You Can Nip It In The Bud; Breast Cancer
Breast cancer is a kind of cancer that develops from breast cells. It usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is called ductal carcinoma.
The vast majority of breast cancer cases occur in females, therefore this article tackles breast cancer in women. Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.
Breast cancer rates are much higher in developed nations compared to developing ones. There are several reasons for this, with possibly life-expectancy being one of the key factors - breast cancer is more common in elderly women; women in the richest countries live much longer than those in the poorest nations. The different lifestyles and eating habits of females in rich and poor countries are also contributory factors, experts believe.
According to the National Cancer Institute, 232,340 female breast cancers and 2,240 male breast cancers are reported in the USA each year, as well as about 39,620 deaths caused by the disease.
The Anatomy of The Female Breast
1. Chest wall.
2. Pectoralis muscles.
3. Lobules (glands that make milk).
4. Nipple surface.
5. Areola.
6. Lactiferous duct tube that carries milk to the nipple.
7. Fatty tissue.
8. Skin.
A mature human female's breast consists of fat, connective tissue and thousands of lobules - tiny glands which produce milk. The milk of a breastfeeding mother goes through tiny ducts (tubes) and is delivered through the nipple. The breast, like any other part of the body, consists of billions of microscopic cells. These cells multiply in an orderly fashion - new cells are made to replace the ones that died. In cancer, the cells multiply uncontrollably, and there are too many cells, progressively more and more than there should be.
Cancer that begins in the lactiferous duct (milk duct), known as ductal carcinoma, is the most common type. Cancer that begins in the lobules, known as lobular carcinoma, is much less common.
Recent developments on breast cancer diagnosis
Blood test to indicate breast cancer risk 'in development'
Researchers from University College London in the UK are developing a simple blood test to help predict the likelihood of a woman developing breast cancer. They publish their research in the open access journal Genome Medicine.
Zinc test for early breast cancer looks promising
A new study suggests it may be possible to detect the early signs of breast cancer with a test that measures changes in zinc isotopes. The researchers, led by scientists from the University of Oxford in the UK, report their findings in the journal Metallomics.
New evidence that MRI may help predict breast cancer in some women
According to a new study published in the journal Radiology, magnetic resonance imaging scans may help predict which women are most likely to develop breast cancer in the future.
Mammography still best for breast cancer screening, experts find
An international group of independent breast cancer experts have met to evaluate the benefits of different methods of screening for breast cancer, arriving at the conclusion that mammography is best for reducing breast cancer mortality in women aged over 50.
Symptoms of breast cancer
A symptom is only felt by the patient, and is described to the doctor or nurse, such as a headache or pain. A sign is something the patient and others can detect, for example, a rash or swelling.
The first symptoms of breast cancer are usually an area of thickened tissue in the woman's breast, or a lump. The majority of lumps are not cancerous; however, women should get them checked by a healthcare professional. Women who detect any of the following signs or symptoms should tell their doctor.
- A lump in a breast.
- A pain in the armpits or breast that does not seem to be related to the woman's menstrual period.
- Pitting or redness of the skin of the breast; like the skin of an orange.
- A rash around (or on) one of the nipples.
- A swelling (lump) in one of the armpits.
- An area of thickened tissue in a breast
- One of the nipples has a discharge; sometimes it may contain blood.
- The nipple changes in appearance; it may become sunken or inverted.
- The size or the shape of the breast changes.
- The nipple-skin or breast-skin may have started to peel, scale or flake.
Causes of breast cancer
Experts are not definitively sure what causes breast cancer. It is hard to say why one person develops the disease while another does not. We know that some risk factors can impact on a woman's likelihood of developing breast cancer. These are:
Getting older - the older a woman gets, the higher is her risk of developing breast cancer; age is a risk factor. Over 80% of all female breast cancers occur among women aged 50+ years (after the menopause).
Genetics - women who have a close relative who has/had breast or ovarian cancer are more likely to develop breast cancer. If two close family members develop the disease, it does not necessarily mean they shared the genes that make them more vulnerable, because breast cancer is a relatively common cancer.
The majority of breast cancers are not hereditary. Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast and/or ovarian cancer. These genes can be inherited. TP53, another gene, is also linked to greater breast cancer risk.
A history of breast cancer - women who have had breast cancer, even non-invasive cancer, are more likely to develop the disease again, compared to women who have no history of the disease.
Having had certain types of breast lumps - women who have had some types of benign (non-cancerous) breast lumps are more likely to develop cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.
