Breast Cancer Awareness

Breast Cancer Awareness

Breast cancer is the most commonly diagnosed cancer in Canadian women. It is the second most common cause of cancer death in women after lung cancer. Breast cancer accounts for  7.3% of cancer-related deaths (15.3% of female cancer deaths) and 2.2% of all mortality (4.3% of all female mortality). Less than 1% of breast cancers occur in men. Mortality rates for breast cancer have been declining in the past three decades due to increased use of screening and more effective treatments at an earlier stage in the disease.

Risk Factors

Breast cancer affects one in eight women over the course of a lifetime. There is no known direct cause for breast cancer but a number of factors can put women more at risk:

Known Risk Factors:

  • Age – increasing age increases risk
  • Family history of breast cancer or Genetic mutations – there are two genetic changes, BRCA1 and BRCA2, that are known to increase the risk of breast cancer (5-10% of all breast cancers). If there is a known family history of breast or ovarian cancer, you may want to discuss genetic testing with your healthcare provider. Women with Ashkenazi Jewish ancestry are more likely to carry this genetic mutation.
  • Other genetic conditions which have been linked to increased incidence of breast cancer: Li-Fraumeni syndrome, Ataxia-telengiectasia (AT), Cowden Syndrome and Peutz-Jeghers Syndrome.
  • Personal factors – women whose periods started before the age of 12 or ended after the age of 55 are at increased risk
  • Lifestyle factors – excessive use of alcohol (more than 1.5 drinks/day) and being overweight
  • Exposure to ionizing radiation therapy to the chest, neck and armpit area, especially in women who have received treatment to these areas for Hodgkin Lymphoma.
  • Additional factors include using certain types of hormone replacement therapy especially combination therapy with progestin and estrogen for > 5 years, this risk goes by 8% for every year on combined therapy and 1% for every year on progestin therapy alone.
  • Use of combined estrogen and progesterone birth control pills may slightly increase the risk for breast cancer, especially if taking for longer than 10 years.
  • Not having children or having your first child after age 30
  • Having dense breasts or an increased number of abnormal cells in the breast
  • Tall adult height may lead to a higher of breast cancer after menopause

 

Symptoms

Symptoms may be very vague, and may include a lump in the breast, a change in size or shape of the breast, nipple discharge, dimpling of the skin, retraction (pulling in) of the nipple when it previously pointed outward or breast skin discoloration.

Prevention & Screening

Clinical breast exam with your healthcare provider and breast self-exam and self-awareness are crucial to early detection. Know what is normal for you and don’t hesitate to seek a healthcare provider’s opinion if you are unsure. Further, screening tests help find breast cancer before any symptoms develop. When breast cancer is found and treated early, the chances of successful treatment are better.

Currently in Canada, screening for breast cancer is recommended for women of average risk between the ages of 50 and 69 through mammogram every 2 years.

Earlier or more frequent screening with the addition of MRI may be recommended if you have high risk factors for breast cancer. You may be at a higher risk if you have:

  • a strong family history of breast cancer
  • certain gene mutations, such as the BRCA1 or BRCA2 mutation which may lead to a higher risk of certain cancers such as breast and ovarian cancer
  • a personal history of lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), invasive breast cancer or atypical hyperplasia
  • dense breast tissue
  • received radiation therapy to the breast or chest

Diagnosis

Breast cancer is usually detected initially with breast ultrasound and/or mammogram. To diagnose, a breast biopsy is generally performed. A biopsy is the removal of pieces of tissue, which are then sent to a lab for testing. If a lump is present, it may be removed at the same time as the biopsy. Lymph nodes around the area may also be checked.

Treatment

Many factors, including the type and stage of cancer, determine the type of treatment recommended.

Surgery

Surgery is performed to remove as much of the cancer as possible. Either the whole breast is removed, called mastectomy, or a part of the breast is removed, called lumpectomy. Mastectomy or lumpectomy does not ensure that the breast cancer is completely eradicated.  There may be small cancer cells remaining in the body. For this reason, surgery is often followed by radiation and/or chemotherapy.

Radiation Therapy

Radiation is done to treat the entire breast. Radiation therapy often begins 4 to 6 weeks after surgery. External beam radiation therapy is always given after breast-conserving surgery. It is sometimes given after a mastectomy. Systemic radiation therapy may be offered for women with breast cancer that has spread to large areas of the bone (bone metastases).


Hormone Therapy and Chemotherapy

These therapies may be done before surgery to shrink a tumor, or after surgery to kill cancer cells that may have spread or that remain in the body.

  • Hormone therapy: is a medication that works against estrogen in the body. The most common side effect of hormone therapy is symptoms of menopause.
  • Chemotherapy: is medicine given in an IV or as a pill. The medicine kills cancer cells. Common side effects include temporary feelings of fatigue, hair loss and nausea.

 

While breast cancer can be frightening diagnosis, an earlier diagnosis always lends to better treatment options. This is why it is important to stay up to date with regular screenings for breast cancer starting at age 50 or earlier if any high risk factors are present. If you have any questions about breast cancer and how to begin your screening, please see your health care provider.

 

References

http://www.uptodate.com

www.cancer.ca

www.statcan.gc.ca