BREAST CANCER: AN INTRODUCTION TO THE LEADING CANCER FOR WOMEN

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Breast cancer is the leading cause of cancer deaths among the female population in the United States. According to breastcancer.org, about one in eight U.S. women (about 12%) develop invasive breast cancer over the course of her lifetime. Cancer.org also reports, in the year 2015 alone, there are going to be a total number of 234,190 new estimated cases of breast cancers in both males and females, and there are going to be an estimated 40, 730 deaths due to breast cancer. Because of the high mortality and morbidity rates caused by breast cancer, there are infinite sources of decisions, educational tools, and information accessible to the public. However, the question is: which source of information is the most accurate and most helpful to the patient who has breast cancer?

What is breast cancer?

Breast cancer is a malignant category of cancer originating from an abnormal and uncontrolled growth of breast cells. The abnormal multiplication of cells in the breast often starts in the cells from the milk-producing glands (lobules) or the in the ducts (which are the passages that drain milk from the lobules to the nipple). However, breast cancer can also begin, although rarely, in the fatty and fibrous connective tissues of the breast (which are known as stromal tissues). BRCA1, BRCA2, PALB2 are three genes that guarantee women to develop breast cancer at some point in their lives. The original role of the BRCA and PALB2 are to enable breast cells to grow normally and to prevent any cancerous growth; however, these genes could contain mutations that are transmitted through generations, so breast cancer risks ultimately increases. According to breastcancer.org, only 5-10% (approximately 1 out of every 10 cases) of cancers are due to abnormalities inherited from your mother or father, and the other 85-90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the wear and tear of life in general. Breast cancer, as one can see, is more fatal to women than it is to men.

What are the symptoms?

The symptoms include any of the following:

-swelling of all or part of the breast

-skin irritation or dimpling

-breast pain

-nipple or the nipple turning inward

-redness, scaliness, or thickening of the nipple or breast skin

-a nipple discharge other than breast milk

-a lump in the underarm area

Source: breastcancer.org

How does one go about screening and testing for breast cancer?

Screening for breast cancer means a physician, who specializes in breast cancer, is going to perform a thorough evaluation of one’s breasts in order to evaluate whether one is at risk for developing breast cancer. Screening and testing are two methods which are important to catch breast cancer early.

There are three types of screening and testing methods for breast cancer:

  • Screening tests: These are specified as mammograms, and this method is proposed, on a yearly basis, for healthy-looking people who are suspected not to have breast cancer. Mammograms are simply used to catch breast cancer.
  • Diagnostic tests: This method of testing is selected for a patient if the physician suspects the patient to have breast symptoms, as evidenced by either symptoms appearing or by the results from the screening test. A biopsy is a specific type of diagnostic test. A diagnostic test is selected to determine whether or not the cancer is present and if it has traveled outside the breast. Because each cancer type is unique to the patient, information resulting from diagnostic tests could determine what treatments would be most effective for a particular patient.
  • Monitoring tests: When the diagnosis is officially breast cancer, physicians continue to monitor the patient to see if the treatments or therapies are working well for the patient. This type of method is also used to discover if remission has occurred.

More specific screening and testing methods are the following:

  • Biopsy
  • Blood cell counts
  • Blood chemistries
  • Blood marker tests
  • Bone scans
  • Breast MRI
  • Breast physical exam
  • Breast self-exam (BSE)
  • CT scans (computerized tomography)
  • Chest x-rays
  • Digital tomosynthesis
  • Ductal lavage
  • FISH test (fluorescence in situ hybridization
  • IHC tests
  • Inform HER2 dual ISH test
  • MammaPrint test
  • Mammograms
  • Mammostrat test
  • MarginProbe
  • Molecular breast imaging
  • Oncotype DX test
  • PET scans
  • Prosigna breast cancer prognostic gene signature assay
  • SPoT-Light HER2 CISH test
  • Thermography
  • Ultrasound

For more information on any of the screening and testing methods above, please go to http://www.breastcancer.org/symptoms/testing/types.

What are the stages of breast cancer?

Stage Definition
Stage 0 Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.
Stage IA The tumor measures up to 2 cm
AND
the cancer has not spread outside the breast; no lymph nodes are involved
Stage IB There is no tumor in the breast; instead, small groups of cancer cells — larger than 0.2 millimeter but not larger than 2 millimeters – are found in the lymph nodes
OR
there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – in the lymph nodes.
Stage IIA No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm)
OR
the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes
OR
the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes
OR
the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone
OR
the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
Stage IIIB The tumor may be any size and has spread to the chest wall and/or skin of the breast
AND
may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.Inflammatory breast cancer is considered at least stage IIIB.
Stage IIIC There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast
AND
the cancer has spread to lymph nodes either above or below the collarbone
AND
the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IV The cancer has spread — or metastasized — to other parts of the body.

 

Source: http://www.breastcancer.org/symptoms/understand_bc/what_is_bc

What are treatment options?

1) Radiation therapy (radiotherapy)

Radiation therapy is utilized, in controlled doses, to aim at destroying cancer cells in tumors. According to Medical News Today, radiation therapy occurs about one month after surgery or chemotherapy; each session lasts a few minutes, and the patient may require three to five sessions per week for three to six weeks. Whether or not radiation therapy is needed is determined by the physician. If the patient does need radiation therapy, the type of radiation therapy he or she may have to use would depend on the patient’s form of breast cancer.

  1. Breast radiation therapy: after a lumpectomy, radiation is administered to the remaining breast issue.
  2. Chest wall radiation therapy: this type of radiation therapy is applied after a mastectomy.
  3. Breast boost: a high-dose of radiation therapy is applied to where the tumor was surgically removed. The appearance of the breast may be altered, especially if the patient’s breasts are large.
  4. Lymph nodes radiation therapy: this type of radiation therapy is targeted at the armpit and the surrounding area to destroy cancer cells that have reached the lymph nodes
  5. Breast brachytherapy: Patients with early-stage breast cancer in the milk ducts that have not been spread benefit from undergoing this type of radiation therapy with a strut-based applicator.

Side Effects of Radiation Therapy: (1) Fatigue; (2) Lymphedema; (3) Darkening of the breast skin; (4) Irritation of the breast skin

All of the information on radiation therapy above are directly from Medical News Today:

http://www.medicalnewstoday.com/articles/37136.php?page=2#treatments_for_breast_cancer

2) Surgery

  1. Lumpectomy (breast-sparing surgery): a physician would recommend this treatment option if the tumor is found to be small enough that the surgeon believes the tumor could easily be dissected from the tissue around it. In short, this method is to surgically remove the tumor and a small portion of healthy tissue around it.
  2. Mastectomy: the breast(s) is surgically removed.
    1. Simple mastectomy: removing the lobules, ducts, fatty tissue, nipple, areola, and some skin
    2. Radical mastectomy: the performance of the simple mastectomy and also involving
  3. Sentinel node biopsy: the surgeon surgically removes one lymph node in order to prevent the lymph node from further traveling through the lympathic system into other parts of the body.
  4. Axillary lymph node dissection: the surgeon/physician may strongly suggest removing several lymph nodes in the armpit if the sentinel node was found to have cancer cells.
  5. Breast reconstruction surgery: the surgeon/physician does his or her best to make a breast that would look as much as possible as the other one. At the patient’s request, this procedure may be simultaneously performed with a mastectomy. In order for the surgeon or physician to recreate the breast, the medical professional may utilize tissue from another part of the patient’s body.

3) Biological therapy (targeted drug therapy)

  1. Trastuzumab (Herceptin): “this monoclonal antibody targets and destroys cancer cells that are HER2-positive. Some breast cancer cells produce large amounts of HER2 (growth factor receptor 2); Herceptin targets this protein. Possible side effects may include skin rashes, headaches, and/or heart damage.”
  2. Lapatinib (Tykerb): “this drug targets the HER2 protein. It is also used for the treatment of advanced metastatic breast cancer. Tykerb is used on patients who did not respond well to Herceptin. Side effects include painful hands, painful feet, skin rashes, mouth sores, extreme tiredness,diarrhea, vomiting, and nausea.”
  3. Bevacizumab (Avastin): “stops the cancer cells from attracting new blood vessels, effectively causing the tumor to be starved of nutrients and oxygen. Side effects may include congestiveheart failure, hypertension (high blood pressure), kidney damage, heart damage, blood clots, headaches, mouth sores. Although not approved by the FDA for this use, doctors may prescribe it “off-label”. Using this drug for breast cancer is controversial. In 2011, the FDA said that Avastin is neither effective nor safe for breast cancer.”

All of these facts on the hormone therapy medications are directly from the following source: http://www.medicalnewstoday.com/articles/37136.php?page=2#treatments_for_breast_cancer

4) Hormone therapy

Estrogen, a hormone for women to develop breast milk in addition to being the hormone responsible for a female being a female, could possibly cause a remission of breast cancer. Therefore, hormone therapy is used to block estrogen from developing levels too high that it could result in a remission of the cancer, especially if the type of the breast cancer the patient has is sensitive to hormones. Hormone therapy is generally used if the patient cannot receive any of the other treatments, such as chemotherapy, radiotherapy, or surgery. Apparently, hormone therapy lasts up to five years after surgery.