Dense breast tissue - women with more dense breast tissue have a greater chance of developing breast cancer.
Estrogen exposure - women who started having periods earlier or entered menopause later than usual have a higher risk of developing breast cancer. This is because their bodies have been exposed to estrogen for longer. Estrogen exposure begins when periods start, and drops dramatically during the menopause.
Obesity - post-menopausal obese and overweight women may have a higher risk of developing breast cancer. Experts say that there are higher levels of estrogen in obese menopausal women, which may be the cause of the higher risk.
Height - taller-than-average women have a slightly greater likelihood of developing breast cancer than shorter-than-average women. Experts are not sure why.
Alcohol consumption - the more alcohol a woman regularly drinks, the higher her risk of developing breast cancer is. The Mayo Clinic says that if a woman wants to drink, she should not exceed one alcoholic beverage per day.
Radiation exposure - undergoing X-rays and CT scans may raise a woman's risk of developing breast cancer slightly. Scientists at the Memorial Sloan-Kettering Cancer Center found that women who had been treated with radiation to the chest for a childhood cancer have a higher risk of developing breast cancer.
HRT (hormone replacement therapy) - both forms, combined and estrogen-only HRT therapies may increase a woman's risk of developing breast cancer slightly. Combined HRT causes a higher risk.
Certain jobs - French researchers found that women who worked at night prior to a first pregnancy had a higher risk of eventually developing breast cancer. Canadian researchers found that certain jobs, especially those that bring the human body into contact with possible carcinogens and endocrine disruptors are linked to a higher risk of developing breast cancer. Examples include bar/gambling, automotive plastics manufacturing, metal-working, food canning and agriculture. They reported their findings in the November 2012 issue of Environmental Health.
Cosmetic implants may undermine breast cancer survival - women who have cosmetic breast implants and develop breast cancer may have a higher risk of dying prematurely from the disease compared to other females, researchers from Canada reported in the BMJ (British Medical Journal) (May 2013 issue). The team looked at twelve peer-reviewed articles on observational studies which had been carried out in Europe, the USA and Canada.
Experts had long-wondered whether cosmetic breast implants might make it harder to spot malignancy at an early stage, because they produce shadows on mammograms. In this latest study, the authors found that a woman with a cosmetic breast implant has a 25% higher risk of being diagnosed with breast cancer when the disease has already advanced, compared to those with no implants. Women with cosmetic breast implants who are diagnosed with breast cancer have a 38% higher risk of death from the disease, compared to other patients diagnosed with the same disease who have no implants, the researchers wrote.
After warning that there were some limitations in the twelve studies they looked at, the authors concluded "Further investigations are warranted into the long term effects of cosmetic breast implants on the detection and prognosis of breast cancer, adjusting for potential confounders".
Recent developments on breast cancer causes
Atypical hyperplasia linked to high lifetime risk of breast cancer
Researchers have long known that atypical hyperplasia - an accumulation of abnormal cells in the ducts or lobules of the breast - can increase a woman's risk of breast cancer. But a new study by researchers from the Mayo Clinic finds that this risk may be higher than previously thought.
Two new genetic risk factors uncovered Collaboration between dozens of worldwide cancer research institutes has added to the ever-improving understanding of breast cancer genetics and personal profiling of the disease by unearthing two new genetic variants associated with a higher risk for the women carrying them.
Breast cancer less likely to recur in women with history of breastfeeding. Breastfeeding is associated with a 30% overall decreased risk of breast cancer recurrence among women who have previously had one subtype of the disease, according to a new study published in the Journal of the National Cancer Institute.
Prenatal DDT exposure linked to increased risk of breast cancer
During the 1960s, the pesticide DDT was in widespread use around the globe. Though the chemical is now banned from use in the US and many other countries due to health concerns, a new study finds women who were exposed to higher levels of the chemical in utero more than 50 years ago may be at almost fourfold increased risk of breast cancer than women exposed to lower levels.
Invasive and Non-Invasive Breast Cancer
Invasive breast cancer - the cancer cells break out from inside the lobules or ducts and invade nearby tissue. With this type of cancer, the abnormal cells can reach the lymph nodes, and eventually make their way to other organs (metastasis), such as the bones, liver or lungs. The abnormal (cancer) cells can travel through the bloodstream or the lymphatic system to other parts of the body; either early on in the disease, or later.
Non-invasive breast cancer - this is when the cancer is still inside its place of origin and has not broken out. Lobular carcinoma in situ is when the cancer is still inside the lobules, while ductal carcinoma in situ is when they are still inside the milk ducts. "In situ" means "in its original place". Sometimes, this type of breast cancer is called "pre-cancerous"; this means that although the abnormal cells have not spread outside their place of origin, they can eventually develop into invasive breast cancer.
