Breast Cancer

     All of you are familiar with the pink ribbon which symbolizes breast cancer awareness. I pulled this particular ribbon off a wonderful site which has other ribbons you can download. The site is Pink Ribbons by Carol Sutton. I did this post because breast cancer is an important subject which affects so many women's lives. I believe we should all support any efforts not only for awareness, but research for a cure. Breast cancer is the second most common cancer among woman. Only skin cancer affects more woman in America. Over their lifetimes 1 in 8 women will develop breast cancer. Breast cancer is the second leading cause of death for women, but it is the number one cause of death for women between the ages of 35-54. Overall only lung cancer kills more women each year. In 2009, 192,370 women where diagnosed with invasive (malignant) breast cancer. Of these 40,610 died. It is no wonder that we are seeing so many efforts to raise awareness about breast cancer.

     The word cancer is a scary word. Almost all of us have either known someone, or had a family member diagnosed with cancer. For women the words "breast cancer" bring up some terrible thoughts. How many women have felt an abnormal lump in their breast, and feared the worst. It should be noted that 8 out of 10 lumps end up being benign or non cancerous. It should also be stated that if you do find a lump, don't take any chances and see your Doctor immediately for an exam. What is cancer? It seems that there are so many kinds, and they affect so many parts of the body. Cancer is actually a group of many related diseases that all have to do with our cells. As part of our normal life cycle cells will grow, divide, reproduce and die. With cancer, due to defects in the DNA of a single cell, that cell will grow and divide out of control. As it spreads and continues to grow it will create a mass of abnormal tissue called a tumor. Often the cancer will spread to other parts of the body where it will form more tumors. This spread of cancer is known as "metastasis." Breast cancer like all cancers works in the same way, and may also spread to other areas of the body.

      Though modern medicine has still not determined the cause of breast cancer as well as other cancers, they have determined risk factors.

Risk Factors for Breast Cancer

1. Genes -- Some people have genes that make them more likely to develop breast cancer. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.

2. Menstrual cycle -- Women who got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

3. Alcohol use -- Drinking more than 1 - 2 glasses of alcohol a day may increase your risk for breast cancer.

4. Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.

5. DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s - 1960s.

6. Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy with estrogen for several years or more.

7. Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.

8. Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a much higher risk for developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk. Especially if the radiation was given during breast development.

9. Age -- As you age your risk of breast cancer increases. 1 of 8 women with invasive breast cancer were under 45 years of age. 2 of 3 were over the age of 55.

10. Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.


Having these risk factors doesn't necessarily mean you will get breast cancer. They are however warning markers. If you are in a high risk category you should get periodic exams including mammograms. I listed below a few symptoms to keep in mind

Symptoms of Breast Cancer to Look For.

1. Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.

2. A mass or lump, which may feel as small as a pea.

3. A change in the size, shape, or contour of the breast.

4. A blood-stained or clear fluid discharge from the nipple.

5. A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed).

6. Redness of the skin on the breast or nipple.

7. A change in shape or position of the nipple

8. An area that is distinctly different from any other area on either breast.

9. A marble-like hardened area under the skin.

1. Chest Wall.

2. Pectoralis muscle. Muscle lying directly below the breast.

3. Lobules. Milk producing glands. Make up a large part of the breasts. number 15-20.

4. Nipple.

5. Areola.

6. Lactiferous Ducts. Connected to the Lobules. Tubes which carry milk towards the Nipple.

7. Fatty Tissue.

8. Skin.

     I included the picture above, so that you could familiarize yourself with the structure of the breast. It will make it easier to understand the different cancers listed below.

Types of Breast Cancer

1.Invasive Ductal Carcinoma (IDC). Most common form of breast cancer. Comprises approximately 80% of all invasive cancers. Starts in the lactiferous ducts and invades the fatty tissue of the breast.

2. Ductile Carcinoma in situ (DCIS). This is ductal carcinoma which is in it's earliest stages and is still in the lactiferous ducts. It hasn't yet invaded the fatty tissue, and thus has the highest curability rate.

3. Infiltrating Lobular carcinoma. This cancer begins in the Lobules, which are the milk producing glands of the breasts. It has spread to surrounding issues or to the rest of the body. It makes up about 10% of all invasive breast cancers.

4. Lobular Carcinoma in situ (LCIS). This isn't considered a true cancer. It stays in the lobules of the breasts. It does serve as a true marker though for an increased risk of developing breast cancer later.

