Prevalence Of Breast Cancer Among Women.
Cancer is a class of diseases characterized by out-of-control growth. Wikipedia pointed out that medically, it is known as a malignant neoplasm, and is a broad group of diseases involving unregulated cell growth. According to the free encyclopedia, cells divided and grow uncontrollably, forming malignant tumors, and invading nearby parts of the body. Abdulkareem (2009) stated that cancer is a public health problem worldwide affecting all categories of persons. According to her, it is the second largest cause of death in developed countries and among the three leading causes of death in developing countries.
Scholars believe that cancer is an abnormal growth of body cells leading to a disease condition capable of causing lethal effect. According to Medical News Today (2003), cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Wikipedia remarked that cancer may also spread to more distant part of the body through the lymphatic system or bloodstream to sites where they produce tumors. However, the free encyclopedia pointed out that not all tumors are cancerous; benign tumors do not invade neighbouring tissues and do not spread throughout the body.
Crediting the same source, there are over 200 different known cancers that affect humans. In a note of corroboration, medical news today (MNT, 2004-2013) remarked that there are over 100 different types of cancers, and each in classified by the type of cell that is initially affected. Specifically, National Cancer Institute identified the following types: Bladder cancer, breast cancer, colon and Renal cancer, Endometrial cancer, Kidney (Renal cell) cancer, leukemia, lung cancer, prostrate cancer, melanoma, Non-Hodgkin Lumphoma, Pancreatic cancer and thyroid cancer. Through a study, Abdukareem (2009) identified and listed the six most common cancers in Nigeria in descending order of frequency as follows: Breast cancer, Cervical cancer, Prostrate cancer, Colorectal cancer, Liver cancer and NAL cancer
By implication, Abdulkareem (2009) has identified Breast cancer as the most frequent occurring cancer in Nigeria.
According to the American cancer society, breast cancer is the second most common newly diagnosed cancer and second leading cause of cancer death in the US. Wikipedia described breast cancer as the type of cancer originating from breast tissue, most commonly fro the inner lining of milk duct or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas, while those originating from lobules are known as lobular carcinomas. Breast cancer occurs in humans and other mammals. According to Wikipedia, the overwhelming majority of human cases occur in women, male breast cancer can also occur. Wikipedia further pointed out that in non-humans; a few types of transmissible cancer have been described, where in the cancer spreads between animals by transmission of the tumors cells themselves. This phenomenon is seen in dogs with sticker’s sarcoma, also known as canine transmissible venereal tumor, as well as devil facial tumour disease in Tasmanian devils.
Abdulkareem (2009) stated that breast cancer is the commonest female cancer and most common cancer in both sexes. According to her, studies have indicated increase in the relative frequency ratio, moving from number 2 or 3 to number one cancer in both sexes. This increase has been attributed to increased awareness and presentation to screening. Abudulkareem (2009) maintained that majority of breast cancers occur in pre-menopausal women with the peak age of the 5th decade. However, Abudulkareem (2009) pointed out that in Nigeria, 3.7-8.6% of all breast cancer is male breast cancers. According to her, this is higher than the 1% recorded from other parts of the world. She further stated that the peak age incidence in male is 40-49; similar to that of female cancer.
According to Abudulkareem (2009), World Health Organization (WHO) reported that about 24.6 million people live with cancer worldwide. 12.5% of all deaths are attributed to cancer and if the trend continues, it is estimated that by 2020, 16 million new cases will be diagnosed per annum out of which 70% will be in developing countries. Wikipedia pointed out that worldwide, breast cancer accounts for 22.9% of all cancers in women. According the encyclopedia, in 2008 alone, breast cancer caused 458,503 deaths worldwide, constituting about 13.7% cancer deaths in women.
In Nigeria, Abudulkareem (2009) stated that the World Health Organization (WHO) estimated incidence of cancer from all sites in 2002 for Nigeria was 90.7 and 100.9 per 10,000 for males and female respectively. Crediting the same sources, mortality rates for male and female were 72.2 and 76 respectively. He pointed out that studies have indicated increase in the relative frequency ratio; moving from number 2 or 3 to the number one cancer in both sexes. According to him, male breast cancer represent 3.7-8.6% of all breast cancer in Nigeria.
