Breast Cancer

Overview

Breast cancer is the growth of abnormal cells in the breast usually in the milk-carrying ducts though it can also start in the milk producing lobes or in other breast tissue. Breast cancer is the most common of cancers among women affecting one in nine Canadians. One in 25 will die from the disease. Breast cancer can also be found in men though it is rare. You can lower your risk of developing the disease or dying from it through breast cancer screening and by reducing certain lifestyle and environmental risk factors.

Causes

While the causes of breast cancer are not fully understood it is known that defects in one of the two genes (BRCA1 or BRCA2) which can be inherited from a parent are the cause of 5-10% of breast cancer cases. Other risk factors include:

Known Risk Factors:

Gender: More than 98% of breast cancers occur in women
Age: risk increases as you get older
Early menstruation (before the age of 12)
Late menopause (after age 55)
Having a first baby after age 30 or never having a baby
Having a close relative with breast cancer
Being physically inactive
Being overweight
Taking hormone replacement therapy

Possible Risk Factors:

Eating too few fruits and vegetables
Drinking too much alcohol
Never breastfeeding
Smoking tobacco or being exposed to second-hand smoke
Using birth control pills

Symptoms

The most common sign of breast cancer is a lump in the breast but not all lumps are cancerous. The most important thing is to be aware of any changes in your breasts. Watch for:

Breast lumps or swelling - anywhere in the breast or underarm area
Nipple discharge -clear or bloody.
Changes in the nipple - indentation retraction itching or burning sensations
Changes in the breast's skin - flattening or indentation dimpling creasing redness scaliness or pitting of the skin
Change in breast size - change in the contour or symmetry of the breast

If you notice any of the above irregularities see your doctor immediately.

Breast self-examination does NOT replace a mammogram or a physical breast exam by a trained health care provider as a way of screening for cancer. Cancer found through BSE is usually larger or at a more advanced stage than cancer found by a mammogram.

Regular breast screening can find cancer when it is small which means:

there is a better chance of treating the cancer successfully
it is less likely to spread
there may be more treatment options

Cancer Care Ontario recommends breast screening as follows:

For all women:

Have a yearly physical breast exam by a trained health care provider such as a family doctor or an OBSP Nurse Examiner. (The Canadian Guide to Clinical Preventive Health Care Guidelines recommends this just for women aged 50-69.)
Be aware of any changes in your breasts. If you find any changes go see your doctor or health care provider.

If you are age 50 to 74

Scientific studies show that breast screening in this age group can reduce deaths due to breast cancer. The OBSP encourages all Ontario women aged 50-74 to go for regular breast screening including a mammogram at the OBSP site nearest you.
It is important to find breast cancer early. Have a mammogram every 2 years at the same time of the year. Some women need to go every year.

If you are over 74

Mammograms are not universally recommended for women over the age of 74. Talk to your doctor or health care provider to find out if breast screening may benefit you.
If you decide after talking with your doctor or health care provider that you would like to be screened at the OBSP you are welcome to call for an appointment.

If you are in your forties:

Mammograms are not universally recommended for women age 40-49. If you are in your forties talk to your doctor or health care provider about the pros and cons of mammograms. Women with a family history of breast cancer or with other concerns may benefit.

In recent years screening programs and better treatments have helped decrease the number of women who die from breast cancer. However it is important for women to know in advance of taking the test that there is a significant rate of "false positives". This is when a woman has a mammogram and the doctor flags a problem which needs further investigation but which ultimately turns out not to be a problem at all. Further investigations might include a second mammogram or an ultrasound or even a biopsy. It is important to know this "going in" as getting an apparent positive result can be quite traumatic.

Treatment

Early detection of breast cancer is the key to successful treatment. When treated in the early stages there is a 95% chance of a five-year survival rate. Cancer treatments are either local or systemic.

Local treats the immediately affected area usually involves surgery or radiation therapy.
Systemic treatments are used when the cancer has spread through the body or to prevent re-occurrence and usually take the form of drugs.

Since everyone is unique treatments vary according to the patient and the cancer (including its stage and grade). There are five treatment options for breast cancer:

Surgery

Surgery can be in the form of a lumpectomy or a mastectomy. There are several degrees of a mastectomy - a subcutaneous a simple a modified radical a partial and a radical.

A lumpectomy involves removing the lump or mass and saving as much of the breast as possible. In most cases radiation therapy is also required.
A subcutaneous mastectomy or skin-sparing mastectomy is the removal of tissue through a small incision. This leaves the skin and nipple intact.
In a simple or total mastectomy the entire breast the nipple and some skin are removed.
In a modified radical mastectomy the entire breast and some underarm lymph nodes are removed
In a partial or segmental mastectomy the tumour is removed as well as the surrounding breast tissue and the lining of the chest muscle and some lymph nodes under the arm might also be removed. Again radiation therapy is required in most cases.
In a radical mastectomy the entire breast the nipple skin lymph nodes some nerves and the underlying muscles are removed.

Women may have reconstructive surgery at the same time as they have their tumour removed. When the chest muscles are still intact breast reconstruction is less complicated.

Radiation therapy

Radiation therapy may be required after a lumpectomy or mastectomy especially if lymph nodes were affected to kill any cancerous cells and prevent further spread of the cancer. Therapy usually begins 3-4 weeks after surgery and occurs 5 days a week for 5-6 weeks.

Chemotherapy

Chemotherapy uses two or more drugs in different combinations to kill cancer cells. Drugs can be taken in pill form or intravenously. Treatments last between three months to a year.

Hormone therapy

Hormone therapy uses drugs to block estrogen or progesterone from binding and is used to treat advanced (metastatic) breast cancer and receptor-positive cancer and to prevent a recurrence of cancer. The most commonly used drug is Tamoxifen and it can be used indefinitely.

Biological therapy

Biological therapy is also called biological response modifier or immunotherapy. It is used to stimulate the immune system into fighting the cancer.

Prevention

While there are risk factors for breast cancer that you cannot change (such as your age your family history or your reproductive history) you can substantially reduce your risk by making positive changes to your lifestyle:

Lose excess weight. Even a small degree of excess weight 5 kg. (11 lbs. and greater) is associated with increased breast cancer risk especially among postmenopausal women.
Be physically active. Studies show that even moderate physical activity may reduce your risk by 30 to 40 per cent. Choose an exercise or activity that makes you feel warm and breathe harder (such as brisk walking) for at least 30 minutes on 5 or more days of the week.
Limit your intake of alcohol. Women who drink alcohol have a modestly increased risk. The more you drink the greater your risk. Limit yourself to not more than one drink per day - 12 ounces (340 mL) of beer 5 ounces (140 mL) of wine or 1.5 ounces (42 mL) of spirits.
Breastfeed your baby. Breastfeeding seems to offer some women protection against breast cancer and it's good for the baby. Breastfeed for at least four months.
Quit smoking. Smoking tobacco and breathing second-hand smoke have been linked in some studies to breast cancer. Tobacco smoke is responsible for 30 per cent of all cancer deaths.
Talk to your doctor about the risks and benefits of hormone replacement therapy (HRT). HRT can relieve symptoms of menopause and reduces the risk of osteoporosis and colon cancer. However HRT increases the risk of breast cancer and heart disease.
Although there is no compelling evidence suggesting that exposure to pesticides and other potentially harmful chemicals is related to breast cancer risk it would still be prudent to minimize exposure to these agents. Follow the warnings and handling procedures in material safety data sheets (MSDSs) that are available for most chemicals. Work with your employer to ensure that your workplace has good air quality and that chemicals are properly handled.