Issue #1: Breast Cancer

Overview:

Breast cancer is a malignant proliferation of epithelial cells linking the ducts or lobules of the breast. It is the most common cause of cancer in women, excluding skin cancer. It is a hormone-dependent disease so that women without functiong ovaries who never receive estrogen replacement do not develop breast cancer.

Epidemiology:

Risk Factors

1. Age - The risk of getting breast cancer increases with age but incidence begins to decline beginning at the age of menopause. The three dates in a woman's life that have a major impact on breast cancer are age at menarche, age at first full-term pregnancy and age at menopause. Women who experience menarche at age 16 have only 50-60% of the breast cancer risk of a woman having menarche (first menstruation) at age of 12; the lower risk persists throughout life. Similarly, menopause occuring 10 years before the median age of menopause (52 years), whether natural or surgically induced, reduces risk of breast cancer by about 35%. Women who have a first full-term pregnancy by age 18 have a reduced (30-40%) risk of breast cancer compared with nulliparous (or women who never experienced pregnancy) women
2. Race - Asian women have a lower risk of developing breast cancer compared to Caucasians. It is said that Asian women have substantially lower concentrations of estrogens and progesterone.
   
3. Diet - Its role to breast cancer etiology is still controversial. While there are associative links between total caloric and fat intake and breast cancer risk, the exact role of fat in the diet is uproven. Obesity and breast cancer have been closely linked with.
   
4. Alcohol intake - There is a risk associated with alcohol intake but the mechanism is still unknown. Some studies say that "Two drinks daily increase the risk of getting breast cancer by about 25 percent."
5. Radiation - It may increase the risk in younger women. Women who have been exposed to radiation before age 30 have an increased risk whereas exposure after age 30 appears to have a minimal carcinogenic effect on the breast.
6. Heredity - It has been implied in many studies that genetics play an important role in breast cancer etiology.

Signs and Symptoms:

Early breast cancer causes no symptoms and is not painful. Usually breast cancer is discovered before any symptoms are present, either on mammography or by feeling a breast lump. A lump under the arm or above the collarbone that does not go away may be present. Other possible symptoms include breast discharge, nipple inversion and changes in the skin overlying the breast.

Screening for Breast Cancer:

Screening procedures have been recommended by doctors for early detection of breast cancer. This includes breast self exam and mammography.

Breast Self Exam:

Women are strongly encouraged to examine their breasts monthly.

1. Timing: It is done monthly, 7 to 10 days after the first day of your menstrual period. If you are not menstruating, you perform it same day every month.

How to do it?

A multimedia presentation of performing breast self examination can be viewed in Komen.org.

Mammography:

Screening mammography has reduced the lethality of breast cancer by promoting detection at an earlier stage. The procedure is justified on an annual basis for women over age 40.

Treatment:

Surgical therapy: Depending on the staging and type of the tumor, just a lumpectomy (removal of the lump only) may be all that is necessary or removal of larger amounts of breast tissue may be necessary. Surgical removal of the entire breast is called mastectomy.

Chemotherapy: Unlike many other epithelial malignancies, breast cancer responds to several chemotherapeutic agents, including anthracyclines, alkylating agents, taxanes, and antimetabolites.

Systemic therapy: This is the use of medications to treat cancer cells throughout the body. It is used for metastatic breast cancer.

Radiation therapy: This is used after surgical removal of the breast tumor. This uses X-rays or gamma rays which are very effective in destroying the cancer cells that might recur where the tumor was removed.

Prognosis (Outcome):

The higher the stage at the time of diagnosis, the worse the prognosis of breast cancer is. This is where the importance of early screening for breast cancer comes important.

Breast Cancer in Males:

Yes, males can have breast cancers but of much lesser incidence than female breast cancer. The male to female ratio is 1:150. It usually presents as a unilateral lump in the breast and is frequently not diagnosed promptly. When male breast cancer is matched to female breast cancer by age and stage, its overall prognosis is identical.

Reference:

Braunwald, E., et al., Harrison's Principles of Internal Medicine. 2001. The McGraw-Hill Companies, Inc.

http://en.wikipedia.org/wiki/Breast_cancer

http://www.infobreastcancer.ca/bse2.htm

http://www.komen.org/bse/