Breast cancer

Breast cancerMany diseases can affect the breast, most of which are harmless changes of the fat and connective tissue. However, the breast can also be affected by the most feared disease among women — breast cancer. Breast cancer is characterized by uncontrolled multiplication of various cells comprising the breast. Many different groups of malignant neoplasms are known and they are differentiated on the basis of the speed of disease´s progression and prognosis.

Why should you have your DNA analysed for predisposition to breast cancer?

GenePlanet examines genes for which a connection with breast cancer development was shown. Familial predisposition is a chapter in itself among risk factors. The greater the number of family members affected by breast cancer, the higher the risk of developing breast cancer. By knowing your risk for breast cancer development you can take appropriate preventive measures.

How is breast cancer prevented or treated?

Due to its genetic background, it is very hard to prevent cancer development. However, risk factors can be diminished by certain methods, including taking hormonal pills which do not increase cancer risk. Due to the development of various techniques, the best treatment option is a surgery. In addition to surgery, there are other therapies such as radiotherapy, chemotherapy, hormonal therapy and therapy with biological drugs.

More detailed description about breast cancer

Breast cancer is the most common cancer in women in the developed world where it affects about 100 per 100,000 women annually. Estimates indicate that every 9th woman shall be affected by breast cancer in the future. White women over the age of 35 are most affected. Other races show lower incidence of this disease. The lowest incidence is in the Southeast Asia and in Africa. Breast cancer can also affect men, but it is 100 times less common than in women.

Breast cancer is characterized by uncontrolled cell division. The cancer-modified cells may travel to other body parts, seed them and grow further. Medically speaking, they metastasise.

Causes for development

The exact cause of breast cancer has not yet been elucidated, but certain risk factors affecting the development of breast cancer are known, including a long time period between the menarche (i.e. the start of menstrual cycles) and menopause (cessation of menstrual cycles), relatively late age at first pregnancy, obesity and a fatty diet. Oral contraceptives also increase the risk.

Familial predisposition is a chapter in itself among risk factors. It has been found that breast cancer appears much more commonly in close relatives than among random population. The greater the number of family members affected by breast cancer, the higher the risk of developing breast cancer. Changes in BRCA1 and BRCA2 genes play an important role in familial predisposition. BRCA genes protect the breast cells from cancer. If these genes malfunction, the protection is gone and cancer may develop.

Disease recognition

The most common sign of breast cancer is a lump or thickening in the breast. Most lumps are harmless, but these changes should nevertheless be evaluated by a physician. Other potential signs of breast cancer include a clear or bloody nipple discharge; retraction or indentation of the nipple; change in the size or contours of the breast; any flattening or indentation of the skin over the breast; redness or pitting of the skin over the breast, resembling the skin of an orange.

The most important diagnostic activity that every woman should regularly perform is breast self-examination to check for possible changes that can be palpated in the breast. Only a fast and timely detection of changes can help diagnose cancer in the early stages when very effective therapy is still possible. Physicians employ various techniques to diagnose breast cancer. The best and most widely used is mammography which is an X-ray imaging of the breast. Unfortunately, mammographies are not error-proof. It may happen that a harmless change is mistaken for breast cancer or, even worse, that breast cancer is overlooked. Besides mammography, the other examination options include a breast ultrasound, MRI or CT.

Biopsy of the disease-modified tissue is an absolute must in breast cancer diagnostics. In this procedure, a physician removes a tissue sample with a needle and sends it to the laboratory for histological examination. Biopsy results reveal the degree of cancer malignancy which aids in further therapeutic decision-making.

Prevention

Regarding cancer development possibilities, avoiding risk factors that can elevate possibilities of cancer appearance is highly advised:

Reduce alcohol intake – a connection between alcohol intake (regardless of its origin, which can be beer, wine or spirit drink) and breast cancer development has been found. Women shouldn’t drink more than a glass per day, but strict alcohol limitation is even more advised.

Normal weight maintenance – the estrogen hormone, whose elevated quantities are connected with breast cancer, is produced by fatty tissue. The effect of increased body weight on breast cancer development is the highest during menopause. Preventive measures sum all actions that help maintain a normal body weight, like regular physical activity (at least 30 minutes per day for most days of a week), appropriate nutrition that contains little fat and a lot of fibers (fruits, vegetables and cereals). Using olive oil is also advised, because it is supposed to reduce the effect of oncogenes that can influence breast cancer development.

