Cancer accounts to a death of 6 million human lives per year. Modern medicine is aging with breath taking advances in cancer care with increasing awareness, preventing, detection, therapy, research and symptom management. Last 15 years has been a revolution. It is likely to fight Cancer out by getting an early detection especially at a pre cancer stage thus yielding best cure with much shorter treatment time, lesser cost, lesser body insult.
Am I at risk for breast cancer? Breast cancer is the most common malignancy-affecting woman in North America and Europe. Every woman is at risk for breast cancer. Close to 200,000 cases of breast cancer were diagnosed in the United States in 2001. Breast cancer is the second leading cause of cancer death in American women behind lung cancer. The lifetime risk of any particular woman getting breast cancer is about 1 in 8 although the lifetime risk of dying from breast cancer is much lower at 1 in 28. The diagnosis once confirmed by Doctor shocks in such a way that not only the patient suffers but entire family suffers the shock. Thus the patient and family both suffer differently and that adds to the total burden of cancer related illness.
Know your breast: The breast is a collection of glands and fatty tissue that lies between the skin and the chest wall. The glands inside the breast produce milk after a woman has a baby. Each gland is called as lobule and many such lobules make up a lobe. There are 15 to 20 lobes in each breast. The milk gets to the nipple from the glands by way of tubes called ducts. The glands and ducts get bigger when a breast is filled with milk, but the tissue that is most responsible for the size and shape the breast is the fatty tissue. There are also blood vessels and lymph vessels in the breast. Lymph is a clear liquid waste product that gets drained out of the breast into lymph nodes. Lymph nodes are small, pea-sized pieces of tissue that filter and clean the lymph. Most lymph nodes that drain the breast are under the arm in what is called the axilla.
Risk factors for breast cancer: They can be divided into those that you cannot change and those that you can change. Some factors that increase your risk of breast cancer that you cannot alter include being a woman, getting older, having a family history (having a mother, sister, or daughter with breast cancer doubles your risk), having a previous history of breast cancer, having had radiation therapy to the chest region, being Caucasian, getting your periods young (before 12 years old), having your menopause late (after 50 years old), never having children or having them when you are older than 30, and having a genetic mutation that increases your risk. Genetic mutations for breast cancer have become a hot topic of research lately. Between 3-10% of breast cancers may be related to changes in either the gene BRCA1 or the gene BRCA2.
Women can inherit these mutations from their parents and it may be worth testing for either mutation if a woman has a particularly strong family history of breast cancer (meaning multiple relatives affected, especially if they are under 50 years old when they get the disease). If a woman is found to carry either mutation, she has a 50% chance of getting breast cancer before she is 70. Family members may elect to get tested to see if they carry the mutation as well. If a woman does have the mutation, she can get more rigorous screening or even undergo preventive (prophylactic) mastectomies to decrease her chances of contracting cancer. The decision to get tested is a highly personal one that should be discussed with a doctor who is trained in counseling patients about genetic testing.
Certain factors which increase a woman’s risk of breast cancer can be altered including taking hormone replacement therapy (long term use of estrogens with progesterone for menopause symptoms slightly increases your risk), taking birth control pills (a very slight increased risk that disappears in women who have stopped them for over 10 years), not breastfeeding, drinking 2 to 5 alcoholic drinks a day, being overweight (especially after menopause), and not exercising. All of these modifiable risk factors are not nearly as important as gender, age, and family history, but they are things that a woman can control that may reduce her chances of developing a breast malignancy. Remember that all risk factors are based on probabilities, and even someone without any risk factors can still get breast cancer. Proper screening and early detection are our best weapons in reducing the mortality associated with this disease.
What are the signs of breast cancer? Unfortunately, the early stages of breast cancer may not have any symptoms. This is why it is important to follow screening recommendations. As a tumor grows in size, it can produce a variety of symptoms including: lump or thickening in the breast or underarm, change in size or shape of the breast, nipple discharge or nipple turning inward, redness or scaling of the skin or nipple, ridges or pitting of the breast skin
Can you prevent breast cancer? The individual cannot control the most important risk factors for the development of breast cancer. There are some risk factors that are associated with an increased risk, but there is not a clear cause and effect relationship. In no way can strong recommendations be made like the cause and effect relationship seen with tobacco and lung cancer. There are a few risk factors that may be modified by a woman that potentially could influence the development of breast cancer. If possible, a woman should avoid long-term hormone replacement therapy, have children before age 30, breastfeed, avoid weight gain through exercise and proper diet, and limit alcohol consumption to 1 drink a day or less. For women already at a high risk, their risk of developing breast cancer can be reduced by about 50% by taking a drug called Tamoxifen for five years. Tamoxifen has some common side effects (like hot flashes and vaginal discharge), which are not serious and some uncommon side effects (like blood clots, pulmonary embolus, stroke, and uterine cancer) which are life threatening. Tamoxifen isn’t widely used for prevention, but may be useful in some cases.
