BREAST CANCER

Breast cancer is the most common cancer among women. More than 180,000 new cases of breast cancer were diagnosed in the United States in 1996. One of every 10 women has breast cancer in her lifetime. The specific cause of breast cancer is not known, but risk factors for breast cancer are as follows:

1. Starting menstrual periods at an early age (11 or 12 years) and going through menopause at a late age (50s).
2. Never having a child or having a first child in the mid 30s.
3. Having a relative (mother, sister, or child) with breast cancer.
4. Using birth control pills for a long period of time (8 to 10 years) or using them before having a first child (possible risk). Using estrogen replacement therapy after menopause (small risk).
5. Eating a high-fat diet and drinking alcohol.

The only sure way to detect breast cancer is by means of biopsy and removal of a suspicious lump that has been detected with mammography (radiograph [x-ray] of the breast) or by means of feeling it. Breast cancer is curable if detected before it has a chance to spread.

A lump in your breast is usually the first sign of a tumor. A tumor can sometimes be detected with a mammogram before you feel a lump. Mammograms have been shown definitely to reduce the chance of dying of breast cancer when the tumor is detected in women older than 50 years. Whether this benefit applies to women in their 40s is controversial.

Breast cancer is a very slow-growing cancer and spreads through the lymphatic and circulatory systems to other parts of the body (lymph nodes, bone, lungs, liver, and brain). Other signs and symptoms are nipple discharge, redness of the breast skin, dimpling of the breast skin, and inversion of the nipple. With spread, swollen lymph nodes are felt, and bone pain, shortness of breath, abdominal pain, and neurologic symptoms can occur.

Once the diagnosis is confirmed by means of biopsy, a physician stages the cancer and determines whether the cancer has spread. Blood tests, radiography of the chest and breasts, computed tomography (CT) scan of the head, chest, and abdomen, and bone scans can be ordered to exclude spread of the cancer. If these studies do not reveal spread, a surgical procedure is extremely important in staging. During the operation the surgeon determines the size of the tumor, whether the tumor has spread to the lymph nodes, and whether the cancer has a specific hormone receptor. This information is vital in deciding on the type of treatment.

Management of breast cancer can be surgical therapy, radiation therapy, chemotherapy, hormonal therapy, or a combination of the four. Treatment involves many different specialists working as a team to offer all the treatments. The primary care physician coordinates the care.

Side effects of surgical treatment depend on the type of operation. Because many lymph nodes are removed from the armpit area, arm swelling may occur after the operation. Breast deformity depends on the amount of breast tissue and the type of surgical procedure (lumpectomy, mastectomy).

Side effects of radiation therapy include dry, red, and itchy skin over the radiation site. Because radiation is over the chest and armpit area, shortness of breath, coughing, and arm swelling may occur.

Side effects of chemotherapy are nausea, vomiting, hair loss, easy bruising, easy bleeding, infections, and sometimes toxicity of the heart muscle.

Side effects of hormonal treatment are hot flashes, nausea, vomiting, irregular menstrual cycles, vaginal bleeding, and skin rash.

• Seek a team of physicians who have experience in all aspects of breast cancer treatment. The management of breast cancer is complex, and you must feel comfortable with the treatment approach you and your team of physicians have decided on. Included in this team of physicians are your primary care physician, oncologist (cancer specialist), surgeon (general surgeon and plastic surgeon if reconstruction of the breast is being considered), and radiation oncologist.
• Remember the importance of nutrition and exercise during and after treatment.
• Educate family members about screening for breast cancer. The American Cancer Society recommends that women between 20 and 39 years of age perform breast self-examinations every month and that a physician perform a breast examination every 3 years. Women 40 to 49 years of age do the same and undergo mammography every 1 or 2 years. Women 50 years and older do the same but undergo mammography once a year.

• Do not ignore any lumps in the breast.
• Do not be afraid to ask for emotional support.
• Do not miss follow-up appointments, because this is the time to monitor treatment success and look for tumor recurrence.

• If you feel a lump.
• If you have any drainage from the nipple or irregular dimpling of the breast or nipple.
• If you are having back pain, lower leg weakness, or bladder or stool incontinence (leaking).
• If you have fever, nausea, or vomiting after chemotherapy.
• If you feel depressed.

American Cancer Society
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345

Reference: Murphy G, Lawrence W, Lenhard R: American Cancer Society textbook of clinical oncology, ed 2, Washington, 1995, Pan American Health Organization.




Four ways to deal surgically with cancer of breast. A, Lumpectomy (tylectomy); B, quadrectomy (segmental resection); C, total (simple) mastectomy; D, radical mastectomy. (From Lowdermilk DL, Perry SE, Bobak IM: Maternity & women's health care, ed 6, St Louis, 1996, Mosby. Used by permission.)

_______________________________________________________________________________________________________________________________
Copyright © 2000 Mosby, Inc.
All rights reserved.  No part of this publication may be reproduced or transmitted in any form or for any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.
_______________________________________________________________________________________________
For Comments/Suggestion send email to: webmaster@apma-nc.com