Dr Dulcy on breast cancer
CAUSES UNCLEAR: EARLY DETECTION LEADS TO EFFECTIVE TREATMENT, GOOD PROGNOSIS
About 90% of patients survive for many years if disease is found promptly.
The incidence of breast cancer among South African women is increasing and it is one of the most common cancers in women of South Africa.
It is the most prevalent cancer among white and Asian women and the second most common cancer among black and coloured women. Breast cancer is cancer that forms in the cells of the breasts. There are 2 main types of breast cancer:
Ductal carcinoma starts in the tubes (ducts) that carry milk from the breast to the nipple. Most breast cancers are of this type. Lobular carcinoma starts in the parts of the breast, called lobules, which produce milk.
Early detection of the condition can lead to effective treatment and a positive prognosis.
About 90% of patients survive for many years after diagnosis when breast cancer is detected at the early stages. Regular selfbreast examination and regular mammograms are important for early detection. Presenting yourself early for treatment may result in more effective treatment, leading to a reduction in pain and suffering and a significant decrease in the loss of life.
Because of the many breast cancer awareness campaigns and research funding, we have seen big improvement in the screening and diagnosis and advances in the treatment of breast cancer.
Breast cancer survival rates have increased and the number of deaths have steadily been declining, which is largely due to a number of factors such as earlier detection, a new personalised approach to treatment and a better understanding of the disease.
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor for prompt evaluation.
CAUSES
It’s not clear what causes breast cancer. According to scientists, breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. The cells may spread (metastasize) through your breast to your lymph nodes, or to other parts of your body. Researchers have identified hormonal, lifestyle and env i r o n m e n - tal factors that may increase your risk of breast cancer.
But it’s not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It’s likely that breast cancer is caused by a complex interaction of your genetic make-up and your environment.
It is commonly inherited. It is estimated that about five to 10% of breast cancers are linked to gene mutations passed through generations of a family.
If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific gene mutations.
RISK FACTORS
The following factors have been associated with an increased risk of breast cancer and they include: Being female: women are much more likely than men are to develop breast cancer. Increasing age: your risk of breast cancer increases as you age. A personal history of breast cancer: if you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast. A family history of breast cancer: if your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease. Inherited genes that increase cancer risk: certain gene mutations that increase the risk of breast cancer can be passed from parents to children. These genes can greatly increase your risk of breast cancer and other cancers, but they don’t make cancer inevitable. Radiation exposure: if you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased. Obesity: being obese increases your risk of breast cancer. Beginning your period at a younger age: Starting your period before age 12 increases your risk of breast cancer. Beginning menopause at an older age: if you began menopause at an older age, you’re more likely to develop breast cancer. Having your first child at an older age: women who give birth to their first child after age 30 may have an increased risk of breast cancer. Having never been pregnant: women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies. Postmenopausal hormone therapy: women who take hormone therapy medications that combine oestrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications. Drinking alcohol: drinking alcohol increases the risk. Not being physically active: women who are not physically active have a higher risk of getting breast cancer. Having dense breasts: dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumours on a mammogram.
DIAGNOSING BREAST CANCER
Tests and procedures used to diagnose breast cancer include: Breast exam. Your doctor will check both of your breasts and lymph nodes in the armpit, feeling for any lumps or other abnormalities. You can also Google self-examination videos on YouTube, which are very helpful. Know your breasts so you can pick up if there are any changes. Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality. Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep with- in the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst. Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. Biopsy samples are sent to a laboratory for analysis, where experts determine whether the cells are cancerous. A biopsy sample is also analysed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options. Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. This is the most expensive of all the above tests and is only done rarely.
STAGES OF BREAST CANCER
Breast cancer stages range from O to IV with O indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.
Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer’s stage helps determine your prognosis and the best treatment options. Complete information about your cancer’s stage may not be available until after you undergo breast cancer surgery.
The tests include: blood tests, such as a complete blood count.