Breast Cancer - Causes, Symptoms and Treatment
Breast cancer is one of the most common cancers affecting women. In the US, about 180,000 women develop it each year. The disease can also occur in men, although cancer of the male breast accounts for less than 1 in 100 cases. The risk of it increases with age, doubling every 10 years.
The disease is most commonly diagnosed in women over age 50. Very few women under age 30 develop it. Despite the rise in incidence, there has been a small drop in the number of deaths in the recent years and only about one-fifth of cases prove fatal. This reduction is due to improvements in treatment and the increased use of mammography for screening, which means that tumors can be detected early, when they often respond well to treatment.
Screening may reduce the number of deaths in women over age 50 by up to 4 in 10. In the US, many doctors recommend that women over age 40 have a mammogram every 1-2 years and every year over age 50. A cancerous tumor may first develop in the breast lobules (the structures in the breast that produce milk). A tumor that originates in the milk ducts may lead to Paget's disease of the breast. Tumors may spread to other organs, such as the lungs or the liver, before being detected.
It is a cancer that originates in the breast tissue of women and men. It can spread to the lymph nodes under the arm before diagnosis. With advanced disease, metastasis can be seen in many body organs, including bone, brain, lung, liver and skin.
Causes:
The underlying cause of most is unclear. However, some risk factors have been identified, many of which suggest that the female hormone estrogen is an important factor in the development and progress of the disease. It is known that women who have their first menstrual period before age 11, or who have a late menopause, seem to be at increased risk of developing this cancer, probably because they are exposed to high levels of estrogen for longer. The number of menstrual cycles before a first pregnancy is also significant. And a woman who has her first child before age 20 has chances. Breast feeding is thought to have an additional protective effect.
Risk factors for developing it include
. Early onset of menses or late menopause
. First pregnancy after age 30
. Family history of the disease
. Radiation exposure
Possible risk factors include
. High fat diet
. Excessive alcohol intake
. Estrogen replacement therapy
. Oral contraceptive use
Symptoms:
It is usually manifest as a painless lump anywhere in the breast or under the arm. Occasionally, its symptoms can be more subtle, such as:
. An inverted nipple
. Bloody discharge from the nipple
. Changes in the skin overlying the breast making it resemble the skin of an orange.
Diagnosis:
Any Breast pain or lumps felt on physical examination by a woman or her physician and any lumps found on mammography (Radiography) should be considered for biopsy. Lumps seen on mammography, but not palpable on examination can be located by ultrasound or mammogram for biopsy. If a diagnosis of it is established, staging tests include:
. Liver function tests
. Alkaline phosphates test to check for bone disease
. Chest X-ray (Radiography)
. Bone Scan (Nuclear Medicine)
Complications:
Complications of it are related to areas of metastasis:
. Metastasis to bone can cause pain, bone fractures or elevated calcium levels in the blood.
. Metastasis to the brain or spinal cord can cause seizures, headaches, weakness, numbness or confusion.
. Metastasis to the lungs can cause breathing difficulty, chest pain or swelling of the face and neck.
Treatment: Self Treatment:
. A well balanced diet should be maintained. Once a diagnosis of it is made all estrogen medication should be stopped, including birth control pills.
Medical Treatment:
Many women will require additional drug therapy after surgery to prevent it from returning. Either tamoxifen (a hormonal pill) or chemotherapy (intravenous medication) may be recommended, depending on the type of tumor. More advanced case is also treated with chemotherapy or hormonal therapy.
Surgical Treatment:
Two alternative initial treatments for it are:
. Lumpectomy with lymph node dissection followed by radiation therapy to the breast.
. Mastectomy (mastectomy, partial or mastectomy, modified radical)
Prevention:
Early detection of it by regular beast self-examination and regular mammography (Radiography) screening is important. A low - fat diet and moderate alcohol intake may be important. Some researchers theorize that exercise for preadolescent girls may be helpful as it delays the age of onset of menstruation.
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Your Independent Guide to Breast Cancer
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Treatments For Breast Cancer
In the past, the treatment options for a particular disease were limited to only a few. With the advancements in medical science, we have scores of treatment options available for any disease.
The various treatment options available for breast cancer have increased in number too. Today there are many ways to combat and deal with breast cancer. They can be broadly classified into the following categories:
1. Surgery: Surgery has been the traditional mode of treatment for breast cancer. However, changes have taken place during recent times. The surgery now is more precise and is directed to the exact spot of the disease so that the damage to the unaffected area is minimized.
a. Lumpectomy: The cancerous lump is removed surgically without removing the surrounding lymph nodes.
b. Mastectomy: This is performed if the lump has become large or in case the cancer has spread to other areas. The affected breast is surgically removed.
c. Lymph Node Dissection: This is the surgical removal of lymph nodes. Usually done in case of invasive breast cancer, it is a procedure performed at the time of mastectomy or lumpectomy. During mastectomy, it is an extension of the breast incision (to the armpit area). If done during lumpectomy, a separate incision is performed in the armpit. A part or all of the lymph nodes are removed. Usually it also involves cutting the nerve carrying sensation to the area.
