INTRODUCTION humoral disease. He postulated that the body

INTRODUCTION

Breast cancer is a disease in which
cells in the breast grow out of control. There are different kinds of breast
cancer. The kind of breast cancer depends on which cells in the breast turn
into cancer. Breast cancer can begin in different parts of the breast. A breast
is made up of three main parts: lobules, ducts, and connective tissue. The
lobules are the glands that produce milk. The ducts are tubes that carry milk
to the nipple. The connective tissue (which consists of fibrous and fatty
tissue) surrounds and holds everything together. Most breast cancers begin in
the ducts or lobules. Breast cancer can spread outside the breast through blood
vessels and lymph vessels. When breast cancer spreads to other parts of the
body, it is said to have metastasized. 
On average, 72 Canadian women
will be diagnosed with breast cancer every day. On average, 14 Canadian women
will die from breast cancer every day .26,300 women will be diagnosed with breast cancer. This
represents 25% of all new cancer cases in women in 2017. 5,000 women will die from
breast cancer. This represents 13% of all cancer deaths in women in 2017. . “The pie graph shown on
page 11 shows the percentage of all estimated new cancer  and death in women.”

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HISTORY

Ancient Egyptians were the first to
note the disease more than 3,500 years ago. The condition was described fairly
accurately in both Edwin Smith and George Ebers papyri. One of the descriptions
refers to bulging tumors of the breast that has no cure. In 460 B.C.,
Hippocrates, the father of Western Medicine, described breast cancer as a
humoral disease. He postulated that the body consisted of four humors – blood,
phlegm, yellow bile, and black bile. He suggested that cancer was caused by the
excess of black bile. In appearance of the breast cancer too black, hard tumors
are seen that burst forth if left untreated to yield a black fluid. He named
the cancer karkinos, a Greek word for “crab,” because the tumors
seemed to have tentacles, like the legs of a crab. Thereafter in A.D. 200,
Galen described the cancer as well. He also suggested excessive black bile but,
unlike Hippocrates, he postulated that some tumors were more dangerous than
others. He suggested medications like opium, castor oil, licorice, sulphur,
salves etc. for medicinal therapy of the breast cancers. During this time of
history breast cancer was a disease that affected the whole body and thus
surgery was not considered.

TYPES OF BREAST
CANCER

There are
many types of breast cancer.
There is also Invasive and Non- invasive
breast cancer. In invasive breast cancer the cancerous cells break out from the
place of origin and affect other nearby cells and organs. In Non-invasive
breast cancer the cancer remains still at the place of origin. It doesn’t
affect the other cells and organs.

The most
common types are ductal carcinoma in situ, invasive ductal carcinoma, and
invasive lobular carcinoma.

Ductal Carcinoma In Situ (DCIS)- Ductal carcinoma in situ(DCIS), is also called intraductal carcinoma and Stage 0 breast cancer.
DCIS is a non-invasive or pre-invasive breast cancer. This means the cells that
line the ducts have changed to cancer cells but they have not spread through
the walls of the ducts into the nearby breast tissue. Because DCIS hasn’t
spread into the breast tissue around it, it can’t spread (metastasize) beyond
the breast to other parts of the body. Nearly all women with this early stage
of breast cancer can be cured.

Invasive (infiltrating) ductal carcinoma (IDC)- This is the most common type of breast cancer. About 8 of
10 invasive breast cancers are invasive (or infiltrating) ductal carcinomas
(IDC). IDC starts in the cells that line a milk duct in the breast, breaks
through the wall of the duct, and grows into the nearby breast tissues. At this
point, it may be able to spread (metastasize) to other parts of the body
through the lymph system and bloodstream. “The diagram shown on page
10 shows the ductal carcinoma.”

Invasive lobular carcinoma (ILC) – Invasive
lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like
IDC, it can spread (metastasize) to other parts of the body. About 1
 invasive breast cancer in 10  is an ILC. Invasive lobular
carcinoma may be harder to detect on physical exam as well as imaging, like
mammograms, than invasive ductal carcinoma. And compared to other kinds of
invasive carcinoma, about 1 in 5 women with ILC might have cancer in both breasts.  

STAGES

There are 2 main
types of staging systems for cancer. These are the TNM system and the number system.

