BREAST CANCER

What are the causes and risks of the disease?
The risk for any woman to develop breast cancer is significant, about 1 in 9 over a lifetime. About 5% to 10% of all breast cancers may be related to genes that are passed through families called BRCA1 and 2 . Women may be at greater risk of developing this cancer if they: 

	started their periods early,
	delayed childbearing to later in life,
	never had children,
	have been treated for other cancers using radiation to the chest
	have close blood relatives, like a mother or sister, who develop breast cancer before menopause.

There may be other risk factors for developing breast cancer, but they are controversial. They include:

	drinking a moderate amount of alcohol
	eating a high-fat diet
	obesity
	using hormones such as estrogen and progesterone

It has been very difficult to predict who will and who will not develop breast cancer. Some studies have shown that women who breastfed their children may have a lower risk of developing breast cancer. On the other hand, some woman who have every risk factor associated with breast cancer, never develop the disease. And other women with no risk factors may develop breast cancer. At this time it is not possible to predict who will and who will not develop breast cancer with absolute accuracy.

What can be done to prevent the disease?
No diet or other similar intervention has been found to prevent breast cancer in rigorous scientific studies. There are studies underway to see if certain drugs can prevent the development breast cancer in high risk women. The medicines, including tamoxifen, are not expected to be 100% effective, and may have serious side effects. There is no other proven method to effectively prevent this cancer.

It is very important to detect breast cancer early when it is much easier to cure. This is best done by a woman checking her breasts once a month for any unusual lumps. The American Cancer Society has helpful guides detailing how to do this. A healthcare provider should check the woman's breasts during routine physical exams every 2 years for women younger than 40, then every year. Recommendations vary for screening mammography. Currently:

 

	For women from the age of 40 to 50, mammography should probably be obtained at least every 2 years and many healthcare providers recommend yearly mammograms in this age group. For women over the age of 50, mammograms done every year clearly saves lives.
	For women with an increased risk for breast cancer, there are no established guidelines for the age to start using screening mammography. This should be discussed and decided with the physician. Mammography is often not useful in women under the age of 35 with current techniques because the breast tissue is too dense to allow accurate interpretation of the X-rays. How is the disease diagnosed? Lumps may be found by a woman or her partner, or by her doctor while physically examining the breast. Sometimes the lump cannot be felt, but is found on a screening mammogram. After the lump is discovered, a tissue sample must be taken in order to find out if it is cancer. If the lump is seen only on mammogram, a needle is guided under X-ray to take a sample. Often the lump is removed through minor surgery. The tissue will sent to a lab, like Aloha Laboratories, Inc. and examined under a microscope to determine if it is cancer. Then the tissue will be tested to see how aggressive the cancer is. Other tests will be done to determine factors that will affect treatment choices. The most common factors are:
	aggressiveness of the tumor cells
	sensitivity to estrogen or progesterone
	the presence of certain proteins. A woman may also undergo other specialized X-rays to see if the cancer has spread beyond the breast. What are the long-term effects? This cancer is fatal if left untreated. It can be cured in the early stages. Once cured, the person will live a normal life. Loss of the breast may be emotionally upsetting. Reconstruction of the lost breast may assist with emotional adjustment. What are the risks to others? There are no direct risks to others. A breast cancer cannot be spread from person to person. When a young woman has breast cancer, this may indicate that other close female relatives are at risk. This does not mean that she will spread it. What are the treatments? Treatment depends on factors found when the tumor was diagnosed and how advanced the cancer is at that time. Early stage cancers can be cured. Advanced stage cancers can often be controlled for long periods. Except for very small ductal carcinomas in situ, or DCIS, most cancers will be treated with additional surgery after diagnosis. DCIS are pre-cancerous tumors that do not invade surrounding tissue. For these small tumors, only a lumpectomy is usually needed. This procedure removes any tumor left from biopsy and the surrounding tissue. Radiation therapy to the affected area will be required. Larger or deep tumors may indicate that the whole breast must be removed. This operation is called a mastectomy. Lymph nodes under the arm on the affected side will be removed for testing. All the nodes may be removed at surgery. Or, only a few may be removed in a special procedure, called sentinel node biopsy, in which a dye is injected at the tumor site. Examination of the breast tissue sample may result in one of these diagnosis:
	Very early stage, low grade. These cancers are very small and in one location. For a diagnosis of DCIS, testing of the tumor would indicate that the tumor is not likely to have spread. In this case, removing just the affected part of the breast with a lumpectomy may be all that is required. Radiation therapy to the affected area may also be recommended.
	Early Stage, no involved nodes. If the cancer is not responsive to hormones, the woman may be offered chemotherapy. If the cancer is responsive to hormones, then a treatment to suppress hormone activity, including drugs like tamoxifen, will be offered. Both treatments are to ensure that any possible cancer left behind is killed or suppressed. Radiation therapy to the affected area may also be recommended.
	Early stage, positive nodes. Chemotherapy will be offered to kill any remaining undetectable cancer. Women whose cancer is responsive to hormones will also receive tamoxifen or similar antihormone drugs. The kind of chemotherapy and intensity of the regimen will be determined by other factors in the tumor. Radiation therapy to the affected area may also be recommended.
	Advanced stage. When the cancer has spread to nearby structures or to other areas of the body, the goal will be to control the cancer. Chemotherapy will be offered. Antihormone drugs can be given to women whose tumors are likely to respond. Other medicine to treat problems caused by the advancing cancer will be used to relieve symptoms. Radiation therapy to the affected area may also be recommended. What are the side effects of the treatments? Surgery: After surgery, the breast can be reconstructed. Reconstruction will restore the normal shape to the breast following lumpectomy or mastectomy. The nerves to the breast area may be cut and the area may remain numb. At first, movement may be restricted. Physical therapy and exercise will restore complete function. Radiation: Women may have fatigue while undergoing radiation but will completely recover. The skin over the affected area may be darkened and feel somewhat different than normal skin. Chemotherapy: Side effects are specific to the drugs. Most are manageable and will resolve when treatment ends. Antihormone therapy: These drugs may cause menopausal symptoms even in women who have already been through menopause. These symptoms usually subside with continued use. What happens after treatment? For people with early stage disease, the side effects of therapy will eventually subside. Those with advanced disease may require changes in therapy to keep the cancer in control. How is the disease monitored? After completing therapy, a person with early stage disease will receive regular monitoring from a healthcare provider to make sure the cancer does not returned. This will include physical exams, mammograms, and other tests. Over time, the frequency will decrease. For those whose cancer is advanced, more frequent monitoring of the progress of the disease and the effect of treatment is necessary.