2. Radiation Therapy: Radiation is a highly targeted and effective way of treatment, which destroys the cancer cells. High levels of radiation are sent directly to the cancer cells. Radiation therapy undertaken after surgery can also kill those cancer cells that could not be treated by surgery. It can also be combined with chemotherapy, to relieve pain, or to shrink the tumor. It is short and relatively easy but side affects can also occur. The traditional radiation therapy is external in nature. Internal radiation therapy is also being experimented. In this process, radiation-producing substances are either implanted directly in to the tumor or injected through a tube.
3. Herceptin: Applicable only to women with HER2-positive breast cancer, it consists of an antibody, the primary role of which is blocking the HER2 protein in cancer cells. It is useful in cases where the breast cancer has spread to other parts of the body. Also known as immune treatment, it is approved by US FDA for women with metastatic disease.
4. Hormone Therapy: It is another effective treatment. It is useful for women having hormone receptive positive breast cancer. Aromatase inhibitors are more effective in women with post menopause and Tamoxifen in women with pre menopause hormone receptive positive breast cancer.
5. Chemotherapy: Chemotherapy, or use of chemicals to treat a disease, is a systematic therapy. Since the use of chemicals affects the whole body by going through the blood stream, it is very effective as it can act on the cells, which are rapidly dividing. A major drawback in this mode of treatment is that the drugs act not only on the cancer cells, they act on healthy cells as well leading to various side-effects like losing hair, nausea, skin diseases and so on.
6. Alternative Therapies: In addition to the above modes of treatment, there are many alternative therapies as well e.g. yoga, acupuncture etc. Since sufficient research is not available in respect of such therapies, it is difficult to come to any decisive conclusion.
Since the disease conditions differ from patient to patient, the ideal treatment for an individual would depend on various factors. The best mode of treatment can be formulated with due consultation between the patient and the doctor.
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Symptoms Of Breast Cancer
In the first stages of breast cancer there is usually no pain. When the disease first develops, there may be no symptoms at all. But as the cancer advances some of the following symptoms may become apparent. If these symptoms are observed then the individual should consult her physician who would then carry out tests to find out for sure if the individual does have breast cancer or not.
. Change in shape and size of the breast
. Lump or mass present in the armpit.
. Presence of a breast mass or breast lump, on examination, which is generally painless, has no regular borders and is firm to hard to the touch.
. A nipple discharge which is abnormal in that it is usually green, bloody or clear to yellow fluid or may look like pus.
. A change in appearance or any sensation of the nipple, that is, if there is any itching, any enlargement or the nipple is retracted.
. Enlargement, pain in the breast, or any discomfort on only one side.
. Change in the feel or color of the skin of the nipple, or areola or the breast itself, that is, a redness, veins on breast surface are accentuated, scaly; dimpled or puckered and a retracted appearance.
. Some symptoms of an advanced case of the disease are weight loss, bone pain, skin ulceration and swelling of one arm.
Of the above-mentioned symptoms there are some that most women are not aware of that are actually symptoms of breast cancer. They are:
. An itchy breast
. A breast that constantly feels warm or hot to the touch - This is a symptom of the rare and dangerous breast cancer known as inflammatory breast cancer.
. A flat or an inverted nipple - Sometimes individuals have an inverted nipple from birth, this does not count as a symptom.
. The skin is dimpled around the breast or has the appearance of an orange peel - Most individuals feel embarrassed about this condition to show it to a physician. Most women think it is cellulite, which is not the case.
. A constant swollen and tender breast and/or a sudden increase in breast size - Women should consult their physician if they notice a sudden increase in breast size and also if there is constant swelling and tenderness in the breast other than when a woman is menstruating as it is fairly common for a woman's breast to get swollen and feel tender during her period.
. Breast is red - This is often a symptom of inflammatory breast cancer, which usually can go undetected by self-breast examination and mammogram.
Some common symptoms of breast cancer in men:
Even though breast cancer is more common amongst women, men too can get breast cancer. It is estimated that over 1600 men in the United States alone get breast cancer each year. Some symptoms of breast cancer in men include:
. Swelling in breast, chest wall or nipple
. A lump
. A discharge from the nipple
. Inversion of the nipple, that is, the nipple turns inward
. Dimpling or puckering of the skin of the breast
. The skin of the breast or the nipple has a reddish appearance or it has a very scaly and dry appearance.
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A Brief History of Breast Cancer
Ancient Egyptians first noted and recorded the disease as tumors, or ulcers, of the breasts, concluded that there was no real cure and that the only form of treatment was cauterization with a tool called the “fire drill”. Since then, there have been many similar cases described by doctors throughout history that concluded that there was no cure; or really effective treatment.
