Breast Cancer

Breast cancer is a heterogeneous disease, commonly known to start as a local lesion in the breast, and then spread gradually, developing into an invasive cancer that attacks the lymph nodes in the armpits, and other organs. Several factors serve as alarms, and determine the type, treatment and result.

  

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Why Early Detection of Breast Cancer by Mammography Is Important?

In most cases, breast cancer does not develop any symptoms at early stages. Symptoms start to appear as the disease develops, and the tumor grows.

Breast cancer causes changes in the shape or feeling of the breast. Those changes may include:

On the onset of any of these symptoms, as a doctor. They may also be caused by triggers other than breast cancer.

The etiology of breast cancer is not fully understood. A variety of interrelated factors, such as genetics, hormones, the environment, sociobiology and physiology can influence its development. Other risk factors such as proliferative breast disorders are also associated with breast cancer development, especially if the biopsy shows a typical hyperplasia. However, in 70% of breast cancer patients no risk factors can be identified.

A positive family history increases the risk of breast cancer in first-line relatives (mother, sister, or daughter). The risk is dependent upon whether the cancer was bilateral and whether it occurred in the pre- or postmenopausal period. It has been established that if the original cancer occurred during the premenopausal period, the risk of breast cancer in immediate relatives is approximately three times higher than in those who have no family history of breast cancer. 

In those with a family history of breast cancer, 5%–10% of cases are attributed to inheritance of autosomal genes. The probability of genetic inheritance increases if there are multiple affected relatives and the cancer occurs at a younger age. 

Two genes, BRCA 1 and BRCA 2 group, and p53, account for the majority of hereditary breast cancers.

Hormone regulation is important in the development of breast cancer. Early pregnancy and early oophorectomy lower the incidence of breast neoplasm. In contrast, late menopause is associated with an increase in the incidence of breast cancer. 

Many of the hormonal risk factors such as long duration of reproductive life, multiparity and late age at the time of the birth of the first child imply increased exposure to estrogen peaks during menstrual cycles. Functioning ovarian tumors that elaborate estrogen are also associated with an increase in breast cancer in postmenopausal women. 

Among the factors that can also influence hormonal balance, resulting in the development of breast cancer, are the use of oral contraceptives and hormone therapy during menopause. A small increase in the risk of breast cancer has been noted in users of oral contraceptives. This risk, however, drops following the cessation of contraceptive use so that at ten years post-use, there is no significant increase in the risk of developing breast cancer. 

Use of oral contraceptives at an older age has also been linked to an increase in the number of breast cancer cases diagnosed. 

Current and recent users of hormone replacement therapy are at a higher risk of developing breast cancer than women who have never used hormone therapy. The risk increases with duration of hormone use, while it decreases significantly following cessation of the therapy. Thus, the lapse of five years post-hormone therapy eliminates the risk of developing breast cancer. A recent preliminary study of approximately 160,000 women conducted in the United States over a five-year period, assessed the major health benefits and risks of the most commonly-used combined hormonal preparations. The study showed that the risk of breast cancer increases by 26% in those women who have used estrogen progesterone therapy compared with those who have not.

 

Environmental Factors:

The primary environmental factor that has been shown to have a direct link with breast cancer is nuclear radiation. Epidemiological studies have shown that women exposed to radiation due to nuclear war and medical diagnostic or therapeutic procedures are at an increased risk of developing breast cancer. Multiple chest fluoroscopes, breast irradiation for metastasis and radiation treatment, particularly for Hodgkin’s lymphoma and thyroid cancer, have all been linked to an increase in breast cancer. Radiation exposure after the age of 40 results in a minimal increase in risk, while radiation in adolescence is associated with the greatest risk of breast cancer development. Irradiation during infancy for thymus enlargement has a linear dose-response risk for subsequent breast cancer development at a later stage in life. Also, geographic variation in incidence of breast cancer may be partially explained by environmental factors influencing the development of the disease.

Age and gender have been found to be risk factors for developing breast cancer. Worldwide, 75% of new cases and 84% of breast cancer deaths occur in women aged 50 and older, with the number of breast cancers diagnosed in women in their fourth decade of life rating at 1 in 232 compared to those in their seventh decade of life, which are rated at 1 in 29. This increase may be directly related to hormonal changes in women in this age group. 

Nutritional intake and imbalances can also influence the risk of developing breast cancer. Consumption of fruits and vegetables may reduce the risk of developing breast cancer, while dietary intake of fat seems to increase the risk. In postmenopausal women, obesity increases the risk of breast cancer. This association is not observed in premenopausal women

Physical activity levels can have an impact on the risk of breast cancer. Although data in this area is not entirely consistent, moderate physical activity is associated with a lower risk of breast cancer. Studies have shown a 30% reduction in risk level associated with a few hours per week of vigorous activity compared to no exercise at all.

