1. Breast Cancer Awareness and Prevention
By Christopher N. Goralczyk
WHAT IS BREAST CANCER?
RISK FACTORS
CLINICAL PRESENTATION
Controllable Risk Factors
Weight: Being overweight is related to increased risk especially for women after menopause. Fat tissue is the main source of estrogen after menopause when the ovaries stop natural production of the hormone.
Diet: Dieticians suggest avoiding trans fats, processed meats, and charred or smoked foods. Diet should include plenty of vegetables and fruits as well as foods high in omega-3 fatty acids.
Exercise: The American Cancer Society suggests minutes of exercise 5 or more days/week.
Alcohol consumption: The liver’s ability to control blood levels of estrogen is limited by alcohol. Studies have shown that increased alcohol consumption increases risk in women.
Estrogen exposure: Estrogen increases breast cell growth and cancer is defined as uncontrolled cell growth. Exposure to estrogen over long periods of time without any breaks increases risk.
Oral contraceptive use: Using birth control pills does increase risk, but only for a limited time. Women who have stopped taking oral contraceptives more than 10 years prior showed no further increase in risk.
Smoking: Smoking cigarettes/cigars is associated with a small increased risk of breast cancer.
Uncontrollable Risk Factors
Gender: The most significant risk factor for breast cancer is being a female as a women’s breasts are constantly changing due to the activity of estrogen and progesterone Men can also get breast cancer, but it is a much lower probability.
Age: Growing older is the second largest risk factor. From ages the risk is 0.44% or 1 in This increases to 3.5% or 1 in when a woman is in her 60s.
Race: White women are slightly more likely to get breast cancer than African American women Asian, Hispanic, and Native American women are less likely to develop breast cancer.
Family History: Having a first-degree relative with history of breast cancer, especially before the age of 50, increases risk.
Pregnancy/Breastfeeding: Pregnancy and breastfeeding reduce overall number of menstrual cycles, reducing future risk. Never having a full-term pregnancy or having the first one after age increases risk.
Radiation Therapy: Having radiation therapy to the chest area as a young child or teenager as treatment for another cancer can increase risk of breast cancer as an adult.
DES Exposure: Women who took a medication called diethylstilbestrol (DES) used to prevent miscarriage from the 1940s-60s have slightly increased risk as well as women whose mothers used DES during pregnancy.
When the tumor is small, breast cancer produces no symptoms and is easily treated This is why screening is so important to find breast cancer at an early stage.
When the cancer has grown to a larger size, the most common physical sign is a painless lump.
Other less common signs/symptoms include:
Breast pain and heaviness
Persistent changes to the breast
Swelling
Thickening
Redness of the breast’s skin
Skin irritation or dimpling
Nipple abnormalities
Spontaneous discharge (especially if bloody)
Erosion
Retraction
Sometimes breast cancer can spread to underarm lymph nodes in early stages causing lump or swelling in the underarm(s).
Important to remember that pain or lack of pain does not indicate the presence or absence of cancer and any abnormalities should be evaluated by a physician.
Cancer is a disease that causes the cells of the body to change and grow uncontrollable causing an eventual lump, or tumor, to grow in most situations. The name of the cancer originates in whichever part of the body the tumor is located.
The two main types of breast cancer are defined as In Situ (contained, not spreading) and Invasive.
The most common In Situ breast cancers are Ductal carcinoma (DCIS) and Lobular carcinoma (LCIS). Both DCIS and LCIS may lead to invasive breast cancer if it is left untreated.
Breast cancer is mostly invasive meaning that the cancer has spread passed the barriers of the glands and ducts into surrounding tissue.
The prognosis of invasive breast cancer depends on what stage the disease is in. There are stages 0-IV with stage IV being the most advanced.
Local stage (Stage I, II) refers to cases confined only to the breast
Regional stage (Stage II, III) refers to cases that have spread to surrounding tissue or nearby lymph nodes
Distant stage (Stage IIIc, IV) refers to cases metastasized to distant organs or lymph nodes above the collarbone
EPIDEMIOLOGY
JOIN THE CAUSE
~1 in 8 U.S. women (~12%) will develop invasive breast cancer over the course of their lifetime.
Female breast cancer represents 14.6% of all new cancer cases in the U.S.
Estimated in 2017:
252,710 new cases of invasive breast cancer in U.S. women
63, 410 new cases of non-invasive breast cancer
2,470 new cases of invasive breast cancer in men
~40,610 U.S. women will die from breast cancer
89.7% of those who develop breast cancer survive for at least 5 years (From )
As of March 2017, there are >3.1 million women with a history of breast cancer in the U.S. (includes women currently being treated and those finished)
SCREENING GUIDELINES
Most breast cancer is detected either during a screening exam, before symptoms develop, or after a lump is noticed. Most masses turn out to be benign (not cancerous).
Monthly breast self-exams are no longer recommended, but self-awareness is very important. Women should be familiar with the appearance and feel of their breasts.
Mammography is a low-dose x-ray procedure that allows visualization of the internal structure of the breast. It is the single most effective method of early detection as it can often identify cancer several years before physical symptoms develop.
Magnetic resonance imaging (MRI) is recommended annually in addition to mammography for women at increased risk starting at the age of 30.
Breast ultrasound is sometimes used and can be more accurate than
mammograms
for women
with dense
breast tissue,
but it can also
increase the
likelihood of
false-positives.
The American Cancer Society Guideline for Breast Cancer Screening released new recommendations in 2015 as follows:
Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years.
Women who are age 45 to 54 should be screened annually
Women who are age 55 and older should transition to biennial screening or have the opportunity for annual screening.
Women should have the opportunity to begin annual screening between the ages
Women should continue screening mammography as long as overall health permits and they have a life expectancy of 10 years or more.
The Society does not recommend clinical breast examination for breast cancer screening among average-risk women of any age.
There are many respected foundations that the public can donate to in order to fund future research and spread awareness.
The National Breast Cancer Foundation was founded in 1991 and it offers many services including;
Breast cancer health training sessions
Free mammograms as well as other diagnostic/screenings (For every $150 donated a woman in need will receive a free mammogram)
Helping patients get past the shock of diagnosis through an online video series and open web forum.
Helping patients overcome the barriers of cost, fear, and misinformation surrounding the disease while navigating through the healthcare system.
People can also participate in a breast cancer awareness walk. There are walks around the entire country usually occurring in the month of October.
APPE Rotation: Big Y Pharmacy Southwick, MA October 2017