The TNM staging
system

TNM
stands for Tumour , Node, Metastasis. This system describes the
size of the initial cancer (the primary tumour), whether the cancer has
spread to the lymph nodes, and whether it has spread to a different part of the
body (metastasised). The system uses letters and numbers to describe the cancer.

T refers
to the size of the cancer and how far it has spread into nearby tissue –
it can be 1, 2, 3 or 4, with 1 being small and 4 large
N refers
to whether the cancer has spread to the lymph nodes – it can be between 0
(no lymph nodes containing cancer cells) and 3 (lots of lymph nodes
containing cancer cells)
M refers
to whether the cancer has spread to another part of the body – it can
either be 0 (the cancer hasn’t spread) or 1 (the cancer has spread)

Number staging
system

Stage 0: Known as ductal carcinoma in
situ (DCIS), the cells are limited to within a duct and have not invaded
surrounding tissues.

Stage 1: At the beginning of this
stage, the tumor is up to 2 centimeters (cm) across and it has not affected any
lymph nodes.

Stage 2: The tumor is 2 cm across and
it has started to spread to nearby nodes.

Stage 3: The tumor is up to 5 cm
across and it may have spread to some lymph nodes.

Stage 4: The cancer has spread to
distant organs, especially the bones, liver, brain, or lungs.

CAUSES

Although the precise causes of breast cancer are unclear, we know the main risk factors. Still, most women
considered at high risk for breast cancer do not get it, while many with
no known risk factors do develop breast cancer. Among the most significant factors are advancing age and a
family history of breast cancer. Risk increases for a woman who has certain
types of benign breast lumps and increases significantly for a woman who
has previously had cancer of the breast or the ovaries . A
woman whose mother, sister, or daughter has had breast cancer is two to three
times more likely to develop the disease, particularly if more than one
first-degree relative has been affected. Researchers have identified two genes
responsible for some instances of familial breast cancer. These genes are known as BRCA1 and BRCA2. About one woman in 200
carries the genes. Having one of them predisposes a woman to breast cancer but does not ensure that she will get it. The greater a woman’s
exposure to the hormone estrogen, the more susceptible she is to breast cancer. Estrogen tells cells to divide; the more the cells divide, the more likely
they are to be abnormal in some way, possibly becoming cancerous .A woman’s
exposure to estrogen and progesterone rises and falls during her lifetime, influenced by the age she
starts and stops menstruating, the average length of her menstrual cycle, and
her age at first childbirth. A woman’s risk for breast cancer is increased if she starts
menstruating before age 12, has her first child after age 30, stops
menstruating after age 55, or has a menstrual cycle shorter or longer than the
average 26-29 days. Women who have taken birth control pills in the recent past
may have a slightly higher risk of developing breast cancer.  This risk
goes away if you have not taken birth control pills for at least 10 years. Some
studies suggest that taking hormone replacement therapy for menopause with
combined estrogen and progestin may increase risk, especially when taken for
more than five years. The jury is still somewhat out on this matter, though.
Heavy doses of radiation therapy may also be a factor, but low-dose mammograms pose almost no risk.

SYMPTOMS

 The main symptoms are thickening of
breast and formation of any lump on the breast.

 Pain in breast and armpits that doesn’t change
with monthly cycle.

 Redness of the breast skin like the skin of
the orange.

 A rash around or on the nipple and also
discharge of blood from nipple.

 Change in the size of the nipple.

 Flaking, peeling or scaling of the skin on the
breast or the nipple.

Thickening or swelling of part of the breast.

Irritation or dimpling of breast skin.

Pulling in of the nipple or pain in the nipple area.

Nipple discharge other than breast milk, including
blood .

Any change in the size or the shape of the breast.

RISK
FACTORS

1) Age
– At 20 years, the chance of developing cancer is less as 0.6 percent. But at
the age of 70 years, it is more like 3.84 percent.

2) Genetics
– There are two types of genes that are responsible for breast cancer. These
are BRCA1 and BRCA2 that are responsible for risk of developing breast cancer,
ovarian cancer or both.TP53 is another gene that is responsible for breast
cancer.

3) A
history of breast cancer or breast lumps – The women who had history of
breast cancer are more likely to develop it again. Sometimes the non- cancerous
lump on the breast can change into cancerous cells. So, if this exists women
should check with health care professional.

4) Dense
Breast tissue – Breast Cancer is more likely to develop in higher density
breast tissue.