Wikipedia remarked that it is nearly impossible to prove what caused a cancer in any individual, because most cancers have multiple possible causes. According to Medical News Today (2003), cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division and death. When this process breaks down, cancer begins to form. Speaking further, Medical News Today (2003) maintained that cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division and death. When this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.
However, Wikipedia stated that decades of research have demonstrated that there exist a link between certain factors and cancer. Such factors include tobacco, diet and exercise, infection, radiation, heredity, hormones, and physical agents such as prolonged exposure to asbestos, powdered metallic cobalt and Mickel and Crystalline silica.
According to Medical News Today (2013), cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Some cancer can be felt or seen through the skin-a lump on the breast or testicle can be an indicator of cancer in those locations. Some oral cancers present white patches inside the mouth or white spots on the tongue. Speaking further, MNT (2013) noted that other cancers have symptoms that are less physically apparent. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. Other less physically apparent symptoms include yellowing of skin and eyes called jaundice, constipation, diarrhea, change in stool size as well as more frequent or infrequent urination.
Wikipedia report noted that the first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the women feels a lump. Indication of breast cancer other than a lump may include thickening differently from the other breast tissue, one breast becoming larger or lower, a nipple changing position or shape or becoming inverted, skin puckering or dumpling, a rash on or around a nipple, discharge from nipples, constant pain in part of the breast or armpit, and swelling beneath the armpit or around the collarbone (MNT, 2003).
Cancer treatment depended on the types of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics, (MNT, 2003). According to the medical report, there is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy or gene therapy. American cancer society (2013-2014) stated that most women with breast cancer will have some types of surgery, and is often combined with other treatments such as radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy for the treatment of breast cancer.
Abdulkareem (2009) stated that the burden of cancer in Nigeria is unknown, mainly because of lack of statistics or under-reporting. According to her, under-reporting could be attributed to the fact that there are inadequate diagnostic facilities, limited access to care and inadequate technical manpower and infrastructure as well as quality of cancer data systems. This is why scholars argued that a less technical means of early detection of cancer, especially breast cancer be encouraged in order to achieve early prevention. American cancer society (2013-2014) advised that all women should become familiar with the appearance and feel of their breast and report any changes promptly to their physicians. Ani (2005) in a similar manner advised that women should train themselves to perform a simple self examination of the breast. According to her, breast cancer patients themselves discover more than 90% of breast lump. This is why this study is very necessary.
1.2 Statement of Problems
The researcher has observed with keen interest that there are several cases of breast cancer among women, reported at the Federal Teaching Hospital Abakaliki (FETHA). This disease condition poses a lot of problems to the patients concerned. The condition no doubt, is associated with some emotional problems like fear and anxiety about the eventual outcome of the diseases or the treatment. Most worrisome is the fact that observation has shown that majority (95%) of the cases are not detected early enough, and that when detected, treatment is not always sought in good time when such a treatment could make any significant difference. This is indeed a problem that would need to be addressed, hence this study.
1.3 Purpose of Study
The purpose of this study is to determine the prevalence of breast cancer among women in Federal Teaching Hospital Abakaliki.
1.4 Specific Objectives of the Study
Based on the above stated purpose, the specific objectives of the study are stated as follows;
- To determine the prevalence of breast cancer at FATHA.
- To ascertain the effect of parity on distribution of the affected women
- To determine the age distribution of suffers.
1.5 Significant of the Study
It is hoped that the findings and recommendations from this study will help create the necessary awareness thereby reducing the prevalence of breast cancer among women in Federal Teaching Hospital Community and the general public. This can be achieved through health education on early detection of lumps and or other breast changes. It will also assist in identifying possible predisposing factors to women breast cancer so as to give proper counseling against them. Knowledge gained from this study will help the researcher in particular and other health workers in general to teach women and other members of the public breast self examination so as to achieve early diagnosis. This will result in breast cancer awareness which will eventually reduce the scourge of the deadly dreaded disease.
1.6 Research Questions
- What is the prevalence of breast cancer among women in Federal Teaching Hospital Abakaliki?
- What the effect of parity as factor associated with breast cancer?
- What is the effect of age distribution on breast cancer?
Scope of the Study
This study is delimited to determining the prevalence of breast cancer in Federal Teaching Hospital Abakaliki. The study is also delimited to women of all ages that have had breast cancer within the years under review (2004-2012).