Diagnosing Breast Cancer
Women are usually diagnosed with breast cancer after a routine breast cancer screening, or after detecting certain signs and symptoms and seeing their doctor about them.
If a woman detects any of the breast cancer signs and symptoms described above, she should speak to her doctor immediately. The doctor, often a primary care physician (general practitioner, GP) initially, will carry out a physical exam, and then refer the patient to a specialist if he/she thinks further assessment is needed.
The following are examples of diagnostic tests and procedures for breast cancer:
Breast exam - the physician will check both the patient's breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape. The patient will be asked to sit/stand with her arms in different positions, such as above her head and by her sides.
X-ray (mammogram) - commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.
Breast ultrasound - this type of scan may help doctors decide whether a lump or abnormality is a solid mass or a fluid-filled cyst.
Biopsy - a sample of tissue from an apparent abnormality, such as a lump, is surgically removed and sent to the lab for analysis. If the cells are found to be cancerous, the lab will also determine what type of breast cancer it is, and the grade of cancer (aggressiveness). Scientists from the Technical University of Munich found that for an accurate diagnosis, multiple tumor sites need to be taken.
Breast MRI (magnetic resonance imaging) scan - a dye is injected into the patient. This type of scan helps the doctor determine the extent of the cancer. Researchers from the University of California in San Francisco found that MRI provides a useful indication of a breast tumor's response to pre-surgical chemotherapy much earlier than possible through clinical examination.
Stages of Breast Cancer
Staging describes the extent of the cancer in the patient's body and is based on whether it is invasive or non-invasive, how large the tumor is, whether lymph nodes are involved and how many, and whether it has metastasized (spread to other parts of the body). A cancer's stage is a crucial factor in deciding what treatment options to recommend, and in determining the patient's prognosis.
Staging is done after cancer is diagnosed. To do the staging, the doctor may order several different tests, including blood tests, a mammogram, a chest X-ray, a bone scan, a CT scan, or a PET scan.
Treatments for breast cancer
A multidisciplinary team will be involved in a breast cancer patient's treatment. The team may consists of an oncologist, radiologist, specialist cancer surgeon, specialist nurse, pathologist, radiologist, radiographer, and reconstructive surgeon. Sometimes the team may also include an occupational therapist, psychologist, dietitian, and physical therapist.
The team will take into account several factors when deciding on the best treatment for the patient, including:
The main breast cancer treatment options may include:
Surgery
Lumpectomy - surgically removing the tumor and a small margin of healthy tissue around it. In breast cancer, this is often called breast-sparing surgery. This type of surgery may be recommended if the tumor is small and the surgeon believes it will be easy to separate from the tissue around it. British researchers reported that about one fifth of breast cancer patients who choose breast-conserving surgery instead of mastectomy eventually need a reoperation.
Mastectomy - surgically removing the breast. Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy means also removing muscle of the chest wall and the lymph nodes in the armpit.
Many undergo pointless mastectomies due to fear - a study carried out at the Dana-Faber Cancer Institute and published in Annals of Internal Medicine found that many young women choose to have their healthy breast removed after being diagnosed with cancer in one breast. Unfortunately, doing so does not improve survival rates, the authors explained.
Sentinel node biopsy - one lymph node is surgically removed. If the breast cancer has reached a lymph node it can spread further through the lymphatic system into other parts of the body.
Axillary lymph node dissection - if the sentinel node was found to have cancer cells, the surgeon may recommend removing several nymph nodes in the armpit.
Breast reconstruction surgery - a series of surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. This procedure may be carried out at the same time as a mastectomy. The surgeon may use a breast implant, or tissue from another part of the patient's body.
Radiation therapy (radiotherapy)
Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any cancer cells that may still be around. Typically, radiation therapy occurs about one month after surgery or chemotherapy. Each session lasts a few minutes; the patient may require three to five sessions per week for three to six weeks. The type of breast cancer the woman has will decide what type of radiation therapy she may have to undergo. In some cases, radiotherapy is not needed.
Side effects of radiation therapy may include fatigue, lymphedema, darkening of the breast skin, and irritation of the breast skin.
Breast brachytherapy - scientists at UC San Diego Moores Cancer Center revealed that patients with early-stage breast cancer in the milk ducts which has not spread, seem to benefit from undergoing breast brachytherapy with a strut-based applicator. This 5-day treatment is given to patients after they have undergone lumpectomy surgery. The researchers found that women who received strut-based breast brachytherapy had lower recurrence rates, as well as fewer and less severe side effects.
