Breast cancer

As the commonest form of cancer among women living in Western countries, breast cancer strikes one woman in every 14 at some time during their lives. It is also responsible for more deaths among women in the 35 to age group than any other disease, killing in total each year more than 12,000 women in the United Kingdom and 34,000 in the United States. There is evidence to suggest that even these high figures are on the increase.

It’s little wonder, then, that breast cancer has become a subject of so much concern and often over-emotional discussion.

But the high levels of publicity serve an essential purpose, for by drawing attention to the problem, they increase the chances of a woman with early symptoms seeking treatment Like all cancers, the earlier the growth is diagnosed, the better the chances of a cure.

What researches reveal

Although a great deal of research has gone into the causes of breast cancer, the evidence is still inconclusive.

At one time doctors thought that the part of the world a woman lived in or the race she belonged to might affect her chances of developing breast cancer. This was because a much higher proportion of women living in Western Europe and the United States developed the disease than, for example, their contemporaries living in South East Asia.

But in the past 10 years it seems that the rate for the disease among Japanese women living in their own country has been increasing to the same rate found among expatriate Japanese living in the United States. Furthermore, second generation Japanese women living in the USA now run the same risk of getting breast cancer as their American compatriots.

This suggest that it’s environment and way of life rather than geographical or racial considerations that are the determining factors.

Some doctors believe that there may be a link between diet and the occurance of breast cancer, but this hasn’t been proved as yet.

What research has shown is that having a child at an early age appears to give a woman a certain amount of protection against developing breast cancer at a later date, and that the degree of protection is the same whether the woman breast or bottle-feeds her baby. It has also been suggested that the younger the woman when she first becomes pregnant (or more precisely the fewer the number of monthly cycles she has experienced between the start of menstruation and her first pregnancy) the smaller the risk she is likely to run.

Breast cancer, the Pill and HRT

The Pill has come under a lot of suspicion in the past and there have been claims that it contributes to the development of breast cancer, but the latest studies seem to have given it an all-clear in this respect. Incidentally, one research project actually came up with results that showed a reduction in the incidence of breast disease among women on the Pill.

But the connection between hormone replacement therapy (HRT), used to treat certain ‘change of life’ symptoms, and breast cancer is slightly more suspect. Although a number of studies have revealed no link between HRT and breast cancer, one large American survey does suggest that there is a slightly higher risk than usual of the disease developing among women who have been receiving HRT for more than 10 years.

Effects of radiation

Certainly exposure to radiation can increase the risk of breast cancer – the larger the quantity and the more frequent the exposure, the higher the risk of developing the disease. Unfortunately this creates something of a dilemma, since standard ‘screening’ procedures to detect cancer (among other things) do involve X-rays. Because no one Knows how low the level of radiation has to be before the risk becomes insignificant, some doctors are afraid diat repeated breast X-rays result in build-ups sufficient to cause cancer.

Most doctors, however agree that the benefits of screening outweigh the small risk that may be involved, and certainly doctors won’t recommend X-rays unless they are absolutely necessarv.

How to examine your breasts

Giving yourself an examination once a month will ensure that you discover any change as early as possible. The best time to do so is just after your period, when the breasts are usually at their softest. (If you are no longer having periods, you can choose any day- but try to stick to the same one each month).

When you first start examining your own breasts, you may well be surprised at their ‘lumpiness’. What you are feeling is a mixture of fat and milk-producing glands which should be soft and lumpy. It will take several sessions for you to get used to your own breasts- remember that it’s quite normal for one breast to be bigger than the other – what matters more is that they should feel the same. The breasts do change in size in the course of the month and become ‘lumpier’ just before a period. It’s because they change that it’s important 10 choose the same point in the menstrual cycle to check your breasts each month.

If you think you have found something during the course of an examination, feel the same part of the other breast, just to make sure it’s not just the way both breasts are made. If there is something unusual, do not hesitate 10 check with vour doctor- he would far rather see you and set your mind at rest, even if it is a false alarm, than have you neglect an important early symptom. Arrange to sec him at the next surgery and, in the meantime, try to leave the breast alone. ‘

Women most at risk from breast cancer

According to die statistics, the women most likely to get breast cancer are those living in highly developed Western countries who are over the age of 30, and who haven’t had any children.

But irrespective of her age, environment, diet, racial characteristics, and , •e whether or not she has had children, a woman whose mother, grandmother, daughter, sister or other close blood relative has already developed breast cancer, is herself at slightly greater risk from the disease than a woman with no family history of this form of cancer.

Signs to watch for

One of the earliest signs of breast cancer is the presence of a hard, rather ill-defined lump in one of the breasts. The lump is nearly always painless, and may occur anywhere in the breast. To begin with it moves freely, being unattached either to tissue beneath it or to the overlying skin.

As the tumour gets larger it pulls in the skin over it to produce a characteristic ‘dimple’ and may also affect the milk ducts causing these to shrink and the nipple to become inverted.

