into the long term effects of cosmetic breast implants on the detection and prognosis of breast cancer, adjusting for potential cofounders."
Diagnosing breast cancer
Women are usually diagnosed with breast cancer after a routine breast cancer screening, or after detecting certain signs and symptoms and seeing their doctor about them.
Below are examples of diagnostic tests and procedures for breast cancer:
1) Breast exam: The physician will check both the patient's breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape. The patient will be asked to sit/stand with her arms in different positions, such as above her head and by her sides.
2) X-ray (mammogram): Commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.
Breast cancer screening has become a controversial subject over the last few years. Experts, professional bodies, and patient groups cannot currently agree on when mammography screening should start and how often it should occur. Some say routine screening should start when the woman is 40 years old, others insist on 50 as the best age, and a few believe that only high-risk groups should have routine screening.
In July, 2012, The American Medical Association said that women should be eligible for screening mammography from the age of 40, and it should be covered by insurance.
In a Special Report in The Lancet (October 30th, 2012 issue), a panel of experts explained that breast cancer screening reduces the risk of death from the disease. However, they added that it also creates more cases of false-positive results, where women end up having unnecessary biopsies and harmless tumors are surgically removed.
In another study, carried out by scientists at the The Dartmouth Institute for Healthy Policy & Clinical Practice in Lebanon, N.H., and reported in the New England Journal of Medicine (November 2012 issue), researchers found that mammograms do not reduce breast cancer death rates.
3) 2D combined with 3D mammograms
3D mammograms, when used in collaboration with regular 2D mammograms were found to reduce the incidence of false positives, researchers from the University of Sydney's School of Public Health, Australia, reported in The Lancet Oncology.
The researchers screened 7,292 adult females, average age 58 years. Their initial screening was done using 2D mammograms, and then they underwent a combination of 2D and 3D mammograms.
Professor Nehmat Houssami and team found 59 cancers in 57 patients. 66% of the cancers were detected in both 2D and combined 2D/3D screenings. However, 33% of them were only detected using the 2D plus 3D combination.
The team also found that 2D plus 3D combination screenings were linked to a much lower number of false positives. When using just 2D screenings there were 141 false positives, compared to 73 using the 2D plus 3D combination.
Prof. Houssami said "Although controversial, mammography screening is the only population-level early detection strategy that has been shown to reduce breast cancer mortality in randomized trials. Irrespective of which side of the mammography screening debate one supports, efforts should be made to investigate methods that enhance the quality of, and hence potential benefit from, mammography screening.
We have shown that integrated 2D and 3D mammography in population breast-cancer screening increases detection of breast cancer and can reduce false-positive recalls depending on the recall strategy. Our results do not warrant an immediate change to breast-screening practice, instead, they show the urgent need for randomised controlled trials of integrated 2D and 3D versus 2D mammography."
4) Breast ultrasound
This type of scan may help doctors decide whether a lump or abnormality is a solid mass or a fluid-filled cyst
5) Biopsy
A sample of tissue from an apparent abnormality, such as a lump, is surgically removed and sent to the lab for analysis. It the cells are found to be cancerous, the lab will also determine what type of breast cancer it is, and the grade of cancer (aggressiveness). Scientists from the Technical University of Munich found that for an accurate diagnosis, multiple tumor sites need to be taken.
6) Breast MRI (magnetic resonance imaging) scan
A dye is injected into the patient. This type of scan helps the doctor determine the extent of the cancer. Researchers from the University of California in San Francisco found that MRI provides a useful indication of a breast tumor's response to pre-surgical chemotherapy much earlier than possible through clinical examination.
Treatments for breast cancer
A multidisciplinary team will be involved in a breast cancer patient's treatment. The team may consists of an oncologist, radiologist, specialist cancer surgeon, specialist nurse, pathologist, radiologist, radiographer, and reconstructive surgeon. Sometimes the team may also include an occupational therapist, psychologist, dietitian, and physical therapist.
The team will take into account several factors when deciding on the best treatment for the patient, including:
- The type of breast cancer
- The stage and grade of the breast cancer - how large the tumor is, whether or not it has spread, and if so how far
- Whether or not the cancer cells are sensitive to hormones
- The patient's overall health
- The age of the patient (has she been through the menopause?)
- The patient's own preferences.
The main breast cancer treatment options may include:
- Radiation therapy (radiotherapy)
- Surgery
- Biological therapy (targeted drug therapy)
- Hormone therapy
- Chemotherapy.
Lumpectomy - surgically removing the tumor and a small margin of healthy tissue around it. In breast cancer, this is often called breast-sparing surgery. This type of surgery may be recommended if the tumor is small and the surgeon believes it will be easy to separate from the tissue around it.
