BREAST CANCER

BREAST CANCER

Breast cancer (BC) is a type of cancer that forms in the cells of the breasts.

Breast cancer is the most common cancer diagnosed in women .It can occur in both men and women, but it's far more common in women

Advances in screening and treatment have improved survival rates dramatically since 1989 till date.  There are around 3.1 million breast cancer survivors in the United States (U.S.). The chance of any woman dying from breast cancer is around 1 in 37, or 2.7 percent.

      TYPES

·           INVASIVE BC: Abnormal cells breaks through the breast tissue barriers & spread to     the other parts of the body through the blood stream and lymph nodes.

·           NON-INVASIVE BC :Abnormal cells remain in a particular location of the breast          without spreading to surrounding tissues

·             Male BC : A rare cancer that forms on the breast tissue of men

•         Angiosarcoma

•         Ductal Carcinoma in situ (DCIS)
•         Inflammatory Breast cancer
•          Paget’s Disease of the Breast
• ·        Recurrent Breast Cancer  

          STAGES OF BREAST CANCER

       Cancer is staged according to the size of the tumor and whether it has spread to               lymph nodes or other parts of the body.

      There are different ways of staging breast cancer. One way is from stage 0 to 4,               but  these may be broken down into smaller stages.

v Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within a duct and have not invaded surrounding tissues.

v Stage 1: At the beginning of this stage, the tumor is up to 2 centimeters (cm) across and it has not affected any lymph nodes.

v Stage 2: The tumor is 2 cm across and it has started to spread to nearby nodes.

v Stage 3: The tumor is up to 5 cm across and it may have spread to some lymph nodes.

v Stage 4: The cancer has spread to distant organs, especially the bones, liver, brain, or lungs.

        MULTIFOCAL BREAST CANCER

         Multifocal breast cancer is a form of breast cancer in which multiple tumors                   arise  in the same area of the breast.

       Experts classify breast cancers into different categories, depending on their                    characteristics. A person can receive one of the following diagnoses:

·        Unifocal breast cancer, where there is only one tumor in the breast.

·        Multifocal breast cancer, when at least two invasive tumors develop in the same quadrant, or area, of the breast. All tumors arise from one original tumor.

·        Multicentric breast cancer, where at least two tumors develop separately, often in different areas of the breast.

            SIGNS/SYMPTOMS

•         Presence of a breast lump or thickening that feels different from the surrounding tissue
•         Change in the size, shape or appearance of a breast
•         Changes to the skin over the breast, such as dimpling
•         A newly inverted nipple
•         Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
•         Redness or pitting of the skin over your breast.

            RISK FACTORS

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 the implants masking cancer during screening, or because the implants bring about changes in breast tissue.

         PREVENTION

•         Keep weight in check
•         Be physically active
•         Eat healthy diet and avoid too much alcohol
•         Breastfeed if possible
•         Avoid birth control pills after age of 35years

TEST/DIAGNOSIS

·        Breast self examination

·        IMAGINE TEST

Ø 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.

Ø An ultrasound scan can help differentiate between a solid mass or a fluid-filled cyst.

Ø An MRI scan involves injecting a dye into the patient, so find out how far the cancer has spread.

      TREATMENT

                   i.            Lumpectomy; During a lumpectomy, a surgeon removes the cancerous cells while saving as much of the surrounding healthy breast tissue as possible. This procedure is especially promising if the cancer is only present in one quadrant of the breast.

                 ii.            Mastectomy; mastectomy is a surgical procedure that involves removing the entire breast and the surrounding lymph nodes. Unless a tumor is larger than 5 centimeters (or 2 inches) in diameter, or large relative to the breast.

              iii.            Radiation therapy: Doctors often recommend radiation therapy in combination with a lumpectomy. After removing as much of the cancer as possible, they may use radiation therapy to destroy any remaining cancer cells. Radiation therapy is an effective method of preventing later breast cancer recurrence.

              iv.            Chemotherapy: Chemotherapy is a systemic, or body-wide, treatment that uses one or more cytotoxic medications that prevent cancer cells from multiplying. When treating multifocal breast cancer, chemotherapy may be used either before or after the primary treatment.

                 v.            Hormone blocking therapy: Doctors use hormone blocking therapy to prevent recurrence in hormone-sensitive breast cancers. These are called estrogen receptive (ER)-positive and progesterone receptor (PR)-positive cancers.

They normally administer hormone blocking therapy is normally used after surgery, but they might sometimes use it beforehand to shrink the tumor.

This 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. However, the treatment will have no effect on cancers that are not sensitive to hormones.

Examples of hormone blocking therapy medications may include:

·        tamoxifen

·        aromatase inhibitors

·        ovarian ablation or suppression

·        a luteinizing hormone-releasing hormone agonist drug called Goserelin, which suppresses the ovaries

              vi.            Biological treatment : Targeted drugs can destroy specific types of breast cancer. Examples of such drugs include trastuzumab (Herceptin), lapatinib (Tykerb), and bevacizumab (Avastin). Doctors administer these drugs for different purposes.

Treatments for breast and other cancers can have severe adverse effects. Therefore, when deciding on a treatment, the patient should discuss with a doctor the risks involved and ways to minimize the negative effects.

PROGNOSIS

The prognosis for someone with breast cancer will depend on the stage of the cancer. Experts calculate a person's outlook by using average 5-year survival rates. However, these parameters are just a guide, and many people live much longer than these might suggest.

The 5-year survival rates for women with breast cancer are as follows:

§  Stage 0 and 1 is close to 100 percent.

§  Stage 2, about 93 percent

§  Stage 3, about 72 percent, and treatment is often successful.

§  Stage 4, or metastatic breast cancer, about 22 percent. There are still many treatment options at this stage.

      REFERENCE

• 1    AskMayoExpert. Breast cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.

•     Breast cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed June 28, 2017.

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