Breast cancer

Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates. Still, breast cancer is the most common cause of death in women between the ages of 45 and 55. Although breast cancer in women is a common form of cancer, male breast cancer does occur and accounts for about 1% of all cancer deaths in men.
Research has yielded much information about the causes of breast cancers, and it is now believed that genetic and/or hormonal factors are the primary risk factors for breast cancer. Staging systems have been developed to allow doctors to characterize the extent to which a particular cancer has spread and to make decisions concerning treatment options. Breast cancer treatment depends upon many factors, including thee type of cancer and the extent to which it has spread. Treatment options for breast cancer may involve surgery (removal of the cancer alone or, in some cases, mastectomy), radiation therapy, hormonal therapy, and/or chemotherapy.

When to seek medical advice

Although most breast changes aren’t cancerous, it’s important to have them evaluated promptly. See your doctor if you discover a lump or any of the other warning signs of breast cancer, especially if the changes persist after one menstrual cycle or they change the appearance of your breast. If you’ve been treated for breast cancer, report any new signs or symptoms immediately. Possible warning signs include a new lump in your breast or a bone ache or pain that doesn’t go away after three weeks. In addition, talk to your doctor about developing a breast-screening program, which may vary, depending on your family history and other significant risk factors.

Young Women

Breast cancer is rare in young women. Just five percent of all breast cancers diagnosed each year in the U.S. occur in women under 40. This rareness can make such a diagnosis especially shocking and challenging for young women. At a time in life most often reserved for family and career, issues of treatment, recovery and survivorship unexpectedly take top spot.
As it is for all women, breast cancer treatment in young women is often very effective and survival is usually good. Overall, however, breast cancers in women under 40 tend to have a poorer prognosis than those in older women. The cancers are more likely to be fast growing and higher grade, and less likely to have hormona receptors, each of which makes the cancer more aggressive. There is some evidence that chemotherapy is less effective in younger premenopausal patients compared to older premenopausal patients.
A woman’s age alone, however, does not substantially affect her treatment. Treatment options are based much more on the cancer’s stage and tumor characteristics than how young or old a woman is. Age, though, may play a role in women favoring certain options over others–whether it’s choosing breast conserving surgery or mastectomy; or choosing chemotherapy or oophorectomy (removal/suppression of the ovaries). Menopausal status is also important for some therapies. For example, aromatase inhibitors may be an option for young women who have already entered menopause. However, since these drugs are used to treat postmenopausal breast cancer only, they are not an option for young women who are premenopausal. Weighing treatment options in relation to a woman’s personal values and lifestyle is key at any stage in life.
One of the main concerns for young women being treated for breast cancer is loss of fertility. Chemotherapy and tamoxifen can each damage the ovaries, causing irregular periods or stopping periods altogether. With tamoxifen, regular periods should return after treatment. With chemotherapy, however, the chances are greater that the loss of periods will be permanent. Even so, regular periods will usually return in women under 40, with risk of permanent menopause slowly increasing with age. Certain chemotherapy regimens may be able to lower the chances of permanent menopause.
Even in women whose periods return, treatment can shorten the window of opportunity for having children. Because of the danger of birth defects, it is recommended that women taking tamoxifen put off pregnancy until after they finish the standard five years of therapy. Additionally, both tamoxifen and chemotherapy tend to bring about natural menopause three to five years earlier than normal, further compressing the time women have for pregnancy and childbirth. There are several steps that women can take that may help preserve their ability to have children after treatment. Storing embryos before treatment is one option. In this procedure, a woman’s eggs are collected over a number of menstrual cycles; they are then fertilized and stored at very low temperatures. After treatment, the embryos can be thawed and implanted into the uterus. The procedure has a good rate of success, but it also has some down sides. Treatment may be delayed while eggs are collected, and a sperm donor is needed to fertilize the eggs before they are stored. A more experimental approach involves storing unfertilized eggs that can then be thawed, fertilized and implanted sometime after treatment. This approach is much less successful, however, and is generally only recommended for women taking part in a research study on the procedure.
There is some evidence that drugs like goserelin (Zoladex) and leuprolide (Lupron) may help protect the ovaries during chemotherapy, making it more likely that regular periods return after treatment. Chemotherapy attacks rapidly dividing cells–which include not only cancer cells but also cells in some other parts of the body, like the ovaries. Goserelin and leuprolide can shut down the ovaries during chemotherapy, theoretically protecting them from damage. More studies are needed before it is known if this approach truly protects the ovaries and speeds a return to regular periods. It is also unclear how this approach may affect a woman’s prognosis.
For women who wish to have a child after treatment, speaking to a fertility specialist prior to making treatment decisions is recommended to understand fully all the options available. Because insurance coverage for fertility services varies widely from state to state, it is also important for women to check with their insurance provider to find out what procedures are covered.

Treatment of breast cancer

A diagnosis of breast cancer is one of the most difficult experiences you can face. In addition to coping with a potentially life-threatening illness, you must make complex decisions about treatment.
Talk with your health care team to learn as much as you can about your treatment options. Consider a second opinion from a breast specialist in a breast center or clinic. Talking to other women who have faced the same decision also may help.
Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. Experimental treatments are also available at cancer treatment centers.

Surgery

Today, radical mastectomy is rarely performed. Instead, the majority of women are candidates for simple mastectomy or lumpectomy. If you decide on mastectomy, you may opt for breast reconstruction.
Breast cancer operations include the following:

Lumpectomy

This operation saves as much of your breast as possible by removing only the lump plus a surrounding area of normal tissue. Many women can have lumpectomy — often followed by radiation therapy — instead of mastectomy, and in most cases survival rates for both operations are similar. But lumpectomy may not be an option if a tumor is very large, deep within your breast, or if you have already had radiation therapy, have two or more widely separated areas of cancer in the same breast, have a connective tissue disease that makes you sensitive to radiation, or if you have inflammatory breast cancer. If you have a large tumor but still want to consider the possibility of lumpectomy, chemotherapy before surgery may be an option to shrink the tumor and make you eligible for the procedure.
In general, lumpectomy is almost always followed by radiation therapy to destroy any remaining cancer cells. But when very small, noninvasive cancers are involved, some studies question the role and benefits of radiation therapy — especially for older women. These studies haven’t shown that lumpectomy plus radiation prolongs a woman’s life any better than does lumpectomy alone.

Partial or segmental mastectomy

Another breast-sparing operation, partial mastectomy involves removing the tumor as well as some of the breast tissue around the tumor and the lining of the chest muscles that lie beneath it. In almost all cases, you’ll have a course of radiation therapy following your operation, similar to if you had a lumpectomy.

Simple mastectomy

During a simple mastectomy, your surgeon removes all your breast tissue — the lobules, ducts, fatty tissue and skin, including the nipple and areola. Depending on the results of the operation and follow-up tests, you may also need further treatment with radiation to the chest wall, chemotherapy or hormone therapy.

Modified radical mastectomy

In this procedure, a surgeon removes your entire breast, including the overlying skin, and some underarm lymph nodes (axillary lymph node dissection), but leaves your chest muscles intact. This makes breast reconstruction less complicated.

Sources: Mayo Clinic, Medicine Net

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