BREAST CANCER

What is cancer?

Cancer occurs when normal healthy cells lose the ability to control their growth and keep multiplying. These abnormal cells join together to form a growth or tumour, and this invades and destroys the surrounding tissues. Cancers are curable only if detected early. Cancer which has spread is generally incurable.

Breast Cancer

Breast cancer is now second leading cause of cancer deaths in women today (after lung cancer) and is the most common cancer among women, excluding nonmelanoma skin cancers. According to the World Health Organization, more than 1.2 million people will be diagnosed with breast cancer this year worldwide. It is the most frequent cancer among females and there is a clear increase in incidence over time.

Risk Factors

There have now been documented several risk factors the most important of which are as follows:

1.    A previous personal history of breast cancer

2.    A family history especially that involving a first degree relative ie. Mother, sister, daughter

3.    Women over 35 years of age

4.    Women who have early menstruation or late menopause

5.    Women who have their first child after the age of 30 or are childless

6.    Others including certain benign breast diseases such as proliferative breast disease with or without atypical features

7.    Smoking and a diet high in saturated fats

Common Symptoms and Signs

The most common symptoms and signs of breast cancer are:

1.    A painless breast lump or a lump in the armpit

2.    Bleeding or discharge from the nipple

3.    A change in the colour or feel of the skin of the breast or nipple, for example dimpling or puckering, or a rash

4.    A change in the size or shape of the breast

Breast Cancer Screening

Screening for breast cancer is now quite established. Current recommendations by various organizations include the following:

1.  Self breast examination every month - you can be taught how to do this by your general practitioner or any physician

2.  A clinical breast examination by a medical practitioner every 4 months

3.  Regular mammography with or without a breast ultrasound beginning at age 40-50. This should be performed yearly if you are over the age of 50. If you are younger than 50, you should have yearly examinations if there is a family history of breast cancer, and this should commence 5-10 years before the earliest case of cancer in the family

If a suspicious lesion is found on examination, the doctor may proceed to perform a biopsy either using a needle to remove some cells from the lump, or the doctor may need to perform a small operation to remove part of or the entire lump for further histological tests.

What happens if Breast Cancer is diagnosed?

The treatment of choice for early stage disease is curative surgery. This can take the form of either mastectomy which is removal of the whole breast, or breast conservation surgery when only part of the breast is removed. The decision is often taken based on the size of the tumour, the size of the breasts and the patient’s preference. The lymph nodes in the armpit are also removed for examination. There is now a new procedure called sentinel lymph node dissection which can minimize the number of lymph nodes removed which leads to less chances of lymphoedema or arm swelling post operatively. Current trends are moving in the direction of breast conservation surgery, and even in women post mastectomy there is an increasing demand for breast reconstructive surgery which can produce a good overall cosmetic effect.

Additional treatment post surgery may include radiotherapy and chemotherapy. Radiotherapy is the use of high energy X rays to kill cancer cells and stop them from growing. It is used primarily to reduce the chance of the tumour growing again in the area of the initial operation. Chemotherapy is the administration of drugs to kill cancer cells, and is a systemic therapy where the drugs enter the body either by mouth or by injection, and travel though the body. Chemotherapy has been proven to reduce the incidence of cancer spread to other parts of the body, thereby increasing survival and prolonging life.

New Treatments
 

There are now several new treatments available for breast cancer. These include new chemotherapy agents, for example the taxanes (Taxol, Taxotere) which are derived from yew trees; new hormonal agents which are taken orally; and targeted therapies such as Herceptin which attacks one of the proteins on the cancer cell surface. These new therapies are also now being incorporated into the post surgical treatment programs for breast cancer patients.

Important: Public awareness