Breast Cancer

Breast Cancer

Breast cancer occurs when abnormal cells grow out of control in one or both breasts. They can invade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.

Breast Cancer

Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100 times more common in women than in men, but survival rates are equal in both sexes.

Overview and statistics:

26 females out of 100 females and 1 male for every 105 males may be diagnosed with breast cancer in the Philippines. Since the 1980s, breast cancer ranks 1st among the top leading cancers afflicting women in the Philippines and ranks 2nd to lung cancer if both sexes are considered. Its incidence starts to peak at the age of 30 in women. (Source: Philippine Cancer Facts & Estimates, PCSI, 2005.) However, it was reported in 2004 that breast cancer cases in the Philippines exceeded lung cancer by 685 cases for both sexes. (source, UP-DOH report, manila bulletin 2004)

Recently, more women are presenting with bilateral disease at an early age (30’s-40’s). Generally, the disease is still being diagnosed late in its course hence the survival rate of breast cancer in the Philippines is below 50%. Making the situation more difficult, an estimated seventy percent (70%) of breast cancer patients in the Philippines are indigents.

Alarmingly, the Philippines has the highest prevalence of breast cancer in Asia. (Source: International Agency for Research on Cancer, 2004). In addition to the successful reduction in fertility and westernization of the Filipino lifestyle, the limited access to breast health contributes significantly to its recorded highest prevalence in Asia. Among the reasons for the limited access to breast health in the Philippines include: location of health facilities, limited income, high prices of diagnostic tests and hospital care, low levels of education, and the lack of breast cancer awareness.

Diagnosis & Tests

The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings). It includes looking at and feeling your breast. Any unusual changes should be reported to your doctor. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved.

Breast Self-Exam

A breast exam by a health professional (such as your doctor, nurse, nurse practitioner, or physician assistant) is an important part of routine physical checkups.

You should have a clinical breast exam at least every three years starting at age 20 and every year starting at age 40. A clinical breast exam may be recommended more frequently if you have a strong family history of breast cancer.

Clinical Breast Exam

Mammography uses special X-ray images to detect abnormal growths or changes in the breast tissue. Mammograms performed on healthy, normal breasts provide a baseline reference for later comparison.

Using a machine and X-ray film made especially for breast tissue, a technician compresses the breast and takes pictures from at least two different angles, creating a set of images for each of your breasts. This set of images is called a mammogram. Breast tissue appears white and opaque and fatty tissue appears darker and translucent.

Mammogram

In a screening mammogram, the breast is X-rayed from top to bottom and from side to side. A diagnostic mammogram focuses in on a particular lump or area of abnormal tissue.

Breast ultrasound is a procedure that may be used to determine whether a lump is a cyst (sac containing fluid) or a solid mass which could be cancer. If it is found to be a cyst, fluid is typically withdrawn from it using a needle and syringe (a process called aspiration). If clear fluid is removed and the mass completely disappears, no further treatment or evaluation is needed.

Breast Ultrasound

Ultrasound can also be used to precisely locate the position of a known tumor in order to guide the doctor during a biopsy or aspiration procedure. Ultrasound helps confirm correct needle placement.

Ultrasound testing works by transmits high-frequency sound waves, inaudible to the human ear, through the breast. The sound waves bounce off surfaces in the breast (tissue, air, fluid) and these "echoes" are recorded and transformed into video or photographic images

Breast MRI (magnetic resonance imaging) is a test that may be used to distinguish between benign (noncancerous) and malignant (cancerous) areas. Performing this test may reduce the number of breast biopsies done to evaluate a suspicious breast mass. Although MRI can detect tumors in dense breast tissue, it cannot detect tiny specks of calcium (known as microcalcifications), which account for half of the cancers detected by mammography.

Breast MRI

A breast biopsy is the removal of cells or tissue from a suspicious mass. The tissue or cells are then examined under a microscope to check for breast cancer cells. A biopsy may be performed when an abnormal breast change is found during a mammogram, ultrasound, or physical examination. A biopsy is the only way to determine if a potential trouble spot is cancerous or benign.

Breast Biopsy

There are many types of breast biopsy procedures. The method recommended by your doctor will depend on how large the breast lump or abnormal area is; where in the breast it is located; how many lumps or abnormal areas -- such as suspicious calcifications -- are present; if you have any other medical problems; and what your personal preferences are.

When a breast biopsy is recommended to test for breast cancer, patients may be able to choose a minimally invasive alternative to surgery known as image-guided needle biopsy. This is a technique that does not require surgery. Most of the time, the radiologist performs this type of biopsy.

Minimally Invasive Breast Biopsy

For breast cancer detection, ductal lavage is a procedure for collecting cells from the milk ducts of the breast for analysis. The procedure is used to identify precancerous cells, called atypical cells. Ductal lavage currently is performed only on women who have multiple breast cancer risk factors to try to detect breast cancer before it starts.

Ductal Lavage

Ductal lavage works on the premise that most breast cancers (about 95%) develop in cells that line the milk ducts of the breast. Cancer usually begins in one duct and may be contained to that duct if caught early, making treatment more effective and increasing survival.

Breast cancer is usually treated with surgery, medicine, and radiation therapy. Because of improved screening methods, diagnosis at an early stage, and improved treatment techniques, the number of deaths from breast cancer has been steadily declining over the past few years. Decisions about how to treat breast cancer are based on a combination of factors that include specific information about the cancer, your preferences, and your health.

Treatment Overview

Radiation therapy

Radiation therapy is the use of high-dose X-rays to destroy cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from the placement of thin plastic tubes containing radiation (radioisotopes) into the area where the cancer cells are found (internal radiation therapy, or brachytherapy).

