Breast Cancer

 

Breast Cancer  

 

Introduction

The female breast is a secondary sex organ located above the pectoral muscle of the torso. The breasts, also called mammaries, allow a mother to lactate in order to produce milk for an infant child. Each breast is composed of fatty tissue and mammary glands, which are connected to the nipple via milk ducts. Every year roughly 232,000 women in the United States are diagnosed with breast cancer. Cancer is defined as the uncontrolled growth of abnormal cells in the body. Breast cancer is a form of cancer that commonly appears in the inner lining of the milk ducts or the lobular areas within the mammary gland. During its later stages, breast cancer may also spread to the lymph nodes (bean shaped masses that filter the blood) near the neck and armpit. Currently about 1 in 8 U.S women, and 1 in 1000 men in the U.S. will develop breast cancer over the course of their lifetime.  Despite this high diagnosis rate, the survival rate of those who are diagnosed with stage 0 cancer is up to 93% for non-invasive duct related growths.

There are four types of breast lumps, which can form within the breast: cysts, fibroadenomas, pseudolumps, and malignant tumors. Cysts are harmless (benign) fluid filled sacs of tissue, that can grow within the breast. Like cysts, breast fibroadenomas are also benign, and are composed of fibrous and glandular tissues. Pseudolumps are also benign and may be composed of scar tissue, hardened silicone, or dead fat cells. A malignant tumor, unlike the other types of breast lumps, is cancerous and not benign. A malignant tumor is an irregularly shaped hard mass of cells that accounts for roughly 20% of all breast lumps.

 

What are the causes and risk factors of cancer?

Breast cancer forms when normal breast cells undergo certain changes in their DNA. DNA is a nucleic acid contained in cells that dictates the genetic code of organisms. These changes to our DNA cause the breast cells to multiply uncontrollably. BRCA1, and BRCA2 are tumor receptor genes that work to prevent cancer tumors from forming. In certain families, these tumor receptor genes may be mutated, which creates up to an 80% chance of developing a cancerous body. Roughly 10% of all breast cancers can be traced to genetic factors.  Other factors that may effect the probability of breast cancer include:

·      Heredity: Having a mother, sister, or daughter with a past experience of breast cancer doubles a female’s risk.

·      Race and Ethnicity: White women are less likely than African-Americans to get breast cancer while Asian, Hispanic and Native-American women have a lower risk of getting and dying from breast cancer when under the age of 45.

·      Menstrual Periods: Women who experience early periods before the age of twelve and menopause after the age of 55 also have a slightly increased risk. This risk may be due to higher overall exposure to the sex hormones estrogen and progesterone.

·      Gender: Above all, being a female is the primary risk for breast cancer. Males are also diagnosed with this disease, although it is over hundred times more common in women than men. This lowered risk for male breast cancer is due to lower levels of circulating estrogen in the body.

·      Having Children: Not having children or having them after the age of 30 causes elevated risk, while having had multiple pregnancies lowers it.

·      Hormones: Recent use of birth control pills, or hormone therapy (such as post-menopausal hormone therapy (PHT) or hormone replacement therapy (HRT)), also increases risk.

·       Lifestyle Choices: Other risk factors include not breast-feeding, daily alcohol consumption, obesity and lack of exercise.

 

Symptoms of Breast Cancer

The early stages of breast cancer are often asymptomatic (are not accompanied by any visible symptoms). This is why regular breast examinations are so important. Symptoms of early breast cancer may include a irregularly shaped lump in the breast or armpit; changes in the shape, feel, or size of the breast or nipple; or a bloody or clear to yellow fluid coming from the nipple. As breast cancer advances, breast tenderness will increase-leading to bone pain, skin ulcers, swelling of the armpit, weight loss, and inflammation.

 

Screening for Breast Cancer

Early detection of breast cancer is the most effective way to improve chances of survival. The American Cancer Society (ACS) recommends three different methods of screening for most adults: mammograms, clinical breast exams, and breast self-exams.

