Breast Cancer

Breast Cancer

 

Breast cancer is the most common cancer among American women .

One in eight women in the United States develops breast cancer .

There are many types of breast cancer that differ in their ability to spread( metastasized )  in other body tissues.

The causes of breast cancer are not yet fully known , although a number of risk factors have been identified.

There are many different types of breast cancer .

Breast cancer is diagnosed with physician and self-examination of the breasts , mammography , ultrasound testing , and biopsy .

Treatment of breast cancer depends on the type of cancer and the stage ( extent of spread of the body) .

According to the American Cancer Society :

Over 200,000 new cases of invasive breast cancer are diagnosed each year .

Nearly 40,000 women are expected to die from breast cancer in 2012 .

There are over 2.5 million survivors of breast cancer in the United States .

The recommendations on the frequency and age when women should get mammography differ slightly between various organizations and working groups.

Between 40 and 50 years , mammograms are recommended every 1 to 2 years (National Cancer Institute). After age 50 , annual mammograms are recommended ( American College of Obstetrics and Gynecology ) .

You should discuss with your doctor the follow up frequency he or she advises and guidelines that follow .

Patients with a family history or specific risk factors may have a different screening schedule , including starting mammograms at an earlier age .

What is breast cancer ?

Breast cancer is a malignant tumor ( a collection of cancer cells) derived from cells of the breast. Although breast cancer occurs mainly in women can also affect men .

The following are risk factors for breast cancer :

Age : The chances of breast cancer increases as you get older .

Family history : The risk of breast cancer is higher among women who have relatives with the disease . Having a close relative with the disease ( sister , mother or daughter ) doubles a woman's risk .

Personal history : Once diagnosed with breast cancer in a breast increases the risk of cancer in the other breast or the possibility of an additional primary cancer in the breast.

Women diagnosed with certain benign breast disease have an increased risk of breast cancer . These include atypical hyperplasia , a condition in which there is abnormal proliferation of cells of the breast, but not developed cancer.

Menstruation : Women who began their menstrual cycle at a younger age ( before 12 ) or went through menopause (after 55 ) have a slightly increased risk.

Breast tissue : women with dense breast tissue ( as documented by mammography ) have a higher risk of breast cancer .

Race : White women have a higher risk of developing breast cancer , but African- American women tend to have more aggressive tumors when they do develop breast cancer .

Exposure to radiation prior breast or diethylstilbestrol use increases the risk of breast cancer .

Having no children or first child after the age of 30 increases the risk of breast cancer .

Breastfeeding for 1 ½ to 2 years may slightly reduce the risk of breast cancer.

Being overweight or obese increases the risk of breast cancer .

Use of oral contraceptives in the last 10 years increases the risk of breast cancer .

Using combined hormone therapy after menopause increases the risk of breast cancer.

Alcohol use increases the risk of breast cancer , and this appears to be proportional to the amount of alcohol.

The exercise appear to reduce the risk of breast cancer .

Genetic risk factors

Approximately 5 % to 10 % of breast cancer cases are thought to be hereditary , resulting directly from gene defects (called mutations ) inherited from a parent .

BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA 1 and BRCA2. If you inherit a mutated copy of either gene from a parent , you have a high risk developing breast cancer in your lifetime .

The risk may be as high as 80 % for members of some families with mutations in BRCA.

These cancers tend to occur in younger women and most often affect both breasts from cancer in women who were not born with one of these mutations . Women with this

Inheritance of mutant genes also have an increased risk for developing other cancers , particularly ovarian cancer .

In the United States , BRCA mutations are more common in females Jewish origin Ashkenazi ( Eastern Europe) origin than in other racial and ethnic, but can occur in any form of racial or ethnic group.

Genetic testing : Genetic testing can be done for mutations in the BRCA1 and BRCA2 genes (or less commonly in other genes , such as PTEN or TP53 ) . Although these tests may be helpful in some cases , the advantages and disadvantages should be carefully considered.

Recommendations from the  American Cancer Society 2013

1.The women aged 40 and older should undergo a mammogram every year and should continue to do so for as long as is without health problems .

 

 

 

2.The women of the 20s and 30s should be subjected to a clinical breast exam as part of a periodic (regular ) health exam by a physician, preferably every three years .

 

The same but each time applies to women aged > 40 years .

 

3.The clinical breast self-examination with the possibility of examination by a physician in the presence of problems has an important role.

 

4. Women at high risk ( > 20 % ) should undergo a magnetic resonance imaging MRI and mammogram every year . Women at moderately increased risk ( 15 % to 20 % lifetime risk ) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram . Yearly MRI screening is not recommended for women whose risk of breast cancer is less than 15%.

 

What is the treatment for breast cancer ?

