Breast Cancer

Breast cancer is the most common cancer in women affecting one in eight women during their lives. It may develop at any time but the risk of developing it increases as women get older. It is far more common in post-menopausal women and the risk continues to increase with rising age.

CAUSE
The cause of breast cancer is not known and while it can also occur in men, the much higher occurrence in women implicates estrogen.

Today, BC like other forms of cancer, is considered to be the final outcome of multiple environmental and hereditary factors. Breathing secondhand smoke increases risk by 70% in younger, primarily pre-menopausal women.
A newly released study indicates a correlation between the drop in breast cancer and the drop in women taking HRT.

SIGNS AND SYMPTOMS
Breast carcinoma elicits so many fears, including those relating to surgery, death, loss of body image and loss of sexuality, however it is more easily treated and often curable if it is found early, therefore regular self examination and screening is essential. The cancer usually shows as a lump or thickening in the breast tissue, although most breast lumps are not cancerous.

Certain predisposing factors are clear.

Women at high risk are those who:

Have a family history of breast cancer.
Have long menstrual cycles, began menses early or menopause late.
Have never been pregnant
Were first pregnant after age 31.
Have had unilateral breast cancer.
Have endometrial or Ovarian cancer.
Were exposed to low level ionizing radiation.

Many other possible factors are still under investigation including, obesity, alcohol and environmental factors.

Those with lower risk include women who:

Were pregnant before age 20.
Have had multiple pregnancies.
Are native American or Asian.

The cancer occurs more often in the left breast and in the upper quadrant.
Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge.

TYPES
When the cancer cells invade the dermal lymphatics, small lymph vessels in the skin of the breast, its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange peel texture to the skin referred to as peau d'orange.

The most common pathologic types are invasive ductal carcinoma, malignant cancer in the breast's ducts, and invasive lobular carcinoma, malignant cancer in the breast's lobules.
Occasionally, BC presents as metastatic disease, that is, cancer that has spread beyond the original organ. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms.

TREATMENT
Much controversy still exists over treatment, options include; Surgery, chemotherapy, Radiotherapy,Hormonal therapies,Herceptin and complementary treatments.

The mainstay of treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy.

In February 2007, the MammaPrint test became the first breast cancer predictor to win formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated.

Interstitial laser thermotherapy (ILT) is an innovative method of treating breast cancer in a minimally invasive manner and without the need for surgical removal, and with the absence of any adverse effect on the health and survival of the patient during intermediate followup.

PREVENTION
Routine (annual) mammography of women older than age 40 or 50 is recommended by numerous organizations as a screening method to diagnose early breast cancer and has demonstrated a protective effect in multiple clinical trials.

Women with one or more first-degree relatives (mother, sister, daughter) with premenopausal cancer should begin screening at an earlier age.

PROGNOSIS
There are many prognostic factors associated with breast cancer: staging, tumour size and location, grade, whether disease is systemic (has metastasized, or traveled to other parts of the body), recurrence of the disease, and age of patient.

With advances in screening, diagnosis, and treatment, the death rate has declined by about 20% over the past decade, and research is ongoing to develop even more effective screening and treatment programs.