Chemotherapy
Medications are used to kill the cancer cells - these are called cytotoxic drugs. The oncologist may recommend chemotherapy if there is a high risk of cancer recurrence, or the cancer spreading elsewhere in the body. This is called adjuvant chemotherapy. If the tumors are large, chemotherapy may be administered before surgery. The aim is to shrink the tumor, making its removal easier. This is called neo-adjuvant chemotherapy.
Chemotherapy may also be administered if the cancer has metastasized - spread to other parts of the body. Chemotherapy is also useful in reducing some of the symptoms caused by cancer. Chemotherapy may help stop estrogen production. Estrogen can encourage the growth of some breast cancers.
Side effects of chemotherapy may include nausea, vomiting, loss of appetite, fatigue, sore mouth, hair loss, and a slightly higher susceptibility to infections. Many of these side effects can be controlled with medications the doctor can prescribe. Women over 40 may enter early menopause.
Protecting female fertility - Scientists have designed a way of aggressively attacking cancer with an arsenic-based chemo medication, which is much gentler on the ovaries. The researchers, from Northwestern University Feinberg School of Medicine in Chicago, believe their novel method will help protect the fertility of female patients undergoing cancer treatment. The scientists say they also developed a way of rapidly testing existing chemotherapy drugs for their effect on ovarian function, so that doctors and patients can make decisions regarding treatment that minimize damage to ovaries.
Although more cancer patients are surviving today thanks to the advances in cancer therapies, a significant number of female patients still face fertility loss after undergoing traditional chemotherapy.
Hormone therapy (hormone blocking therapy)
Used for breast cancers that are sensitive to hormones. These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers. The aim is to prevent cancer recurrence. Hormone blocking therapy is usually used after surgery, but may sometimes be used beforehand to shrink the tumor.
If for health reasons, the patient cannot undergo surgery, chemotherapy or radiotherapy, hormone therapy may be the only treatment she receives.
Hormone therapy will have no effect on cancers that are not sensitive to hormones. Hormone therapy usually lasts up to five years after surgery.
Ovarian ablation or suppression - pre-menopausal women produce estrogen in their ovaries. Ovarian ablation or suppression stop the ovaries from producing estrogen. Ablation is done either through surgery or radiation therapy - the woman's ovaries will never work again, and she will enter the menopause early.
Reduce the Risk
If the following points are adhered to, they can help reduce the risk of a woman developing breast cancer.
Alcohol consumption - women who drink in moderation, or do not drink alcohol at all, are less likely to develop breast cancer compared to those who drink large amounts regularly. Moderation means no more than one alcoholic drink per day.
Physical exercise - exercising five days a week has been shown to reduce a woman's risk of developing breast cancer. Researchers from the University of North Carolina Gillings School of Global Public Health in Chapel Hill reported that physical activity can lower breast cancer risk, whether it be mild or intense, or before/after menopause. However, considerable weight gain may negate these benefits.
Diet - some experts say that women who follow a healthy, well-balanced diet may reduce their risk of developing breast cancer.
Fish oils - a published study found that women who regularly consumed fish and marine n-3 polyunsaturated fatty acids had a 14% lower risk of developing breast cancer, compared to other women. The authors, from Zhejiang University, China, explained that a "regular consumer" should be eating at least 1 or 2 portions of oily fish per week (tuna, salmon, sardines, etc).
Postmenopausal hormone therapy - limiting hormone therapy may help reduce the risk of developing breast cancer. It is important for the patient to discuss the pros and cons thoroughly with her doctor.
Bodyweight - women who have a healthy bodyweight have a considerably lower chance of developing breast cancer compared to obese and overweight females.
Women at high risk of breast cancer - the doctor may recommend estrogen-blocking drugs. Preventive surgery is a possible option for women at very high risk.
Breast cancer screening - patients should discuss with their doctor when to start breast cancer screening exams and tests.
Breastfeeding - women who breastfeed run a lower risk of developing breast cancer compared to other women. A team of researchers reported in the Journal of Clinical Nursing that breastfeeding for at least six months reduces the risk of early breast cancer. This only applies to non-smoking women, the team added. They found that mothers who breastfed for six months or more, if they developed breast cancer, did so on average ten years later than other women.
The vast majority of breast cancer cases occur in females, therefore this article tackles breast cancer in women. Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.