1. Mammography is currently the most effective method of screening for breast cancer. This technique involves taking an X-ray picture of the breast to detect the presence of dense lumps of tissue. During a mammogram procedure, a radiology technologist will place a female breasts onto a plate that contains an X-ray film. Another plate will push the breast down against the film to secure the breast and obtain a clear image. While the patient raises one arm, a picture of each breast will be taken and later reviewed by a qualified radiologist. Abnormal results, such as fluid-filled pockets, or calcifications (solid bits of calcium), appear as solid white-colored masses on the X-ray. The ACS recommends women begin receiving mammograms at the age of forty and attend regular return visits every two years from the ages of fifty to seventy-four.

   

2. A clinical breast examination (CBE) is a physical examination of the breast done by a health professional. CBEs are often used in conjunction with regular mammograms, which result in the most effective screen for breast cancer.  The ACS recommends a clinical breast exam (not necessarily a mammogram) be performed every three years for women in their twenties and thirties, and annually for women over forty. During a clinical breast exam, a health professional will ask the patient questions about any current problems he or she may be experiencing, along with a medical history and any potential risk factors. The examiner will then ask the patient to remove his or her clothes from the waist up and lie on the examination table. Each breast, underarm, and collarbone will be inspected for changes in size, skin changes, or signs of injury or infection (bruising or redness). After the visual inspection, the doctor or nurse will feel each breast for any unusual painful areas from the region one inch below the breast to the collarbone, as well as the armpit (axillary area) and around the neck (lymph nodes). Following the examination the doctor may instruct the patient on how to examine themselves using the breast self-exam method.

 

3. Breast self-exams (BSEs) are a simple and relatively effective way to screen for changes in breast tissue at home without a doctor or nurse. A BSE should be conducted with a doctor’s approval, one week after your normal menstrual period begins every month. This is the period when breast tissue is likely to be swollen or tender. To conduct the exam, begin by removing all clothes above the waist. Visually inspect the breasts in front of a mirror with arms at your sides, above your head, and on your waist for any noticeable changes in appearance or coloration. For most women, breasts are not identical, so do not be alarmed if they are not exactly the same size or shape. Next, raise one arm and inspect the upper areas of the breast and the armpit for any lumps, rashing, or dimpling. With one arm still raised, lightly squeeze the nipple to check for variation in color, density, or any kind of discharge. Finally, lay down on your back. Using the pads of the three middle fingers of your left hand, move in small coin-sized circles over the right breast. Repeat this procedure using the other hand for the left breast. Implement lighter levels of pressure to check tissue close to the surface of the skin, while using higher levels to check tissue close to the ribs or breastbone. Continue to examine the entire breast using a lengthwise strip, or spiral pattern that extends from the collarbone to the bra line, and from the armpit to the breastbone. By the end of a BSE, women (and men) should know how their breasts look and feel normally. Any unexpected changes should be promptly reported to a doctor for further examination.

 

Diagnosis

If a mammogram detects a breast lump, a biopsy is conducted to determine whether the abnormality is cancerous. During a biopsy, a sample of the irregular tissue is removed and inspected under a microscope by a specialized doctor referred to as a pathologist. The pathologist will use a number of tests to determine if the tissue is cancerous.

In a needle aspiration biopsy, the doctor uses a hollow needle attached to a syringe to withdraw (or aspirate) a specimen of the tissue. Once the needle is in place, fluid or tissue is drawn out. Clear fluid indicates a benign cyst, while cloudy or bloody fluid indicates the possibility of cancer. When solid tissue fragments or a bloody fluid are withdrawn, they are inspected under a microscope to determine the type of lump or cyst and its severity.

