Importance of Breast Cancer Screening - Term Paper Example

Breast cancer is the cancerous growth of tissues within the breast giving rise to malignant tumors. Females are more prone to breast cancer than men due to constant exposure of breast cells to estrogen. The individuals having first-degree family history of BRCA1 or BRCA2 gene mutation are highly prone to breast cancer. Ethnic specific mutations of BRCA1 and BRCA2 are found in Ashkenazi (European) Jewish origin and in some families in Iceland, the Netherlands, and the Balkans. American Cancer Society has reported that breast cancer related deaths are declining due to increased awareness among the population. Like all the cancerous growth, early stage breast cancer also does not produce any clinical manifestations to get it noticed early. Therefore, recommended check up guidelines should be followed regularly with alertness before major clinical manifestations are observed. Early stage diagnosis of breast cancer and its treatment, may actually cure the cancer. The different treatment alternatives for breast cancer include surgery, radiation therapy, hormonal therapy, and/or chemotherapy. Proactive preventive measures of cancer are related to reducing potential causes of breast cancer. Aromatase inhibitors are used to prevent recurrence in early-stage breast cancer and are under clinical trials as prevention measures in high-risk postmenopausal women. Introduction Breast carcinoma is uncontrolled growth of cells causing lump or mass of tumor in the breast. In breast cancer, normal cells grow abnormally and give rise to transformed cells which eventually spreads in the body. These evade on healthy cells, tissues and organs by depriving them of essential nutrients and space. It is the second most leading cause of cancer mortality in US. National Cancer Institute has estimated that in the US, 0.5% women will develop breast cancer by the age of 50 and it may rise to10% by the age of 80 (Paddock). In 2007, it was estimated that 178,480 new females with invasive breast cancer will be diagnosed in addition to 62,030 cases of in situ breast cancer (Breast Cancer Facts & Figures 2007-2008, p.2). The breast cancer related deaths equal to 40,460 women was predicted in 2007. American Cancer Society has reported that breast cancer related deaths are declining due to increased awareness among the population. This decline could be directly attributed to more number of women undergoing screening test like mammography. This makes early diagnosis possible and early treatment leads to better clinical outcome in terms of improved survival rates. Still women between the ages of 45 and 55 are predisposed to breast cancer related deaths. Importance of breast cancer screening; early detection; monthly self-breast exams The breasts are made up of lobules (milk producing glands), ducts (passages from glands to nipple), and stroma (fatty tissue, blood vessels etc.). The type of breast cancer is classified according to the part of the breast which is getting affected due to tumorous growth. 80% cases are ductal cancer, 10-15% cases are lobular cancer, and remaining cancers like medullary cancer, colloid cancer, tubular cancer, mixed tumors, metaplastic carcinoma are less frequently observed. Breast carcinoma is also broadly classified into invasive type, noninvasive type or combination of both. Ductal and lobular cancers are noninvasive or carcinoma in situ. The cancer which has spread to other parts is called invasive or infiltrating breast cancer. It is very important to diagnose breast cancer as early as possible even before any clinical signs develop. Breast cancers are diagnosed by mammogram screening. It is necessary for females above 40 years should do mammograms (x-ray of breast) annually. Physical examination by clinician and self physical examination are necessary as a routine activity. Monthly breast self-exams are necessary to inspect for alterations in the breasts or any lump formation. It should be remember that these changes are besides normal swelling, tendering due to aging or menstruation, hormonal pills, or pregnancy etc. If any lump formation, or clinical manifestations or abnormal mammogram leads to further evaluation. The physician asks medical history (family history of the patient due to its inherent disorder character), and get informed by observing and asking patients symptoms and risk factors related to breast cancer. The doctor examines the patient by raising hands of the patient and abnormal lump formation. Then diagnostic mammogram by breast imaging techniques like ultrasound or magnetic resonance imaging is done to investigate the infected area in detail. This would help to valuate spread and extent of