1.8 Operational Definition of Terms
Prevalence: The existing or registered number of breast cancer cases.
Breast cancer: A disease condition characterized by uncontrollable divisions of cells leading to manifestation of lumps on the breast.
Malignant: Persistent cell division, tending to become progressively worse and to result in lethality or death.
Programmatic cells: These are cells that follow an orderly path of growth, division and eventual death.
2.1 Concept of Breast Cancer
The study of cancer is called oncology. This has been made possible as a result of countless efforts of doctors and scientists around the world. Their discoveries in anatomy, physiology, chemistry, epidemiology, and other related fields made oncology what it is today. Technological advancements and the ever-increasing understanding of cancer make this field one of the most rapidly evolving areas of modern medicine (American Cancer society, 2012).
Mandal (2013) pointed out that human body is made up of trillions of living cells. These cells grow, divide, and die in an orderly fashion. This process according to him, is a tightly regulated one that is controlled by the deoxyribonucleic acid (DNA) machinery within the cell. When cells of the body at any particular site start to grow out of control, they may become cancerous. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. In addition, these cells can also invade other tissues of the body. This is a property that normal cells do not posses.
Cancer cells therefore originate from normal cells when their DNA or blue prints within the cell nucleus are damaged. According to Mandal (2013), DNA is in every cell and it directs the entire cell’s action, growth, death, protein synthesis, etc. When DNA is damaged in a normal cell, the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, and the cell does not die. Instead it gives rise to more such abnormal cells with abnormal DNA. These new cells all have the same defective DNA of original cancer cell. As the cells proliferate they may form lumps that progress into tumors. Tumors that are cancerous are said by malignant tumors. Corroborating this, American Cancer Society (2012) maintained that cancer begins when cells in part of the body grows out of control. According to the society, there are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells. Lending her support, Ani (2005) stated that as the cells continue to proliferate, the mass of abnormal tissue that they form enlarge, penetrating neighbouring tissue, destroying normal cell and taking their places. Cells are spread from this primary site via Lymphatic or brood vessels of diffusion. When the above descriptions happen to breast cells, cancer of the breast is said to have occurred.
Breast cancer is a type of cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk (Wikipedia,). the encyclopedia stated that breast cancer occurs in humans and other mammals. The overwhelming majority human cases occur in women, male breast cancer can also occurs. American Cancer Society (2013-2014) described breast cancer as a group of diseases that cause cells in the body to change and grow out of control. Bray, McCarron and Parkin (2004) maintained that cancer of the breast in women is a major health burden worldwide. It is the most common cause of cancer among women in both high-resource and low-resource settings.
According to American Cancer Society (2013-2014), breast cancer begins in the breast tissue that is made up of glands for milk production, called lobules, and the duct that connect the lobules to the nipple. Abdulkareem (2009) described breast cancer as the commonest female cancer and most common cancer in both sexes. According to her, majority of breast cancer occur in pre-menopausal women with the peak age in the 5th decade.
2.2 Risk Factors for Breast Cancer
American Cancer Society (2013) defined a risk factor as anything that affects (or increases) one’s chances of getting a disease, such as breast cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Again, smoking of tobacco or cigarette is a risk factor for cancer of the lung, mouth, larynx (voice box), bladder, kidney, and several other organs.
Abudulkareem (2009:26) proposed that those (women) who fall within the following category are at greater risk of developing breast cancer.
- Female gender
- Increasing age
- Maternal relative with breast cancer
- Abnormal genes (BRCAI, BRCA2 genes)
- Late age at first pregnancy and longer reproductive span (early menarche < 12 yrs, late menopause>50yrs).
- Others are obesity
- Increased dietary fat and alcohol intake
- Cigarette smoking
- Previous breast lesion with atypical changes
- Previous breast cancer.
Brest Cancer Research (2004) added that the association between socio-economic status and risk of breast cancer is well established, with women in higher socio-economic grouping being at higher risk. The research further stated that when social class is measured by income or education level, better side has greater risk. However, the greater risk for women from affluent background in outweighed by their lower mortality, women from deprived backgrounds often presenting with more advanced disease. Another proven risk factor is exposure to exogenous hormones as oral contraceptives, and hormone replacement therapy result in increase in the risk of breast cancer.
