Detecting Breast Cancer and Treatment Options

Detecting breast cancer early enough is very crucial to increasing better treatment outcomes. Breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women. The World Health Organization reports that in 2018, an estimated 627,000 women died from breast cancer – that is approximately 15% of all cancer deaths among women.

Breast cancer is a form of cancer that develops when cells within the breast begins to grow out of control. These cells form a tumour within the breast and these present as lumps that can be felt within the breast or seen on an x-ray.  Major awareness campaigns carried out on breast cancer in Nigeria is aimed at enlightening women on how to identify lumps on their breast and to know when they are not just cysts but malignant tumours.

Most Common Signs and Symptoms in Detecting Breast Cancer
symptoms-of-Breast-Cancer

The most conspicuous symptom of breast cancer is the lump. But that is not all. In order to be successful in detecting breast cancer in good time, check your breast regularly for any of the following signs and symptoms. If you notice any of these, pay your doctor a visit to clinically examine your breast in order to rule out breast cancer or diagnose the breast cancer early enough.

Breast cancer may come in various types, but here are some of the things to look out for when you are examining your breast :

  • A breast lump or thickening that feels different from the surrounding tissue.
  • Redness or pitting of the skin over the breast, having the appearance of an orange.
  • One breast becoming larger than the other.
  • Inversion of the nipples or the nipples could also change shape.
  • Skin dimpling or pickling.
  • A rash on or around the nipple.
  • Discharge from the nipple, especially around younger women could also be a sign.
  • Constant pain in part of the breast or armpit and swelling beneath the armpit or around the collarbone.
  • Peeling or scaling of the areola (the pigmented area of skin around the nipple).
  • Unexplained weight loss could be a sign, although this is not a definitive sign as it can also be an indicator to some other underlying health issues.
  • As with weight loss, joint or bone pains can also be a manifestation of metastatic breast cancer, but this is non-specific as it could also be a sign of other diseases.

In ways more than one, women are now educated on how to carry out routine self-examination of their breasts because detecting breast cancer early is important in treatment.

Breast Self Examination

Diagnosing Breast Cancer

As per global standards, though it is quite possible to identify or initially recognize a possible breast cancer case by standard case definition based on signs and symptoms, these may not lead to a definitive diagnosis. It is most common that a health worker may carry out a physical examination of the breast (palpation) and mammography.

Inconclusive results from the mentioned processes may likely result to a health care worker, removing a sample of the fluid in the lump for microscopic analysis in a process known as fine needle aspiration. A clear fluid makes the lump highly unlikely to be cancerous but a bloody fluid is indicative of breast cancer.

Breast tissue biopsy (a process where samples of the cells or tissues are extracted medical examination to determine the presence of a disease), may also be carried out by a pathologist to determine whether cancer cells are present and to conclude a case diagnosis as breast cancer. There are also prescribed medical examinations which includes blood tests, x-rays, CT-scans and endoscopy.

In Nigeria, diagnosis and detection of breast cancer is primarily dependent on typical investigation such as breast tissue biopsy x-rays, abdominal ultrasonographic scan and CT scan. There is limited use of mammography, flow cytometry, frozen section histology. The options to use advanced techniques such as stereotactic core needle biopsy (which measures calcium deposits or masses that are not visible on ultrasound), tumour markers, estrogen/progesterone receptor status and PET (Positron Emission Tomography) scans are not always available.

Treatment Options After Detecting Breast Cancer

Surgery

Surgical treatment may include Mastectomy (removal of the whole breast), Quadrantectomy (removal of one-quarter of the breast), and Lumpectomy (removal of a small part of the breast).

800px-Mastectomie_02
Medication

Adjuvant therapy (the drugs used in addition to surgery) are available for treatment of breast cancer. There are three types of medications available for adjuvant therapy and they are hormone-blocking therapy, chemotherapy and monoclonal antibodies.

  1. Hormone-blocking therapy : The presence of high level of estrogen encourages the growth of some forms of breast cancer and this is because of the presence of hormone (estrogen ER+ and progesterone PR+) receptors on the surface of these cancer cells. These ER+ cancers can be treated with drugs that either prevents the production of estrogen or blocks off the receptor binding sites and prevents the estrogen from binding to the receptors; this is known as a competitive inhibition and an inhibitor such as aromatase inhibitors are used.
  2. Chemotherapy : Chemotherapy is mostly used in treating stages 2-4 cancers that are estrogen receptor negative (does not have estrogen receptor sites on the surface). They are often administered as combination therapy and administered for a period of 3-6 months. Most chemotherapy work by causing DNA damage as cells replicate. In this process, they also damage and prevent cancer cells from replicating.
  3. Monoclonal antibodies : These antibodies therapy enlists the natural immunity of the body to combat cancerous cells. Monoclonal antibodies are synthesized to mimic the functions of the natural body immune system. They are designed to bind to antigens that are generally more on the surface of the cancers cells than on the healthy cells. In doing this, it mimics the immune system and attacks these cells. They can work in many ways which may include: triggering cell-membrane destruction which causes the destruction of the outer membrane of the cancer cells. They can also work by flagging cancer cells by coating cancer cells and making them a specific target for the immune system to destroy. They can also block cancerous cell growth and can directly attack these cancer cells.

Radiation

Radiation therapy delivered in form of external beam radiotherapy or internal radiotherapy (brachytherapy) is given after surgery to the region of the tumour bed and regional lymph nodes, to destroy microscopic tumour cells that may have escaped excision during surgery. Radiotherapy can be administered during the surgery but is conventionally administered after the surgery and can considerably reduce the risk of recurrence up to 50-66% when delivered in the correct dose.

Prevention Tips Against Breast Cancer

For a proper understanding of prevention of breast cancer, it is important to understand the causes. Defining risk factors does not constitute a clear chance to having the disease but it is educative and gives everyone a clear path to understanding possibilities and being on the lookout.

Risks factors could be modifiable (such as lifestyle) which could be and fixed factors (such as age, sex and genetics) and hence cannot be changed. Lifestyles such as smoking of tobacco, sitting regularly for a prolonged period, hormonal birth control medications, and occupational hazards such as radiation and constant contact and inhalation of organic solvents, polycyclic aromatic hydrocarbons, etc, could greatly increase ones risk.

Genetics has also been reported to be a minor cause of breast cancer to an estimate of about 5-10% of all cases. Some medical conditions such as atypical ductal hyperplasia and lobular carcinoma in situ found in benign breast conditions such as fibrocystic breast changes are correlated with an increased breast cancer risk.

Given that causes and risk factors have been understood, one can begin to lay hands around preventive methods.

  • Lifestyle: Women can reduce their chances of having breast cancer by reducing their level of alcohol and tobacco intake maintaining a healthy weight and actively breast feeding their children. Physical activities also reduce chances of developing breast cancer. Reducing exposure to uncontrolled radiations, organic solvents, polycyclic aromatic hydrocarbons and limiting the dose of hormone therapy also reduces the risk of breast cancer.
  • Pre-emptive surgery: People with a high chance of developing breast cancer (BRA1 and BRA2 mutation) may be advised to undergo prophylactic bilateral mastectomy (a process whereby both of the breasts are removed before any cancer is diagnosed or the appearance of any suspected lumps).

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