     Before I move on, I would like to take a moment to talk about our lymph system. The lymph system is important to understand because it is one of the ways in which breast cancers can spread. The lymphatic system is an important part of our body's defense mechanism. It filters out organisms that cause disease, produces certain white blood cells, and generates antibodies. This system has several parts. Lymph nodes are small, bean-shaped collections of immune system cells that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph instead of blood, away from the breast. Lymph contains tissue fluid and waste products, as well as white blood cells. There are more than 100 lymph nodes in the body. They are mainly in the neck, groin and armpits. They are important as barriers to infection by filtering out and destroying toxins and germs. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes. Most lymphatic vessels in the breast connect to lymph nodes in our armpits. Some lymphatic vessels connect to lymph nodes inside the chest, and to those located  either above or below the collarbone It is important to understand the lymph nodes when dealing with breast cancer. Not only can cancer spread through the lymph nodes through vessels, but imagine the damage it can do to your immune system.

Course of Action if you Suspect Breast Cancer

1. Physical exam, including a breast exam.

2. Mammogram.  Use of low dose amplitude x-rays to examine the breast to detect characteristic masses and/or microcalcifications. Microcalcifications are small white dots appearing on the mammogram. They are indications of small bits of calcium. They sometimes are an indication of a precancerous condition. It should be noted that 10% of the time pre-cancerous lumps are not picked up by the mammogram.

3. Ultrasound. It is the diagnostic imaging of deep structures of the body using echoes of pulses of ultrasonic waves. Most of you are familiar with this being used to view fetuses.

4. Biopsy. The examining Physician may request a biopsy. A tissue sample is sent to a Pathologist who checks it for abnormal cell shapes or growth patters.

Treatments

     Though breast cancer is not fully understood, many advances have been made in it's treatment. The key is to be aware of the signs of breast cancer and to get treatment as soon as possible. Treatment will depend on the size and location of the tumor in the breasts. I will be looking at two types of treatment. Local and systemic. They are often used in combination to fight breast cancer.

Local Treatments. These are treatments to remove, destroy or control the cancer cells in a particular area.

1. Surgery. Breast cancer is treated with either breast-conserving surgery (lumpectomy, partial mastectomy) or modified radical mastectomy. Breast reconstruction can be done either at the same time as surgery or later.

2. Radiation. Radiation therapy is usually given after breast-conserving surgery. Radiation therapy uses a special kind of high-energy beam to damage cancer cells while minimizing damage to nearby healthy cells. Radiation therapy can reduce the risk of breast cancer recurrence by up to 70%.


Systemic Treatments. These are treatments which are used to control or destroy cancer, not just in the breasts, but in the entire body.

1. Hormone Therapy. Studies have found that two hormones which a woman's body produces (estrogen and progesterone) can often promote the growth of cancer cells. Hormone therapy involves either inhibiting the production of these two hormones, or turning off their production from the ovaries. A commonly used drug is Tamoxifen.

2. Biological Treatment. This is an alternate to chemotherapy. It utilizes the bodies own immune system or hormones to act on cancer cells using antibodies to attack or block activities of cancerous cells. It is a targeted approach which leaves healthy cells intact. Antibodies can be natural, produced by our own immune system, or made artificially. A commonly used manufactured antibody is Herceptin.

3. Aromatase Inhibitors. These are drugs in pill form. They are used to inhibit the production of estrogen. It will not stop the ovaries from producing estrogen, so it is only used by post-menopausal women. A common  aromatase inhibitor is Femara.

4. Chemotherapy. Uses medicines to weaken and destroy cancer cells in the body including cells at the original cancer site as well as cancer cells that may have spread to other parts of the body. They are delivered via the bloodstream and thus affect the whole body. There are quite a few chemotherapy medicines. In many cases, a combination of two or more medicines will be used as a chemotherapy treatment for breast cancer. These include anthacylines and taxanes.



   Now that we've learned about breast cancer, where do we go from here. Even with all the awareness, research, and new treatments, too many women are dying from breast cancer. More women need to be aware of the risk factors. It also helps to make some lifestyle changes. These include eating a diet rich in foods loaded with antioxidants, getting plenty of  exercise, and looking at weight reduction. Don't forget that the most important things are prevention and getting screenings. The key is early detection. This includes the use of self-examinations, regular Doctor's exams, and periodic mammograms. These are particularly important for women in high risk categories, and those over 50. Remember that awareness isn't just for women. All you guy out there need to learn more about something that effects the woman you love. I know I learned a lot from writing this post. To all you ladies out there who are fighting breast cancer; I wish you well, God bless you, and take care.