Breast cancer rates are much higher in developed nations compared to developing ones. There are several reasons for this, with possibly life-expectancy being one of the key factors - breast cancer is more common in elderly women; women in the richest countries live much longer than those in the poorest nations. The different lifestyles and eating habits of females in rich and poor countries are also contributory factors, experts believe.
According to the National Cancer Institute, 232,340 female breast cancers and 2,240 male breast cancers are reported in the USA each year, as well as about 39,620 deaths caused by the disease.
The Anatomy of The Female Breast
2. Pectoralis muscles.
3. Lobules (glands that make milk).
4. Nipple surface.
5. Areola.
6. Lactiferous duct tube that carries milk to the nipple.
7. Fatty tissue.
8. Skin.
A mature human female's breast consists of fat, connective tissue and thousands of lobules - tiny glands which produce milk. The milk of a breastfeeding mother goes through tiny ducts (tubes) and is delivered through the nipple. The breast, like any other part of the body, consists of billions of microscopic cells. These cells multiply in an orderly fashion - new cells are made to replace the ones that died. In cancer, the cells multiply uncontrollably, and there are too many cells, progressively more and more than there should be.
Cancer that begins in the lactiferous duct (milk duct), known as ductal carcinoma, is the most common type. Cancer that begins in the lobules, known as lobular carcinoma, is much less common.
Recent developments on breast cancer diagnosis
Blood test to indicate breast cancer risk 'in development'
Researchers from University College London in the UK are developing a simple blood test to help predict the likelihood of a woman developing breast cancer. They publish their research in the open access journal Genome Medicine.
Zinc test for early breast cancer looks promising
A new study suggests it may be possible to detect the early signs of breast cancer with a test that measures changes in zinc isotopes. The researchers, led by scientists from the University of Oxford in the UK, report their findings in the journal Metallomics.
New evidence that MRI may help predict breast cancer in some women
According to a new study published in the journal Radiology, magnetic resonance imaging scans may help predict which women are most likely to develop breast cancer in the future.
Mammography still best for breast cancer screening, experts find
An international group of independent breast cancer experts have met to evaluate the benefits of different methods of screening for breast cancer, arriving at the conclusion that mammography is best for reducing breast cancer mortality in women aged over 50.
Symptoms of breast cancer
A symptom is only felt by the patient, and is described to the doctor or nurse, such as a headache or pain. A sign is something the patient and others can detect, for example, a rash or swelling.
The first symptoms of breast cancer are usually an area of thickened tissue in the woman's breast, or a lump. The majority of lumps are not cancerous; however, women should get them checked by a healthcare professional. Women who detect any of the following signs or symptoms should tell their doctor.
- A pain in the armpits or breast that does not seem to be related to the woman's menstrual period.
- Pitting or redness of the skin of the breast; like the skin of an orange.
- A rash around (or on) one of the nipples.
- A swelling (lump) in one of the armpits.
- An area of thickened tissue in a breast
- One of the nipples has a discharge; sometimes it may contain blood.
- The nipple changes in appearance; it may become sunken or inverted.
- The size or the shape of the breast changes.
- The nipple-skin or breast-skin may have started to peel, scale or flake.
Causes of breast cancer
Experts are not definitively sure what causes breast cancer. It is hard to say why one person develops the disease while another does not. We know that some risk factors can impact on a woman's likelihood of developing breast cancer. These are:
Getting older - the older a woman gets, the higher is her risk of developing breast cancer; age is a risk factor. Over 80% of all female breast cancers occur among women aged 50+ years (after the menopause).
Genetics - women who have a close relative who has/had breast or ovarian cancer are more likely to develop breast cancer. If two close family members develop the disease, it does not necessarily mean they shared the genes that make them more vulnerable, because breast cancer is a relatively common cancer.
The majority of breast cancers are not hereditary. Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast and/or ovarian cancer. These genes can be inherited. TP53, another gene, is also linked to greater breast cancer risk.
A history of breast cancer - women who have had breast cancer, even non-invasive cancer, are more likely to develop the disease again, compared to women who have no history of the disease.
Having had certain types of breast lumps - women who have had some types of benign (non-cancerous) breast lumps are more likely to develop cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.
Dense breast tissue - women with more dense breast tissue have a greater chance of developing breast cancer.
Estrogen exposure - women who started having periods earlier or entered menopause later than usual have a higher risk of developing breast cancer. This is because their bodies have been exposed to estrogen for longer. Estrogen exposure begins when periods start, and drops dramatically during the menopause.
