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Breast Cancer

at a glance

Breast Cancer Journey

Facing cancer is an overwhelming and challenging journey. Whether you or a loved one are on a jounry to cure cancer or to prevent cancer, the surgical options, adjuvant therapies, diagnostic testing, and outcomes can be overwhelming. We understand that breast cancer is life-changing; it is a journey you or a loved one did not choose, can plan for or anticipate. We have created this simple guide to help you understand breast cancer a little more and help better prepare for the journey ahead.

What is Breast Cancer?

Breast cancer is a development of abnormal cancerous cells that grow uncontrolled within the breast tissue and develop into a tumor. Although some tumors can be non-cancerous (benign), other tumors, known as malignant tumors, are cancerous.

Breast cancer most commonly begins in the cells that line the milk ducts and lobules within the breast. In some cases, the cells continue to grow and invade healthy tissues in nearby lymph nodes and other parts of the body (1).

What are the types of breast cancer?

There are several types of breast cancer. Breast cancer is usually divided into two types:

1) Noninvasive cancer:
The tumor is found in the ducts of the breast (also known as ductal carcinoma in situ) but has not spread into the breast tissue surrounding the ducts.

2) Invasive breast cancer:
Cancer has spread through the lining of the ducts (ductal invasive cancer) or lobules (lobular invasive cancer) and into the surrounding tissue. The most common type of invasive breast cancer is ductal invasive, while invasive lobular cancer is less common.

Other types of breast cancers are Paget’s disease of the breast, which is usually linked with DCIS and causes a scaly rash on the nipple, and inflammatory breast cancer (in which the breast becomes inflamed and swollen). However, Paget’s disease and inflammatory breast cancer are rare.

Breast cancer symptoms

Breast cancer can have several symptoms. However, the most common noticeable symptom of breast cancer is a lump or thickened breast tissue in the area of the breast or armpit. Although breasts can be naturally lumpy due to hormonal changes, and not all lumps are cancerous, it is important to always carry out frequent self-breast examinations and or have any lumps checked by a doctor.

Other known symptoms include:

A change in shape or size of one of both breasts

Dimpling on the skin of your breasts

A rash around the nipple

A change in the appearance of the nipple

Swelling in one or both armpit and discharge from the nipple

Breast Cancer causes

It is estimated that around one in eight women will develop invasive breast cancer in their lifetime (2).

There are some factors that have been known to increase the risk of breast cancer.

  • A family history of breast cancer – Cancer does not run in families. However, genes known as BRCA1 and BARCA2 can increase both breast cancer and ovarian cancer risk. It is estimated that around one in eight women will develop invasive breast cancer in their lifetime (2).
  • Previously diagnoses breast cancer.
  • Age: Most common (8/10 cases) in women over 50 who have been through the menopause.
  • Previous benign lump (non-cancerous lump) – a benign lump is not breast cancer; however, some benign lumps can change the breast tissue causing abnormal cells to grow in the ducts and lobes.
  • Alcohol- increases your risk of developing breast cancer by 10% for every alcoholic unit you consume a day.
  • Smoking – increases the risk of not just breast cancer but other cancers such as lung and oral cancer.
  • Obesity - excess fatty tissues produces more estrogen which promotes the growth of cancer cells.
  • Estrogen exposure can stimulate breast cancer cells, causing them to grow.

Breast Cancer diagnosis

Following the finding of a suspicious lesion or breast lump, your doctor will refer you to a specialist breast cancer clinic to undertake further testing and breast screening. Depending on your age and symptoms, you may undergo one of the following breast imaging and testing procedures to examine the lump:

 

Mammogram: uses a low dose x-ray to take an off the breast.

Ultrasound: uses sound waves to build an image of the breast and lymph nodes in the armpit. If you are under 35 years of age, you may require an ultrasound scan in place of a mammogram. This is because the breast tissue in women under 35 years of age is much denser and reduced the image quality with a mammogram.

Tissue biopsy: a small tissue or cell sample is taken of the lump or abnormal area via a needle.

Scans and x-rays: A computerized tomography (CT) scan, chest x-ray, magnetic resonance imaging (MRI) scan, or a liver ultrasound scan can help evaluate the spread of cancer. If there is suspicion cancer has spread to your bones, you may need a bone scan.

Hormone receptor test: Evaluates a sample of cancer cells 2. Keep in touch and listen taken at the time of the biopsy to evaluate the response of the cells calls to to either or patients progesterone hormones. If the Keep in contact by sending them messages or making regular phone catch estrogen up. Cancer often have many visitors when they are first diagnosed, but as the treatment continues can feel like cancer people cell has during forgotten hormone they attaches to the the hormone re- about them. Make sure you check on them throughout their treatment and offer your support listening them ceptor test, this means the by cancer cells to are hormone recep- regularly. tor-positive and may be treated by lowering the levels of the hormones in the body.

Epidermal Growth factor Receptor 2 (HER2) test: Evaluates if the cancer is stimulated by a protein called epidermal growth factor receptor 2 (HER2). If the cancer is stimulated by this protein, the cancer can be treated by blocking the effects of the HER2; this is called targeted therapy.

Grading and staging the Cancer

Once the tests are complete, your doctor will evaluate how far
the cancer has spread and how likely the cancer is to spread.

This is known as grading and staging (3). Your doctor will use medically recognized systems to stage and grade the cancer and establish the best treatment option for your cancer.