Usually, breast cancer is diagnosed using the “needle aspiration” biopsy technique. Occasionally, however, surgery is required to remove all or part of the lump for inspection because a needle aspiration biopsy is inconclusive. This is referred to as a surgical or “open” biopsy. During and open biopsy, the surgeon removes the entire cancerous mass and abnormal area as well as the surrounding perimeter of the normal-appearing breast tissue. This is called an excisional biopsy. If the mass is too large to be removed easily, only part of it may be excavated in an incisional biopsy. Surgical biopsies are more invasive than needle aspiration biopsies and often lead to stitches, scarring, and a change in shape of the breast.

 

Treatment

Breast cancer is treated in several different ways, depending on the kinds of breast cancer and how far it has spread. Hormonal therapy, immunotherapy, chemotherapy, radiation and surgery are common treatments used for various types of cancer, including breast cancer.

·      In hormonal therapy, levels of hormonal estrogen are lowered or blocked from breast cancer cells to prevent cancer cells from getting the hormone levels they need to grow.

·      Immunotherapy works with the body’s immune system to fight cancer or control side effects from other types of treatment.

·      Chemotherapy implements drugs or medicines that can shrink or kill the cancer.

·      Radiation therapy uses high-energy rays to kill cancer cells.

·      Surgical treatments, either lumpectomy or mastectomy, cut out and remove cancerous tissue from the body.

There are two types of mastectomies: radical mastectomy and partial mastectomy. In a radical mastectomy, the breast is completely removed, including the nipple, overlying skin, muscles beneath the breast, and lymph nodes. Unlike a radical mastectomy, partial mastectomies are used in less severe forms of stage I or II breast cancer. A lumpectomy, a type of partial mastectomy, is a common surgical procedure designed to remove a breast lump or benign tumor and the surrounding tissue. Lumpectomies are far less invasive than mastectomies and involve a local incision that allows for the breast to be spared. Today, radical mastectomies are rarely performed, as they are generally not as effective as less invasive forms of mastectomy procedures. Mastectomies and lumpectomies are often followed by radiation and chemotherapy to ensure the cancer has been completely removed and will not return.

 

 

Breast cancer and its treatment may or may not affect a woman’s sexuality in a number of different ways:

1. Feelings of grief and fear triggered by the cancer diagnosis may temporarily reduce sexual drive.

2. The side effects of the cancer treatment may be debilitating, and impair sexual behavior.

3. Some treatments may have impaired libido or decreased physiological arousal due to hormone changes in the body.

4. Women who have encountered breast cancer (especially in the case of mastectomy recipients) may fear that they are no longer attractive to their partner.

 

Women diagnosed with breast cancer are encouraged to discuss their issues to help resolve them. Currently, the American Cancer Society offers counseling to women who have undergone a mastectomy to help them cope with the change. Even so, most women who have had a mastectomy report no change in the key aspects of their sexuality (like frequency of sex or overall satisfaction).  Modern techniques of breast reconstruction are now able to rebuild the breast mound using skin graphs and fat from the abdomen. The nipple may also be replaced and connected to recipient blood vessels to create a symmetrical and realistic breast for healthy sexual function. Women with breast-conserving surgeries, such as lumpectomies, are even less likely than mastectomy patients to report enduring post-cancer sexual difficulties.

 

References:

http://www.cdc.gov/cancer/breast/basic_info/treatment.htm

http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-di...

http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-what-causes

http://www.mayoclinic.com/health/lumpectomy/MY00833

www.ncbi.nlm.nih.gov           

http://breastcancer.about.com/od/risk/a/lump_overview.htm

http://www.breastcancer.org/symptoms/understand_bc/statistics

http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-ov...

http://women.webmd.com/breast-self-examination?

http://women.webmd.com/clinical-breast-examination

http://women.webmd.com/mammogram

http://www.cdc.gov/cancer/breast/basic_info/treatment.htm

http://www.cancer.org/cancer/breastcancer/moreinformation/breastreconstr...

LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2009. 58-60. Print.

 

Last updated 10 March 2013.

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