Breast Cancer: Preventive of Breast Cancer

Size of breast cancer

How is breast cancer prevented ?

Reviewing the risk factors and modifying the ones that can be altered (increase exercise, keep a good body weight, etc.) can help in decreasing the risk.

Following the American Cancer Society's guidelines for early detection can help early detection and treatment. There are some subgroups of women that should consider additional preventive measures: Women with a strong family history of breast cancer should be evaluated by genetic testing. This should be discussed with your health-care provider and be preceded by a meeting with a genetic counselor who can explain what the testing can and cannot tell and then help interpret the results after testing.

Chemoprevention is the use of medications to reduce the risk of cancer. The two currently approved drugs for chemoprevention of breast cancer are tamoxifen (a medication that blocks estrogen effects on the breast tissue) and raloxifene (Evista), which also blocks the effect of estrogen on breast tissues. Their side effects and whether these medications are right for you need to be discussed with your health-care provider.

Aromatase inhibitors are medications that block the production of small amounts of estrogen usually produced in postmenopausal women. They are being used to prevent reoccurrence of breast cancer but are not approved at this time for breast cancer chemoprevention.

Preventive surgery: For a small group of patients who have a very high risk of breast cancer, surgery to remove the breasts may be an option. Although this reduces the risk significantly, a small chance of developing cancer remains.

Some of the reasons for this approach may include

•  Mutated BRCA genes found by genetic testing,
• A strong family history, 
• A personal history of cancer in one breast.

Beware of Breast cancer: symptoms and sign

What are The symptoms and signs of breast cancer ?

The most common sign of breast cancer is a new lump or mass in the breast. 

In addition, the following are possible signs of breast cancer:

• Nipple discharge or redness  
• Breast or nipple pain
• Swelling of part of the breast or dimpling .

It’s better to discuss with your health-care provider to get some more informations. 

The Diagnoses of breast cancer 

Although breast cancer can be diagnosed by the above signs and symptoms, the use of screening mammography has made it possible to detect many of the cancers early before they cause any symptoms.

The American Cancer Society has the following recommendations for breast cancer screenings: 

• Women age 40 and older should have a screening mammogram every year and should continue to do so as long as they are in good health. Mammograms are a very good screening tool for breast cancer. As in any test, mammograms have limitations and will miss some cancers. The results of your mammogram, breast exam, and family history should be discussed with your health-care provider.
• Women in their 20s and 30s should have a clinical breast exam (CBE) as part of regular health exams by a health-care professional about every three years for women in their 20s and 30s and every year for women 40 years of age and over. 

CBE are an important tool to detect changes in your breast and also trigger a discussion with your health-care provider about early cancer detection and risk factors. 

Breast self-exam (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health-care professional. If a woman wishes to do BSE, the technique should be reviewed with her health-care provider. The goal is to feel comfortable with the way the woman's breast feels and looks and therefore detect changes.

Women at high risk (greater then 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderate risk (15%-20%) should talk to their doctor about the benefits and limitations of adding MRI screening to their yearly mammogram.

Breast Cancer: The causes of Breast Cancer

The causes of breast cancer There are many factors can increase the chance of developing breast cancer. Although we know some of these factors, cannot detect how these factors cause the development of a cancer cell. The risk factor of breast cancer Some of the breast cancer risk factors can be modified (such as alcohol use) while others cannot be influenced (such as age). It is important to discuss these risks with your health-care provider anytime new therapies are started (for example, postmenopausal hormone therapy). The following are risk factors for breast cancer: 

• Age: The chances of breast cancer increase 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, daughter) doubles a woman's risk. 
• Personal history: Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast. 
• Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.
• Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.
• Breast tissue: Women with dense breast tissue (as documented by mammogram) 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 previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer. 
• Having no children or the first child after age 30 increases the risk of breast cancer.
• Breastfeeding for one and a half to two years might slightly lower 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 seems to be proportional to the amount of alcohol used. * Exercise seems to lower the risk of breast cancer.

Breast cancer and Type : What is breast cancer ?

Breast cancer predominantly occurs in women, it can also affect men.

Breast cancer is a malignant tumor (a collection of cancer cells) arising from the cells of the breast.

What are the different types of breast cancer?

There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers. Some of the most common types of cancer are as follows:

• Ductal carcinoma in situ: The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS). This type of cancer has not spread and therefore usually has a very high cure rate.   

