October Is Breast Cancer Awareness Month

by Meemaw

Breast cancer is a terrible disease. Well, ANY cancer is terrible, but breast cancer is the most common in women. Most of us know at least one woman who has battled this terrible disease, but probably several women you know are or have had to deal with breast cancer. We can get some statistics from the American Cancer Society.

From the American Cancer Society's Breast Cancer Guide (You can download a printable pdf from here)

Are you at risk for breast cancer?

I've read loads of references, but I found the American Cancer Society's guide to be more understandable than most. They list many risks for breast cancer:

• Being female (however, men can get breast cancer as well).
• Older age (the majority of cases are women over 55) That's not to say that younger women can't get breast cancer, as I know several; it just means the majority of cases are over age 55.
• Inherited genes (a couple of genes called BRCA1 and BRCA2 show an increased risk for breast cancer.) These genes are inherited from earlier generations. As in most cases, just because you inherited the gene, it doesn't automatically mean you'll get breast cancer, only that your chance is higher.
• Gene Mutations - your own genes are capable of mutation. It doesn't happen often (much less often that the inherited genes above, but it does happen.
• A family history of breast cancer (if someone in your family has had it, you are at an increased risk.
• If you have already had it, your risk is higher (generally coming out of remission to a new occurrence.)
• Race & Ethnicity - White and African-American women have a greater risk than Asian, Hispanic or Native American women.
• Alcohol Consumption - the more you drink, the higher your risk.
• Overweight or Obesity
• Lack of physical activity
• Birth Control drugs
• Hormone Therapy after menopause to lessen the menopausal symptoms.

Causes of breast cancer

So far, there is no conclusive evidence that environmental chemicals or vitamins & diet will contribute to your risk for cancer. Smoking &/or secondhand smoke have not been conclusively shown to cause it either. So far, medical research has not shown exactly what causes cancer.

Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs mostly in women, but men can get it, too.

Can cancer be prevented?

There is no foolproof way to prevent breast cancer, but medical researchers suggest lessening your chances are a good way to try:

• Stay healthy - lose weight if you are overweight, and don't drink too much alcohol (1 drink per day is considered healthy). Also, increase your physical activity.
• If you have a family history of breast cancer, you should talk to your doctor about some of the drugs that have been shown to decrease the risk of cancer - drugs such as tamoxifen and raloxifene have been shown to reduce the risk, but these drugs can have their own risks and side effects.
• In recent years, some women who have been tested and have the gene mutations described above (BRCA1 and BRCA2) have opted to have preventive surgery. One of the most famous examples is Angelina Jolie, who had a double mastectomy after learning that she had the defective BRCA1 gene. Her mother, grandmother and an aunt have all died from breast cancer or a second cancer.

Tests and Treatment

The most important test for breast cancer is that the woman knows what her breasts are like normally (through monthly breast self-exam) and will know when something doesn't seem right. Abnormalities include:

• A new lump or mass where nothing was felt before
• Swelling of all or part of a breast (even if no distinct lump is felt)
• Skin irritation or dimpling
• Breast or nipple pain
• Nipple retraction (turning inward)
• Redness, scaliness, or thickening of the nipple or breast skin
• Nipple discharge (other than breast milk)
• Swollen lymph nodes near the breast (it's possible for the cancer to spread to the lymph nodes, so be aware of them as well.)

Additionally, women should schedule regular doctor's exams and a mammography.

Specialized tests can be ordered if necessary. They include:

Ultrasound (Sonogram) - Shows shapes and can tell if there is a lump or swelling within the breast, even if it can't be felt. It can also tell if a cyst is fluid-filled or a solid mass.

MRI - An MRI uses magnets and radio waves to outline objects and will make a detailed image of the breast. Combined with an injection of gadolinium, the image can show very small details.

Scintimammography - In this newer test, a slightly radioactive drug called a tracer is injected into a vein. The tracer attaches to breast cancer cells and is detected by a special camera. This technique is still being studied to see if it will be useful in finding breast cancers. Some doctors believe it may be helpful in looking at suspicious areas found by regular mammograms, but its exact role is still unclear. At this time, however, scintimammography should not be used as a replacement for screening mammograms.

