Breast cancer is a kind of cancer developing from breast cells. It involves abnormal breast cells growth and, in serious stages, can invade into other parts of the body (World Health Organization 1). The majority of breast cancer cases occur in women, however men can have breast cancer as well. National Cancer Institute reports that 232 340 female breast cancers and 2 240 male breast cancers occur in the USA each year, as well as 39 620 people die from this disease annually (Nordqvist 1). Breast cancer is more common in the developed countries. As for more statistics, in these countries 80% - 90% patients survive breast cancer and live at least 5 years after curing the disease. In the developing countries survival rates are lower (Office for National Statistics 2).
Because breast cancer is noticeable, it was the form of cancer most frequently described in ancient documents (Olson 9-13). The first mentioned case dates back to ancient Egypt, describes a woman with metastatic stage of cancer and tells that “there is no treatment”. In ancient Greece breast cancer was associated by patients with divine punishment. In 18th century different theories were developed about the causes of cancer, and some of the researchers of that time blamed restrictive clothing or lack of sexual activity to be the reason of breast cancer. Nowadays breast cancer is curable, and the causes of it are investigated, although in many cases woman develop the disease having low risk rates.
Breast cancer modifies the cells of the breast tissue. There are different risk factors that lead to developing this disease. These include female sex, lack of exercise, alcohol abuse, not having children, genetic predisposition (Pasche 19), older age, hormonal therapy during menopause, radiation. There are more than 18 sub-types of breast cancer, but the most widespread are lobular carcinomas (cancer developing from lobules) and ductal carcinomas (ones developing from milk ducts). 80% of breast cancer cases are diagnosed after women discover a hardening, a lump, or thickened skin in their breast. The lump may also be located in lymph nodes in armpits. The diagnosis is confirmed after taking a biopsy from the concerning lump. Further tests aim at discovering the stage of the disease, the damage that cancer cells have made on the breast tissue, and whether the cancer cells are spread beyond the breasts. The doctor will also determine which treatments the cancer will respond to.
Breast cancer screening is called mammography. The US Preventive Services Task Force recommends 40 to 70 years old women to make mammography every two years (Siu 3). This age group is the most vulnerable to breast cancer. However, mammography is a controversial procedure, due to the fact that some scientists find it harmful (Gøtzsche 4).
The symptoms and early signs of the disease are easy to discover without mammography. Apart from the abovementioned skin hardenings or lumps, the woman must also pay attention to one breast becoming larger or lower, abnormal changes in the nipple (changing of position, becoming inverted), rash around the nipple, fluid leaking from the nipple, constant pain in the breast or armpit area. There is also an inflammatory type of breast cancer which is more difficult to diagnose as its symptoms do not resemble the usual ones. Inflammatory breast cancer is often mistaken for breast inflammation, as the symptoms include swelling, itching, pain, redness around the nipple as well as the abnormal orange-peel texture to the breast skin. Breast cancer can also present a metastatic form, in which the cancer spreads to other parts of the body, beyond the original organ. In these cases the most common organs that the cancer migrates to are lungs, brain, and liver. Unexplainable weight loss can be an alarming sign in this case, as well as jaundice, bone and joint pains, fevers and chills. All of these symptoms are non-specific, potentially signalizing other diseases.
A person’s lifestyle, although is not a crucial factor, influences their health and may lead to a higher risk of developing breast cancer. For example, smoking tobacco increases the risk, especially for people who started smoking in early age. Long-term smokers are at highest danger. Also, the disease often chooses people with lack of physical activity, having sitting jobs and paying no attention to exercise. Taking oral contraceptives can also increase the risk of having breast cancer, although this theory is not well studied at the moment (Veljković 659). Dietary factors also have an influence. If a person consumes alcohol frequently, has a high fat diet or suffers from obesity caused by high cholesterol levels, the risk of breast cancer developing increases. Other factors include radiation and chemicals.
The cells of the breast tissue become cancerous when they lose the ability to stop dividing, attach to other cells or to stay where they belong. There are different stages of the disease. The doctors use the TNM system to determine the stage, where T stands for the size of the tumor, N tells whether or not the tumor has spread to the lymph nodes, and M shows if the cancer is metastatic. If the tumor is big, and spreads beyond the breast, the prognosis is worse. There are 5 main stages of breast cancer development. In stage 0 the cancer is in marker condition. Stages from 1 to 3 indicate that the cancer is developing in the breast area, but is not spread to other parts of the body. Stage 4 tells that the cancer has escaped into the blood stream and became metastatic.
