Today I want to talk about a common disease that has remained the second leading cause of death among women globally. Despite increased awareness and improved management options, breast cancer has continued to pose a great health challenge to women worldwide.
By BruceBlaus - Own work, CC BY-SA 4.0, Wikimedia
In this post, I will talk about breast cancer, what we need to know and how to prevent it. Though the incidence of breast cancer is much higher in women, it is important to note that it can affect men too. So everyone needs to be on the alert.
To start this discussion, let us first of all look at the normal structure of the breast. The breast is the mammary gland which is composed of cells and tissues that assist it to perform its normal function of milk production and also channel the produced milk to the nipple where the baby can access it. The part which produces the milk here is called the lobes while the part that gathers the produced milk and channels it to the nipple is called the ducts.
Breast cancer occurs when the cells and tissues of these lobes and ducts start growing uncontrollably. Normally, the body has some mechanisms in place to control cellular growth and functions. When the body for some reason loses this control mechanism, the cells grow and divide without control which results in cancer.
When this abnormal cell growth occurs in the ducts of the breast, it is called invasive ductal carcinoma which is the commonest type of breast cancer. When it occurs in the lobes, it is called invasive lobular carcinoma. There can also be mixed ductal and lobular carcinoma. In these types, the cells grow and infiltrate into the surrounding tissues of the breast, armpit, and even distant organs like the lungs, liver, bones, etc. This is referred to as metastases.
However, when the cells multiply but have not breached the basement membrane of the epithelium and have not yet invaded other cells and tissues, they are regarded as pre-invasive cancer, and in medical terms, it is called Carcinoma In Situ. So you can have Ductal Carcinoma In Situ (DCIS) or Lobular Carcinoma In Situ (LCIS).
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Other types of breast cancers include Tubular carcinoma, medullary carcinoma, colloid carcinoma, Inflammatory carcinoma, etc.
It is also important to note that not all breast tumors are cancerous. Some breast tumors are described as benign, meaning that the growth is only limited to the affected breast, it doesn't expand to the surrounding structures or other parts of the body. These types generally have a good outcome.
For example, Fibroadenoma usually presents as a painless lump in the breast. It is very common among young women and can easily be removed surgically through a process called an excision biopsy. Other breast tumors in this category include; phyllodes tumor, duct ectasia, lipoma of the breast, traumatic fat necrosis, chronic breast abscess, Tuberculosis of the breast, etc. In this discussion, we will focus on breast cancers which are malignant tumors.
WHY IS THIS BREAST CANCER AWARENESS VERY IMPORTANT TO US
According to the Centre for Disease Control (CDC),
Each year in the United States, about 264,000 cases of breast cancer are diagnosed in women and about 2,400 in men. About 42,000 women and 500 men in the U.S. die each year from breast cancer. Black women have a higher rate of death from breast cancer than White women.
**SYMPTOMS OF BREAST CANCER **
Patients who have breast cancers usually come with complaints of a lump in the breast, breast pain, and or nipple discharge which is most times bloody. They may also notice a deformity in the nipple or the dark area around the nipple called the areola. Other symptoms caused by the spread of the disease to other organs may be present.
If cancer has spread to the lungs, the patient will be having difficulty in breathing and cough with blood in the sputum. For spread to the bones, the patient with be having bone pain, low back pain, and also frequent fractures. When cancer spreads to the brain, the patient may have convulsions and disorientation. The patient will have yellow eyes when the tumor spreads to the liver. Other complications will include weight loss, fever, loss of appetite, and a general feeling of unwell.
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CAUSES/ RISK FACTORS OF BREAST CANCER
Cancer is caused by some changes in the genetic makeup of cells through a process called a mutation. Though there is no singular factor that has been known as the direct cause of cancer, many factors have been found to contribute to this disease. Those are the risk factors for cancer. These include:
Estrogen: In my last post, I talked about this hormone extensively and its role in influencing the growth of many cancers in the body. Breast cancer is one of those estrogen-dependent cancers. So factors like early age of first menstrual period (menarche), late age of last menstrual period (menopause), use of oral contraceptive pills, hormone replacement therapy, late age of first full-term pregnancy, and reduced breastfeeding period are factors that cause an increased level of estrogen or unopposed action of estrogen and are prominent risk factors for breast cancer.
Gender and Age are also risk factors for this cancer. The female gender, especially those who are older than 50 years are at a more increased risk of breast cancers than the younger ones.
The genetic makeup of the individual also plays a key role. Those who have their immediate family/first-degree relatives with breast cancers are at increased risk. Also, those who inherited the gene mutation called the BRCA1 and BRCA2 genes are at more risk.
A diet high in saturated fats and a high intake of alcohol as well as some drugs like reserpine, L-thyroxine, and diethylstilbestrol are also risk factors.
Those who have had radiation to their chest or women who have dense breasts have also been found to be at more increased risk, as well as obese and sedentary women.
It is important to note here that having any of these risk factors does not automatically mean that the individual will develop breast cancer. Just these factors may help to fuel the disease.
By Mikael H盲ggstr枚m, M.D., CC0, Wikimedia
INVESTIGATIONS
It is not everyone that has a breast lump that has breast cancer. Some investigations need to be done to determine if this is breast cancer or not. These are regarded as the investigations to make a diagnosis.