cancer. Any suspicious growth is further screened using needle or surgical breast biopsy depending upon the type of patient and doctor. This positively confirms the presence or absence of malignant tumor in the breast (Breast Cancer Treatment Guidelines for Patients, Version VIII, 2006, p. 7-10). Analysis of causes, effects, risk factors and symptoms of breast cancer The factors attributed to potential cause of breast cancer are discussed below (American Chemical Society, 2009): Gender: Females are more prone to breast cancer than men due to constant exposure of breast cells to estrogen. Age: The chances of breast cancer increases with the age. It has been noted that until 45 years of age 12.5% invasive breast cancers cases are found and after the age of 55 the number rises to 66.6%. Genetic factors: The mutation in the breast cancer genes (BRCA) is one of the causes of developing breast cancer. But, only 5% of female population suffering from breast cancer have altered BRCA gene. In the United States, less than 1% of all breast carcinomas occur in men. (Tai et al., 2007, p.1811). BRCA1 and BRCA2, is generally responsible for developing the breast cancer. Genetic disorder is caused by passing altered gene from one of the parents to their offspring. Therefore, family history of hereditary diseases plays an important role in genetic counseling for both men and women. Faulty BRCA gene carriers have seven times high risk for developing breast cancer and ovarian cancer. Onset of breast cancer might be early in altered BRCA gene carriers. Such mutations account for 40% of familial breast cancer (Chen et al., 2006, p. 863). Genetically predisposed male population is also at high risk for developing breast carcinomas (Tai et al., 2007, p.1811). BRCA2 mutations have higher incidences of male breast carcinoma than BRCA1 mutations carriers (Tai et al., 2007, p.1812). Men in their 30s and 40s are more prone to the relative risk of developing breast cancer. Contralateral prophylactic mastectomy have shown positive clinical outcome in genetically predisposed BRCA1 and BRCA2 mutated gene carriers (Schmidt et al., 2005, P1.09). Hormonal therapy: Long term use of birth control pills and hormone replacement therapy (after menopause) augments the chances of breast cancer. The person is more prone to cancer related death due to late detection and faulty mammograms of patients on hormonal therapy. Alcohol abuse: Alcohol abuse increase chances of breast cancer in women. Obesity: Obesity combine with menopause increase the chances of breast cancer in women. Other factors: Use of high fat diet, breast implants, environmental pollutants, early onset of menstruation, late menopause, antiperspirants etc also might cause breast cancer. (American Chemical Society, 2009). The risk factors also can be broadly classified into high risk and moderate risk individuals (Breast Cancer Facts & Figures 2007-2008, p.14). Some women are highly prone to breast cancer due to: Presence of altered breast cancer genes BRCA1 or BRCA2. First-degree family history of BRCA1 or BRCA2 gene mutation The breast cancer risk increase more than 25% when analysed based on risk assessment tools More exposure of the chest to radiation therapy between the 10 to 30 years of age. Possessing Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or first degree family history of one of these disorders. The personal history of breast cancer increases the chances of new breast cancer by 3 to 4 fold apart from recurrence of the past cancer. Some women are moderately prone to breast cancer due to: The breast cancer risk is around 15% when analysed based on risk assessment tools Own a personal past of breast carcinoma Heavy dense breast tissue carriers Symptoms Like all the cancerous growth, early stage breast cancer also does not produce any clinical manifestations to get it noticed early. Therefore, recommended check up guidelines should be followed regularly with alertness before major clinical manifestations are observed. A painless mass can be observed when tumor has grown up to a sizable length. The symptoms like thickening, swelling, redness, and nipple abnormalities such as spontaneous discharge, erosion, inversion, or tenderness might or might not develop. But for any continued abnormality the individual has to seek immediate advice of the health care provider (Breast Cancer Facts & Figures 2007-2008, p.13). Couple of facts about breast cancer among ethnic groups, the age group who are likely to be affected, etc. African Americans have higher occurrence of breast cancer before age 40 than White women. After 40 years of age, this trend gets reversed, and higher incidence of breast cancer is found in White women (Breast Cancer Facts & Figures 2007-2008, p.1). There is an elevated relative and cumulative risks of BRCA mutation in some ethnic groups, such as people of Ashkenazi (European) Jewish origin and in some families in Iceland, the Netherlands, and the Balkans (Tai et al., 2007, p.1812). The mortality rates of BRCA1 and BRCA2 mutated gene carriers and non carriers are not much different (Paddock). African Americans have higher male-to-female ratio for breast cancer than the white populations (Tai et al., 2007, p.1812). Psychological & Physical effects of people who have breast cancer Mental agony of cancerous patients is but natural. Psychological & Physical effects of people who have breast cancer can be looked upon from many angles. Women who are diagnosed of a breast cancer, experiences an emotionally traumatic feeling. They might be suffering from depression, anxiety, panic, fear. They might be feeling isolated and sad. They feel that they would never be easily accepted by family and society. Since the breast cancer is more uncommon in men, they are more reluctant to discuss this issue with their social support systems. Psychosocial team that consists of a social worker, a mental health professional, and a pastoral counselor can help her in reducing distress resulting from psychosocial and spiritual issues. They should assist her by finding positive events in such situation and at the same time mentally prepared the client for all possible outcomes. All the concerns should be explored in the patient by proper communication about the implications of breast cancer by healthcare team. They should able to convince the sufferers that unwanted tragedy can be prevented by proper diagnostic tests, right decision and proper treatment. There can be some medical complications in which patient’s life would be in danger. With the appropriate guidance the individual might be able to live relatively improved quality life with peace. The patients experience stress and fatigue for at least 10 years even after they get rid of breast cancer. Physical activity like aerobics and resistance training are useful to alleviate psychosocial problems of the disease and the treatment. Types of prevention or possible treatment of breast cancer Early stage diagnosis of breast cancer and its treatment, may actually cure the cancer. American cancer Society has suggested monthly self breast examination for two age groups: a) between 20-40 years and b) age greater than 40 years. Annual clinical examination and mammogram is necessary for elder age group; while younger age women should get their breast checked once in three years (Breast Cancer Facts & Figures 2007-2008, p.14). The possible treatment of breast cancer is attributed to several factors like stage and biological characteristics of the breast cancer, age & preferences of the patient, advantages and disadvantages of a particular treatment in a specific patient. The different treatment alternatives include surgery, radiation therapy, hormonal therapy, and/or chemotherapy. Surgery Surgery is opted as the primary treatment to remove affected parts of the breast that can not be cured. One of the surgeries like Lumpectomy, mastectomy, radical mastectomy are selected depending upon the stage of the cancer. Lumpectomy is the removal of the cancerous tissue followed with 5 to 7 weeks of radiation therapy. Mastectomy is the removal of entire breast, and radical mastectomy is the removal of entire breast along with the lymph nodes under the arms. The mastectomy is often followed with reconstruction of breast using saline filled or silicon implants. All surgeries are equally effective. Sentinel lymph node biopsy is done in early stage patients to evaluate cancerous growth in the lymph nodes and if needed it is followed by surgery (Breast Cancer Facts & Figures 2007-2008, p.18). Radiation therapy This is indicated to remove remaining dreaded cancerous cells in the breast, chest walls, & arm pits for 5 to 7 weeks. External radiation therapy is chosen depending upon the size and extent of the cancer, may include the chest wall if the patient has 4 or more positive lymph nodes or a very large tumor. An accelerated partial breast irradiation (APBI) is a new technique with fewer side effects and is under clinical trials. Systemic therapy The treatment options under systemic therapy are biologic therapy, chemotherapy, and hormone therapy. It is often indicated in metastatic breast cancer. Neoadjuvant therapy is systemic treatment administered in patients before surgery to decrease the size of tumor to remove it effectively without need of mastetctomy. Neoadjuvant therapy is equally good when survival, disease progression, and distant recurrence are compared with other treatments. Biologic therapy: When growth-promoting protein HER2/neu production increases in around 15% to 30% breast cancer, tumors tend to grow faster and have high risk of recurrence. FDA approved monoclonal antibody preparation Herceptin® (tratuzumab) is used in early-stage HER2 positive breast cancers and metastatic breast cancer. The clinical trials have positive outcomes in terms of reduced risk of recurrence and death by 52% and 33%. Chemotherapy: Chemotherapy reduces mortality rate of patients by killing cells and thus decrease size and growth of the tumor and prevents development of metastasis. The type of chemotherapy depends on the size of the cancer, the number of lymph nodes involved, the presence of estrogen or progesterone receptors, and the HER2/neu protein quantity. Various combination of drugs like cyclophosphamide, methotrexate, fluorouracil, doxorubicin (adriamycin), epirubicin, paclitaxel (Taxol), and docetaxel (Taxotere) are given for 3 to 6 months. Hormone therapy: Antiestrogen drug Tamoxifen is used to block estrogen receptor related breast cancer in both postmenopausal and premenopausal women. 5 years of recommended tamoxifen therapy has positive outcomes in terms of reduced risk of recurrence and death by 41% and 33%. Aromatase inhibitors (AIs) drugs like letrozole, anastrozole, and exemestane are used in postmenopausal women for treating both early stage and late stage breast carcinomas. These inhibitors block estrogen producing enzyme. AIs are preferred over tamoxifen due to lesser side effects in postmenopausal women (Breast Cancer Facts & Figures 2007-2008, p.19). Prevention Reduction of risk factors of breast cancer related to obesity, alcohol abuse etc. are proactive preventive measures of cancer. Regular exercise and physical activity is necessary to balance the healthy body weight. The mammography diagnosis of breast cancer is getting improved with the help of film and digital mammography techniques. When a breast density shown by mammogram augments over a duration, the individual is highly prone to breast cancer in the future (Breast Cancer Facts & Figures 2007-2008, p.20). Aromatase inhibitors are used to prevent recurrence in early-stage breast cancer and are under clinical trials as prevention measures in high-risk postmenopausal women. Novel treatment strategies (e.g. tyrosine kinase inhibitors and retinoids) for preventing estrogen-receptor negative breast cancer are being studied. Aspirin is also being evaluated to prevent breast carcinomas (Breast Cancer Facts & Figures 2007-2008, p.20). Future scope The issues to be addressed in breast cancer are from cellular basic science to clinical research. Novel approach to study molecular pathways of BCRA1 and BCRA2 and their mutations for effective drug therapy is necessary. Identification of new potential molecular targets and risk factors leading to breast cancer should be given emphasis. The feasibility studies of drugs like breast cancer vaccine should be completed fast. Accuracy of imaging studies and biomarkers should be increased to study abnormalities in the breast. Establish a general clinical database for all the patients including their history and clinical signs to track the drug efficacy. More and more breast cancer awareness programs and compulsory check ups should be arranged by the government to further decline the mortality rates of breast cancer patients. Early detection and prevention of breast cancer is a key to make the population free from breast cancer. References American Chemical Society, What Are the Risk Factors for Breast Cancer, Detailed Guide Breast cancer, Last Revised: 03/02/2009 http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp Chen, S., Iversen, S., Friebel, T., Finkelstein, D., Weber, L., Eisen, A., et al. “Characterization of BRCA1 and BRCA2 mutations in a large United States sample”. J Clin Oncol 24 (2006): 863–71. Tai, Yu Chuan, Domchek , S., Parmigiani , G., Chen, S. “Breast Cancer Risk Among Male BRCA1 and BRCA2 Mutation Carriers”. J Natl Cancer Inst 99 (2007): 1811 –1814. Schmidt, M., van Sprundel, T. Rookus, M., Brohet, R., van Asperen, C., etc. “Clinical outcome for BRCA1 and BRCA2 mutation carriers after contralateral prophylactic mastectomy”. Breast Cancer Research 7(Suppl 2) (2005):P1.09. Paddock, Catharine. BRCA Gene Does Not Increase Breast Cancer Death, New Study, Medical News Today. Article Date: 12 Jul 2007 American Cancer Society. Breast Cancer Facts & Figures 2007-2008. Atlanta: American Cancer Society, Inc. www.cancer.org/downloads/STT/BCFF-Final.pdf National Comprehensive Cancer Network, American Cancer Society. Breast Cancer Treatment Guidelines for Patients, Version VIII, 2006 screening.iarc.fr/doc/Breast_VIII.pdf Read More