According to the stage of the disease, the overall state of health of the patient and individual needs the doctor selects the best ways of treatment. The most radical and effective is surgical removal of the tissue affected by cancer. The surgeon typically removes the tumor and a part of tissue that surrounds it. Lumpectomy refers to a surgery that removes only a small part of the breast tissue with the cancerous cells and is usually involved at early stages of the disease. If the cancer is more developed, the surgeon can perform quadrantectomy (removal of one quarter of the breast) or, in more serious cases, mastectomy (removal of the whole breast). Modern plastic surgery allows the patient to reconstruct the breast area, making the surgery unnoticeable. This type of surgery can be performed at any moment after mastectomy. Some women choose to use breast prostheses alternatively.
After the operation, the patient usually undergoes a course of radiotherapy to ensure that all of the tumor cells are destroyed, including the microscopic ones that could escape surgery.
While preparing to the operation, additional medications can be required. One of the most widespread methods is chemotherapy. It is used at stages 2-4 and is usually prescribed in courses for 3-6 months periods. The chemotherapy is aiming at destroying the fast-growing cancer cells as well as the fast-replicating ones. However, chemotherapy has its side effects. For example, sometimes it destroys fast-growing normal breast cells. The other side effect is damage to the heart muscle that certain chemicals make. This effect is one of the most dangerous, especially for older patients.
Some types of breast cancer depend on the estrogen or progesterone as they require it in order to grow. To cure these types of cancer hormone blocking therapy can be used. Hormone blocking drugs either block the cells’ receptors sensible to the mentioned hormones, or simply block the production of the specific hormone in the body. This therapy stops breast cancer from growing and prepares the patient for surgical removal of the tumor.
In the pre-operation period monoclonal antibodies can be also used. This medication has proved its efficacy to stop cancer cells growth. Nevertheless, this is a very expensive treatment that causes side effects on 2% of patients, affecting the heart muscle (Moja et al. 23).
Breast cancer can occur in women during pregnancy. In fact, it occurs at the same rate in pregnant women as in non-pregnant women of the same age. It is more difficult to notice and diagnose breast cancer in this case because the mentioned symptoms are mistaken for the usual discomfort during pregnancy. Moreover, some types of breast cancer screening are forbidden for pregnant women (for example, PET scans).
Being diagnosed with breast cancer influences the psychology of a person, and sometimes the psychological effects can be severe. In most of the hospitals where cancer is treated special support groups are organized under psychotherapist’s supervision. Cancer treatment is not a pleasant procedure, for example side effects of chemotherapy are difficult to cope with and are often a cause for depression or anxious moods. In cases when cancer is treated with hormonal blocking therapy a negative effect can be observed on the psychological well-being of a woman. In 2007 University of Georgia researchers conducted a study that suggested a need for better psychological and physical wealth promotion among the older breast cancer patients (Robb 34). This study shows how important is the role of health practitioners, nurses and family is in the life of a patient suffering from the disease. It is important to maintain an understanding atmosphere for the patient, believe in the positive outcome and be as supportive as possible.
There is a wide range of measures that can be taken in order to prevent breast cancer. While some of the risk factors cannot be escaped (e.g. genetic predisposition), others can. To reduce the risk of having breast cancer, a person should quit smoking, limit alcohol consumption, control their weight and the amount of cholesterol, have a healthy diet, be physically active, have children, and avoid exposure to all kinds of pollution.
As to the unconventional ways of cancer treatment, there is a set of approaches not medically approved but practiced, especially in non-western countries. These treatments can be complementary (used in addition to the conventional therapy) or alternative (replacing the conventional therapy). These methods root into different medical systems, for example, holistic medicine, which aims at healing not only the body, but the spirit. Traditional Chinese medicine is famous for healing with the help of acupuncture, herbs, qigong, and massage. Indian medicine features the ayurvedic approach, an ancient therapy that harmonizes spirit, mind and body through special foods, massage and meditation. There are also different less widespread approaches originating from the practices of natives from Hawaii, South America etc.
The pink ribbon is a well-known international symbol of breast cancer awareness, worn to show support to those who were diagnosed with breast cancer, and to manifest the faith in scientific progress that can help finding more effective cures for this disease. The pink ribbon is inexpensive to make and is usually sold during different fundraising campaigns. Also, it is used to mark products for women interested in breast cancer prevention.
In conclusion it should be stated that breast cancer is a difficult and the most common cancer disease, affecting around 12% of women worldwide. However, in early stages breast cancer is curable and has a favorable prognosis. It is possible to minimize the risk of having the disease, and this is made through establishing healthy habits, being physically active, quitting smoking and stopping alcohol consumption. It is important to raise breast cancer awareness for women to take care about their health and undergo prevention diagnostics after a certain age.
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