Breast cancer occurs when the cells of the
breast (the building blocks that make up our body) starts
growing independently without the body needing or instructing
them to do so.
What causes breast cancer
Most people would like to know what causes breast cancer. Why have I developed breast cancer? Why has my wife, sister, daughter or friend developed breast cancer? Is it something that I (they) did or failed to do? Is there something I (they) could have done to prevent it from happening to me (them)?
There are no known direct causes of breast cancer but there are some things that increase the possibility that one person will develop it compared to another. Many of these factors either cannot be changed or it is not desirable to change them. These are:
Age – The older a woman is, the more likely it is that she will get breast cancer.
Estrogen – Amount of estrogen the body is exposed to. Estrogen is one of the female hormones. It is essential for women to have adequate amounts of it in their body. However, the body should not be continuously exposed to it without break. These breaks occur naturally when a woman becomes pregnant and breast feeds. Therefore situations that lead to exposure of the woman’s body to estrogen either naturally or artificially are associated with increased risk of breast cancer. These include, starting one’s menses at an early age (before 12 years), continuing to menstruate till late in life (beyond 55 years), never having a child, or having the first child late in life (after 30 years of age), As you can see these things are not under our control. However we can control artificial exposure to estrogen such as use of some oral and injectable contraceptives, fertility pills, etc.
Body size and shape - The taller one is, the more likely it is that one will develop breast cancer. People who become or remain fat after their regular menstruation has stopped also have increased risk of breast cancer. In all age groups, accumulating fat around the tummy and waist increases risk of breast cancer.
Family history – The risk of breast cancer is higher in those women whose mother, sister(s) or daughter(s) have developed it
Past history of breast cancer – Women who have developed breast cancer in one breast have an increased risk of developing it in the other breast
Some benign breast diseases – Some women have had lumps removed from their breast which the doctor has told them is not cancer. Some of these lumps however may have features that suggest that the person may develop breast cancer in the future and should be closely monitored.
What is certain is that the development of breast cancer is not the individual’s fault. It is not directly related to diet nor is it an infection. It is not sexually transmitted and you can not catch it from close contact with somebody who has it.
How can one recognize breast cancer
The earliest evidence of breast cancer is the presence of a painless lump in the breast (this also called a swelling, tumour or mass). This swelling feels like a “boil” except that it is painless. A woman who feels something like this in her breast should see her doctor immediately. All such lumps must be removed and tested. A breast that is harboring early breast cancer does not look or feel different from normal. It does not cause aches, pain, fever, vomiting, frequent stooling, or loss of appetite neither does it interfere with day to day activities. You do not need to have seen or heard of it before. And it probably has never occurred in any member of your family or anyone you know. At this stage, there is still hope that the disease may be cured with treatment.
Breast cancer may also start as a wound (ulcer) of the nipple and or the skin surrounding it.
In some women on the other hand, the nipple may start to sink into the breast. It is no longer situated at the same level as the other side. When you compare the picture below with the first picture in this brochure, you see that there is an obvious swelling above the nipple and the nipple itself has changed size and position.
This case is already quite advanced and it is better to come to hospital before this stage. If the lump is neglected, it continues to increase in size. It may grow through the skin to form a sore (ulcer, wound) which discharges foul-smelling blood and liquid, and which does not heal except the cancer is treated.
As the disease progresses, it spreads to other parts of the body like the brain, lungs, bones and liver – a process called metastasis. It is spread to these areas that cause harm and once this has occurred, though treatment is still necessary, cure is practically impossible.
Such spread may be recognized by the presence of cough, difficulty with breathing, swelling of the tummy, pain in the bones especially those of the back, leg weakness or paralysis.
Is early detection possible
Early detection is possible through the practice of breast awareness. These are a series of steps that a women does once a month to check her breasts for lumps, thickenings, and other signs of breast disease. Ask your doctor to teach you about breast awareness and to examine your breasts at least once every year. Yearly mammography may also be useful.
Staging of Breast Cancer
The extent of spread of the disease in a patient is described by “staging” and these are -
Stage I: Tumor is smaller than or equal to 2 centimeters in diameter and underarm (axillary) lymph nodes test negative for cancer.
Stage II: Tumor is between 2 and 5 centimeters in diameter with or without positive lymph nodes, or tumor is greater than 5 centimeters without positive lymph nodes.
Stage III: This stage is divided into substages known as IIIA and IIIB:
IIIA: Tumor is larger than 5 centimeters with positive movable lymph nodes, or tumor is any size with lymph nodes that adhere to one another or surrounding tissue.
IIIB: Tumor of any size has spread to the skin, chest wall, or internal mammary lymph nodes (located beneath the breast and inside the chest).
Stage IV: Tumor, regardless of size, has spread to distant sites such as bones, lungs, or lymph nodes not near the breast.
Stages I and II are early, while III and IV are advanced breast cancer.
How is breast cancer treated
Early breast cancer is treated by:
Surgery – This may be removal of the entire breast or a part of it. What is done depends on several factors and you should discuss this with your doctor.
Chemotherapy – This is the use of drugs to destroy cancer cells that may have spread to other parts of the body or to shrink the swelling in the breast. Though these drugs have side effects, there are many ways doctors can control these and make the experience of chemotherapy tolerable for patients.
Hormone treatment – This is the use of drugs that alter the rate of growth of the cancer by adjusting the hormonal composition of the body. It can be done by surgery, radiotherapy or drugs.
Radiotherapy – This is the use of high energy rays to destroy the cancer cells.
Many options are available to the patient with breast cancer depending on the stage of the disease, the desire of the patient, cost, ability to comply with complex treatment plans and available facilities.
Treatment takes a long period of time and requires many hospital visits. It is also expensive and may require significant amount of time away from work and home. A patient must discuss these issues with her doctor.
It is important for the patient who has breast cancer to discuss with members of her family so that she can educate them about the illness and help them to initiate breast awareness. She will also benefit from their support and encouragement.
Outcome of treatment
The result of treatment in any one individual may differ from another. The outcome of treatment depends on:
Stage at diagnosis. The earlier the stage the better the result of treatment
The biological nature of the cancer in the individual. We determine this from laboratory tests that are done on the tumour after its removal from the patient
Compliance with an adequate and well formulated treatment plan
Where there is no armpit swelling (axillary nodes), and the cancer is 3 cm or less in diameter, more than 90% of such patients are alive in five years. 60% of patients with 2-4 armpit nodes involved will be free of disease in five years compared with 40% with 6 – 10 nodes involved.
What if the patient’s disease is already advanced? Does that mean nothing can be done? Where there is life, there is hope. The data quoted above refers to the result from large numbers of patients; no doctor can tell you that this is what will happen in your individual case, so always expect the best. Even when the disease is not responding to treatment, doctors can still do a lot to make sure that patient does not suffer or have pain.
What about traditional/alternative /complementary treatment? Everybody who looks after patients with breast cancer wishes for quick cure so that patients will no longer suffer. Unfortunately, the best science has to offer is still not good
Designed and Produced by
Professor Clement A. Adebamowo, Division of Oncology, Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria