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Breast Cancer

INCIDENCE

Breast cancer is the most common malignancy among women and has the highest fatality rate of all cancers affecting this sex. It is the leading cause of death among women aged 35-54. In 1999 an estimated 175,000 women were diagnosed with breast cancer. That is one woman every three minutes. At the same time 43,000 will die, at the rate of one every two minutes. The incidence of men diagnosed with breast cancer is rare, however it does occur. Approximately 1,300 men a year are diagnosed, and 400 die annually due to the disease. A total of 75% of all breast cancers occur in women with no known risk factors. 80% of breast cancers occur in women aged 50 and up. The mortality rate would decrease if every woman over 50 was informed and followed guidelines. When confined to the breast, the survival rate is 95%. Studies have shown that more white women than black women get breast cancer, however more black women die of breast cancer because they are not diagnosed at an early stage.

SIGNS AND SYMPTONS

Most breast cancers appear as a slowly growing, painless mass, though a vague discomfort may be present. Physical signs include a retracted nipple, bleeding from the nipple, distorted areola or breast contour, skin dimpling over the lesion, attachment of the mass to surrounding tissues including the underlying fascia and overlying skin, and enlarged lymph nodes. In most advanced stages of the disease the skin nodules with ultimate breakdown and ulcer formation may be seen. Metastases should be sought immediately so that further spread will not be a factor. Among the common sites of metastases are the lungs and pleura, the skeleton (specifically the spine, pelvis, and skull), and the liver. Whenever possible, distant spread of the disease should be confirmed by a lymph nose biopsy, by x-ray, or by liver and bone scans using radioactive isotopes.

WHO IS AT RISK?

All women and men are at risk of getting breast cancer. However personal history with family members having breast cancer adds an increase to the risk factor. Contradictory to this though studies have shown that 75% of breast cancer occurs in women with no history and no known risk factors. Not ever having children, or having ones first child after 30 yrs., also increases the risk of breast cancer in women. Heavy alcohol abuse is a risk factor as well. Studies have also shown that women who began menstruation early, twelve years or less, and women who began menopause late, fifty-five years plus, also have a greater risk of breast cancer.

PREVENTION

There are three ways to attempt to detect prevention, however since there is no cure, one cannot determine what actions to take to prevent. The most common technique for early detection is by a regular doctors examination. The second technique at detecting breast cancer is by a breast self-examination (BSE), and lastly, by mammogram. BSE should begin when a woman is eighteen or older, so that the breast is fully developed. During the BSE women should begin to learn what is normal and what is not in their breasts. Mammography is the best method at detecting breast cancer. A woman should have a mammogram when she is 40 yrs. old, and then one every two years until she is 50 yrs. old. Once a woman is 50 yrs. old she should have a mammogram annually because as ones age increases, so does the risk of getting breast cancer. Many women also need to be educated about the risks of breast cancer and how to detect it early. The majority of women with breast cancer do not know about the fortunateness of detecting breast cancer early, never mind follow the detection guidelines.

TREATMENT

Therapy depends mainly on the extent of the disease and the patient's age. If there is evidence of wider metastasic spread, treatment will be palliative. This means that treatment will lessen the severity of pain, however it will not cure. When there is no evidence of spread, the treatment of choice is total mastectomy and modified radical mastectomy. This is an entire or partial removal of the affected breast. In the best circumstances, the 10 yr. survival rate is greater than 50%. However these "clinical cures" may recur with fatal outcome as late as 20 yr after surgery. Total or Partial Mastectomy Is now accepted as an equivalent alternative to conventional radical mastectomy for the treatment of all primary operable breast cancers. The entire, or partial area of, breast is removed together with virtually all of the axillary lymph nodes, but since the pectoral muscles are preserved their function is left intact, the cosmetic result is far superior. In addition, the procedure leads to far better breast reconstruction using implants that often can be inserted 6-12 mos. after surgery. Radiotherapy This technique is sometimes used instead of surgery. After a radical Mastectomy if additional metastases are found, the internal lymph node chain may be irradiated because of the high incidence of occult lymph node metastases in this area when the disease has already reached the axilla. For recurrent cancer, palliative radiotherapy can be valuable in controlling local chest wall or cervical lymph node recurrences and relieving pain from skeletal metastases. Irradiation is of little value for large internal metastases. Hormonal Therapy This treatment has proven to be of the greatest use in palliation of symptoms or in delaying the advancement of breast cancer. It is most often combined with radiotherapy when cancer recurs following a mastectomy and when the tumour is so advanced that surgery is not indicated or is palliative. Chemotherapy Chemotherapy is useful in patients that have a high risk of developing recurrent cancer after a mastectomy.. Chemotherapy is used in the management of patients with recurrent breast cancer usually after the failure of previous hormonal manipulations. A variety of chemotherapeutic agents are used in various combinations, sometimes with a corticosteroid to suppress endogenous adrenal function or with the estrogen antagonist tamoxifen. (Quote) The agents in chemotherapy have demonstrated value in halting or delaying the appearance of metastases, especially in premenopausal patients, and in treating recurrences.