Treatments

Treatment for breast cancer can vary, depending on the extent/size of the cancer, and whether or not it has spread to nearby organs. Treatments include:

Surgery - the extent of surgery, from a lumpectomy (removing only the tumor and a bit of surrounding tissue) to a mastectomy (removal of the breast) depends on the extent of the cancer (how big it is and how far it has spread).

Radiation Therapy - treatment with high-energy rays (such as x-rays) or particles that destroy cancer cells. There are 2 main types of radiation therapy that can be used to treat breast cancer:

• External beam radiation: This type of radiation comes from a machine outside the body.
• Internal radiation (brachythera): This type of radiation is placed inside the body for a short time.

Chemotherapy - treatment with cancer-killing drugs that may be given intravenously (injected into a vein) or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Chemo can have many side effects, depending on which drug you take, the dose of drugs given, and the length of treatment. Some of the most common possible side effects include:

• Hair loss and nail changes
• Mouth sores
• Loss of appetite or increased appetite
• Nausea and vomiting

• Increased chance of infections (from low white blood cell counts)
• Easy bruising or bleeding (from low blood platelet counts)
• Fatigue (from low red blood cell counts and other reasons)
• Diarrhea

Side effects can also include (for certain chemo drugs) - nerve damage, tingling of hands & feet, which might get much worse, extreme fatigue, fertility issues, heart damage and decreased brain function.

Hormone therapy - In some types of cancers, the woman's estrogen tells the cancer cells to multiply. Hormone therapy can counteract some of this by lowering the estrogen levels or blocking the cancer's reaction to the estrogen. However, the medications used in the hormone therapy can cause other side effects that may be severe.

An alternative to hormone therapy is for the woman to have her ovaries removed so the estrogen isn't produced, but this pushes her body into menopause, if she hadn't begun it yet, and that has its own side effects.

Cancer stages

Stage I
These breast cancers are still relatively small and either have not spread to the lymph nodes or have a tiny area of cancer spread in the sentinel lymph node (the first lymph node to which cancer is likely to spread).

Stage II
These breast cancers are larger than stage I cancers and/or have spread to a few nearby lymph nodes.

Stage III
In stage III breast cancer, the tumor is large (more than 5 cm or about 2 inches across) or growing into nearby tissues (the skin over the breast or the muscle underneath), or the cancer has spread to many nearby lymph nodes.

Stage IV
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. As the cancer progresses, it may also spread to the brain or other organs.

Each progressive stage requires more aggressive treatment, using surgery plus radiation and chemo in various forms. Higher stages require systemic treatment (traveling throughout the body) since it has spread. Your best friend at this point is knowledge, so you need to find out as much as you possibly can about your cancer.

Questions for your doctor (from the ACS Guide)

You may not need to ask all of the following questions, or may have others not listed here, but this list includes many important things you need to know;

When you're told you have breast cancer

• Exactly what type of breast cancer do I have?
• How big is the cancer? Where exactly is it?
• Has the cancer spread to my lymph nodes or other organs?
• What's the stage of the cancer? What does that mean?
• Will I need any other tests before we can decide on treatment?
• Do I need to see any other doctors or health professionals?
• What is the hormone receptor status of my cancer? What does this mean?
• What is the HER2 status of my cancer? What does this mean?
• How do these factors affect my treatment options and long-term outlook (prognosis)?
• What are my chances of survival, based on my cancer as you see it?
• Should I think about genetic testing? What would the pros and cons of testing be?
• How do I get a copy of my pathology report?
• If I'm concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?

As you can tell, there are no absolute answers. Once a cancer is diagnosed, extensive conferences with one's oncologist are necessary to determine the course of treatment most likely to eradicate the cancer. Many factors (age, health, type and stage of cancer among others) will be discussed to help you and your doctor decide on the best course of treatment. Even with the best doctors and correct course of treatment, it is possible to have a recurrence of breast cancer, or even develop a second cancer (colon, stomach, uterine, ovarian, etc). One of the best ways to avoid breast cancer is to stay healthy and pay attention to your health by scheduling regular exams. Extensive research is also being conducted. Maybe soon we can rid the world of this terrible disease.