• Nowadays, breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women.
  • Increased public awareness and improved screening have led to earlier diagnosis at stages amenable to complete surgical resection and curative therapies. Consequently, survival rates for breast cancer have improved significantly, particularly in younger women
  • This article addresses the types, causes, clinical symptoms and various approach both non- drug (such as surgery and radiation) and drug treatment (including chemotherapy) of breast cancer.

INTRODUCTION

  • Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. The available evidence suggests a growing incidence of breast cancer in Africa.
  • Breast cancer refers to cancers originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.
  • Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death.
  • Usually, cancer is named after the body part in which it originated; thus, breast cancer refers to the erratic growth and proliferation of cells that originate in the breast tissue.
  • The breast is composed of two main types of tissues i.e., glandular tissues and supporting tissues. Glandular tissues house the milk-producing glands and the milk passages while supporting tissues include fatty and fibrous connective tissues of the breast. The breast is also made up of lymphatic tissue that removes cellular fluids and waste.
  • There are several types of tumours that may develop within different areas of the breast. Most tumours are the result of benign (non-cancerous) changes within the breast. For example, fibrocystic change is a non-cancerous condition in which women develop accumulated packets of fluid, formation of scar-like connective tissue, lumpiness, and areas of thickening, tenderness, or breast pain
  • Most breast cancers begin in the cells that line the ducts. Some begin in the cells that line the lobules, while a small number start in the other tissues

RISK FACTORS OF BREAST CANCER

·      A previous history of breast cancer

A woman who has had breast cancer has an increased risk of getting breast cancer in the other breast

·      Significant family history

If several members of patient’s family have had particular types of cancer, patient may have an increased risk of developing breast cancer.

·      Genetic causes

Family history has long been known to be a risk factor for breast cancer. Both maternal and paternal relatives are important. The risk is highest if the affected relative developed breast cancer at a young age, had cancer in both breasts, or if she is a close relative. First-degree relatives (mother, sister and daughter) are most important in estimating risk. Breast cancer in a male increases the risk for all his close female relatives.

Note: A common gene mutation of breast cancer is also shared with ovarian cancer.

·      Hormonal causes

Alteration in hormonal level may precipitate breast cancer. Women who had early menstrual periods (before age 12) and late menopause have an increased risk. Other hormone related risk factors include pregnancy in early age, hormonal replacement therapy and use of oral contraceptive pills

·      Life style and dietary cause

Sedentary life style, high dietary intake of fat, obesity- particularly in postmenopausal women- may cause breast cancer. The use of alcohol is also another one cause of breast cancer. The risk increases with the amount of alcohol consumed.

·      Environmental cause

There is known to be a slight increase in risk in ladies who work with low doses of radiation over a long period of time-for example, X-ray technicians

SIGNS AND SYMPTOMS

  • The classic symptom for breast cancer is a lump found in the breast or armpit. Doing monthly breast self-exam (BSE) is a great way to be familiar with the breasts’ texture, cyclical changes, size, and skin condition.
  • The general alerting features of breast cancer are symptoms such as
    • swelling or lump in the breast
    • swelling in the armpit
    • nipple discharge (clear or bloody)
    • pain in the nipple
    • retracted nipple
    • scaly or pitted skin on nipple
    • persistent tenderness of the breast
    • unusual breast pain or discomfort.
  • In advanced stage (metastatic) of disease underarm lymph nodes are present with other symptoms such as bone pain (bone metastases), shortness of breath (lung metastases), drop in appetite (liver metastases), unintentional weight loss (liver metastases) and headaches

SCREENING/DIAGNOSIS OF BREAST CANCER

  • A mammogram is a screening test for breast cancer which uses special X-ray images to detect abnormal growths or changes in breast tissue.
  • The risk of breast cancer increases with age. That is why it is very important for all menopausal women to get regular mammograms.
  • Mammography is your best defence against breast cancer because it can detect the disease in its early stages, before it can be felt during a breast exam. Research has shown that mammography can increase breast cancer survival.
  • The American Cancer Society recommends women ages 40 to 44 should have a choice to start yearly screening mammograms if they would like.  Women ages 45 to 54 should have a mammogram each year and those 55 years and over should continue getting mammograms every 1 to 2 years.
  • Breast cancer is usually diagnosed by harvesting a sample from a suspicious nodule detected by mammogram or by palpitation.

Today there are so many approaches, which can be made for the treatment of the cancer of breast such as surgery, radiation therapy chemotherapy, hormonal therapy and recently nanotechnology and gene therapy. All these are dependent on ones stage of cancer. With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined. In fact, about 90% of women newly diagnosed with breast cancer will survive for at least five years. Research is ongoing to develop even more effective screening and treatment programs.

Written By: Dr. Aleck Gonga

Medical Specialist, Afya Pap

REFERENCES

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