  1. Hormone therapy medications:
    1. Tamoxifen: “prevents estrogen from binding to estrogen captor positive cancer cells. Side effects may include changes in periods, hot flashes, weight gain, headaches, nausea, vomiting, fatigue, and aching joints.”
    2. Aromatase inhibitors: “this type of medication may be offered to women who have been through the menopause. It blocks aromatase. Aromatase helps estrogen production after the menopause. Before the menopause, a woman’s ovaries produce estrogen. Examples of aromatase inhibitors include letrozole, exemestane, and anastrozole. Side effects may include nausea, vomiting, fatigue, skin rashes, headaches, bone pain, aching joints, loss of libido, sweats, and hot flashes.”
  • Ovarian ablation or suppression: “pre-menopausal women produce estrogen in their ovaries. Ovarian ablation or suppression stop the ovaries from producing estrogen. Ablation is done either through surgery or radiation therapy – the woman’s ovaries will never work again, and she will enter the menopause early.”

All of these facts on the hormone therapy medications are directly from the following source: http://www.medicalnewstoday.com/articles/37136.php?page=2#treatments_for_breast_cancer

5) Chemotherapy

Chemotherapy is the treatment method used when the cancer has spread to other parts of the body (metastasized) besides the origin of the tumor.

  1. Adjuvant chemotherapy: medications like cytotoxic drugs are recommended by physicians when there is a risk of cancer recurrence.
  2. Neo-adjuvant chemotherapy: in order to shrink the tumor to better facilitate the removal of it during surgery, this type of radiation therapy is used.

Side effects: (1) Nausea; (2) Vomiting; (3) Loss of appetite; (4) Fatigue; (5) Sore Mouth; (6) Hair Loss; (7) Slightly higher susceptibility to infections; (8) Women over 40 years of age may experience early menopause

How can one prevent breast cancer?

  • Alcohol consumption
  • Physical exercise
  • Diet
  • Postmenopausal hormone therapy
  • Body weight
  • Women at high risk of breast cancer
  • Breast cancer screening
  • Breastfeeding

What are available digital tools for breast cancer?

The following apps are free and are available in the Google Play Store:

1) FYI: Breast Cancer by Mark Corrigan

Rating: 5.0 stars

Downloads: 100

This app is great because of the following factors: (1) there are categories that the user could click on or go into for more information on breast cancer; (2) there are endless questions about breast cancer; and, (3) there are answers to those questions on breast cancer. The categories the user is able to click on for more information are the following: (1) signs, symptoms, and diagnoses; (2) treatment; (3) risk factors; (4) general information. The user could save the questions he or she would want to ask the question later. In addition, the terminology used in this app is comprehensible to the 5th grader’s level.

2) Breast Cancer Symptoms

Rating: 4.3 stars

Downloads: 5,000

This app is hard to follow because of the color scheme in addition the compressed information in different sections of the app.

3) Early Detection Plan

Rating: 4.2 stars

Downloads: 100,000

This app is great because the color scheme is easy to follow and gives the user an organized schedule of when to do a breast exam. The app also specifies on three different types of exams: (1) breast self-exam; (2) clinical breast exam; (3) mammogram. Based upon what you may need and where you live, there are also local clinics listed on the app that the breast cancer patient could use and easily go to.

4) Breast Cancer by Magna Health Solutions

Rating: 4.0 stars

Downloads: 1,000

This app is user-friendly with the color scheme being easy to follow. The font is large enough to be able to read at a distance. All the information about breast is described in the common layman’s terms within the following categories of breast cancer: (1) types of breast cancer; (2) symptoms; (3) risk factors; (4) diagnostic tools; (5) treatment options for breast cancer. However, the downside to this abundant amount of information is that there is no credible source to support the data in this app.

Sources

For more information on breast cancer or to see where the information on breast cancer in this article came from, please review the following sources:

1) Breastcancer.org

http://www.breastcancer.org/symptoms/understand_bc

http://www.breastcancer.org/symptoms/understand_bc/statistics

2) Cancer.org

http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2015/

http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf

3) Mayo Clinic

http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/definition/con-20029275

4) Medical News Today

http://www.medicalnewstoday.com/articles/37136.php

http://www.medicalnewstoday.com/articles/37136.php?page=1#treatments_for_breast_cancer

http://www.medicalnewstoday.com/articles/37136.php?page=2#treatments_for_breast_cancer

http://www.medicalnewstoday.com/articles/37136.php#symptoms_of_breast_cancer

http://www.medicalnewstoday.com/articles/37136.php#causes_of_breast_cancer

5) NIH: National Cancer Institute

http://www.cancer.gov/types/breast

6) WebMD

http://www.webmd.com/breast-cancer/

 

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