When doctors started to understand the human circulatory system in the seventieth century, they also managed to establish a link between breast cancer and the lymph nodes in the armpits. Between the seventeen and eighteen hundreds, the French surgeon Jean Petit and Scotsman Benjamin Bell were the first ones to remove the lymph nodes, breast tissue and chest muscle in an effort to save woman from breast cancer.
By the 1880s, William Halsted started performing mastectomies. His procedure became known as the Halsted Radical Mastectomy and it remained a popular procedure in the fight against breast cancer right up to the 1970s.
Breast cancer is a cancer of the glandular breast tissue and is found in both male and female patients. Worldwide breast cancer accounts for almost 1% of all deaths, is the fifth most common form of cancer and the most common form found in women.
Although breast cancer is the most prevalent cancer in women in the United States, it is only the second most common cause of cancer death in women (after lung cancer). U.S. women have a one in eight lifetime chance of developing invasive breast cancer and an almost 3% chance of breast cancer causing their death. Due to our modern lifestyle the ‘experts’ claim and have also noted, a significant increase in the number of cases since the 1970s.
The breast is composed of identical tissues in males and females. Therefore breast cancer also occurs in males, though it is less common. Although men have a lower risk of developing breast cancer, this risk appears to be rising. There seems to be an increased incidence of breast cancer in men with prostate cancer.
The notable point about male breast cancer is that the prognosis is worse in men than in women and treatment of men with breast cancer is similar to that of the treatment given to older women. Because the male breast tissue is confined to the area directly behind the nipple, treatment for males has usually been a mastectomy.
On a more positive note, most breast cancer symptoms do not turn out to represent underlying breast cancer. These normally turn out to be benign diseases of the breast and only represent the more common symptoms similar to breast cancer itself. However, any appearance of new breast symptom should be taken very seriously by patients and doctors; because of the possibility of an underlying breast cancer that can develop at any age.
As with all types of cancer, the detection and treatment of breast cancer has a far greater chance of a positive outcome by detecting it earlier rather than later.
Michael Russell - EzineArticles Expert Author
Your Independent guide to Breast Cancer
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What To Expect When You Suspect Breast Cancer
Breast cancer can be frightening, but knowledge is power. If you've been vigilant in your personal breast exams and mammograms there may come a time when a lump or suspicious area is found. The first thing that will probably happen is you'll get another mammogram. This time it's called a diagnostic mammogram and it will concentrate on the suspicious area. You may also get an ultrasound, with is painless and can often tell the difference quickly between benign and malignant growths.
Depending on the results of the previous tests, the doctors are likely to recommend a biopsy next. A biopsy takes a small piece of the lump for examination under a microscope. It is the best way to make sure if breast cancer is present. The biopsy can take many forms from a surgical procedure to a fine needle, which isn’t much worse than getting a shot. It depends on the type and location of the mass. Your doctor will decide which type of biopsy is best in your case.
Once the biopsy sample is retrieved, a pathologist will study and characterize it. If it is found to be cancerous, it is further classified in various ways to identify its size and strength. The mass will be tested for the presence of special estrogen and progesterone receptors. If present, the cancer can be treated with hormone therapy.
Another receptor called the HER-2/neu is also sought. Other therapies are directed and cancers containing this receptor.
At this point the patient is “staged”. The stages of breast cancer are complex, but here is a simplified description:
Stage 0 – Abnormal cells are found in the lining of a gland within the breast. This is indicative of a future cancer, but not representative of present cancer.
Stage I – The earliest stage where the tumor is less than 2 cm across and is contained within the breast.
Stage II – Early stage where the tumor is either: a. Less than 2 cm. across and in both the breast and the lymph nodes under the arm b. between 2 and 5 cm. and may be in breast or breast and lymph nodes under the arm c. More than 5 cm. and only in the breast
Stage III - Advanced breast cancer where: a. The tumor is less than five cm. across, in both breast and lymph nodes under the arm b. The cancer is extensive in the lymph nodes under the arm. c. The cancer is in the lymph nodes or other tissues located near the breastbone. During stage III your doctor will be checking to find signs of metastatic disease. When cancer has “metastasized,’ it has spread from the breast/lymph node areas into other distant organs of the body. These tests will take the form of chest x-rays and CT and bone scans.
Stage IV – Metastatic breast cancer, where the cancer has spread to other organs.
Almost all breast cancer victims will have some type of surgery to remove as much of the cancerous growth as possible. No matter how successful, most will probably undergo a regimen of chemotherapy as well. This kills off any microscopic scraps of the disease that may remain to grow into full-fledged cancer again. Other therapies such as radiotherapy (radiation therapy), hormonal therapy, or biologic therapy may be proscribed.
Once treated, breast cancer patients need to be monitored for recurrence. At first this means every 3-4 months. These become less and less frequent, but annual mammograms are even more important for former breast cancer patients than for the normal population.
Michael Russell
Your Independent guide to Breast Cancer
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