Avoiding long term hormonal therapy in menopause – research has determined that there is an increased risk of cancer development in the cases of combined estrogen and progesterone use during a period longer than 5 years. The risk is significantly reduced when the therapy is cancelled. The same goes for hormonal therapy after turning 60 years old or more.

Aspirin – a reductive effect of Aspirin on risk of breast cancer development has been established. Doses of Aspirin for this kind of effect are unfortunately higher than for cardiovascular disease prevention and increased possibilities of side effects like stomach ulcers are present.

Avoid pesticides – organochlorides, a group of pesticides, which include the banned DDT, can bind the same receptors like oestrogen.

In women with a highly increased risk for breast cancer development (mother or daughter with breast cancer, positive biopsy, etc.) there are other preventives to consider:

Chemopreventive – the use of medications from the group of selective modulators of the estrogen receptor. Tamoxifen is used for women 35 years old or more, who have a significantly increased risk for cancer development in the next five years. By using it is possible to achieve a reduction of risk by one third in the non-invasive cancer form, and by one half in the invasive one. Raloxifene is used in women with increased risk during menopause.
Radical surgery – one or both breasts can be removed (radical mastectomy). This form of prevention is usually recommended to women that already had breast cancer, have a positive family history, positive genetic testing or whose doctor had discovered early-stage cancerous cells. The other procedure is radical oophorectomy, in which both ovaries are removed. Even though this kind of surgery is normally done for ovary cancer prevention, oophorectomy before menopause also reduces risk for breast cancer development.

Therapy

Early diagnosis and therapy is of crucial importance when treating breast cancer. For early discovery different methods, from breast self-examining to mammography, are used. This is especially important for women with an increased risk. Ask your doctor or gynaecologist for brochures about self-examining and about screening programs in your region.

Treatment exists for every disease type and stage and usually consists of surgery and additional therapy like radiotherapy, chemotherapy, hormonal or biological therapy.

Surgical procedures are:

Lumpectomy – in this surgery cancerous tissue and some healthy tissue surrounding it is removed. Procedure is usually followed by radiotherapy. The surgery cannot be done if the cancerous mass is too big, if it is present too deep in the breast tissue, if there are two separated cancerous forms, if the woman already had radiotherapy or if there is an inflamed cancerous form present.

Partial or segmental mastectomy – cancerous form, surrounding tissue and upper part of breast muscle are removed. All this is followed by radiotherapy. Mastectomy – the whole breast, glands, fatty tissue, areole and nipple are removed. Depending on the surgery’s outcome and additional tests, this can be followed by radiotherapy.
Modified radical mastectomy – the whole breast and part of armpit lymph nodes are removed but the breast muscle is preserved, which can ease further breast reconstructions.

During surgery biopsy of first armpit lymph node is performed. If it is positive, meaning that metastases are present, surgical emptying of armpit has to be done. But if biopsy is negative, all this is not necessary. Knowing if firs lymph node is positive or negative is also important for choosing right additional therapy (radiotherapy or chemotherapy).

Systemic treatment includes:

Hormonal therapy – depends on the hormonal responsiveness of tumour, which is determined by the presence of hormonal receptors in the tumour. The goal of therapy is to prevent tumour from reoccurring, or in case of metastases, to control it and possibly shrink it. Drugs like Tamoxifen (selective estrogen receptor modulator), aromatese inhibitor (prevents estrogen formation) or progestins can be used, or working of ovaries can be inhibited (surgical removal, radiaton or use of drugs that inhibit their performance).

Chemotherapy – used in combination with cytostatics. The goal of therapy is to eliminate cancerous cells and thus to prevent the cancer from reoccurring or in the metastases from forming, or in case that metastases are already present, to control them and shrink them. Because of the non-selective work of cytostatics, side effects like hair loss, nausea, vomiting and tiredness are often present.

Biological medications – it is based on the use of antibodies that can distinguish between healthy and cancerous cells. Trastuzumab binds proteins (HER2-neu) that are in larger amounts produced by cancerous cells in and thus kills them. Medication can be used in combination with other chemotherapeutics or in monotherapy. Bevacizumab binds to newly formed vessels in tumour and prevents its growth. Without new vessels a tumour cannot sustain its high growth. Lapatinib has an effect similar to trastuzumab. But this molecule is smaller and can perform its action inside cell. It is used in combination with chemotherapeutics with women that have advanced type of metastasing breast cancer.