Breast profile:

1. A ducts 
2. B lobules 
3. C dilated section of duct to hold milk
4. D nipple
5. E fat 
6. F pectoralis major muscle 
7. G chest wall/rib cage
8. Enlargement: 

1. A normal duct cells 
2. B ductal cancer cells 
3. C basement membrane
4. D lumen (center of duct)

• Invasive ductal carcinoma: This cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.

Breast profile:

1. A ducts 
2. B lobules
3. C dilated section of duct to hold milk 
4. D nipple 
5. E fat 
6. F pectoralis major muscle 
7. G chest wall/rib cage 

Enlargement:

1. A normal duct cells 
2. B ductal cancer cells breaking through the basement membrane 
3. C basement membrane

• Invasive lobular carcinoma: This breast cancer starts in the glands of the breast that produce milk. Approximately 10% of invasive breast cancers are invasive lobular carcinoma. 

Breast profile:

1. A ducts
2. B lobules 
3. C dilated section of duct to hold milk
4. D nipple 
5. E fat 
6. F pectoralis major muscle 
7. G chest wall/rib cage 

Enlargement:

1. A normal lobular cells 
2. B lobular cancer cells
3. C basement membrane 

The remainder of breast cancers are much less common and include the following:

• Mucinous carcinoma are formed from mucus-producing cancer cells. Mixed tumors contain a variety of cell types. Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue. 
• Inflammatory breast cancer: This cancer makes the skin of the breast appear red and feel warm (giving it the appearance of an infection). These changes are due to the blockage of lymph vessels by cancer cells.
• Triple-negative breast cancers: This is a subtype of invasive cancer with cells that lack estrogen and progesterone receptors and have no excess of a specific protein (HER2) on their surface. It tends to appear more often in younger women and African-American women. 
• Paget's disease of the nipple: This cancer starts in the ducts of the breast and spreads to the nipple and the area surrounding the nipple. It usually presents with crusting and redness around the nipple. 
• Adenoid cystic carcinoma: These cancers have both glandular and cystic features. They tend not to spread aggressively and have a good prognosis. The following are other uncommon types of breast cancer: Papillary carcinoma Phyllodes tumor Angiosarcoma Tubular carcinoma

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Breast Cancer: The treatment of breast cancer

Patients with breast cancer have many treatment options. Most treatments are adjusted specifically to the type of cancer and the staging group. Treatment options should be discussed with your health-care team. Below you will find the basic treatment modalities used in the treatment of breast cancer. 

• Surgery . Most women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer can be divided into breast conserving surgery and mastectomy. 
• Breast-conserving surgery. This surgery will only remove part of the breast (sometimes referred to as partial mastectomy). The extent of the surgery is determined by the size and location of the tumor. In a lumpectomy, only the breast lump and some surrounding tissue is removed. The surrounding tissue (margins) are inspected for cancer cells. If no cancer cells are found, this is called "negative" or "clear margins." Frequently, radiation therapy is given after lumpectomies.
• Mastectomy. During a mastectomy (sometimes also referred to as a simple mastectomy), all the breast tissue is removed. If immediate reconstruction is considered, a skin-sparing mastectomy is sometimes performed. In this surgery, all the breast tissue is removed as well but the overlying skin is preserved. 
• Radical mastectomy. During this surgery, the surgeon removes the axillary lymph nodes as well as the chest wall muscle in addition to the breast. This procedure is done much less frequently 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 might give you a choice between a lumpectomy and a mastectomy. Lumpectomy allows sparing of the breast but usually requires radiation therapy afterward. If lumpectomy is indicated, long-term follow-up shows no advantage of a mastectomy over the lumpectomy. 
• Radiation therapy Radiation therapy destroys cancer cells with high energy rays. There are two ways to administer radiation therapy: 

1. External beam radiation This is the usual way radiation therapy is given for breast cancer. A Team of radiation is focused onto the affected area by an external machine. The extent of the treatment is determined by your health-care team and is based on the surgical procedure performed and whether lymph nodes were affected or not. The local area will usually be marked after the radiation team has determined the exact location for the treatments. Usually the treatment is given five days a week for five to six weeks.
2. Brachytherapy This form of delivering radiation uses radioactive seeds or pellets. Instead of a beam from the outside delivering the radiation, these seeds are implanted into the breast next to the cancer. 