When a woman is diagnosed with breast cancer, her doctor should define its stage, to determine how the disease is likely to develop, and how it should be treated.

Not all women will need all of these tests and procedures. The doctor selects the appropriate tests based on your specific circumstances.

The doctor determines the breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. 

Most women undergo surgery for breast cancer and many also receive additional treatment after surgery, such as chemotherapy, hormone therapy or radiation. Chemotherapy might also be used before surgery in certain situations.  

Radiation therapy (also known as radiotherapy) uses high-powered beams of energy, such as X-rays and protons, 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 of the whole breast is commonly used after a lumpectomy. Breast brachytherapy may be an option after a lumpectomy if you have a low risk of cancer recurrence.

Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, your doctor may recommend chemotherapy after surgery to decrease the chance that the cancer will recur.

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.

Hormone therapy is used to treat breast cancers that are sensitive to hormones. Doctors refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.

Hormone therapy can be used before or 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 surgery or medications to stop hormone production in the ovaries.

Targeted drug treatments attack specific abnormalities within cancer cells.

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. 

Stem-cell therapy is a treatment option for triple-negative breast cancer. It is a mixture of immunotherapy and chemotherapy usually used for treating advanced breast cancer spread into other body parts.

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care aims to improve the quality of life for both patients with cancer and their families.

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help the patient cope with side effects of treatment when combined with the doctor's care.

Many breast cancer survivors experience fatigue during and after treatment that can continue for years. When combined with your doctor's care, complementary and alternative medicine therapies may help relieve fatigue.

Talk with your doctor about:

Clinically, among 100 female patients aged 40–65 years presenting with breast complaints, the following is likely: 30% have no breast lesion, 40% have fibrocystic changes, 7% have a benign tumor diagnosis and 10% have carcinoma. 

Breast disease can therefore be divided into the following groups.

Breast cancer detection and prevention is a systemic and continuous management process that includes planning, developing and evaluating breast cancer detection programmes, including policy formulation and the identification of priorities. 

Comprehensive plans for screening and detection of breast cancer must be developed, including outreach and education with the general population, training for medical and technical staff, development of programmes and processes for accurate diagnosis of breast cancer, and facilities for timely and effective treatment. 

The responsibility for the development and implementation of a breast cancer detection programme rests with the Ministry of Health or other relevant organization. 

The overall aim should be to establish a mechanism for the political and technical support of the programme. A successful managerial approach to breast cancer detection rests on the combined impact of several activities including surveillance, protection, continuing education and prevention, early detection and care.

Surveillance is key for identifying problems and developing appropriate and timely interventions. The aims of surveillance activities include, but are not limited to, the following: 

Cancer protection can be defined as the activities and processes associated with protecting individuals from cancer or its recurrence, and affecting the burden of disease and disability. Protection includes a number of activities such as continuing education efforts, health promotion, prevention and early detection of disease (screening).

The first step to initiate an effective continuing education programme is advocacy on the urgency and importance of the programme to the government officials and policymakers who can place breast cancer detection on the KSA national agenda. 

Public education programmes should focus on prevention, better understanding of the illness and the benefits of early detection. In addition, education programmes for health care recipients and their families should be developed to ensure that the benefits of health care services are maximized. These programmes should be developed to increase understanding of the needs of patients and the ability to cope with these needs. Finally, health promotion is the key strategy for controlling the risk factors for breast cancer through a collective and multisectoral policy.

Although breast cancer cannot be prevented, the risks of developing breast cancer can be minimized through specific preventive activities. These include achieving changes in lifestyle, diet, overall physical characteristics and obesity, and interventions for women at high risk of developing breast cancer using tamoxifen and other anti-estrogen compounds. 

The most important and beneficial area of protection activities is the early detection of breast cancer (screening). Diagnosis of breast cancer during the early stages of disease has been positively linked to a decrease in the mortality and morbidity of the illness. 

Cancer control programmes must ensure the diagnosis of the disease at the earliest possible stage when treatment is most effective, and cure is most likely. Beyond the initial early detection and diagnosis of breast cancer, improving the treatment and care provided to women with breast cancer is obviously an integral factor in decreasing overall mortality from breast cancer.

Treatment of breast cancer should be expanded beyond surgery to include interventions such as drug therapy and radiation procedures. Additionally, adjuvant therapies should be used to prevent the recurrence of breast cancer. Finally, increasing the psychosocial support and the palliative care available can increase the quality of life for women with breast cancer and their families.