26/11/2017
What is breast cancer?
An early diagnosis of breast cancer
increases the chance of recovery.
After puberty , a woman's breast
consists of fat, connective tissue, and
thousands of lobules, tiny glands that
produce milk for breast-feeding. Tiny
tubes, or ducts, carry the milk toward
the ni**le.
In cancer, the body's cells multiply
uncontrollably. It is the excessive cell
growth that causes cancer.
Breast cancer can be:
Ductal carcinoma: This begins in
the milk duct and is the most
common type.
Lobular carcinoma: This starts in
the lobules.
Invasive breast cancer is when the
cancer cells break out from inside
the lobules or ducts and invade
nearby tissue, increasing the chance
of spreading to other parts of the
body.
Non-invasive breast cancer is when
the cancer is still inside its place of
origin and has not broken out.
However, these cells can eventually
develop into invasive breast cancer.
Symptoms
The first symptoms of breast cancer
are usually an area of thickened
tissue in the breast, or a lump in the
breast or in an armpit.
Other symptoms include:
a pain in the armpits or breast
that does not change with the
monthly cycle
pitting or redness of the skin of
the breast, like the skin of an
orange
a rash around or on one of the
ni**les
a discharge from a ni**le,
possibly containing blood
a sunken or inverted ni**le
a change in the size or shape of
the breast
peeling, flaking, or scaling of the
skin on the breast or ni**le
Most lumps are not cancerous, but
women should have them checked by
a health care professional.
10 risk factors
Breast cancer usually starts in the
inner lining of milk ducts or the
lobules that supply them with milk.
From there, it can spread to other
parts of the body.
The exact cause remains unclear, but
some risk factors make it more likely.
Some of these are preventable.
1. Age
The risk increases with age. At 20
years, the chance of developing
breast cancer in the next decade is
0.6 percent . By the age of 70 years,
this figure goes up to 3.84 percent.
2. Genetics
If a close relative has or has had,
breast cancer, the risk is higher.
Women who carry the BRCA1 and
BRCA2 genes have a higher risk of
developing breast cancer, ovarian
cancer or both. These genes can be
inherited. TP53 is another gene that
is linked to a greater breast cancer
risk.
3. A history of breast cancer or
breast lumps
Women who have had breast cancer
before are more likely to have it
again, compared with those who have
no history of the disease.
Having some types of benign, or non-
cancerous breast lumps increases the
chance of developing cancer later
on. Examples include atypical ductal
hyperplasia or lobular carcinoma in
situ.
4. Dense breast tissue
Breast cancer is more likely to
develop in higher density breast
tissue.
5. Estrogen exposure and breast-
feeding
Being exposed to estrogen for a
longer period appears to increase the
risk of breast cancer.
This could be due to starting periods
earlier or entering menopause later
than average. Between these times,
estrogen levels are higher.
Breast-feeding, especially for over 1
year, appears to reduce the chance
of developing breast cancer, possibly
because pregnancy followed by
breastfeeding reduces exposure to
estrogen.
6. Body weight
Women who are overweight or have
obesity after menopause may have a
higher risk of developing breast
cancer, possibly due to higher levels
of estrogen. High sugar intake may
also be a factor.
7. Alcohol consumption
A higher rate of regular alcohol
consumption appears to play a role.
Studies have shown that women who
consume more than 3 drinks a day
have a 1.5 times higher risk.
8. Radiation exposure
Undergoing radiation treatment for a
cancer that is not breast cancer
increases the risk of breast cancer
later in life.
9. Hormone treatments
The use of hormone replacement
therapy (HRT) and oral birth control
pills have been linked to breast
cancer, due to increased levels of
estrogen.
10. Occupational hazards
In 2012, researchers concluded that
exposure to certain carcinogens and
endocrine disruptors, for example in
the workplace, could be linked to
breast cancer.
In 2007, scientists suggested that
working night shifts could increase
the risk of breast cancer, but more
recent research concludes this is
unlikely.
Cosmetic implants and breast cancer
survival
Women with cosmetic breast implants
who are diagnosed with breast
cancer have a higher risk of dying
from the disease and a 25 percent
higher chance of being diagnosed at
a later stage, compared with women
without implants.
This could be due to due to the
implants masking cancer during
screening, or because the implants
bring about changes in breast tissue.
More research is needed.
Diagnosis
A diagnosis often occurs as the
result of routine screening, or when a
woman approaches her doctor after
detecting symptoms.
Some diagnostic tests and
procedures help to confirm a
diagnosis.
Breast exam
The physician will check the patient's
breasts for lumps and other
symptoms.
The patient will be asked to sit or
stand with her arms in different
positions, such as above her head
and by her sides.
Imaging tests
A mammogram is a type of x-ray
commonly used for initial breast
cancer screening. It produces images
that can help detect any lumps or
abnormalities.
A suspicious result can be followed
up by further diagnosis. However,
mammography sometimes shows up
a suspicious area that is not cancer.
This can lead to unnecessary stress
and sometimes interventions.
An ultrasound scan can help
differentiate between a solid mass or
a fluid-filled cyst .
An MRI scan involves injecting a dye
into the patient, so find out how far
the cancer has spread.