• Chemotherapy. Chemotherapy is treatment of cancers with medications that travel through the bloodstream to the cancer cells. These medications are given either by intravenous injection or by mouth. Chemotherapy can have different indications and may be performed in different settings as follows: Adjuvant chemotherapy: If surgery has removed all the visible cancer, there is still the possibility that cancer cells have broken off or are left behind. If chemotherapy is given to assure that these small amounts of cells are killed as well, it is called adjunct chemotherapy. Neoadjuvant chemotherapy: If chemotherapy is given before surgery it is referred to as neoadjuvant chemotherapy. Although there seems to be no advantage to long-term survival whether the therapy is given before or after surgery, there are advantages to see if the cancer responds to the therapy and by shrinking the 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 health-care team will need to determine the most appropriate length of treatment. There are many different chemotherapeutic agents that are either given alone or in combination. Usually these drugs are given in cycles with certain treatment intervals followed by a rest period. The cycle length and rest intervals differ from drug to drug.
• Hormone therapy. This therapy is often used to help reduce the risk of cancer reoccurrence after surgery, but it can also be used as adjunct treatment. Estrogen (a hormone produced by the ovaries) promotes the growth of a few breast cancers, specifically those containing receptors for estrogen (ER positive) or progesterone (PR positive). 

The following drugs are used in hormone therapy:

• Tamoxifen (Nolvadex): This drug prevents estrogen from binding to estrogen receptors on breast cells.
• Fulvestrant (Faslodex): This drug eliminates the estrogen receptor and can be used even if tamoxifen is no longer useful. 
• Aromatase inhibitors: They stop estrogen production in postmenopausal women. Examples are letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).

Targeted therapy

As we are learning more about gene changes and their involvement in causing cancer, drugs are being developed that specifically target the cancer cells. They tend to have fewer side effects then chemotherapy (as they target only the cancer cells) but usually are still used in adjunct with chemotherapy. 

Targeting HER2/Neu protein

Monoclonal antibody: Trastuzumab is a engineered protein that attaches to the HER2/Neu protein on breast cancer cells. It helps slow the growth of the cancer cell and may also stimulate the immune system to attack the cancer cell more effectively. It is given IV either once a week or every three weeks.

Drugs that target new tumor blood vessels.

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

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

Alternative treatments

Whenever a disease has the potential for much harm and death we search for alternative treatments. As a patient or the loved one of a patient you want to try everything and leave no option unexplored. The danger in this approach is usually found in the fact that the patient might not avail themselves of existing, proven therapies. You should discuss your interest in alternative treatments with your health-care team and together explore the different options.

Breast Cancer: Family history can cause breast cancer

How can  Family history cause breast cancer ?
If you have a strong (positive) family history for breast cancer, ovarian cancer, or even prostate cancer, this information is relevant to your diagnosis. A strong family history in this case usually means that a mother, sibling, child, or father has had a related malignancy. Information about other family members (aunts, nieces, etc.) is also important. This is especially significant if the diagnosis of breast cancer was made at an early age or involved both breasts or a breast and an ovary in the same individual. A positive family history may necessitate a more comprehensive diagnostic workup, more involved treatment, and consideration of genetic testing, not only for you but for other family members.

What other studies should be done on my tissue biopsy?

Microscopic evaluation of the slides made from involved tissue provides critical information about the tumor. A reasonably accurate prediction of tumor behavior can be made based on the appearance of the cancer cells, their size and similarity to one another, and the presence or absence of these cells in the lymphatic and blood vessels immediately adjacent to the tumor. This type of evaluation is a standard part of the diagnostic process.

However, there are additional relevant data which the laboratory should obtain, and this analysis is directed by the pathologist at the time of diagnosis. This information includes, at a minimum, an assessment of the estrogen and progesterone receptors on the malignant cells and the status of at least one oncogene, called her-2-neu. An oncogene is a gene that plays a normal role in cell growth but, when altered, may contribute to abnormal cell division and tumor growth.

Currently, these tests (estrogen and progesterone receptors and her-2-neu) have an accurate enough predictive value that their status should be determined in all cases of breast cancer. Test results are available within a few days to a week after removal of the tumor tissue. The results of these tests should then be taken into account in the final decision-making about treatment. These tests are constantly evolving and changing, and your treatment team will be able to discuss the current standard and advanced testing available.