5) Estrogen
exposure and breast feeding – Due to long term exposure to estrogen appears
to be cause of breast cancer because the concentration of estrogen become low
and high while entering the menopause.

And also women who breastfeed more than 1
year are less likely to develop cancer as breastfeeding reduces estrogen.

6) Body
Weight – women who are overweight or obese are at more risk of developing
cancer due to high level of estrogen. High Sugar content is also a cause of
breast cancer.

7) Alcohol
Consumption – Women who consume at least 3 drinks a day have 1.5 times
higher risk of developing cancer.

8) Cosmetic
implants and breast cancer survival – Women with cosmetic breast implants
are diagnosed with breast cancer have a higher risk of dying from the disease
and a 25 percent higher chance of being diagnosed at a later stage, compared
with women without implants.

DIAGNOSIS

A diagnosis often occurs as the result of routine screening, or when a
woman approaches her doctor after detecting symptoms. The doctor may ask about 
personal and family medical history and do a physical exam. The doctor
also may order lab tests, scans, or other tests or procedures. Diagnostic tests are used to confirm the presence of
cancer , identify the type of cancer identify the grade of the cancer (how
abnormal the cells look and behave) ,find the site where the cancer started
(primary tumour) ,determine the stage of the cancer (how far the cancer has
progressed),help plan cancer treatment ,monitor response to treatment , help
determine if cancer has returned (recurred)

SELF
EXAM

Adult women of all ages are
encouraged to perform breast self-exams at least once a month.  Johns
Hopkins Medical center states, “Forty percent of diagnosed
breast cancers are detected by women who feel a lump, so establishing a regular
breast self-exam is very important.” While mammograms can help you
to detect cancer before you can feel a lump, breast self-exams help you to be
familiar with how your breasts look and feel so you can alert your healthcare
professional if there are any changes.

In the Shower :Using the pads of
your fingers, move around your entire breast in a circular pattern moving from
the outside to the center, checking the entire breast and armpit area. Check
both breasts each month feeling for any lump, thickening, or hardened knot.
Notice any changes and get lumps evaluated by your healthcare provider.

In
Front of a Mirror :Visually inspect your breasts with your
arms at your sides. Next, raise your arms high overhead .Look for any changes
in the contour, any swelling, or dimpling of the skin, or changes in the
nipples. Next, rest your palms on your hips and press firmly to flex your chest
muscles. Left and right breasts will not exactly match—few women’s breasts do,
so look for any dimpling, puckering, or changes, particularly on one side.

 Lying Down: When lying down, the breast tissue spreads out evenly along
the chest wall. Place a pillow under your right shoulder and your right arm
behind your head. Using your left hand, move the pads of your fingers around
your right breast gently in small circular motions covering the entire breast
area and armpit. Use light, medium, and firm pressure. Squeeze the nipple;
check for discharge and lumps. Repeat these steps for your left breast.

LAB
TEST

High or
low levels of certain substances in your body can be a sign of cancer. So, lab
tests of the blood, urine, or other body fluids that measure these substances
can help doctors make a diagnosis. However, abnormal lab results are not a sure
sign of cancer. Lab tests are an important tool, but doctors cannot rely on
them alone to diagnose cancer.

BREAST EXAM

Your doctor will check both of your breasts and lymph
nodes in your armpit, feeling for any lumps or other abnormalities.

MAMMOGRAM

 A mammogram is an X-ray of the breast. Mammograms are
commonly used to screen for breast cancer. Patient will stand in front of the mammography machine, and
breast is placed between 2 plastic compression plates. The plates are then
pressed together to flatten, or compress, the breast.

BREAST
ULTRASOUND

Ultrasound uses sound waves to produce images of
structures deep within the body. Ultrasound may be used to determine whether a
new breast lump is a solid mass or a fluid-filled cyst.

BIOPSY

A
biopsy is the only definitive way to make a diagnosis of breast cancer. During
a biopsy, your doctor uses a specialized needle device guided by X-ray or
another imaging test to extract a core of tissue from the suspicious area.
Often, a small metal marker is left at the site within your breast so the area
can be easily identified on future imaging tests.

