Breast cancer starts when abnormal cells in the breast begin to grow uncontrollably. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. It is spread when the cancer cells get into the blood or lymph system and are carried to other parts of the body. Breast cancer occurs almost entirely in women, but men can get it too.
Breast cancers can start from different parts of the breast. Most of them begin in the ducts that carry milk to the nipple (ductal cancers). Some start in the glands that make the breast milk (lobular cancers). There are several other types of breast cancers that are less common, including inflammatory breast cancer and Paget's disease of the breast.
According to the WHO, breast cancer is the most common cancer among women. It affects around 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627,000 women died from breast cancer – that is approximately 15% of all cancer deaths among women.
CAUSES/ RISK FACTORS
Changes or mutations in DNA can cause normal breast cells to become cancer. Persons can inherit these DNA mutations or abnormal genes from their parents. Women who have a BRCA1 mutation or BRCA2 mutation (or both) have a significantly higher risk of being diagnosed with breast cancer.
Other lifestyle-related risk factors, such as diet and physical activity, may affect a person’s chance of developing breast cancer. Hormones, especially estrogen, seem to play a role in many cases of breast cancer as well. Some of the common risk factors for breast cancer include:
II. Older age at first birth or never having given birth
III. Starting menopause at a later age
The most common symptom of breast cancer is a new lump or mass in the breast. The lump may be hard or soft, painless or painful. Not all breast lumps are cancer; it is important to get all new breast masses, lumps or other changes investigated by a doctor as soon as possible. Other possible symptoms of breast cancer include:
There are several ways to identify and investigate a breast lump. These include breast exams, mammograms, ultrasound and biopsy.
Screening consists of testing women to identify cancers before any symptoms develop. Various methods have been evaluated as breast cancer screening tools, including breast self-exam, clinical breast exam and mammography.
Adult women should do breast self-exams at least once a month; this allows lumps to be detected early. Many women, who were diagnosed with breast cancer, detected their own breast lump. Women should be familiar with how their breasts normally look and feel so that they could notice changes easily. For more information on how to do breast self-exams visit the link below.
Clinical Breast Exam
This is an examination of both breasts performed by a trained health professional. They are similar to breast self-exam, and the lymph nodes under the arms are examined more thoroughly. If a lump were found, additional tests would need to be done such as a mammogram or ultrasound.
Mammography and Ultrasound
A mammogram uses low-energy X-rays to identify abnormalities in the breast. Mammograms can show a breast lump before it can be felt, which is why it is the test most preferably used to screen for breast cancer. Women should start having regular mammograms by the age of 50 years (or at 40 years old if you have a family history of breast cancer); this may be yearly, or every other year.
A breast ultrasound is another imaging test that is done after finding a lump during a breast exam. Ultrasounds are also good at determining whether a breast lump is cystic or solid. If the lump is solid then a biopsy should be done.
A breast biopsy is usually done by using a needle to remove some of the cells from the lump in the breast. The cells are then observed by a pathologist under the microscope, to determine whether or not the lump is cancer. If the results prove that the lump is in fact cancerous, then a few more tests may be done to determine the best course of treatment.
Breast Cancer Hormone Receptor Status (if cancer is diagnosed)
Estrogen and Progesterone Receptor Test
This is a laboratory test to measure the amount of estrogen and progesterone (hormone) receptors that are in the cancer tissue. If breast cancer cells have estrogen receptors, the cancer is called ER-positive breast cancer. If breast cancer cells have progesterone receptors, the cancer is called PR-positive breast cancer. Most breast cancers are ER and/or PR positive. These breast cancers usually grow more quickly, and may respond to treatment that blocks estrogen and progesterone, which stops the cancer from growing.
HER2 Status (if cancer is diagnosed)
Human Epidermal Growth Factor type 2 receptor (HER2 Test)
HER2 is a gene that can be a factor in the development of breast cancer. This laboratory test measures how many HER2 genes there are in a sample of breast tissue. If there are more HER2 genes than normal, the cancer is called HER2 positive. HER2-positive breast cancers tend to grow faster and are more likely to spread and return, compared to HER2-negative breast cancers. These breast cancers can be treated with drugs that target the HER2 protein.
Breast cancer is treated using a combination of surgery, radiotherapy, chemotherapy and hormone therapy.
Surgery is the most common type of treatment for breast cancer. There are two types of surgery; the type a patient gets depends on the type of breast cancer, the size and location of the tumor and other factors.
Mastectomy and Breast Conservation Surgery
With a Mastectomy, the entire breast is removed, including some of the surrounding tissues. A double mastectomy involves the removal of both breasts. In Breast Conservation Surgery, only the part of the breast containing the cancer and some surrounding normal tissue is removed. Women who have had surgery for breast cancer also have the option of getting breast reconstruction surgery after.
Some women may need to have radiotherapy after surgery, to ensure that all remaining cancer cells are destroyed. Radiotherapy involves using high-energy rays; the type most commonly used is External Beam Radiation, where rays from a machine are aimed at the affected breast. There are other types of radiotherapy available. Radiotherapy may be done over several weeks and side effects may include skin reactions and pain in the breast or chest area.
Chemotherapy uses anti-cancer drugs that may be taken by mouth or given intravenously into the blood stream. Not all persons with breast cancer will need this treatment. Chemotherapy may be given before surgery to shrink large tumors, after surgery to try to kill any remaining cancer cells or it may be the main treatment used in persons with advanced cancer that has spread outside the breast.
Hormone Therapy (and other treatment)
Breast cancers that are ER-Positive or PR-Positive can be treated with hormone therapy after surgery, to prevent the cancer from coming back. These drugs block estrogen receptors, and thereby stop estrogen from stimulating breast cancer cells to grow. One such drug is Tamoxifen which can be taken for up to 5 years after surgery.
Aromatase inhibitors (AIs) are another class of drugs commonly used by breast cancer patients; these drugs stop estrogen production.
Herceptin is a drug commonly used to treat women with HER-2 positive breast cancers.
Ensure you have a healthy diet, exercise regularly, maintain a healthy weight, and avoid tobacco use and excess alcohol consumption, because these habits are essential to reduce your risk of breast cancer. This is beneficial for all person affected by breast cancer as well.
Breast Reconstruction Surgery
If you think that you would want to have reconstructive surgery done, it is best to discuss this with your breast surgeon and a plastic surgeon before hand. This gives the surgical team time to plan out the best treatment options for you, whether you want to have the reconstructive surgery done immediately after your mastectomy or at a later date.
If you have the opportunity to breastfeed, take it. Breastfeeding may decrease your risk of getting breast cancer. There are also numerous benefits of it to the baby.
Adult women should perform regular breast exams, and should be familiar with their breasts enough, that they can detect subtle changes. Women 50 years or older should get regular mammograms, which can detect lumps not commonly felt.
Living with breast cancer
If you are living with breast cancer, visit the link below for more information.
I hope these tips on BREAST CANCER were helpful; remember Your Health Is Invaluable.
By Dr. J. Lawarna Matthew
(National Institute of Health) National Cancer Institute
American Cancer Society
Breast Cancer Consortium-Archives (Image)
Visit https://www.cancer.gov/types/breast and https://www.cancer.org/cancer/breast-cancer.html for more information
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Dr. J. Lawarna Matthew