Obesity - post-menopausal obese and overweight women may have a higher risk of developing breast cancer. Experts say that there are higher levels of estrogen in obese menopausal women, which may be the cause of the higher risk.
Height - taller-than-average women have a slightly greater likelihood of developing breast cancer than shorter-than-average women. Experts are not sure why.
Alcohol consumption - the more alcohol a woman regularly drinks, the higher her risk of developing breast cancer is. The Mayo Clinic says that if a woman wants to drink, she should not exceed one alcoholic beverage per day.
Radiation exposure - undergoing X-rays and CT scans may raise a woman's risk of developing breast cancer slightly. Scientists at the Memorial Sloan-Kettering Cancer Center found that women who had been treated with radiation to the chest for a childhood cancer have a higher risk of developing breast cancer.
HRT (hormone replacement therapy) - both forms, combined and estrogen-only HRT therapies may increase a woman's risk of developing breast cancer slightly. Combined HRT causes a higher risk.
Certain jobs - French researchers found that women who worked at night prior to a first pregnancy had a higher risk of eventually developing breast cancer. Canadian researchers found that certain jobs, especially those that bring the human body into contact with possible carcinogens and endocrine disruptors are linked to a higher risk of developing breast cancer. Examples include bar/gambling, automotive plastics manufacturing, metal-working, food canning and agriculture. They reported their findings in the November 2012 issue of Environmental Health.
Cosmetic implants may undermine breast cancer survival - women who have cosmetic breast implants and develop breast cancer may have a higher risk of dying prematurely from the disease compared to other females, researchers from Canada reported in the BMJ (British Medical Journal) (May 2013 issue). The team looked at twelve peer-reviewed articles on observational studies which had been carried out in Europe, the USA and Canada.
Experts had long-wondered whether cosmetic breast implants might make it harder to spot malignancy at an early stage, because they produce shadows on mammograms. In this latest study, the authors found that a woman with a cosmetic breast implant has a 25% higher risk of being diagnosed with breast cancer when the disease has already advanced, compared to those with no implants. Women with cosmetic breast implants who are diagnosed with breast cancer have a 38% higher risk of death from the disease, compared to other patients diagnosed with the same disease who have no implants, the researchers wrote.
After warning that there were some limitations in the twelve studies they looked at, the authors concluded "Further investigations are warranted into the long term effects of cosmetic breast implants on the detection and prognosis of breast cancer, adjusting for potential confounders".
Recent developments on breast cancer causes
Atypical hyperplasia linked to high lifetime risk of breast cancer
Researchers have long known that atypical hyperplasia - an accumulation of abnormal cells in the ducts or lobules of the breast - can increase a woman's risk of breast cancer. But a new study by researchers from the Mayo Clinic finds that this risk may be higher than previously thought.
Two new genetic risk factors uncovered Collaboration between dozens of worldwide cancer research institutes has added to the ever-improving understanding of breast cancer genetics and personal profiling of the disease by unearthing two new genetic variants associated with a higher risk for the women carrying them.
Breast cancer less likely to recur in women with history of breastfeeding. Breastfeeding is associated with a 30% overall decreased risk of breast cancer recurrence among women who have previously had one subtype of the disease, according to a new study published in the Journal of the National Cancer Institute.
Prenatal DDT exposure linked to increased risk of breast cancer
During the 1960s, the pesticide DDT was in widespread use around the globe. Though the chemical is now banned from use in the US and many other countries due to health concerns, a new study finds women who were exposed to higher levels of the chemical in utero more than 50 years ago may be at almost fourfold increased risk of breast cancer than women exposed to lower levels.
Invasive and Non-Invasive Breast Cancer
Invasive breast cancer - the cancer cells break out from inside the lobules or ducts and invade nearby tissue. With this type of cancer, the abnormal cells can reach the lymph nodes, and eventually make their way to other organs (metastasis), such as the bones, liver or lungs. The abnormal (cancer) cells can travel through the bloodstream or the lymphatic system to other parts of the body; either early on in the disease, or later.
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| Early Visible Symptoms of Breast Cancer |
Non-invasive breast cancer - this is when the cancer is still inside its place of origin and has not broken out. Lobular carcinoma in situ is when the cancer is still inside the lobules, while ductal carcinoma in situ is when they are still inside the milk ducts. "In situ" means "in its original place". Sometimes, this type of breast cancer is called "pre-cancerous"; this means that although the abnormal cells have not spread outside their place of origin, they can eventually develop into invasive breast cancer.