Then if it is breast cancer, we will want to find out the extent and how far the disease has spread to other tissues and organs in the body. This is determined through another group of investigations called staging investigations. And then finally, we will do a third group of investigations that will help us to treat/manage the patient.
To make a diagnosis of breast cancer, there are 3 groups of investigations done which are normally regarded as triple assessments. These are the Clinical assessment, radiological investigations, and histological/cytological analysis.
In Clinical assessment, a physical examination is done on the patient by the doctor who examines the breast and all other systems of the body. In Radiological investigations, a breast ultrasound or mammography is done depending on the age. For women less than 35 years of age, a breast ultrasound scan is preferred while for those above 35 years, a mammogram is done.
In the histological/cytological analysis, a procedure called the fine needle aspiration cytology (FNAC) is done especially in younger women. To determine the histological subtype or grade of the tumor, a biopsy is done which can be a trucut, wedge, incision, or excision biopsy. These investigations help the doctor to say that yes, this is breast cancer and also know some other details about cancer.
By Linda Bartlett (photographer), Public Domain, Wikimedia
In the second group of investigations which is to know the extent of the disease, investigations in this category include a skeletal bone survey or bone scan, chest x-ray, abdominal ultrasound scan, liver function test as well as diagnostic investigations on the second (normal) breast. The findings of these tests will help the doctor know how far the disease has spread in the body.
The third group of investigations that help in the treatment of the patient includes; Urinalysis, full blood count, serum electrolyte, urea and creatinine, Electrocardiogram, etc.
TREATMENT
The treatment of breast cancer usually involves surgery, drugs, hormones, immune therapy, or radiation depending on the stage of the disease. Those who have an early-stage disease that is still confined to the breast will benefit from surgery and the outcome is generally good. This is why early detection is very very important before the disease spreads.
However, those who get to the hospital late when the disease has spread will not benefit from surgery before taking off the breast at that time won't change much since the cancer cells have spread all over the body already. These people rely more on chemotherapy (drugs that kill cancer cells). Surgery can only be done to just reduced the burden of the disease but not for a cure (palliative surgery).
So for those who will benefit from surgery, the types of surgery can either be a simple mastectomy where only the affected breast is removed, or radical mastectomy where the affected breast is removed alongside the surrounding muscles, lymph nodes, etc.
However, this radical mastectomy is not a more common practice as patients don't benefit much from it compared to the issues associated with it. Currently, the preferred procedure is called a modified radical mastectomy which is a great improvement from the previous method.
By Monica Giovannini, Carmelo D', CC BY-SA 2.0, Wikimedia
The second group of surgery is called conservative breast surgery where the part of the affected breast is removed, instead of the whole breast. The procedures here can be either a wide local excision, a lumpectomy where the lump only is just removed, or a quadrantectomy where just a quadrant of the breast is removed.
After surgery, there are available prostheses which can be external prostheses or breast reconstruction surgery using silicon gel or muscle flaps. This helps to restore the beautiful appearance of the woman and gives her psychological and social fulfillment.
Drugs are given as the second line of treatment for early cases and as the first line of treatment for late cases. These drugs are targeted to kill the rapidly multiplying cancer cells. They are called cytotoxic chemotherapy and examples include cyclophosphamides, methotrexate, adriamycin, 5 fluorouracil, etc.
Radiotherapy can also be given when indicated and involves channeling a beam of radiation to burn off the tumor cells. They are used to prevent the chances of recurrence after surgery.
With the understanding of the roles of estrogen and progesterone in cancer growth, hormone therapy has been developed for hormone receptor-positive tumors. These hormone therapies are the tamoxifen and aromatase inhibitors and have proven to be effective in cancer treatment. Immune therapy like trastuzumab is also given for those that are growth factor receptor positive.
PREVENTION OF BREAST CANCER
This is the most important aspect of this discussion as it is very possible to lower the risks of developing breast cancer. Early detection is also very important and those who come early usually have an excellent outcome and possible total cure.
The first step here is a screening method called a mammogram. This is an X-Ray of the breast which helps to find breast cancers very early when treatment is very easy with a good outcome. This is often recommended every 3 years interval, especially for women who are 40 years and above. However, you need to discuss with your health provider to advise you on the mammogram schedule best suitable for you.
The next here is a self-breast examination. This is an examination that a woman can do on her breast by herself to look out for any lump or changes in the breast. This helps to detect these changes very early and urgent intervention is given. This is usually recommended once a month. You can check this material Here on how to do a self-breast examination.
By Linda Bartlett, National Cancer Institute, Public Domain, Wikimedia
Other preventive measures are those that help us to prevent the various risk factors. These include maintaining a healthy lifestyle, appropriate weight, a diet rich in fruits and vegetables, regular exercise, and rest. Also, consult your doctor before taking any oral contraceptive pills or hormone replacement therapy.
In conclusion, breast cancers are common in our environment. Early detection and prompt treatment are very key to effective treatment, recovery, and improved outcomes.
Though not all lumps are cancerous, any new lump noticed in the breast should be reported to the doctor immediately for proper examination, investigation, and advice. Together, we can win the fight against breast cancer!
Thanks so much for reading.
For references and further reading, please check the resources below;
