Breast cancer awareness and research funding has helped improve the screening, diagnosis and advances in the treatment of breast cancer.
Breast cancer survival rates have increased, and the number of deaths has reduced greatly, which is largely due to a number of factors such as earlier detection, a prompt approach to treatment and a better understanding of the disease.
WHAT IS BREAST CANCER?
This is the type of cancer that forms within the cells of the breast.
Breast cancer is the most common invasive cancer in women, and the second main cause of cancer death in women, after lung cancer. Breast cancer can occur in both men and women, but it's far more common in women.
RISK FACTORS TO BREAST CANCER
Factors that are associated with an increased risk of breast cancer include:
▶Being female: Women are much more likely than men are to develop breast cancer.
▶Age: Your risk of breast cancer increases as you age.
▶Previous history of breast cancer: If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
▶Heredity: If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, you have a higher risk of breast cancer. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
▶Radiation exposure: If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
▶Obesity: Being overweight increases your risk of breast cancer.
▶Early menachy: Beginning your period before age 12 increases your risk of breast cancer.
▶Late menopause: If you began menopause at an older age, you're more likely to develop breast cancer.
▶Grand primiparous: Women who give birth to their first child after age 35 may have an increased risk of breast cancer.
▶have never been pregnant: Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
▶Hormone therapy: Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
▶Alcohol: Drinking alcohol increases the risk of breast cancer.
SIGNS AND SYMPTOMS OF BREAST CANCER
▶A breast lump or thickening that feels different from the surrounding tissue
▶Bloody discharge from the nipple
▶Change in the size, shape or appearance of a breast
▶Changes to the skin over the breast, such as dimpling
▶A newly inverted nipple
▶Peeling, scaling or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
▶Redness or pitting of the skin over your breast, like the skin of an orange.
STAGES OF BREAST CANCER
There are different ways of staging breast cancer. One way is from stage 0 to 4, and it is staged according to the size of the tumor and whether it has spread to lymph nodes or other parts of the body.
Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within a duct and have not invaded surrounding tissues.
Stage 1: At the beginning of this stage, the tumor is up to 2 centimeters (cm) across and it has not affected any lymph nodes.
Stage 2: The tumor is 2 cm across and it has started to spread to nearby nodes.
Stage 3: The tumor is up to 5 cm across and it may have spread to some lymph nodes.
Stage 4: The cancer has spread to distant organs, especially the bones, liver, brain, or lungs.
MANAGEMENT OF BREAST CANCER
The main options include:
◻biological therapy, or targeted drug therapy
Most women undergo surgery for breast cancer and also receive additional treatment before or after surgery, such as chemotherapy, hormone therapy or radiation.
There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.
✔Breast cancer surgery
Operations used to treat breast cancer include:
▶Removing the breast cancer (lumpectomy). During lumpectomy, which may be referred to as breast-sparing surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors.
▶Removing the entire breast (mastectomy). Mastectomy is surgery to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola (simple mastectomy).
In a skin-sparing mastectomy, the skin over the breast is left intact to improve reconstruction and appearance. Depending on the location and size of the tumor, the nipple may also be spared.
▶Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor.If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.
▶Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel node, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.
▶Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.
Some women choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon.
Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a breast implant (silicone or water-filled) or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).
External beam radiation is commonly used after lumpectomy for early-stage breast cancer. Care giver may also recommend radiation therapy to the chest wall after mastectomy for larger breast cancers or cancers that have spread to the lymph nodes.
Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, your care giver may recommend chemotherapy to decrease the chance that the cancer will re-occur. This is known as adjuvant systemic chemotherapy.
Chemotherapy is sometimes given before surgery in women with larger breast tumors. The goal is to shrink a tumor to a size that makes it easier to remove with surgery.
Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.
Hormone therapy — perhaps more properly termed hormone-blocking therapy is often used to treat breast cancers that are sensitive to hormones. Care givers sometimes refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.
Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:
Medications that block hormones from attaching to cancer cells. Selective estrogen receptor modulator.
◼ (SERM) medications act by blocking estrogen from attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors and killing tumor cells.
SERMs include tamoxifen, raloxifene (Evista) and toremifene (Fareston).
Possible side effects include hot flashes, night sweats and vaginal dryness. More-significant risks include blood clots, stroke, uterine cancer and cataracts.
◼ Aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).
Side effects include hot flashes, night sweats, vaginal dryness, joint and muscle pain, as well as an increased risk of bone thinning (osteoporosis).
Targeted drug treatments attack specific abnormalities within cancer cells.
Targeted drugs used to treat breast cancer include:
COPING AND SUPPORT MECHANISM
A breast cancer diagnosis can be overwhelming. And just when you're trying to cope with the shock and the fears about your future, you're asked to make important decisions about your treatment.
Every woman has her own way of coping with a breast cancer diagnosis. Until you find what works for you, it might try the following:
✔Learn what you need to know about your breast cancer. If you'd like to know more about your breast cancer, ask your care giver for the details of your cancer. the type, stage and hormone receptor status.
Ask for good sources of up-to-date information on your treatment options. Knowing more about your cancer and your options may help you feel more confident when making treatment decisions. Still, some women may not want to know the details of their cancer. If this is how you feel, let your care provider know that, too.
✔Talk with other breast cancer survivors. You may find it helpful and encouraging to talk to other women with breast cancer. Find out about support groups in your area and online.
✔Find someone to talk about your feelings with. Find a friend or family member who is a good listener, or talk with a clergy member or counselor. Ask your cear provider for a referral to a counselor or other professional who works with cancer survivors.
✔Keep your friends and family close. Your friends and family can provide a crucial support network for you during your cancer treatment.
✔As you begin telling people about your breast cancer diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with, whether it's having someone to talk to if you're feeling low or getting help preparing meals.
✔Maintain intimacy with your partner. In Western cultures, women's breasts are associated with attractiveness, femininity and sexuality. Because of these attitudes, breast cancer may affect your self-image and erode your confidence in intimate relationships. Talk to your partner about your insecurities and your feelings.
PREVENTION OF BREAST CANCER
Making changes in your daily life may help reduce your risk of breast cancer. Try to:
▶breast cancer screening: Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.
▶breast self-exam for breast awareness: Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breasts, talk to your care provider promptly.
Breast awareness can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.
▶Drink alcohol in moderation: if at all. Limit the amount of alcohol you drink to less than one drink a day, if you choose to drink.
▶Exercise: Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your doctor whether it's OK and start slowly.
▶Limit postmenopausal hormone therapy: Combination hormone therapy may increase the risk of breast cancer. Talk with your care provider about the benefits and risks of hormone therapy.
Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.
▶Healthy weight: If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your care giver about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise.
▶Healthy diet: Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer.
The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. People who follow the Mediterranean diet choose healthy fats, like olive oil, over butter and fish instead of red meat.
Written By: Abubakar Bukola, RN.
[Nurse Abubakar is an admin on JustAskNurse]