Diagnosing Breast Cancer
Women are usually diagnosed with breast cancer after a routine breast cancer screening, or after detecting certain signs and symptoms and seeing their doctor about them.
If a woman detects any of the breast cancer signs and symptoms described above, she should speak to her doctor immediately. The doctor, often a primary care physician (general practitioner, GP) initially, will carry out a physical exam, and then refer the patient to a specialist if he/she thinks further assessment is needed.
The following are examples of diagnostic tests and procedures for breast cancer:
Breast exam - the physician will check both the patient's breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape. The patient will be asked to sit/stand with her arms in different positions, such as above her head and by her sides.
X-ray (mammogram) - commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.
Breast ultrasound - this type of scan may help doctors decide whether a lump or abnormality is a solid mass or a fluid-filled cyst.
Biopsy - a sample of tissue from an apparent abnormality, such as a lump, is surgically removed and sent to the lab for analysis. If the cells are found to be cancerous, the lab will also determine what type of breast cancer it is, and the grade of cancer (aggressiveness). Scientists from the Technical University of Munich found that for an accurate diagnosis, multiple tumor sites need to be taken.
Breast MRI (magnetic resonance imaging) scan - a dye is injected into the patient. This type of scan helps the doctor determine the extent of the cancer. Researchers from the University of California in San Francisco found that MRI provides a useful indication of a breast tumor's response to pre-surgical chemotherapy much earlier than possible through clinical examination.
Stages of Breast Cancer
Staging describes the extent of the cancer in the patient's body and is based on whether it is invasive or non-invasive, how large the tumor is, whether lymph nodes are involved and how many, and whether it has metastasized (spread to other parts of the body). A cancer's stage is a crucial factor in deciding what treatment options to recommend, and in determining the patient's prognosis.
Treatments for breast cancer
A multidisciplinary team will be involved in a breast cancer patient's treatment. The team may consists of an oncologist, radiologist, specialist cancer surgeon, specialist nurse, pathologist, radiologist, radiographer, and reconstructive surgeon. Sometimes the team may also include an occupational therapist, psychologist, dietitian, and physical therapist.
The team will take into account several factors when deciding on the best treatment for the patient, including:
- The type of breast cancer.
- The stage and grade of the breast cancer - how large the tumor is, whether or not it has spread, and if so, how far.
- Whether or not the cancer cells are sensitive to hormones.
- The patient's overall health.
- The age of the patient (has she been through menopause?).
- The patient's own preferences.
The main breast cancer treatment options may include:
- Radiation therapy (radiotherapy).
- Surgery.
- Biological therapy (targeted drug therapy).
- Hormone therapy.
- Chemotherapy.
Surgery
Lumpectomy - surgically removing the tumor and a small margin of healthy tissue around it. In breast cancer, this is often called breast-sparing surgery. This type of surgery may be recommended if the tumor is small and the surgeon believes it will be easy to separate from the tissue around it. British researchers reported that about one fifth of breast cancer patients who choose breast-conserving surgery instead of mastectomy eventually need a reoperation.
Mastectomy - surgically removing the breast. Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy means also removing muscle of the chest wall and the lymph nodes in the armpit.
Many undergo pointless mastectomies due to fear - a study carried out at the Dana-Faber Cancer Institute and published in Annals of Internal Medicine found that many young women choose to have their healthy breast removed after being diagnosed with cancer in one breast. Unfortunately, doing so does not improve survival rates, the authors explained.
Sentinel node biopsy - one lymph node is surgically removed. If the breast cancer has reached a lymph node it can spread further through the lymphatic system into other parts of the body.
Axillary lymph node dissection - if the sentinel node was found to have cancer cells, the surgeon may recommend removing several nymph nodes in the armpit.
Breast reconstruction surgery - a series of surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. This procedure may be carried out at the same time as a mastectomy. The surgeon may use a breast implant, or tissue from another part of the patient's body.
Radiation therapy (radiotherapy)
Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any cancer cells that may still be around. Typically, radiation therapy occurs about one month after surgery or chemotherapy. Each session lasts a few minutes; the patient may require three to five sessions per week for three to six weeks. The type of breast cancer the woman has will decide what type of radiation therapy she may have to undergo. In some cases, radiotherapy is not needed.
Side effects of radiation therapy may include fatigue, lymphedema, darkening of the breast skin, and irritation of the breast skin.
Breast brachytherapy - scientists at UC San Diego Moores Cancer Center revealed that patients with early-stage breast cancer in the milk ducts which has not spread, seem to benefit from undergoing breast brachytherapy with a strut-based applicator. This 5-day treatment is given to patients after they have undergone lumpectomy surgery. The researchers found that women who received strut-based breast brachytherapy had lower recurrence rates, as well as fewer and less severe side effects.