There are limited data suggesting that vitamin A may protect against breast cancer but further research is needed before it can be recommended for prevention. Other things being investigated include phyto estrogens (naturally occurring estrogens that are in high numbers in soy), vitamin E, vitamin C, and other drugs. Further testing of these substances is also needed before they can be recommended for breast cancer prevention. Right now, the most important thing any woman can do to decrease her risk of dying from breast cancer is to have regular mammogram screening, perform breast self-exams once a month. Follow a few, easy steps, you will soon know what is normal for you and will quickly be aware of any changes. If you find a lump or other change, note down where it is and make an appointment to see your doctor as soon as possible.
Question for young women’s are how to look? Well it is medically suggested that you stand up straight in front of a mirror with your arms loosely by your sides. Raise your arms above your head and move from side to side so you can see your breasts in the mirror, from different angles. What should you look for? A change in the size of either breast, change in the shape or position of nipple, bleeding or discharge from the nipples, unusual dimpling or puckering.
How do you feel for changes? Lie flat on your back with your head on a pillow. Put a folded towel under the shoulder on the side of the breast you are checking. This helps to spread the tissue so that it is easier to feel. Examine one breast at a time. Put the hand on the same side of the breast that you are going to examine under your head. With your other hand flat and fingers together, use the flats of your fingers to feel around the breast in small, circular movements, in an anticlockwise direction. Cover the whole of the breast including the nipple. Check your armpit for lumps in the same way, starting in the hollow and moving down towards the breast.
Now examine the other breast in the same way. If you think you have found something, feel the same area on the opposite breast. If they are the same it’s probably just your shape, but if you are at all worried, do visit your doctor. Breast cancer happens when cells in the breast begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. However, some tumors are not really cancer because they cannot spread or threaten someone’s life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors. Theoretically, any of the types of tissue in the breast can form a cancer, but usually it comes from either the ducts or the glands. Because it may take months to years for a tumor to get large enough to feel in the breast, we screen for tumors with mammograms, which can sometimes see disease before we can feel it.
The earlier that a breast cancer is found, the more likely it is that treatment can be curable. Screening mammograms are simply x-rays of each breast. The breast is placed between two plates for a few seconds while the x-rays are taken. If something appears abnormal, or better views are needed, magnified views or specially angled films are taken during the mammogram. Mammograms often detect tumors before they can be felt and they can also identify tiny specks of calcium that could be an early sign of cancer. Regular screening mammograms can decrease the mortality of breast cancer by 30%. Woman should get a yearly mammogram starting at age 40 (although some groups recommend starting at 50), and women with a genetic mutation that increases their risk or a strong family history may want to begin even earlier. Between the ages of 20 and 39, every woman should have a clinical breast exam every 3 years and after age 40 every woman should have a clinical breast exam done each year.
There are some experimental screening modalities that are currently being studied. These include MRI, ductal lavage, ultrasound, optical tomography, PET scan, and digital mammograms. Depending on the results of the mammograms and/or ultrasounds, your doctors may recommend that you get a biopsy. A biopsy is the only way to know for sure if you have cancer, because it allows your doctors to get cells that can be examined under a microscope. There are different types of biopsies; they differ on how much tissue is removed. Some biopsies use a very fine needle, while others use thicker needles or even require a small surgical procedure to remove more tissue. Your team of doctors will decide which type of biopsy you need depending on your particular breast mass. Once the tissue is removed, a pathologist will review the specimen. The pathologist can tell if it is cancer or not; and if it is cancerous, then the pathologist will characterize it by what type of tissue it arose from, how abnormal it looks (known as the grade), whether or not it is invading surrounding tissues, and if the entire lump was excised, the pathologist can tell if there are any cancer cells left at the borders (also known as the margins). The pathologist will also test the cancer cells for the presence of estrogen and progesterone receptors as well as a receptor known as HER-2/neu. Basic 4 stages of breast cancer are called as
Stage 0 (called carcinoma in situ) Lobular carcinoma in situ (LCIS) refers to abnormal cells lining a gland in the breast. Ductal carcinoma in situ (DCIS) refers to abnormal cells lining a duct.
Stage I – early stage breast cancer where the tumor is less that 2 cm across and hasn’t spread beyond the breast
Stage II – early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm (with or without spread to the lymph nodes under the arm); or the tumor is greater than 5 cm and hasn’t spread outside the breast
Stage III – locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast
Stage IV – metastatic breast cancer where the cancer has spread outside the breast to other organs in the body
Depending on the stage of your cancer, your doctor may want additional tests to see if you have metastatic disease. If you have a stage III cancer, you will probably get a chest x-ray, CT scan and bone scan to look for metastases. Each patient is an individual and your doctors will decide what is necessary to adequately stage your cancer.
What are the treatments for breast cancer?