If the tumour continues to spread, it may attach itself to the overlying skin, sometimes causing skin ulcers. It may also invade the tissue beneath, eventually becoming fixed to the underlying muscles. If the cancer spreads into the lymphatic glands under the arm, obvious and hard lumps will appear in the armpit.

Importance of early diagnosis

Cancer of the breast alone is not fatal; the danger lies in the fact that it has the capacity to spread by shedding cells which can be carried by the bloodstream all over the body. Cancer may develop in the bones, liver, lungs, brain or elsewhere. Women patients with symptoms as different as jaundice or spontaneous bone fractures may in fact be suffering from secondary growths, in the liver or bones, of an original breast cancer.

The cancer can spread and form these new growths almost from the moment it first develops, so die earlier it is diagnosed, the better are the patient’s prospects of halting the disease, whatever form the treatment takes.

If you find you have a lump, however small, in your breast you should see a doctor without delay. Fewer than a quarter of these lumps turn out to be malignant – often they are harmless cysts or benign tumours known which are also more easily dealt with, if diey need any treatment, while they are still small.

Since early detection of breast cancer is so vital to a patient’s subsequent recover)’, in some countries (such as the United Kingdom) special clinics have been set up in certain areas. These provide tree medical examinations to screen women for breast cancer as well as other illnesses. Women attending these centres are taught how to examine their own breasts regularly to check, whether any lumps have developed so that these can be reported to a doctor and diagnosed promptly.

Diagnosing a lump in the breast

To find out whether a lump is cancerous or not the doctor consulted will carry out a thorough examination of both of the patient’s breasts. He will ask her to sit up straight lacing him, first with her arms by her sides, and then with her arms above her head so that he can see whether the nipple has become inverted or if there is any dimpling or lack of symmetry in one of the breasts. Then, while the patient is lying down with her head and shoulders propped up by pillows, the doctor will examine each breast carefully, section by section, with the Oat of his hand. If he detects an isolated lump not attached to other parts of the breast tissue, he will either carry out a himself, or refer the patient to a specialist.

This is a simple and virtually painless test whereby the doctor can draw off fluid from the lump, by means of a thin, hollow syringe. If the lump is a harmless cyst, drawing out the fluid content will cause it to disappear so the test is in effect, both the means of diagnosing and curing the condition.

If no fluid is drawn off and the lump proves to be solid, the doctor will probably follow this up right away with to obtain a small sample of the suspect tissue for more detailed tests. This will probably involve spending a few hours in the outpatient department of a hospital.

The minute piece of tissue taken from the lump (via a very small incision in the breast) can then be examined by a pathologist to see if it contains cancer cells. If the breast tumour is found to be malignant. The patient can be checked immediately, to see whether she has any secondary growths.

An is sometimes carried out when the patient has an isolated, unattached lump in her breast. If the other tests (needle aspiration or outpatient bi-opsv) fail to yield satisfactory results or cannot be undertaken. The patient is admitted to hospital to have the whole lump removed under a general anaesthetic, so it can then be analyzed for any signs of cancer.

I (breast cancer is diagnosed, the doctor will discuss with the woman concerned and with her husband or family the most suitable kind of treatment for her particular condition so that she knows exactly what’s going to happen to her before she undergoes surgcry or other forms of treatment.

Treating the disease in its early stages

If breast cancer is diagnosed early on, while the tumour is still small, the surgeon usually carries otit a mastectomy, an operation to remove the whole, or part of the breast. He will probably treat the glands in the adjoining armpit too, as the disease often spreads rapidly to this area. The glands may be removed surgically as an extension of the mastectomy operation, or they may be dealt with after the operation by a course of radiotherapy lasting for approximately six weeks.

Surgery is not necessarily the only answer to early breast cancer. For patients who feel that they are unable to face a mastectomy, it may be possible to treat the disease by modern radiotherapy techniques but this option is not usually recommended. Although these techniques are still largely in the experimental stage, most surgeons are willing to discuss and consider this alternative method of treatment.

Follow up

After the initial treatment, doctors follow up their breast cancer patients indefinitely so that if the disease recurs, cither in the original area of the operation or elsewhere in the body, it can be detected as soon as possible. If the cancer does reappear, it can often be successfully controlled either by radiotherapy or drugs.

Although most women adjust very well to a mastectomy over a 12-month period, and quickly get used to the’false’ breast form with which they are provided, many doctors continue to monitor carefully their breast cancer patients’ psychological reaction to the operation to see whether it might be better to reconstruct the breast by inserting a plastic implant under the surface layer of skin, although this is not always possible or advisable.

Treatment of advanced breast cancer

II ihe disease is too far advanced for surgery, patients are usually treated by a combination of radiotherapy and anticancer drugs. Good teamwork between surgeon, radiotherapist and cancer treatment specialists are helping to prolong and improve the life of many breast cancer patients.