Breast cancer

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Breast Cancer

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Breast cancer is cancer of breast tissue. Worldwide, it is the most common form of cancer in females, affecting approximately one out of twelve to thirteen women who reach age ninety at some stage of their life in the Western world. It is (after lung cancer) the second most fatal cancer in women. [1] Because the breast is composed of identical tissues in males and females, breast cancer can also occur in males, but here the incidence is very low, less than 1 percent.

History of breast cancer

Breast cancer is one of the oldest known forms of cancer tumors. Our oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 B.C. The Edwin Smith Papyrus, or writing, describes 8 cases of tumors or ulcers of the breast that were treated by cauterization, with a tool called "the fire drill." The writing says about the disease, "There is no treatment." [2] At least one of the described cases is male. This papyrus is 5 meters long and is kept in the New York Historical Society. Scholars believe that the actual document is a copy of an original document from the 30th century before Christ. In any case, for centuries, physicians described similar cases in their practises, with the same sad conclusion. It wasn't until greater understanding of the circulatory system was added to the body of medical knowledge in the 17th century that doctors made the link to the lymph glands in the armpit. The French surgeon Jean Louis Petit (1674-1750) and later the Scottish surgeon Benjamin Bell (1749-1806) were the first to remove the lymph nodes, breast tissue, and breast muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up to the 1970's and was performed on Betty Ford.

Types of breast cancer

Causes

The cause of breast cancer is unknown, but research shows that certain risk factors are associated with the disease.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for breast cancer include:

  • Sex: Female, although men can also get breast cancer
  • Age: 50 or older
  • Personal history of breast cancer
  • Family members with breast cancer
  • Changes in breast tissue, such as atypical ductal hyperplasia, radial scar formation, and *lobular carcinoma in situ (LCIS)
  • Changes in certain genes (BRCA1, BRCA2, and others)
  • Race: Caucasian
  • Increased exposure to estrogen over a lifetime through:
    • Early onset of menstruation
    • Late onset of menopause
    • No childbearing or late childbearing
    • Absence of breastfeeding
    • Taking hormone replacement therapy for long periods of time (Prempro for more than four years)
  • Tobacco use
  • Increased breast density (more lobular and ductal tissue and less fatty tissue)
  • Radiation therapy before the age of 30 years old
  • Overuse of alcohol

Note: Studies show that most women with known risk factors do not get breast cancer. And many women who get breast cancer have none of the risk factors listed above, other than the risk that comes with growing older.

Symptoms

When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause the following changes:

A lump or thickening in or near the breast or in the underarm area or in the neck A change in the size or shape of the breast Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast Ridges or pitting of the breast skin (like the skin of an orange) A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

Clinical Breast Exam–The doctor carefully feels the breast lump and the tissue around it. The doctor examines the size and texture of the lump and determines whether the lump moves easily. The doctor will examine both breasts, since the tissue can be very “lumpy” throughout the breast in some patients.

Mammography–x-rays of the breast used to see lumps or other changes in breast tissue

Ultrasonography–the use of high-frequency sound waves to see whether a lump is a fluid-filled cyst (usually not cancer) or a solid mass (which may or may not be cancer)

Biopsy–removal of tumor tissue to be tested for cancer cells. Types of biopsies for breast cancer include:

Fine-needle aspiration–removal of fluid and/or cells from a breast lump using a thin needle Needle biopsy–removal of tissue with a needle from an area that looks suspicious on a mammogram but cannot be felt

Surgical biopsy:

Incisional biopsy–cutting out a sample of a lump or suspicious area Excisional biopsy–cutting out all of a lump or suspicious area and an area of healthy tissue around the edges

Hormone Status Evaluation—Breast cancer tissue is tested for the presence of estrogen and progesterone receptors, which are used to help plan therapy.

Treatment

Once breast cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent.

Treatments include:

Surgery Surgery is the removal of the cancerous tumor and nearby tissues, and possibly nearby lymph nodes. The most common procedures performed today are the lumpectomy (which may be called a tylectomy, segmentectomy, or quadrantectomy) and the modified radical mastectomy.

Lumpectomy–removal of the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed.

Segmentectomy–removal of the cancer and a larger area of normal breast tissue around it.

Simple Mastectomy–removal of the breast, or as much of the breast as possible, without the intentional removal of the lymph nodes.

Radical Mastectomy–removal of the breast, both chest muscles, the lymph nodes under the arm, and some additional fat and skin. This procedure is only considered in rare cases if the cancer has spread to the chest muscles, and is rarely performed in the United States at this time.

Modified Radical Mastectomy–removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles.

Axillary Lymph Node Dissection–removal of the lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system.

Sentinel Lymph Node Biopsy–the placement, by the surgeon, of a small amount of blue dye and/or a radioactive tracer in the area where the tumor was located. The dye or tracer is then followed into the armpit and only those lymph nodes picking up the substance are removed. The accuracy rate for this procedure exceeds 95% in experienced hands and reliably identifies those lymph nodes that may contain cancer. Presently, those remaining lymph nodes should be removed if any sentinel nodes contain cancer. This method is usually done in women who do not have lymph nodes that can be felt in the armpit. The potential side effects are far less than seen after a standard lymph node dissection.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Two main types of radiation may be used:

External Radiation Therapy–radiation directed at the breast from a source outside the body.

Internal Radiation Therapy–radioactive materials placed into the breast in or near the cancer cells.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Biologic Therapy

Biologic therapy is the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. It is also called biologic response modifier (BRM) therapy.

Prevention

Because the cause of breast cancer is unknown, finding it early and treating it is the best way to prevent dying from the disease. And because it does not cause symptoms in the early stages, it is important to have screening tests to find the cancer before symptoms appear.

Women age 20 or older should perform a breast self-exam (BSE) every month. Women between the ages of 20-39 should have a clinical breast exam by a health professional every three years. A breast exam should be performed more regularly if there is a family history or there have been previous breast biopsies. Women age 40 and older should have a screening mammogram every year. Some advocate that a mammogram should be given sooner for patients with a strong family history or whom have had previous breast biopsies performed.

After age 40, women should have a breast exam by a healthcare professional every year.

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