Mastectomy - surgically removing the breast. Simple mastectomyinvolves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy means also removing muscle of the chest wall and the lymph nodes in the armpit.
Sentinel node biopsy - one lymph node is surgically removed. If the breast cancer has reached a lymph node it can spread further through the lymphatic system into other parts of the body.
Axillary lymph node dissection - if the sentinel node was found to have cancer cells, the surgeon may recommend removing several nymph nodes in the armpit.
Breast reconstruction surgery - a series of surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. This procedure may be carried out at the same time as a mastectomy. The surgeon may use a breast implant, or tissue from another part of the patient's body.
Radiation therapy (radiotherapy)
Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any cancer cells that may still be around. Typically, radiation therapy occurs about one month after surgery or chemotherapy. Each session lasts a few minutes; the patient may require three to five sessions per week for three to six weeks.
The type of breast cancer the woman has will decide what type of radiation therapy she may have to undergo. In some cases, radiotherapy is not needed.
Radiation therapy types include:
Breast radiation therapy - after a lumpectomy, radiation is administered to the remaining breast tissue
Chest wall radiation therapy - this is applied after a mastectomy
Breast boost - a high-dose of radiation therapy is applied to where the tumor was surgically removed. The appearance of the breast may be altered, especially if the patient's breasts are large.
Lymph nodes radiation therapy - the radiation is aimed at the axilla (armpit) and surrounding area to destroy cancer cells that have reached the lymph nodes
Breast brachytherapy - scientists at UC San Diego Moores Cancer Center revealed that patients with early-stage breast cancer in the milk ducts which has not spread, seem to benefit from undergoing breast brachytherapy with a strut-based applicator. This 5-day treatment is given to patients after they have undergone lumpectomy surgery. The researchers found that women who received strut-based breast brachytherapy had lower recurrence rates, as well as fewer and less severe side effects.
Side effects of radiation therapy may include fatigue, lymphedema, darkening of the breast skin, and irritation of the breast skin.
Chemotherapy
Medications are used to kill the cancer cells - these are called cytotoxic drugs. The oncologist may recommend chemotherapy if there is a high risk of cancer recurrence, or the cancer spreading elsewhere in the body. This is called adjuvant chemotherapy.
On the off chance that the tumors are expansive, chemotherapy might be controlled before surgery. The point is to contract the tumor, making its evacuation simpler. This is called neo-adjuvant chemotherapy.
Chemotherapy may likewise be directed if the disease has metastasized - spread to different parts of the body. Chemotherapy is additionally helpful in decreasing a portion of the side effects caused by growth.
Chemotherapy may help stop estrogen creation. Estrogen can energize the development of some bosom tumors.
Reactions of chemotherapy may incorporate sickness, regurgitating, loss of hunger, weariness, sore mouth, balding, and a marginally higher helplessness to contaminations. Huge numbers of these reactions can be controlled with meds the specialist can recommend. Ladies more than 40 may enter early menopause.
You can take in more about chemotherapy in this article.
Securing female fruitfulness - Researchers have outlined a method for forcefully assaulting malignancy with an arsenic-based chemo medicine, which is substantially gentler on the ovaries. The scientists, from Northwestern College Feinberg Institute of Pharmaceutical in Chicago, trust their novel strategy will help secure the richness of female patients experiencing disease treatment.
Hormone treatment (hormone blocking treatment)
Hormone treatment is utilized for bosom diseases that are delicate to hormones. These sorts of disease are frequently alluded to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) tumors. The point is to anticipate tumor repeat. Hormone blocking treatment is typically utilized after surgery, yet may now and then be utilized heretofore to shrivel the tumor.
In the event that for wellbeing reasons, the patient can't experience surgery, chemotherapy or radiotherapy, hormone treatment might be the main treatment she gets.
Hormone treatment will have no impact on malignancies that are not delicate to hormones.
Hormone treatment as a rule keeps going up to five years after surgery.
The accompanying hormone treatment pharmaceuticals might be utilized:
Tamoxifen - keeps estrogen from authoritative to ER-positive tumor cells. Symptoms may incorporate changes in periods, hot flashes, weight pick up, migraines, queasiness, regurgitating, weakness, and throbbing joints.
Aromatase inhibitors - this kind of solution might be offered to ladies who have experienced the menopause. It pieces aromatase. Aromatase helps estrogen creation after the menopause. Prior to the menopause, a lady's ovaries deliver estrogen. Cases of aromatase inhibitors incorporate letrozole, exemestane, and anastrozole. Symptoms may incorporate queasiness, heaving, weakness, skin rashes, migraines, bone agony, throbbing joints, loss of moxie, sweats, and hot flashes.