Surgery: Almost all women with breast cancer will have some type of surgery in the course of their treatment while some women will be candidates for what is called breast conservation therapy (BCT) where surgeons perform a lumpectomy which means they remove the tumor with a little bit of breast tissue around it but do not remove the entire breast. Some patients will have a sentinel lymph node biopsy procedure first to determine if a formal lymph node dissection is required. Sometimes, the surgeon will remove a larger part (but not the whole breast), and this is called a segmental or partial mastectomy. Most patients with DCIS that have a lumpectomy are treated with radiation therapy to prevent the local recurrence of DCIS.More advanced breast cancers are usually treated with a modified radical mastectomy. Modified radical mastectomy means removing the entire breast and dissecting the lymph nodes under the arm.
Chemotherapy: is the use of anti-cancer drugs that go throughout the entire body. The higher the stage of cancer you have, the more important it is that you receive chemotherapy; however, even stage I patients may benefit from chemotherapy in certain cases. In early stage patients, the risk of recurrence may be small, and thus the benefits of the chemotherapy are even smaller. There are many different chemotherapy drugs, and they are usually given in combinations for 3 to 6 months after you receive your surgery. Depending on the type of chemotherapy regimen you receive, you may get medication every 3 or 4 weeks; and you may have to go to a clinic to get the chemotherapy because many of the drugs have to be given through a vein. Two of the most common regimens are AC (doxorubicin and cycolphosphamide) for 3 months or CMF (cycolphosphamide, methotrexate, and fluorouracil) for 6 months. There are advantages and disadvantages to each of the different regimens that your medical oncologist will discuss with you. Based on your own health, your personal values and wishes, and side effects you may wish to avoid, you can work with your doctors to come up with the best regimen for your lifestyle.
Radiotherapy: uses high-energy rays (similar to x-rays) to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless. Radiation therapy is used in all patients who receive breast conservation therapy (BCT). It is also recommended for patients after a mastectomy that had large tumors, lymph node involvement, or close/positive margins after the surgery. Radiation is important in reducing the risk of local recurrence and is often offered in more advanced cases to kill tumor cells that may be living in lymph nodes.
Hormonal Therapy: When the pathologist examines your tumor specimen, he or she finds out if the tumor is expressing estrogen and progesterone receptors. Patients whose tumors express estrogen receptors are candidates for therapy with an estrogen-blocking drug called Tamoxifen. Tamoxifen is taken by pill form for 5 years after your surgery. This drug has been shown to drastically reduce your risk of recurrence if your tumor expresses estrogen receptors. However, there are side effects commonly associated with Tamoxifen including weight gain, hot flashes and vaginal discharge that patients may be bothered by. There are also very uncommon side effects like blood clots, strokes, or uterine cancer that may scare patients from choosing to take it. You need to remember that your chances of having a recurrence of your cancer are usually higher than your chances of having a serious problem with Tamoxifen, but the decision to undergo hormonal therapy is a personal one that you should make with your doctor. There are also newer drugs, called aromatase inhibitors that act by decreasing your body’s supply of estrogen; these drugs are reserved for patients who have already gone through menopause. Talk to your doctors about these new therapies.
Biologic Therapy: The pathologist also examines your tumor for the presence of HER-2/neu over expression. A compound called Herceptin (or Trastuzumab) is a substance that blocks this receptor and helps stop the breast cancer from growing.
Follow-up testing: Once a patient has been treated for breast cancer, they need to be closely followed for a recurrence. At first, you will have follow-up visits every 3-4 months. The longer you are free of disease, the less often you will have to go for checkups. After 5 years, you could see your doctor once a year. You should have a mammogram of the treated and untreated breasts every year. Because having had breast cancer is a risk factor for getting it again, having your mammograms done every year is extremely important. If you are taking Tamoxifen, it is important that you get a pelvic exam each year and report any abnormal vaginal bleeding to your doctor.
Drink Green Tea: Generations of families in India and Asia have been turning to tea to cure what ails them. Green tea could benefit at least five vital organs, including the heart. Earlier, green tea was thought to improve urinary and brain function, combat beriberi disease, and alleviate indigestion. In other words, green tea was considered to be a multi-purpose elixir, able to treat a wide variety of health problems. But this ancient remedy has now found a place in modern scientific literature, thanks to a new wave of studies on the medicinal properties of green tea. While studies on human subjects have been inconclusive, initial evidence from the laboratory looks incredibly promising.
While green tea can be beneficial in attacking everything from high cholesterol to depression, it has perhaps gotten the most attention for its impact on cancer.
Antioxidants are important because they can stop the enzyme activities that give rise to cancer. In essence, they repair DNA problems that have been caused by oxidants or free radicals. Green tea has been considered a godsend for good health because it contains antioxidants known as catechins. These substances have been called impressive inhibitors of cancer growth. Here’s how they do it: lab tests show that they combat oxidants prior to cell injuries, stop the growth of tumor cells, and reduce the occurrence of tumors.
This article is meant to give you a better understanding of breast cancer. Use this knowledge when meeting with your physician, making treatment decisions, and continuing your search for information.
Stay Healthy, as Health is Wealth!