October marks the month when many of those involved in the treatment and prevention of breast cancer once again take the stage and with a loud voice attempt to increase public awareness in a concerted attempt to further reduce the incidence of this most distressing illness.
In this article by Dr Allen Rezai, the key aspects of breast cancer and its treatment are discussed in the context of modern medical diagnosis and treatment methods so as to broaden awareness and give hope both to those already suffering from breast cancer and the many people, women and men, who are concerned about it.
Dr Allen Rezai M.B., Ch.B, M.D. is a Doctor of Medicine and a Senior Consultant Plastic and Reconstructive Surgeon with practices in Harley Street, London and Dubai Healthcare City where he is the founder of Elite Plastic & Cosmetic Surgery Group. Dr Rezai lead the team who successfully performed the first DIEP Flap reconstructive breast surgery in the Middle East. CLICK on the image below to read Victoria’s story.
According to one UK based Breast Cancer Care charity the number of newly diagnosed breast cancer cases has risen by 20% in the past 10 years. This increase is in spite of regular campaigning by those involved in cancer care over this period of time. It must be said that the rise is due in part to the increased surveillance and earlier diagnosis of cancer, which years ago might even have gone undetected, but it is also due to the ageing population and lifestyle factors such as higher levels of obesity.
The good news is that more people than ever before, now survive cancer diagnosis, and the answers to the following 10 broad questions should lift a veil from the mystique still widely prevalent concerning breast cancer, and hopefully also allay certain fears.
1) What exactly is breast cancer?
Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumour that can often be seen on an x-ray or felt as a lump. The tumour is malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread (metastasise) to distant areas of the body. Breast cancer occurs primarily in women, but men can also get it.
Cells in nearly any part of the body can become cancerous and can spread to other areas of the body. Breast cancers can start from different parts of the breast. Most cancers begin in the ducts that carry milk to the nipple. Some start in the lobules, glands that make breast milk. A small number of cancers start in other tissues in the breast. These cancers are called sarcomas (can occur in soft tissues such as fat, muscle, nerves, fibrous tissues, blood vessels or in any of the other tissues that support, surround and protect the organs of the body) and lymphomas (cancer of the lymphatic system which starts from the lymph node)
Although many types of breast cancer can cause a lump in the breast, not all do. However, it’s important to understand that most breast lumps are not cancer – they are benign. Benign breast tumours are abnormal growths, but they do not spread beyond the breast and they are not life threatening, although they can increase the risk of getting breast cancer. Any breast lump or change needs to be checked by a health care provider to determine whether it is benign or cancerous, and whether it might impact your future cancer risk.
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2) What are the risk factors for breast cancer?
First of all, before answering this question in more detail, it must be stated that most women who have one or more breast cancer risk factors never develop breast cancer, while many women with breast cancer have no known risk factors (other than being a woman and growing older). Some risk factors, like a person's age or race, can't be changed. Others are linked to personal behaviours such as smoking, drinking and diet. They can also change over time due to ageing and lifestyle changes.
The following are some of the most significant factors which have been directly linked to a tendency to develop breast cancer:
FACTORS OUT OF YOUR CONTROL
Being a woman. Simply being a woman is the main risk factor for breast cancer. Men can also have breast cancer, but the risk is less than 1%.
Getting older. As you get older, your risk of breast cancer increases. Most invasive breast cancers (those that have spread from where they started) are found in women age 55 and older.
Genetic factors. About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene defects (called mutations) passed on from a parent. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes.
Having a family history of breast cancer. Although it’s important to note that most women (about 8 out of 10) who get breast cancer do not have a family history of the disease,
Having a personal history of breast cancer. A woman with cancer in one breast has a higher risk of developing a new cancer in the other breast or in another part of the same breast.
Having dense breast tissue. Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Someone is said to have dense breasts (on a mammogram) when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts on a mammogram have a risk of breast cancer that is up to 2 times that of women with average breast density.
Starting menstruation (periods) before age 12. Women who have had more menstrual cycles because they started menstruating early (before age 12) have a slightly higher risk of breast cancer.
Going through menopause after age 55. Women who have had more menstrual cycles because they went through menopause later also have a slightly higher risk of breast cancer.
Having radiation to your chest. Women who as children or young adults were treated with radiation therapy to the chest for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) have a significantly higher risk for breast cancer.
Having children. Women who have not had children or who had their first child after age 30 have a slightly higher overall breast cancer risk.
FACTORS YOU CAN CONTROL
Drinking alcohol. Drinking alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who have 1 alcoholic drink a day have a very small increase in risk, however this risk increases with the volume of regular alcohol consumption.
Being overweight or obese. Being overweight or obese after menopause increases breast cancer risk.
Physical activity. Evidence is growing that physical activity in the form of exercise reduces breast cancer risk.
Tobacco smoke. In recent years an increasing number of studies have shown that heavy smoking over a long period of time is linked to a higher risk of breast cancer.
Birth control. Studies have found that women using oral contraceptives (birth control pills) have a slightly higher risk of breast cancer than women who have never used them.
It is also worthwhile pointing out that over the years there have been suggestions that certain other factors might increase the risk of breast cancer. Such as using antiperspirants, wearing tight bras, induced abortion, and breast implants. However, studies have since confirmed that this is not the case and they do not increase risk.
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3) Can breast cancer be prevented?
There is no sure way to prevent breast cancer, but there are things you can do that might lower your risk, such as changing certain risk factors that are directly under your control.
For example, body weight, physical activity and, to some extent, diet have all been linked to breast cancer, so these might be areas where you can take positive action.
For people who possess certain risk factors for breast cancer, such as a family history, there are a number of medical options such as FDA approved prescription drugs, Tamoxifen and Raloxifene, may help prevent breast cancer. However, these powerful drugs can have side effects, so they aren’t right for everyone. Suitability of these drugs should be discussed with your Doctor.
Those with a strong family history of breast cancer can talk to their doctor about genetic testing for mutations in genes that increase the risk of cancer, such as the BRCA genes. If you have a genetic mutation or come from a family with a mutation but haven't been tested, you could consider Prophylactic Mastectomy with or without Breast Reconstruction to lower your risk of cancer.
4) Can breast cancer be found early?
Screening exams, such as mammograms (X-ray of the breasts), find cancers before they start to cause symptoms, it can detect breast cancer up to two years before the tumour is felt by you or your doctor. This is called early detection. Cancers that are found early – when they’re small and haven’t spread – are easier to treat and have better outcomes. The earlier breast cancer is found, the better the chance that treatment will work.
It is recommended by Cancer Care organisations that:
Women aged 40 – 45 or older who are at average risk of breast cancer should have a mammogram once a year.
Women at high risk should have yearly mammograms along with an MRI starting at age 30.
Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread beyond the breast. But screening exams can often find breast cancers when they are small and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the outlook (prognosis) of a person with this disease.
Early detection tests for breast cancer save thousands of lives each year. Many more lives could be saved if even more women and their health care providers took advantage of these tests.
5) What are the signs and symptoms of breast cancer?
A lump isn’t the only sign of breast cancer. Tumours in the breasts grow slowly, and by the time a lump can be felt, it may have been already growing for probably 10 years. Also, not all breast cancers can be identified using mammograms therefore knowing how your breasts normally look and feel is an important part of keeping up with your breast health, and finding breast cancer as early as possible gives you a better chance of successful treatment and survival.
Here are some other warning signs that could indicate early stage of breast cancer:
Enlarged or swollen lymph nodes
Changes in breast size, shape or feel
Skin changes such as dimpling or puckering
Nipple retraction (turning inward) or pulling to one side or a different direction
Redness, scaliness, or thickening of the nipple or breast skin
Itching of the breast or nipple may be a sign of inflammatory breast cancer
Nipple changes or discharge (other than breast milk)
Lingering pain on one spot of the breast
Late signs and symptoms include bone pain, nausea, weight loss, headache, double vision, muscle weakness and loss of appetite.
In most cases these signs are not cancer, however, the only way to know for sure is to see your doctor so that he or she can find the cause. If you have breast cancer, it is best to find it at an early stage, when the chances of survival are highest.
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6) How is breast cancer treated?
Most people with breast cancer will have some type of surgery to remove the tumour. Depending on the type of breast cancer and how advanced it is, other types of treatment may also be needed, either before or after surgery, or sometimes both. However, surgery is less likely to be a main part of the treatment for more advanced breast cancers. Treatment plans will be decided upon the type of breast cancer, its stage, and any special situations, such as if the cancer is found to be invasive, non-invasive, or whether occurring during pregnancy. It will also depend on other factors including overall health and personal preferences.
Surgery may be undertaken for a variety of reasons. For example, to remove as much of the cancer as possible (known as breast-conserving surgery or mastectomy); to determine whether the cancer has spread to the lymph nodes under the arm; to restore the breast’s shape after the cancer has been removed (breast reconstruction); or to relieve symptoms of advanced cancer.
There are two main types of surgery to remove breast cancer. Firstly, there is what is known as breast-conserving surgery (also called a lumpectomy, quadrantectomy, or partial mastectomy), in which only the part of the breast containing the cancer is removed. The other type is the well-known mastectomy, in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues.