 

TREATMENT

Treatment will depend on:

·        
The type of breast cancer

·        
The stage of the cancer

·        
Sensitivity to hormones

·        
The patient’s age, overall health,
and preferences

The main options include:

1)      Surgery
– The types of surgeries are lumpectomy, Mastectomy, Sentinel node biopsy,
Axillary lymph node dissection and reconstruction

2)      Radiation Therapy
– Controlled doses of radiation are targeted at the tumor to destroy the cancer
cells. Used from around a month after surgery, along with chemotherapy.

3)      Chemotherapy
– Medications known as cytotoxic drugs may be used to kill cancer cells, if
there is a high risk of recurrence or spread. This is called adjuvant
chemotherapy. If the tumor is large, chemotherapy may be administered before
surgery to shrink the tumor and make its removal easier. This is called
neo-adjuvant chemotherapy.

4)      Hormone blocking therapy
– Hormone blocking therapy is used to prevent recurrence in hormone- sensitive
breast cancers. There are often referred to estrogen receptive(ER) positive and
progesterone receptor (PR) positive cancers.

5)      Biological Treatment
– Targeted drugs destroy specific types of breast cancer. Examples include
trastuzumab, lapatinib and bevacizumab.

PREVENTION

Many factors over the course of a lifetime can
influence your breast cancer risk. You can’t change some factors, such as
getting older or your family history, but you can help lower your risk of
breast cancer by taking care of your health in the following ways. Keep
a healthy weight. Exercise regularly (at least four hours a week). Research
shows that lack of night time sleep can be a risk factor. Don’t drink alcohol, or limit alcoholic drinks to no more than one
per day. Avoid exposure to chemicals that can cause cancer (carcinogens) and
chemicals that interfere with the normal function of the body. Limit  exposure to radiation from medical imaging tests like X-rays, CT
scans, and PET scans if not medically necessary . If you are taking, or have
been told to take, hormone replacement therapy or oral contraceptives (birth
control pills), ask your doctor about the risks and find out if it is right for
you. Breastfeed any children you may have, if
possible.

COST
REALTED TO CANCER CARE

For patients not covered by
health insurance, breast cancer treatment typically costs $15,000-$50,000 or more for
a mastectomy or $17,000 to $35,000 or more for a lumpectomy followed by radiation. Chemotherapy can cost about $10,000-$100,000 or more, depending on the drugs, the method
of administration and the length or number of treatments. Depending on the
individual case and the type and number of treatments needed, the total cost of
breast cancer treatment, on average, can reach $100,000 — or, in advanced cases, $300,000 or more.  A study published in BMC Cancer found that
the average total cost of care over a mean follow-up of 532 days was
about $128,500 for
women with metastatic breast cancer receiving chemotherapy as their primary
treatment. This includes the cost of the chemotherapy drugs, additional drugs
to help manage side effects, administration of the drugs and medical care for
chemotherapy-related complications. Mammogram cost $100 every six to twelve
months . Breast cancer patients will need regular follow-up doctor
visits and screenings to check for recurrence.

LATEST
RESEARCH ON BREAST CANCER

Doctors
are working to learn more about early-stage and locally advanced breast cancer,
including ways to prevent it, how to best treat it, and how to provide the best
care to people diagnosed with this disease. The following areas of research may
include new options for patients through clinical trials. Always talk with your
doctor about the best diagnostic and treatment options for you. Areas of
research includes research on the causes of early-stage and locally advanced
breast cancer, such as endocrine (hormone) disrupters, environment causes,
diet, and lifestyle choices, to find other ways to help prevent the disease.
Finding new ways to prevent early-stage and locally advanced breast cancer and
to help find breast cancer early. Developing ways to best evaluate the genes
and proteins at work in each patient and each breast cancer, to determine the
best treatment options for each patient. Determining what early-stage cancers
may or may not need chemotherapy.

CONCLUSION

A plan for the diagnosis and treatment of cancer is a key
component of any overall cancer control plan. Its main goal is to cure cancer
patients or prolong their life considerably, ensuring a good quality of life.
In order for a diagnosis and treatment programme to be effective, it must never
be developed in isolation. It needs to be linked to an early detection
programme so that cases are detected at an early stage, when treatment is more
effective and there is a greater chance of cure. It also needs to be integrated
with a palliative care programme, so that patients with advanced cancers, who can
no longer benefit from treatment, will get adequate relief from their physical,
psychosocial and spiritual suffering. Furthermore, programmes should include a
awareness-raising component, to educate patients, family and community members
about the breast cancer risk factors and the need for taking preventive
measures to avoid developing cancer.