Breast Cancer | What treatments are used for invasive breast cancer
Breast cancer is the one of the commonest malignancies afflicting women. In some parts it is the most common malignancy. It is currently estimated that one in 14 of all female children born will develop breast cancer
in their lifetime.
Despite extensive investigation into the cause of breast cancer there is still no known cause.
What are the risk factors for breast cancer?
The exact cause of breast cancer is not known and most likely involves many factors:
Geographical: It is much more common in the western world.
Genetic: A family history of breast cancer will increase the risk of developing breast cancer in a woman by three to five times. Recently, a breast cancer gene (BR CA 1) has been identified. If a woman has this gene present in her chromosomes, there is an 85% chance of developing either breast or ovarian cancer, or both in her lifetime.
Hormonal: It appears to be more common in women who did not bear children. It is also less common in women who have their first child at early age.
Women who started their menstrual periods before age 12, those who delayed menopause until after age 55, and those who had their first pregnancy after age 30 have a mildly increased risk of developing breast cancer (less than two times the normal risk).
What factors have a protective effect?
Pregnancy and breast feeding have a protective effect in preventing breast cancer.
How is breast cancer diagnosed?
The prognosis of breast cancer is closely related to the stage of disease at the time of diagnosis, therefore screening for breast cancer is extremely important. Numerous studies have confirmed that populations which get screened for breast cancer yield patients having much smaller tumors with much better prognosis. Currently, mammography and breast examination serve as the foundation in screening for breast cancer. Mammography is an x-ray examination of the breast. It has the ability to detect a cancer in the breast when it is quite small, long before it may be felt by breast examination. Eighty-five to 90% of all breast cancers are detectable by mammography. Approximately 10 to 15 percent of breast cancers are not visible on mammography, but can be felt on physical examination of the breast.
The imporatance of Breast Self Examination cannot be overstressed. A percentage of breast cancers is not seen on mammography and it is extremely important for a woman to perform Breast Self Examinations.
Currently, it is recommended that a woman should have a baseline mammogram between the ages of 35 and 40 years. Between 40 and 50 years of age mammograms are recommended every other year. After age 50 years, yearly mammograms are recommended.
Other diagnostic tests and procedures:
Breast BiopsyUltrasound: An ultrasound is a test that uses sound waves to visualize structures inside the body. It is often used to distinguish between cysts and solid tumors in the breast. Fluid within cysts can be aspirated (withdrawn with a needle and syringe) for analysis in the laboratory.
Biopsy: It is a procedure which involves removal of a piece of tissue to analyze under the microscope. Biopsy still remains the only confirmatory test for breast cancer.If an area of the breast is suspicious for a cancer, a biopsy is usually performed to confirm or deny the diagnosis.
What treatments are used for invasive breast cancer?
The treatment of breast cancer is determined primarily by the stage of the disease.Currently, in most of the cases when breast cancer is detected it is already an invasive cancer.This generally requires a combination of treatment modalities.The treatment plans are divided into local therapy and systemic therapy.
It is designed to remove or kill the cancer cells in the breast and adjacent lymph nodes.It involves surgery, radiation, or both.
SSurgery involves removal of a part or whole of the cancerous breast and in most cases removal of lymph nodes in the axilla.The exact extent of breast removal depends on the extent of spread and the surgeon’s choice.Sometimes it is possible to provide the patient with a few alternatives regarding the extent of breast removal.
There are many terms used in connection with breast cancer surgery. Mastectomy is a general term for removal of the breast. A modified radical mastectomy involves removal of the breast and the axillary lymph nodes. A simple mastectomy removes the breast, but not the lymph nodes. Lumpectomy, partial mastectomy, and quadrentectomy refer to removing only a portion of the breast. An axillary dissection means removal of a portion of the lymph nodes under the arm.
Radiation therapy is the use of special high energy x-ray beams to kill rapidly growing cells, such as cancer cells. Since it is not always possible to remove all the cancerous cells, especially in the lymph nodes, radiatiion therapy is used to kill as many cancer cells as possible. It is a generally a painless treatment and is given in an outpatient setting without the need for hospitalization.
A systemic therapy is incorporated to treat the potential and actual risk of cancer cells spreading elsewhere. This systemic therapy is called chemotherapy, and utilizes drugs to kill cancer cells.
What happens after the surgical procedure?
After surgery the presence or absence of cancer in the lymph nodes plays an important role in determining further treatment. If the cancer has spread to the lymph nodes, the risk of the cancer recurring is much higher and the addition of chemotherapy and/or hormonal therapy is usually indicated.
Chemotherapy and hormonal therapy, used in addition to surgery, is known as adjuvant systemic therapy. The purpose of this therapy is to eradicate microscopic deposits of breast cancer cells which still may be present in other areas of the body.
Chemotherapy in adjuvant breast cancer treatment
usually involves using a combination of drugs, typically, cyclophosphamide (CYTOXAN or NEOSAR), methotrexate, and 5-flourouracil (CMF), or cyclophosphamide, doxorubicin (ADRIAMYCIN, RUBEX) and 5-flourouracil. Currently, six cycles of chemotherapy which encompasses about six months of therapy is standard.
Breast cancer tissue is also tested for estrogen and progesterone receptors, or the so-called hormone receptors. The hormones have a role in promoting the growth of cancerous cells. If these hormone receptors are present, the use of an anti-estrogenic agent called tamoxifen can be used. In older, post-menopausal women it can decrease the risk of recurrent breast cancer similar to the decrease seen with the use of chemotherapy.
There are a few important things which will go a long way in fighting breast cancer.
* The best chance of eliminating breast cancer is prevention.
* Women themselves can do a lot by doing breast self examination and thereby detecting any suspicious growth at the earliest.
* Early diagnosis of breast cancer can be achieved with routine mammography and early biopsy of suspicious lesions. The earlier a breast cancer is found, the better the chances of a cure.
* The more the community is educated about breast cancer issues, the better chance we have of this deadly disease.