Following a mastectomy (or some breast-conserving surgeries), a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance. This is known as breast reconstruction, of which there are several varieties, with options depending upon the individual, medical situation and personal preferences.
Other treatments might also be necessary following mastectomy, such as radiation therapy, hormone therapy, chemotherapy, or targeted therapy, each of which has their own specific reasons for application, and indeed possible side effects.
Radiation - The need for radiation depends upon the type of surgery, whether the cancer has spread to the lymph nodes or somewhere else in the body, and in some cases, a person's age.
Chemotherapy - Some women with breast cancer might also receive chemotherapy. This treats the whole body for breast cancer, not just the breast. Many different side effects are possible from chemotherapy drugs, but not all patients will have the same ones. Chemotherapy is treatment with cancer-killing drugs that may be given either intravenously (injected into a vein) or by mouth.
Hormonal Therapy is most often used following surgery to help reduce the risk of the cancer recurring, but it can also be started before surgery, and is usually employed for at least 5 years. It can also be used to treat cancer that has come back following treatment or that has spread to other parts of the body.
for breast cancer is a more recent innovation. As researchers have learned more about changes in cancer cells that cause them to grow out of control, new types of drugs have been developed to target some of these cell changes. These special drugs are designed to block the growth and spread of cancer cells. However, they work differently from chemotherapy drugs, which attack all cells that are growing quickly, and not just the cancer cells. Targeted drugs sometimes work even when chemotherapy does not, and they can also help other types of treatment work better. They also tend to have less severe side effects than chemotherapy.
SEE ALSO: Breast Reconstruction Following Cancer
7) I have been diagnosed with breast cancer. Can I still have children?
Many women are able to become pregnant after treatment for breast cancer. However, some treatments make it harder to get pregnant. If a cancer patient thinks that they may want to have children one day, or just want to keep their options open, the best time to talk to a doctor about fertility is before commencing the cancer treatment.
Many breast cancers are sensitive to oestrogen, so there has been concern that, for women who have had breast cancer, the high hormone levels that result from a pregnancy might increase the chance of the cancer coming back. However, studies have shown that pregnancy does not increase the risk of the cancer coming back after successful treatment. There is also no proof that breastfeeding after cancer treatment increases the risk of recurrence. In fact, some research suggests having a history of breastfeeding might actually lower the risk of the cancer coming back.
Many doctors advise breast cancer survivors to wait at least 2 years after all cancer treatment has finished before trying to get pregnant. This is thought to be enough time to find any early return of the cancer, which could affect a person's decision to become pregnant. However, this advice is not based on data from any clinical trials, and some breast cancers can return after the 2-year mark, so each case is different. Thus the decision should be based on many things, including age, desire for more pregnancies, type of breast cancer, and the risk of the cancer coming back early.
There is no proof that a woman's past breast cancer has any direct effect on her baby. Researchers have found no increased rate of birth defects or other long-term health concerns in children born to women who have had breast cancer. On the other hand, for those still getting any type of treatment for breast cancer, it is essential to talk to their doctor before trying to become pregnant. Certain drugs can affect a growing foetus, so it is safer to wait to get pregnant until all treatment is complete.
Those who have had breast surgery and/or radiation may have problems breastfeeding from the affected breast. Studies have shown reduced milk production in a treated breast as well as structural changes that can make it difficult and painful for the baby to latch onto the breast. Yet still many women are able to breastfeed.
However, for those still taking any medicines to treat breast cancer, it is very important to talk with their doctor before trying to breastfeed, since some drugs can enter the breast milk and might affect the baby.
8) What is it like to be a breast cancer survivor?
Early detection and treatment of breast cancer is the key to survival.
When breast cancer is detected before it has spread to lymph nodes, the 5-year survival rate is 97%.
People who have had breast cancer can still get other cancers, although most don’t get cancer again. Breast cancer survivors are at higher risk for getting another breast cancer, as well as some other types of cancer. Indeed, they can be affected by a number of health problems, but often the major concern is facing cancer again.
The most common second cancer in survivors of breast cancer is another breast cancer. The new cancer can occur in the opposite breast, as well as in the same breast for women who were treated with breast-conserving surgery. The risk of a second breast cancer is increased no matter which treatments have been employed. This is probably because factors like genetics or hormonal risk factors might play a role in these cancers.
Whilst it is not possible to prevent all cancers, there are steps that can be taken to lower the risk and stay as healthy as possible. Getting the recommended early detection is one way to do this.
Women (and men) who have had breast cancer should do their best to stay away from tobacco products. Smoking increases the risk of many cancers and might further increase the risk of some of the second cancers seen after breast cancer.