Breast cancer is the most common form of cancer in women. Although it may develop any time after puberty, it most often arises after age 50. It occurs in men, but rarely.
The survival rate has improved because of earlier diagnosis and the variety of treatments now available. Bur the death rate hasn’t changed in the past 50 years. Breast cancer is the number two killer (after lung cancer) of women ages 35 to 54.
Read more: Breast Cancer
Breast cancer occurs more often in the left breast than the right, and more often in the upper outer quadrant (the upper part of the breast closest to the arm). A woman may not be able to feel a slowÂgrowing breast tumor by touch for up to 8 years, until it has a 3/8-inch (1-centimeter) diameter.
Breast cancer may spread by way of the lymphatic system and bloodstream, through the right side of the heart to the lungs, and eventually to the other breast, chest wall, liver, bone, and brain.
What Causes it?
The cause of breast cancer isn’t known, but its high incidence in women suggests that estrogen is a cause or contributing factor. Certain predisposing factors are clear, though. Women at high risk include those who:
- have a family history of breast cancer
- have long menstrual cycles (began menstruating early or experienced menopause late)
- have never been pregnant
- were first pregnant after age 31
- have had cancer in one breast
- have had endometrial or ovarian cancer
- were exposed to low-level ionizing radiation.
Researchers have looked into many other possible predisposing factors, including estrogen therapy, drugs that lower blood pressure, a high-fat diet, obesity, and fibrocystic breasts.
Women at lower risk for breast cancer include those who:
- were pregnant before age 20
- have had more than one pregnancy
- are Indian or Asian.
- What are its Symptoms?
Warning signs of possible breast cancer include:
- a lump or mass in the breast
- change in the symmetry or size of the breast
- change in the skin, such as thickening or dimpling, scaly skin around the nipple, an orange-peel-like appearance, or ulcers
- change in skin temperature (a warm, hot, or pink area)
- unusual drainage or discharge from the breast
- change in the nipple, such as itching, burning, erosion, or retraction
- pain (with an advanced tumor)
- spread of cancer to the bone, pathologic bone fractures, and increased calcium in the blood
- swelling of the arm.
How is it Diagnosed?
The most reliable way to detect breast cancer is by a monthly selfÂexam, with immediate evaluation of any abnormality. Other tests include mammography (an X-ray of the breast) and biopsy (removal of breast tissue).
Mammography is indicated for a woman with signs or symptoms of breast cancer. Every woman should have a baseline (initial) mammogram between ages 35 and 39. Women ages 40 to 49 should have one every 1 to 2 years; women over age 50, women who have a family history of breast cancer, or those who’ve had cancer in one breast should have a mammogram every year.
Because mammography can produce a false-negative result in as many as 30% of all tests, most doctors do a fine-needle aspiration or surgical biopsy if the woman has a suspicious mass, even if the mammogram is negative. Ultrasound, which can distinguish a fluid-filled cyst from a tumor, can be used instead of an invasive surgical biopsy.
Bone scans, a computed tomography scan (commonly called a CAT scan), measurement of a substance called alkaline phosphatase, liver function studies, and a liver biopsy can detect the spread of cancer to distant sites.
A test called a hormonal receptor assay is done to determine if the tumor is estrogen- or progesterone-dependent. This test guides decisions to use therapy that blocks the action of the estrogen hormone, which supports tumor growth.
How is it Treated?
Much controversy exists over breast cancer treatments. In choosing therapy, the woman and her doctor should consider the stage of the disease, the woman’s age and menopausal status, and the possible disfiguring effects of surgery.
A woman with breast cancer may undergo one or any combination of the following treatments:
Surgery involves either lumpectomy or mastectomy (removal of all or part of the breast).
Chemotherapy is used either as the main treatment or as an auxiliary to the main treatment (known as adjuvant therapy), depending on such factors as the tumor stage and estrogen receptor status. The most commonly used drugs are cyclophosphamide, fluorouracil methotrexate, doxorubicin, vincristine, paclitaxel, and prednisone.
A treatment called peripheral stem cell therapy may be used for a woman with advanced breast cancer. In this treatment, blood is removed from a large vein. Certain cells undergo purification and are frozen and eventually reinfused.
Read more: Leukemia
Primary radiation therapy before or after tumor removal is effective for small tumors in early stages that haven’t spread to distant sites. It’s also used to prevent or treat local recurrence. Also, a woman with inflammatory breast cancer may undergo radiation before surgery to make the tumor easier to remove.