Breast cancer is the most common cancer in women, being responsible for almost 20 percent of all cancer deaths in women. It ranks second after lung cancer. Roughly 180,000 women are diagnosed with this disease each year, of which 44,000 will die. With increased awareness and increased use of routine mammograms, more women are diagnosed in the earlier stages of this disease, at which time a cure may be possible. For every 100 women, one man is diagnosed with this disease. The disease is more common in women after age 40. It is also more frequent in women of a higher social-economic class.
CAUSES OF BREAST CANCER
Many factors are known to increase the risk of development of breast cancer:
• Genetic predisposition. A few genetic markers have been linked to development of breast cancer.
• History of breast cancer in a first-degree relative
• History of breast cancer in the same patient, in the opposite breast
• Onset of menstruation in early ages
• Late onset of menopause
• Radiation exposure
• Heavy alcohol consumption
• High fat diet
• Obesity
• First pregnancy after age of 30
• Very tall women
SIGNS AND SYMPTOMS
More women are now being diagnosed by means of a routine mammogram. Others may feel a lump in the breast or notice abnormal discharge from the nipple, or feel thickness or swelling of the skin or nipple. It is frequently diagnosed by a physician during a routine breast examination.
Any lump in the breast and any mammogram abnormality must be studied very carefully. If any degree of suspicion exists as to the nature of the lump, it should be
biopsied. This may be accomplished by Fine Needle Aspiration, a Core Biopsy or Surgical Biopsy.
TREATMENT
Surgery is the mainstay of therapy for breast cancer. The choice of which type of surgery is based on a number of factors, including the size and location of the tumor, the type of tumor and the person's overall health and personal wishes. Breast-sparing surgery is often possible.
The cancer is staged, using the information from surgery and from other tests. Staging is a classification that reflects the extent and spread of a tumor and has an impact on treatment decisions and also the prognosis for recovery.
• Staging in breast cancer is based on the size of the tumor, which parts of the breast are involved, how many and which lymph nodes are affected, and whether the cancer has metastasized to another part of the body.
• Cancers may be referred to as invasive if they have spread to other tissues. Those that do not spread to other tissues are called noninvasive. Carcinoma in situ is a noninvasive cancer.
STAGING
Breast cancer is staged from 0 to IV.
• Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no affected lymph nodes or metastasis. This is the most favorable stage of breast cancer.
• Stage I is breast cancer that is less than 2 cm (3/4 in) in diameter and has not spread from the breast.
• Stage II is breast cancer that is fairly small in size but has spread to lymph nodes in the armpit OR cancer that is somewhat larger but has not spread to the lymph nodes.
• Stage III is breast cancer of a larger size, greater than 5 cm (2 in), with greater lymph node involvement, or of the inflammatory type.
• Stage IV is metastatic breast cancer: a tumor of any size or type that has metastasized to another part of the body. This is the least favorable stage.
PREVENTION
The most important risk factors for the development of breast cancer are sex, age, and genetics. Because women can do nothing about these risks, regular screening is recommended in order to allow early detection and thus prevent death from breast cancer.
Regular screening includes breast self-examination, clinical breast examination, and mammography.
Breast self-examination (BSE) is cheap and easy. Routine monthly examination may be helpful. Previously considered critical, more recent studies suggest that self breast exam may be less valuable than previously thought, especially for women who are having routine clinical breast examination and/or mammography.
• For women who are menstruating, the best time for examination is immediately after the monthly period.
• For women who are not menstruating or whose periods are extremely irregular, picking a certain date each month seems to work best.
• Instruction in the technique of breast self-examination can be obtained from your health-care provider or from any one of several organizations interested in breast cancer.
Clinical breast examination: The American Cancer Society recommends a breast examination by a trained health-care provider once every three years starting at age 20 years, and then yearly after age 40 years.
Mammograms are recommended every one to two years starting at age 40 years. For women at high risk for the development of breast cancer, mammogram screening may start earlier, generally 10 years prior to the age at which the youngest close relative developed breast cancer.
Obesity after menopause and excessive alcohol intake may increase the risk of breast cancer slightly. Physically active women may have a lower risk. All women are encouraged to maintain normal body weight, especially after menopause and to limit excess alcohol intake. Hormone replacement should be limited in duration if it is medically required.
In women who are genetically at high risk for the development of breast cancer, tamoxifen has been shown to significantly decrease the incidence of the disease. Side effects should be carefully discussed with your health-care provider prior to embarking on therapy. A second drug, raloxifene (Evista), which is now being used for the treatment of osteoporosis, also blocks the effects of estrogen and appears to prevent breast cancer. Initial studies showed that both tamoxifen and raloxifene were able to reduce the risk of invasive breast cancer, but raloxifene did not have this protective effect against noninvasive cancer. Studies are ongoing to further characterize the effectiveness and indications for use of raloxifene as a breast cancer preventive drug.
Occasionally, a woman at very high risk for development of breast cancer will decide to have a preventive or prophylactic mastectomy to avoid developing breast cancer. Additionally, removal of the ovaries has shown to reduce the risk of developing breast cancer in women who have the BRCA1 mutation and who have their ovaries surgically removed before they reach age 40.