Biopsy
A sample of tissue is surgically
removed for laboratory analysis. This
can show whether the cells are
cancerous, and, if so, which type of
cancer it is, including whether or not
the cancer is hormone-sensitive.
Diagnosis also involves staging the
cancer, to establish:
the size of a tumor
how far it has spread
whether it is invasive or non-
invasive
whether it has metastasized, or
spread to other parts of the body
Staging will affect the chances of
recovery and will help decide on the
best treatment options.
Treatment
Treatment will depend on:
Chemotherapy can be an option for
breast cancer.
the type of breast cancer
the stage of the cancer
sensitivity to hormones
the patient's age, overall health,
and preferences
The main options include:
radiation therapy
surgery
biological therapy, or targeted
drug therapy
hormone therapy
chemotherapy
Factors affecting the choice will
include the stage of the cancer, other
medical conditions, and individual
preference.
Surgery
If surgery is needed, the choice will
depend on the diagnosis and the
individual.
Lumpectomy : Removing the tumor
and a small margin of healthy tissue
around it can help prevent the spread
of the cancer. This may be an option
if the tumor is small and likely to be
easy to separate from the
surrounding tissue.
Mastectomy : Simple mastectomy
involves removing the lobules, ducts,
fatty tissue, ni**le, ar**la, and some
skin. Radical mastectomy removes
muscle from the chest wall and the
lymph nodes in the armpit as well.
Sentinel node biopsy: Removing one
lymph node can stop the cancer
spreading, because if breast cancer
reaches a lymph node, it can spread
further through the lymphatic system
into other parts of the body.
Axillary lymph node dissection : If
there are cancer cells on a node
called the sentinel node, the surgeon
may recommend removing several
nymph nodes in the armpit to prevent
the spread of disease.
Reconstruction: Following breast
surgery, reconstruction can recreate
the breast so that it looks similar to
the other breast. This can be done at
the same time as a mastectomy, or at
a later date. The surgeon may use a
breast implant, or tissue from another
part of the patient's body.
Radiation therapy
Controlled doses of radiation are
targeted at the tumor to destroy the
cancer cells. Used from around a
month after surgery, along with
chemotherapy, it can kill any
remaining cancer cells.
Each session lasts a few minutes,
and the patient may need three to
five sessions per week for 3 to 6
weeks, depending on the aim and the
extent of the cancer.
The type of breast cancer will dictate
what type of radiation therapy, if any,
is most suitable.
Adverse effects include fatigue ,
lymphedema, darkening of the breast
skin, and irritation of the breast skin.
Chemotherapy
Medications known as cytotoxic
drugs may be used to kill cancer
cells, if there is a high risk of
recurrence or spread. This is called
adjuvant chemotherapy.
If the tumor is large, chemotherapy
may be administered before surgery
to shrink the tumor and make its
removal easier. This is called neo-
adjuvant chemotherapy.
Chemotherapy can also treat cancer
that has metastasized, or spread to
other parts of the body, and it can
reduce some symptoms, especially in
the later stages.
It may be used to reduce estrogen
production, as estrogen can
encourage the growth of some breast
cancers.
Adverse effects include nausea,
vomiting, loss of appetite, fatigue,
sore mouth, hair loss , and a slightly
higher susceptibility to infections.
Medications can help control many of
these.
Hormone blocking therapy
Hormone blocking therapy is used to
prevent recurrence in hormone-
sensitive breast cancers. These are
often referred to as estrogen
receptive (ER) positive and
progesterone receptor (PR) positive
cancers.
Hormone blocking therapy is normally
used after surgery, but it may
sometimes be used beforehand to
shrink the tumor.
It may be the only option for patients
who cannot undergo surgery,
chemotherapy, or radiotherapy.
The effects normally last for up to 5
years after surgery. The treatment will
have no effect on cancers that are
not sensitive to hormones.
Examples include:
tamoxifen
aromatase inhibitors
ovarian ablation or suppression
a luteinising hormone-releasing
hormone agonist (LHRHa) drug
called Goserelin, to suppress the
ovaries
Hormone treatment may affect a
woman's future fertility.
Biological treatment
Targeted drugs destroy specific types
of breast cancer. Examples include
trastuzumab (Herceptin), lapatinib
(Tykerb), and bevacizumab (Avastin).
These drugs are all used for different
purposes.
Treatments for breast and other
cancers can have severe adverse
effects.
The patient should discuss with a
doctor the risks involved and ways to
minimize the negative effects, when
deciding on treatment.
Prevention and outlook
There is no sure way to prevent
breast cancer, but some lifestyle
decisions can significantly reduce the
risk of breast and other types of
cancer.
These include:
avoiding excess alcohol
consumption
following a healthy diet with
plenty of fresh fruit and
vegetables
getting enough exercise
maintaining a healthy body mass
index ( BMI )
Women should think carefully about
their options for breast-feeding and
the use of HRT following menopause,
as these can affect the risk.
Preventive surgery is an option for
women at high risk.
Outlook
With treatment, a woman who
receives a diagnosis of stage 0 or
stage 1 breast cancer has an almost
almost 100 percent chance of
surviving for at least 5 years.
If the diagnosis is made at stage 4,
the chance of surviving another 5
years is around 22 percent.
Regular checks and screening can
help detect symptoms early. Women
should discuss their options with a
doctor.