Ovarian removal or concealment - pre-menopausal ladies create estrogen in their ovaries. Ovarian removal or concealment prevent the ovaries from creating estrogen. Removal is done either through surgery or radiation treatment - the lady's ovaries will never work again, and she will enter the menopause early.
A luteinising hormone-discharging hormone agonist (LHRHa) medicate called Goserelin will smother the ovaries. The patient's time frames will quit amid treatment, yet will begin again when she quits taking Goserelin. Ladies of menopausal age (around 50 years) will most likely never begin having periods again. Reactions may incorporate state of mind changes, dozing issues, sweats, and hot flashes.
Organic treatment (directed medications)
Trastuzumab (Herceptin) - this monoclonal counter acting agent targets and decimates malignancy cells that are HER2-positive. Some bosom tumor cells deliver a lot of HER2 (development factor receptor 2); Herceptin focuses on this protein. Conceivable reactions may incorporate skin rashes, migraines, as well as heart harm.
Lapatinib (Tykerb) - this medication focuses on the HER2 protein. It is likewise utilized for the treatment of cutting edge metastatic bosom malignancy. Tykerb is utilized on patients who did not react well to Herceptin. Reactions incorporate excruciating hands, difficult feet, skin rashes, mouth wounds, outrageous tiredness, looseness of the bowels, heaving, and queasiness.
Bevacizumab (Avastin) - prevents the malignancy cells from pulling in fresh recruits vessels, adequately making the tumor be famished of supplements and oxygen. Reactions may incorporate congestive heart disappointment, (hypertension), kidney harm, heart harm, blood clumps, cerebral pains, mouth bruises. Despite the fact that not affirmed by the FDA for this utilization, specialists may endorse it "off-name". Utilizing this medication for bosom malignancy is questionable. In 2011, the FDA said that Avastin is neither successful nor alright for bosom disease.
Low measurement ibuprofen - investigate did on research center mice and test tubes has proposed that standard low-dosage headache medicine may end the development and spread of bosom disease. Tumor campaigners advised that in spite of the fact that the momentum comes about show awesome guarantee, this exploration is at a beginning period and still can't seem to be appeared to be powerful on people.
Avoiding bosom growth
Some way of life changes can help essentially lessen a lady's danger of creating bosom tumor.
Liquor utilization - ladies who drink with some restraint, or don't drink liquor by any means, are less inclined to create bosom tumor contrasted with the individuals who drink expansive sums frequently. Control implies close to one mixed drink for every day.
Physical exercise - practicing five days seven days has been appeared to decrease a lady's danger of creating bosom tumor. Scientists from the College of North Carolina Gillings School of Worldwide General Wellbeing in Church Slope revealed that physical action can bring down bosom disease chance, regardless of whether it be either gentle or extreme, or earlier/after menopause. Be that as it may, extensive weight pick up may discredit these advantages.
Eating regimen - a few specialists say that ladies who take after a sound, all around adjusted eating regimen may diminish their danger of creating bosom growth. An investigation distributed in BMJ (June 2013 issue) found that ladies who consistently expended fish and marine n-3 polyunsaturated unsaturated fats had a 14% lower danger of creating bosom disease, contrasted with other ladies. The creators, from Zhejiang College, China, clarified that a "consistent buyer" ought to eat no less than 1 or 2 parts of slick fish every week (fish, salmon, sardines, and so forth).
Postmenopausal hormone treatment - restricting hormone treatment may help decrease the danger of creating bosom tumor. It is essential for the patient to talk about the upsides and downsides altogether with her specialist.
Bodyweight - ladies who have a sound bodyweight have an extensively bring down shot of creating bosom malignancy contrasted with hefty and overweight females.
Ladies at high danger of bosom growth - the specialist may suggest estrogen-blocking drugs, including tamoxifen and raloxifene. Tamoxifen may raise the danger of uterine disease. Preventive surgery is a conceivable choice for ladies at high hazard.
Bosom disease screening - patients ought to examine with their specialist when to begin bosom malignancy screening exams and tests.
Breastfeeding - ladies who breastfeed run a lower danger of creating bosom malignancy contrasted with other ladies. A group of analysts from the College of Granada in Spain revealed in the Diary of Clinical Nursing that breastfeeding for no less than a half year decreases the danger of early bosom malignancy. This exclusive applies to non-smoking ladies, the group included. They found that moms who breastfed for a half year or more, on the off chance that they created bosom disease, did as such all things considered ten years after the fact than other ladies.
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