Breast cancer is a matter of serious concern for most women because one in eight women in the US is likely to be affected by this form of cancer. Awareness of the symptoms of the disease and the ability to conduct self-examination are the key to early discovery and treatment of breast cancer. Most women who get cancer of the breast are worried about the effect of the disease on their lives, their health, their body image, their sexuality, and they are often unaware of the options available for treatment.
Making decisions on the course of treatment to be followed will depend on the stage of the cancer, the age and health of the patient, and her family history.
Breast cancers may be of two types: ductal carcinoma and lobular carcinoma. Ductal carcinoma is more common that lobular carcinoma. A tumor in the duct that allows the milk to flow to the nipple is called ductal carcinoma. On the other hand, a tumor in the lobules, the glands that produce milk, is termed lobular carcinoma. When the cancer remains limited to the duct or the lobules and has not spread to nearby breast tissues or the lymph nodes under the arms, it is said to be in situ or non-invasive.
Left untreated, some of these may turn into invasive cancers and spread to other parts of the body. In women with ER positive cancer, the hormone estrogen causes the tumor to grow. Some women have cancers that are termed HER2 positive because the gene HER2, which is responsible for the division and growth of cells, is defective and causes cells to grow faster, enabling the tumor to grow aggressively.
Among breast cancer tests, mammograms are the most commonly used to screen for cancers. When a woman doing a breast self exam notices a lump or a swelling, she needs to report it to her doctor. The health care professional will then conduct a clinical breast exam to see if further tests are needed. Women who are at a high risk of developing breast cancer for various reasons are advised to take a screening mammogram once in three years after the age of 30. Understanding the mammogram results is important to avoid anxiety, particularly if you have to go for follow up tests like a breast MRI or a breast ultrasound.
Ultrasound may be used to get an image of the inside of the breast and see if the lump felt is a cyst-filled with fluid or a solid tumor. MRI is generally used to confirm the mammogram findings and to get a clearer image.
A breast biopsy is done to extract a small piece of tissue from the lump in the breast and examine the sample under a microscope to detect cancer cells. When the mass is filled with fluid, a needle may be inserted to get a sample of the fluid and rule out cancer. This is a minimally invasive breast biopsy. The tissue sample may also be taken by making a surgical incision on the breast at the site of the lump. In cases where the presence of a cancerous tumor is established, a sentinel node biopsy may be done to determine how far the cancer has spread. Sentinel lymph nodes from the underarm may be surgically removed and examined for cancer cells. The presence of cancer cells in the nodes points to the metastasizing of the cancer. Doctors may use ductal lavage to obtain a sample of the fluid from the milk ducts to check for the presence of cancerous cells in women who are in the high risk category. While it is not a complete screening test it itself, it can indicate the presence of abnormal cells in the breast.
Gender plays a very important role in breast cancer as it affects women mostly, though men have been known to suffer from this form of cancer too. Genetic abnormalities and hormonal factors influenced by fertility, lifestyle, and age are some of the risk factors identified by doctors, though there are no definitive breast cancer causes. Women who have undergone radiation therapy, particularly in the chest at an age when the breasts are still developing are more at a risk for developing the disease.
Girls who reach puberty early and women who go through menopause later in life have higher chances of developing breast cancer. Also, at risk are women who have never had children or those who had their first child after the age of 30 years. As women age, their chances of getting breast cancer go up after the age of 50 years. This is the reason that doctors recommend yearly mammograms after crossing fifty. Unfortunately, having cancer in one breast increases the chances of getting the disease in the other breast too. Hormonal causes that could increase the risk of breast cancer include hormone replacement therapy that women undergo during menopause.
Cancer history of the individual is a vital factor that may increase the risk of getting breast cancer from a tumor elsewhere in the body. Those women with close relatives who have had breast cancer are counseled to go for regular checkups, though the inheritance of faulty genes is one of the rare genetic causes of breast cancer. Lifestyle and dietary causes such as obesity, lack of regular exercise, and consumption of alcohol have been identified by researchers as probable risk factors. Exposure to radiation is an important environmental cause that may lead to breast cancer in women. Benign breast disease may be caused by fibrocystic changes that happen to the breasts around the time of menstruation. Nipple discharge caused by intraductal papillomas and lumps caused by sudden injury or fibroadenomas are all considered benign breast diseases.
Regular breast self-examination is important for all women over the age of 30 because early breast cancer symptoms are not easy to find.
Not all lumps in the breast are hard with uneven edges, doctors have also asked women to look for soft rounded lumps and report them so that they can be verified. It must be understood that tumors may be benign or malignant and only a biopsy can rule out malignancy. Scaly or pitted skin on nipple in both men and women could be a sign of Paget's disease, breast cancer, or a simple fungal infection or a cyst. It is best to get it examined by a doctor as soon as possible to rule out cancer and avoid unnecessary worry.
Breast cancer treatment depends on the types, stage, and location of the cancerous lump. For cancers that are contained in the breast and have not spread to the lymph nodes or other parts of the body, surgery is the recommended option. Surgery for breast cancer is not only about mastectomy, there is the option of lumpectomy, which involves only the removal of the tumor and a bit of the surrounding tissue. Radiation therapy is also used for the treatment of localized cancers. Chemotherapy, hormone therapy, and targeted therapy focus on systemic treatment to arrest the further growth and spread of cancer cells to other parts of the body.
Targeted therapies use specific drugs that block the growth of new cancer cells, without harming healthy cells in the body. To compensate for the bone minerals lost due to chemotherapy, biophosphonate drugs are used to reduce the risk of osteoporosis. One other the side effect of chemotherapy is the destruction of stem cells in the bone marrow, which leads to lower blood cell count, fewer white blood cells to fight infection, and low platelet count resulting in the inability to stop bleeding. Removing some stem cells from the patient's bone marrow before chemotherapy and reintroducing them back into the body is one way of tackling the problem.
High-dose chemotherapy with stem cell transplant, however, has more serious side effects than normal chemotherapy. Clinical trials of this treatment are on to study whether the benefits outweigh the unpleasant side effects. Complementary and alternative therapies such as acupuncture, yoga, and meditation help patients manage the pain and the side effects to improve their quality of life.