An Overview Of Breast Cancer Michael.

McFarlane, Contributor Breast cancer is the most common cancer among women in Jamaica, followed in incidence by cancer of the cervix, large bowel and uterus. The diagnosis of breast cancer is fraught with significant concerns for women, which include treatment options, follow-up care and issues relating to long-term survival. For women who do not have breast cancer the significant concern is the potential risk of developing a breast cancer. Risk The lifetime risk of developing a breast cancer falls in the intermediate range with 43 new cases of breast cancer diagnosed per 100,000 of the population. All women are at risk for breast cancer and while men may develop breast cancer they are 100 times less likely to develop a breast cancer. Other factors include age, changes in the levels of circulating hormones during life, the age at menstruation, the age at first child birth, number of pregnancies, the age at menopause, obesity and the level of physical activity. Breast cancer risk is increased in women with a strong family history or a known genetic mutation but this risk only accounts for five to 10 per cent of all breast cancers. More than 80 per cent of women who develop a breast cancer have no known risk factors. The risk of a 50-year-old developing a breast cancer in 20 years is only two per cent and increases to four per cent if a firstdegree relative (mother, sister or daughter) had a breast cancer. Early detection Early detection has the greatest impact on survival. Cancers that are less than 10mm in diameter when detected are associated with more than 98 per cent chance of long-term survival whereas cancers detected at 5cm or more in diameter are associated with a 60 per cent chance of long-term survival. Screening Screening allows detection of cancers in women without symptoms and allows detection of the cancer at an earlier stage than would be found by random examination. All women in their 20s and 30s should have a clinical breast examination every three years. At age 40 all women should have clinical breast examinations yearly and should start yearly mammograms. Breast self-examination is also an additional option for women and should be done monthly preferably in the first week following the periods or at the same time monthly for women not menstruating. Digital mammography, which allows X-ray pictures of the breast to be stored on a computer (rather than film) allows ongoing analysis of the changes in the breast on an annual basis, with the added benefit of analysis by the computer. This technology offers significant benefits over film mammography for premenopausal women and those with dense breasts. Also women at high risk for developing breast cancer should have a magnetic resonance imaging (MRI) scan along with their annual mammogram. Even though mammography allows detection of breast cancers before they cause symptoms, some cancers are missed and cannot be detected by this method. It is important for women to know that mammograms are not foolproof. They can miss up to 25 per cent of cancers that may be detected during a physical examination. Moreover, nearly 80 - 90 per cent of suspicious mammograms turn out to be benign. The most common sign of a breast cancer is the presence of a lump in the breast, which is usually

painless. Any change in the normal appearance or the texture of a woman's breast may be a sign of breast cancer and requires urgent attention by a physician. Other signs include the following: An area of thickening Redness of the skin

Change in the nipple, for example,. discharge or inversion or scaliness Dimpling of the skin of the breast A lump under the arm Swelling of all or a part of the breast.

Diagnosis Once there are signs or symptoms that suggest breast cancer further evaluation may be necessary to confirm the diagnosis. A definitive diagnosis of breast cancer can only be made by taking a sample of the suspicious tissue for microscopic examination. This is called a biopsy. Treatment The treatment of breast cancer involves four approaches namely surgery, radiotherapy, chemotherapy and hormone therapy. >Most patients will require some form of surgical treatment. The initial surgical treatment is usually a lumpectomy (removal of the lump) for most patients with early stage disease or mastectomy (removal of the breast). Breast conserving procedures like lumpectomy are now considered to be appropriate treatment and as successful as the mastectomy procedure for most women with early stage breast disease and are followed by a course of radiotherapy. Newer forms of mastectomy are now available and allow spectacular results following total mastectomy. Skin-sparing mastectomy allows removal of all of the breast tissue leaving the skin of the breast intact. This procedure may even be done in selected cases without removal of the nipple and is called a nipple-sparing mastectomy. Immediate plastic surgery is required for reconstruction of the breast, which yields excellent results. Cosmetic surgery performed during or after mastectomy allows restoration of a normal appearance and allows women who choose this procedure to have an improved sense of well-being and a better quality of life. New technology for administering radiotherapy called accelerated partial breast irradiation (APBI) involves giving the complete dose over a period of five days or as a single large dose in the operating theatre immediately after lumpectomy instead of the usual five-week course. This technique provides tumour control similar to whole breast radiation for selected patients with excellent cosmetic results. As information improves about the genetic changes that cause cancer, scientists have been able to develop drugs that that are more specific with fewer side effects. This is called targeted therapy and these drugs work differently to the standard chemotherapy drugs. Some of these drugs, for example,

Herceptin belong to a class of newer agents called monoclonal antibodies which specifically retard the effects of certain protein from causing too much growth of the cancer cells. Other agents affect the growth of small blood vessels (angiogenesis) necessary for the growth of the cancer. Prognosis More than 88 per cent of women diagnosed with breast cancer will survive at least 10 years when the diagnosis is made early and the majority of these women will go on to have long term survival. Dr. Michael.McFarlane is a senior lecturer and consultant surgeon at the University Hospital of the West Indies; email: yourhealth@gleanerjm.com.