Breast Cancer

Many diseases can affect the breast, most of which are harmless changes of the fat and connective tissue. However, the breast can also be affected by the dominant disease amongst woman— breast cancer.

Breast cancer is the most common cancer in women in the developed world where it affects about 100 per 100,000 women annually. Estimates indicate that 1 in 9 woman shall be affected by breast cancer in the future. White women over the age of 35 are most affected. Other ethnicities show lower incidence of this disease, the lowest of which is in Southeast Asia and Africa. Breast cancer can also affect men, but it is 100 times less common than in women.

Breast cancer is characterised by uncontrolled cell division. The cancer-modified cells may travel to other body parts, seed them and grow further. Medically speaking, they metastasise.

Causes for development

The exact cause of breast cancer has not yet been explained, but certain risk factors affecting the development of breast cancer are known, including a long time period between the menarche (i.e. the start of menstrual cycles) and menopause (cessation of menstrual cycles), relatively late age at first pregnancy, obesity and a fatty diet. Oral contraceptives also increase the risk.

Familial predisposition is a chapter in itself among risk factors. It has been found that breast cancer appears much more commonly in close relatives than among random population. The greater the number of family members affected by breast cancer, the higher the risk of developing breast cancer. Changes in BRCA1 and BRCA2 genes play an important role in familial predisposition. BRCA genes protect the breast cells from cancer. If these genes malfunction, the protection is gone and cancer may develop.

Disease recognition

The most common sign of breast cancer is a lump or thickening in the breast. Most lumps are harmless, but these changes should nevertheless be evaluated by a physician. Other potential signs of breast cancer include a clear or bloody nipple discharge; retraction or indentation of the nipple; change in the size or contours of the breast; any flattening or indentation of the skin over the breast; redness or pitting of the skin over the breast, or the skin appearing like that of an orange.

The most important diagnostic activity that every woman should regularly perform is breast self-examination to check for possible changes that can be palpated in the breast. Only a fast and timely detection of changes can help diagnose cancer in the early stages when very effective therapy is still possible.

Physicians employ various techniques to diagnose breast cancer. The best and most widely used is mammography which is an X-ray imaging of the breast. Unfortunately, mammographies are not error-proof. It may happen that a harmless change is mistaken for breast cancer or, even worse, that breast cancer is overlooked. Besides mammography, the other examination options include a breast ultrasound, MRI or CT.

Biopsy of the disease-modified tissue is an absolute must in breast cancer diagnostics. In this procedure, a physician removes a tissue sample with a needle and sends it to the laboratory for histological examination. Biopsy results reveal the degree of cancer malignancy which aids in further therapeutic decision-making.

Prevention

Regarding cancer development possibilities, avoiding risk factors that can elevate possibilities of cancer appearance is highly advised:

Reduce alcohol intake – a connection between alcohol intake (regardless of its origin, which can be beer, wine or spirit drink) and breast cancer development has been found. Women shouldn’t drink more than a glass per day, but strict alcohol limitation is even more advised.

Normal weight maintenance – the oestrogen hormone, whose elevated quantities are connected with breast cancer, is produced by fatty tissue. The effect of increased body weight on breast cancer development is the highest during menopause. Preventive measures sum all actions that help maintain a normal body weight, like regular physical activity (at least 30 minutes per day for most days of a week), appropriate nutrition that contains little fat and a lot of fibres (fruits, vegetables and cereals). Using olive oil is also advised, because it is supposed to reduce the effect of oncogenes that can influence breast cancer development.

Avoiding long term hormonal therapy in menopause – research has determined that there is an increased risk of cancer development in the cases of combined oestrogen and progesterone use during a period longer than 5 years. The risk is significantly reduced when the therapy is cancelled. The same goes for hormonal therapy after turning 60 years old or more.

Aspirin – a reductive effect of Aspirin on risk of breast cancer development has been established. Doses of Aspirin for this kind of effect are unfortunately higher than for cardiovascular disease prevention and increased possibilities of side effects like stomach ulcers are present.

Avoid pesticides – organochlorides, a group of pesticides, which include the banned DDT, can bind the same receptors like oestrogen.

In women with a highly increased risk for breast cancer development (mother or daughter with breast cancer, positive biopsy, etc.) there are other preventives to consider:

Chemopreventive – the use of medications from the group of selective modulators of the estrogen receptor. Tamoxifen and Raloxifene can be offered to post-menopausal women, who have a significantly increased risk for cancer development in the next five years, if they have no past history. 

Radical surgery – one or both breasts can be removed (radical mastectomy). This form of prevention is usually recommended to women that already had breast cancer, have a positive family history, positive genetic testing or whose doctor had discovered early-stage cancerous cells. The other procedure is radical oophorectomy, in which both ovaries are removed. Even though this kind of surgery is normally done for ovary cancer prevention, oophorectomy before menopause also reduces risk for breast cancer development.

Therapy

Early diagnosis and therapy is crucially important for the treatment of breast cancer. For early discovery, different methods are used, from breast self-examining to mammography. This is especially important for women with an increased risk. Ask your doctor or gynaecologist for brochures about self-examining and about screening programs in your region.

Treatment exists for every disease type and stage and usually consists of surgery and additional therapy like radiotherapy, chemotherapy, hormonal or biological therapy.