Cancer Treatment

There are several treatment options available to treat breast cancer, which can be either used alone or in combination (4) (5)

Chemotherapy: uses drugs known as cytotoxic (anti-cancer) drugs, which are given to kill the cancer cells and administered once every 2-4 weeks following your surgery. In some cases, up to 8 cycles of chemotherapy may be given to treat the cancer. Chemotherapy can be either administered in the hospital via an infusion into the back of your hand or orally at home. In some cases, chemotherapy may be given before surgery (neoadjuvant chemotherapy) to shrink the sizes of a large tumor.

Radiation therapy: uses low doses of radiotherapy to kill the cancer cells. Radiation therapy is usually given over a period of around 3-5 weeks every 3-5 days and is generally given after surgery.

Hormone therapy: uses drugs, surgery, or radiotherapy to reduce the production of hormones (estrogen and progesterone) in hormone receptor-positive cancers.

Targeted therapy: Uses drugs to change the cell's production and growth of HER2 positive cancers.

Lumpectomy (wide local excision): also known as breast-conserving surgery, is a cancer-treating procedure that removes the cancerous tumor and a margin of healthy cells around the tumor but preserves the remaining breast tissue. This can be achieved at the same time as reducing the size of both breasts in a procedure known as therapeutic mammoplasty.

Mastectomy: is a surgical procedure to completely remove one or both of your breasts, following a positive diagnosis of breast cancer, or as a prophylactic measure if you are a high risk of cancer. Your surgeon will remove the breast tissue (including cancerous cells) but preserve as much of the skin envelope and natural contour of the breast as possible. In some cases, the nipple may need to be removed as part of the procedure, known as a skin-sparing mastectomy. In other instances, your surgeon may be able to preserve the nipple, a procedure known as a nipple-sparing mastectomy; these surgical options depend on your individual circumstances.

Breast Reconstruction following Cancer Treatment

Following your surgical treatment, you can opt to have your breasts reconstructed. This can be at the time of your surgical treatment known as immediate reconstruction, or you can delay your breast reconstruction until all cancer treatment is complete, known as delayed reconstruction. For more information on breast reconstruction visit the breast reconstruction at a glance blog.

Reference List

  1. National Breast Cancer Fondation. Breast Cancer FAQ. National Breast Cancer Foundation. [Online] https://www.nationalbreastcancer.org/breast-cancer-faqs/- can-a-healthy-diet-help-to-prevent-breast-cancer/.
  2. American Cancer Society. Breast Cancer Facts & Figures 2020. American Cancer Society. [Online] https://www.cancer.org/cancer/breast-cancer.html.
  3. American Cancer Society. Breast Cancer Dectection and Diagnosis. [Online] 2020. https://www.cancer.org/content/dam/CRC/PDF/Public/8579.00.pdf
  4. Cancer Research UK. Treatment options for breast cancer | Cancer Research UK. Cancer researchuk.org. [Online] 2017. Available at: https://www.cancerresearchuk.org/about-can- cer/breast-cancer/treatment/treatment-decisions.
  5. American Cancer Society. Treating Breast Cancer. American Cancer Society. [Online] 2020. https://www.cancer.org/content/dam/CRC/PDF/Public/8581.00.pdf.
  6. American Cancer Society. Breast Reconstruction. American Cancer Society. [Online] https://www.cancer.org/content/dam/CRC/PDF/Public/8582.00.pdf.
  7. American Cancer Society. Breast Cancer Risk and Prevention. American Cancer Society. [Online] 2020. https://www.cancer.org/content/dam/CRC/PDF/Public/8578.00.pdf
  8. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. The Lancet 360(9328). 9328, 2002, The Lancet, Vol. vol 360 , pp. 187–195.
  9. Pregnancy and the risk of breast cancer. Britt K, Ashworth A, Smalley M. 4, 2007, Endocrine Related Cancer, Vol. 14, pp. 907-933.
  10. Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies. Cancer, Collaborative Group on Hormonal Factors in Breast. 11, 2020, The Lancet Oncology, Vol. 13, p. 1141.
  11. Farhadieh, R.D., Bulstrode, N. and Cugno, S. Plastic and reconstructive surgery : approach and techniques. [ed.] Nj: Hoboken. Chichester, West Sussex ; : John Wiley & Sons Inc., (2015).
  12. Henk Giele and Cassell, O. Plastic and reconstructive surgery. s.l. : Oxford: Oxford University Press., 2016.
  13. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2017, National Cancer Institute. Bethesda, MD,. National Cancer Institute. [Online] 2019. https://seer.cancer.gov/csr/1975_2017/.
  14. Janis, J.E. Essentials of plastic surgery. s.l. : Johanneshov: Mtm, 2018.
  15. Nice.org.uk. Nice.org.uk. Overview | Advanced breast cancer: diagnosis and treatment | Guidance. [Online] 2009. https://www.nice.org.uk/guidance/CG81.
  16. McDonald JA, Goyal A, Terry MB.Alcohol Intake and Breast Cancer Risk: Weighing the Overall Evidence. Current breast cancer reports. 3, 2013, Vol. 5.
  17. Body Mass Index and Breast Cancer Risk According to Postmenopausal Estrogen-Progestin Use and Hormone Receptor Status. Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. 1, 2014, Epidemiologic Reviews., Vol. 36, pp. 114-136.
  18. National Cancer Society. Dense Breasts: Answers to Commonly Asked Questions. 7. National Cancer Society. [Online] https://www.cancer.gov/news-events/cancer-cur- rents-blog/2015/dense-breasts-screening.
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