 

Surgery

Most women with breast cancer will require surgery. Generally , surgical treatments for breast cancer can be divided into breast conserving surgery and mastectomy .

Sparing mastectomy breast

This surgery will remove only a portion of the breast (sometimes referred to as partial mastectomy ) . The extent of surgery is determined by the size and location of the tumor .

In a lumpectomy , only the breast swelling and some surrounding tissue removed. The surrounding tissue ( margins ) inspected for tumor cells . If not found the tumor cells , it is called " negative " or " clear margins . " Often, radiation is given after lumpectomy .

Mastectomy

During a mastectomy (sometimes also referred to as a simple mastectomy ), all of the breast tissue has been removed. If direct restoration considered , all the breast tissue is removed and, but the overlying skin is maintained.

Radical mastectomy

During this surgery , the surgeon removes the axillary lymph nodes and chest muscle than the chest . This process is much less often than in the past , as in most cases , a modified radical mastectomy is as effective .

Modified radical mastectomy

This surgery removes the axillary lymph nodes in addition to the breast tissue .

Depending on the stage of the cancer , your health care team can give you a choice between a lumpectomy and mastectomy . Lumpectomy allows salvage breast tissue, but usually requires radiation therapy later . There is  no advantage from a mastectomy over lumpectomy , if lumpectomy is indicated .

Radiotherapy

Radiation therapy destroys cancer cells with high-energy rays . There are two ways to provide radiation therapy :

External radiation

This is the usual way given radiotherapy for breast cancer . A radiation beam focused onto the affected area from outside the machine. The extent of treatment is determined by the group of health care based on surgical procedure performed if lymph nodes were affected or not.

The area usually characterized , since the radiation group has determined the exact position for the treatments . Usually the therapy is given 5 days per week for 5-6 weeks.

Brachytherapy

This form of radiation delivery using radioactive granules or pellets . Instead of a beam from the outside of the radiation delivery , these seeds are implanted into the breast near the cancer.

Chemotherapy

Chemotherapy is the treatment of cancers with drugs that travel through the bloodstream to cancer cells . These drugs are given either intravenously or orally .

Chemotherapy can have different indications and can be performed in different settings as follows :

Adjuvant chemotherapy : If surgery has removed all visible cancer , there is still the possibility that cancer cells have ceased or have been left behind . If the chemotherapy is given to ensure that these small amounts of cells are also killed , said supplement tion chemotherapy.

Neoadjuvant chemotherapy : If chemotherapy is given before surgery is referred to as neoadjuvant chemotherapy . Although there seems to be no advantage for long-term survival whether treatment is given before or after surgery , there are advantages to see if the cancer responds to treatment, and the shrinking of cancer before surgical removal .

Chemotherapy for advanced cancer : If the cancer has metastasized to distant sites in the body , chemotherapy can be used for treatment. In this case , the healthcare team should determine the most appropriate course of treatment .

There are many different chemotherapeutic agents are administered either alone or in combination. Usually these drugs are given in cycles with some periods of treatment followed by a rest period. The cycle length and rest intervals differ from drug to drug.

Hormone Therapy

This treatment is often used to help reduce the risk of cancer recurrence after surgery , but can also be used as adjunctive therapy.

Estrogen ( a hormone produced by the ovaries ) promotes the growth of some breast cancers , especially those that contain estrogen receptors (ER positive) or progesterone (PR positive) .

The following drugs used in hormone therapy :

Tamoxifen (Nolvadex): This drug prevents estrogen from binding to estrogen receptors in breast cells .

Fulvestrant (Faslodex): This drug eliminates the estrogen receptor and may be used even if tamoxifen is no longer useful.

Aromatase inhibitors : They stop estrogen production in postmenopausal women. Examples include letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).

Targeted therapy

As we learn more about genetic changes and their involvement in causing cancer drugs developed specifically targeting tumor cells . They tend to have fewer side effects, then chemotherapy ( such as targeting only the cancer cells ), but usually still used in supplement to chemotherapy.

Targeting HER2/neu protein

Monoclonal antibody: Trastuzumab artificial protein associated with the protein HER2/neu in breast cancer cells . It helps to slow the growth of cancer cell and can also stimulate the immune system to attack the cancer cells more effectively.

Given intravenously either once weekly or every 3 weeks.

Drugs targeting neoplasms tumor blood vessels

The tumors requires new blood vessels grow. The process of blood vessel growth is medically known as angiogenesis . New drugs are developed to target this growth and fight certain cancers , including breast cancer .

The Bevacizumab is a monoclonal antibody directed against the cells of the blood vessels . Newer results of the study seem to suggest that this drug slows the growth of cancer in some patients but did not improve survival. The use of this drug should be discussed with your health care team .Παρουσίαση1