Chemotherapy
Medications are used to kill the cancer cells - these are called cytotoxic drugs. The oncologist may recommend chemotherapy if there is a high risk of cancer recurrence, or the cancer spreading elsewhere in the body. This is called adjuvant chemotherapy. If the tumors are large, chemotherapy may be administered before surgery. The aim is to shrink the tumor, making its removal easier. This is called neo-adjuvant chemotherapy.
Chemotherapy may also be administered if the cancer has metastasized - spread to other parts of the body. Chemotherapy is also useful in reducing some of the symptoms caused by cancer. Chemotherapy may help stop estrogen production. Estrogen can encourage the growth of some breast cancers.
Side effects of chemotherapy may include nausea, vomiting, loss of appetite, fatigue, sore mouth, hair loss, and a slightly higher susceptibility to infections. Many of these side effects can be controlled with medications the doctor can prescribe. Women over 40 may enter early menopause.
Protecting female fertility - Scientists have designed a way of aggressively attacking cancer with an arsenic-based chemo medication, which is much gentler on the ovaries. The researchers, from Northwestern University Feinberg School of Medicine in Chicago, believe their novel method will help protect the fertility of female patients undergoing cancer treatment. The scientists say they also developed a way of rapidly testing existing chemotherapy drugs for their effect on ovarian function, so that doctors and patients can make decisions regarding treatment that minimize damage to ovaries.
Although more cancer patients are surviving today thanks to the advances in cancer therapies, a significant number of female patients still face fertility loss after undergoing traditional chemotherapy.
Hormone therapy (hormone blocking therapy)
Used for breast cancers that are sensitive to hormones. These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers. The aim is to prevent cancer recurrence. Hormone blocking therapy is usually used after surgery, but may sometimes be used beforehand to shrink the tumor.
If for health reasons, the patient cannot undergo surgery, chemotherapy or radiotherapy, hormone therapy may be the only treatment she receives.
Hormone therapy will have no effect on cancers that are not sensitive to hormones. Hormone therapy usually lasts up to five years after surgery.
Ovarian ablation or suppression - pre-menopausal women produce estrogen in their ovaries. Ovarian ablation or suppression stop the ovaries from producing estrogen. Ablation is done either through surgery or radiation therapy - the woman's ovaries will never work again, and she will enter the menopause early.
Reduce the Risk
If the following points are adhered to, they can help reduce the risk of a woman developing breast cancer.
Alcohol consumption - women who drink in moderation, or do not drink alcohol at all, are less likely to develop breast cancer compared to those who drink large amounts regularly. Moderation means no more than one alcoholic drink per day.
Physical exercise - exercising five days a week has been shown to reduce a woman's risk of developing breast cancer. Researchers from the University of North Carolina Gillings School of Global Public Health in Chapel Hill reported that physical activity can lower breast cancer risk, whether it be mild or intense, or before/after menopause. However, considerable weight gain may negate these benefits.
Diet - some experts say that women who follow a healthy, well-balanced diet may reduce their risk of developing breast cancer.
Fish oils - a published study found that women who regularly consumed fish and marine n-3 polyunsaturated fatty acids had a 14% lower risk of developing breast cancer, compared to other women. The authors, from Zhejiang University, China, explained that a "regular consumer" should be eating at least 1 or 2 portions of oily fish per week (tuna, salmon, sardines, etc).
Postmenopausal hormone therapy - limiting hormone therapy may help reduce the risk of developing breast cancer. It is important for the patient to discuss the pros and cons thoroughly with her doctor.
Bodyweight - women who have a healthy bodyweight have a considerably lower chance of developing breast cancer compared to obese and overweight females.
Women at high risk of breast cancer - the doctor may recommend estrogen-blocking drugs. Preventive surgery is a possible option for women at very high risk.
Breast cancer screening - patients should discuss with their doctor when to start breast cancer screening exams and tests.
Breastfeeding - women who breastfeed run a lower risk of developing breast cancer compared to other women. A team of researchers reported in the Journal of Clinical Nursing that breastfeeding for at least six months reduces the risk of early breast cancer. This only applies to non-smoking women, the team added. They found that mothers who breastfed for six months or more, if they developed breast cancer, did so on average ten years later than other women.
Credits: Medical News Today, Google images. Edited
Thank you very Steady info ... hopefully more successful.
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