Radiation therapy is standard treatment for many types of cancer. It may be used in combination with surgery, chemotherapy, or hormonal therapy.

Chemotherapy

Chemotherapy is the use of medication to destroy cancer cells. Chemotherapy is called a systemic treatment because the medications enter the bloodstream, travel through the body, and can destroy cancer cells outside the target area.

Chemotherapy may be taken by mouth (orally), or it may be given through a needle into a vein (intravenously, or IV) or a muscle (intramuscular, or IM).

Hormone therapy

for breast cancer

Hormone therapy is used to change the way hormones stimulate cancer growth. These medicines either block the effects hormones have on the cancer cells or block the production of the hormones.

If tests show that the breast cancer cells have estrogen and progesterone receptors (ER/PR-positive), hormone therapy may be used. Tamoxifen and aromatase inhibitors are the most commonly used hormonal therapies. Other hormonal therapies include progestins, such as megestrol (Megace), and antiestrogen, such as fulvestrant.

Neoadjuvant Therapy

Neoadjuvant therapy is treatment given before the primary treatment for a condition or disease. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy given before surgery to remove cancer.

Neoadjuvant therapy is often given to reduce the size of the surgical area or to provide for a better cosmetic result. Additional chemotherapy, radiation therapy, or hormone therapy is usually needed following the surgery for the treatment of cancer.

Mastectomy

A mastectomy is the surgical removal of the breast. It is used to treat breast cancer.

Partial or segmental mastectomy is the removal of the area of the breast that contains cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. The lymph nodes under the arm are also removed and examined under a microscope (auxiliary lymph node dissection or sentinel node biopsy).

Total (or simple) mastectomy is the removal of the whole breast.

Modified radical mastectomy is the removal of the breast, the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles.

Radical mastectomy (Halsted radical mastectomy) is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the most common operation for breast cancer, but now it is rarely used.

Breast-conserving

surgery (lumpectomy)

Breast-conserving surgery (lumpectomy) is the surgical removal of a breast lump and some of the tissue around it. The lump (and sometimes the lymph nodes under the arm) is removed and sent to the lab for examination.

Breast-conserving surgery can be used in early-stage breast cancer and when the breast lump is small compared with the size of the breast. Radiation therapy is used after breast-conserving surgery for invasive breast cancer.

Lymph node surgery

for breast cancer

staging

Whether you have a mastectomy or breast-conserving surgery (lumpectomy) for breast cancer, your doctors need to know whether the cancer has spread to the lymph nodes. Lymph node involvement increases the likelihood that cancer cells have spread through the bloodstream to other parts of the body. Women with some forms of very early breast cancer, such as ductal or lobular carcinoma in situ, do not need lymph node testing.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies being studied in the treatment of breast cancer.

Preoperative Assess patient’s reaction to

the diagnosis and ability to cope with it.

Take a complete health and gynecologic history.

Ask about coping skills, supportive systems, knowledge deficit, and presence of discomfort.

Perform a complete physical assessment, with particular attention to breasts and related mass signs and symptoms

Monitor pulse and blood pressure for signs of shock and hemorrhage.

Avoid performing blood pressure readings, injections, intravenous lines, and venipuncture on the operative side to prevent infection and compromised circulation.

Inspect dressings for bleeding on a regular basis.

Monitor drainage. Turn and encourage deep

breathing. Assess graft areas for unusual

redness, pain, swelling, or drainage.

Nursing MangementPostoperative

Breast Cancer Myths

and Misconceptions

The truth behind some of the mostcommon misconceptions about breastcancer.

Public awareness about breast cancer hasincreased dramatically over the past 20

years.Yet misleading ideas still persist. Here, weexplain the truth behind commonmisconceptions.

Myth: The "one in eight chance of breast cancer" statistic means that if eight women are randomly selected, one of them must have or will get breast cancer.

Fact: In reality, the statistic -- which comes from the National Cancer Institute -- is an estimate of a woman's chance of developing breast cancer during her entire lifetime.

Myth: Only women can get breast cancer.

Fact: Men have breast tissue, so it is possible for them to develop breast cancer. Like all cells of the body, a man's breast duct cells can undergo cancerous changes.

Myth: Using deodorant or antiperspirant causes breast cancer.

Fact: This urban legend has suggested that chemicals in antiperspirants are absorbed through the skin, interfere with lymph circulation and cause toxins to accumulate in the breast that eventually lead to breast cancer.

Myth: Any mass that shows up on a mammogram is most likely cancerous.

Fact: Most abnormalities will turn out not to be cancer. A mass could be a cyst or another benign breast condition.

Myth: Breast-feeding increases your risk for breast cancer.

Fact: A woman who breast-feeds can get breast cancer, but no studies indicate that breast-feeding causes breast cancer. In fact, some studies indicate that breast-feeding can reduce a woman's risk of developing the disease.

Myth: Birth-control pills cause breast cancer.

Fact: Today's birth-control pills contain a low dose of the hormones estrogen and progesterone. They have not been associated with an increased risk of breast cancer and, in fact, can provide some protection against ovarian cancer.

Sources: American Cancer Society, National Cancer Institute, National Breast Cancer Foundation

Misconceptions of

Breast Cancer

There are a number of “myths” about the risk factors and causes of breast cancer that sound plausible but have little or no scientific theory or data to support them.

There is no body of evidence that an increased risk for breast cancer can be attributed to: The use of antiperspirants, Wearing an underwire or tight fitting bra, A bump or knock to the breast, Stress, Having silicon breast implants, Termination of pregnancy (This includes both

induced abortion and spontaneous miscarriage)

Information source: National Breast and Ovarian Cancer Centre