- One out of every ten women develops cancer of the breast (an incidence of 10%)
- Among women who are 25 – 74 years of age, breast cancer is the leading cause of cancer mortality.
- Cancinoma of the breast is more common on the left breast than the right. It is more common in the outer than the inner quadrant.
- Cancer of the breast is commoner in women who have no children and in women who have not breast fed.
- Cancer of the breast is 5 times more likely to occur in women who have family history of breast cancer.
- Cancer of the breast is one of the leading causes of death from all causes of death in women between ages 39 to 44 years.
The typical presentation of breast cancer is that of a lump in the breast which in the early stages is isolated, movable and painless.
As the cancer advances, fixation, retraction of skin or nipple, ulceration, pain, redness and ancillary masses may appear.
EARLY detection depends on SELF examination by women at monthly intervals and twice yearly by physicians. Breast self examination (BSE) should be performed monthly, one week after the menses.
To make an early diagnosis the DOCTOR must have a high degree of suspicion regarding all breast lumps as well as a basic knowledge of breast problems.
The most common type of breast lesions and their frequencies are: fibrocystic disease 34% breast cancer 27% fibroadenoma 19% intraductal papilloma 6%, duct ectasia 4% other types of breast lesions 11%.
Patients at high risk of breast cancer are:
- Those over the age of 40 years
- Those with a family history of breast cancer
- Women who have never been pregnant or never had children.
- Women having their first baby after age 35 years.
- Women with a previous history of cancer in one breast
- Women with explosure of breast to excessive ionizing radiation.
- Women with endometrial or ovarian cancer
- Women with high dietary intake of fat.
- Women with chronic psychological stress.
- Women leaving in the western hemisphere of Europe or America.
- White women in the upper socio economic group.
Biopsy is mandatory in breast lumps, any suspicion found by mammogram or breast scan even if there are no clinical findings. It is also mandatory in any serous or bloody nipple discharge even if there are no lumps, and mammograms are negative. A woman should have a baseline mammogram between age 35 to 40 years of age. Between 40 and 50 years, mammogram are recommended every other year, after 50 years of age, yearly mammogram are recommended.
15% of patients who survive treatment of the initial breast cancer for 3 or more years develop cancer in the opposite breast.
Contralateral hidden cancers are seen in about 25% of patients with breast cancer recently proved on one side.35% of women with untreated breast cancer are known to survive for 5 years.
Irrespective of all diagnosis, techniques including mammogram, some cancers still unfortunately still elude early detection. Reliance for early detection of breast cancer must be placed on self examination.
Recommendations for surgery, radiation and chemotherapy depends on the type, size, location and the extent of the tumour, the patient’s age, relation to the menopause and other factors.
Breast monthly self examination (BSE), breast scan and mammogram in those of high risk group aids early detection and treatment.
What is breast Cancer?
Breast cancer is a malignant tumour (a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women, it can also affect men.
What Causes Breast Cancer
There are many risk factors that increase the chance of developing breast cancer. Some of the breast cancer risk factors can be modified (such as alcohol) while other cannot be influenced (such as age).
The chances of breast cancer increases as you get older.
The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, daughter) doubles a woman’s risk.
Previous Breast Cancer: –
Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or a recurrence in the same breast.
Women who started their menstruation as a younger age (before 12) or went through menopause later (after 55 years have a slightly increased risk.
Breast Tissue: –
Women with dense breast tissue on mammogram have a higher risk of breast cancer.
White women have a higher risk of developing breast cancer, but African Americans and black women have more aggressive tumours when they do develop breast cancer.
- Exposure to previous chest radiation increases the risk of breast cancer.
- Having no children or the first child after age 30 increases the risk of breast cancer.
- Breast feeding for one and a half to 2 years slightly lowers the risk of breast cancer.
- Being overweight or obese increases the risk of breast cancer.
Breast Cancer Symptoms and Signs
The most common signs of breast cancer are a new lump or mass in the breast. In addition, the following are possible signs of breast cancer:
Nipple discharge or redness
Breast or nipple pain
Swelling of part of the breast or dumpling.
How is Breast Cancer Diagnosed?
Although breast cancer can be diagnosed by the above signs and symptoms, the use of screening MAMMOGRAM has made it possible to detect many of the cancers early before they cause any symptoms.
Women age 40 years and older should have a screening MAMMOGRAM every year and should continue to do so as long as they are in good health.
Women in their 20s and 30s should have a clinical and self breast examination regularly by their gynaecologist during any gynaecological encounters.
What is Treatment of Breast Cancer?
Patients with breast cancers have many treatment options. Most treatments are adjusted to the type of cancer and the staging group.
Most women with breast cancer will require surgery. The surgery could be breast conserving surgery or mastectomy.
Breast conserving surgery will only remove part of the breast. (Partial Mastectomy) and usually followed by radiation therapy.
Mastectomy means all the breast tissues are removed.
Radical mastectomy means the whole breast tissue is removed in addition to the axillary lymph nodes and the chest wall muscles.
Radiation Therapy: –
Destroys cancer through external beam radiation or through branchy therapy.
chemotherapy is the treatment of breast cancers with medications given either through intravenous injections or orally.
Adjuvant Chemotherapy means chemotherapy is given after the surgery.
Neo adjuvant Chemotherapy means it is given before the surgery.
Hormone Therapy: –
This is usually used to prevent or reduce the risk of breast cancer recurrence. Tamoxifen prevents oestrogen from binding to oestrogen receptors on the breast cells. Other hormones that can be used are Fulvestrant, Aromatase inhibitors such as letrozole, anatrozole and exemestane.