2.3 Prevention of Breast Cancer
Scholars have advanced some measures to strategically prevent or reduce the risk of breast cancer. Wikipedia opined that women may reduce their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breast feeding their children properly. The encyclopedia stated that this modification might prevent 38% breast cancer in US, 42% in the UK, 28% in Brazil and 20% in China. The benefits of moderate exercise such as brisk walking are seen at all age groups including postmenopausal women. The use of marine Omega-3 polyunsaturated fatty acids appear to reduce the risk. Breast Cancer Research (2004) pointed out that prevention trials have shown that tamoxifen lowers breast cancer incidence by 30-40% in high risk women. However, as tamoxifen and raloxifene raise the risk of thromboembolic disease and endometrial cancer about twofold, different strategies are being advocated to improve the risk.
Removal of both breasts before any cancer has been diagnosed or any suspicious lump or other lesson has appeared (a procedure known as properly lactic bilateral mastectomy) may be considered in people with BRCAI and BRCA2 mutations, which are associated with a substantially heightened risk for an eventual diagnosis of breast cancer. National Cancer Institute advocated Hormones therapy as a way of preventing breast cancer, as well as use of surgery. Virtually all the scholars in the field of breast cancer recommended breast screening as one sure way, of preventing breast cancer. For example, Wikipedia recommended the following;
- Clinical and self breast examinations;
- Genetic screening,
- Ultrasound and
- Magnetic resonance imaging
Worldwide, breast cancer accounts for 22.9% of all cancers (excluding non-melanoma skin) cancers in women. In 2008, breast cancer caused 458, 503 deaths worldwide (13.7% of cancer death in women). Breast cancer is more than 100 times more common in women than in men. Cancer of the breast is responsible for over one million of the estimated ten million neoplasm diagnosed worldwide each year in both sexes. It is also the primary cause of cancer death among women globally, responsible for about 375,000 deaths in the year 2000. American Cancer Society (2013-2014) stated that in 2013, an estimated 232,340 new cases of invasive breast cancer will be diagnosed among women, as well as an estimated 64,640 cases of in situ breast cancers in the some 2013, approximately 39,620 women are expected to die from breast cancer. Also in 2013, about 2, 240 men will be diagnosed with breast cancer and 410 men will die from the disease. Diagnosis also revealed that about 2.9 million US women who had history of breast cancer were alive on January, 2012.
2.5 Causes/Predisposing Factors
Mercola (2014) pointed out that there is no known specified cause of breast cancer world over. American Cancer Society (2013) and Mayo Clinic (2013) argued that even when one has a risk factor, or even several of them, does not mean that such one will develop the disease. According to them, most women who have one or more breast cancer have no apparent risk factor. Even when a women with risk factors developed breast cancer, it is very hard to know how much these factors might have contributed. Mercola (2014) however, opined that it is fairly safe to say that there are likely multiple contributors, many of them environmentally based. According to him, a cancer research in UK has singled out hormonal factors, such as having children later in life, having fever children or taking birth control pills, as probable culprits.
Specifically, the following suspected factors have been identified as contributing to breast cancer development.
- Gender: Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but this disease is about 100 times more common among women than men. This is probably because men have less of the female hormones estrogen and progesterone, which can promote breast cancer cell growth.
- Aging: The risk of developing cancer increases with increase in age of women. Mayo Clinic (2013) and American Cancer Society (2013-2014) both agreed that increase in age increases the risk of having cancer in women specifically, American Cancer Society (2013-2014) stated that 88% of breast cancer deaths occurred in women 50 years of age and older.
- Family History: If one’s mother has the history of breast cancer, the probability that the daughter will suffer the disease is more likely. Still, majority of the people diagnosed with breast cancer have no family history of the disease.
- Inherited genes that increase cancer risk: Certain genes that are known to increase the risk of breast cancer can be passed from parents to children. The most common gene mutations are referred to as BRCA 1 and BRCA 2. These genes can greatly increase people’s risk of breast cancer and other cancers however; they do not make cancer inevitable. American Cancer Society (2013) pointed out that about 5% to 10% of breast cancer cases thought to be hereditary. Although in some families with BRCA 1 mutations the life time risk of breast cancer is as high as 80%, on the average this risk seems to be in range of 55 to 65%. For BRCA2 mutations the risk in lower, about 45%.
- Radiation exposure: Radiation exposure has been associated with breast cancer development. People who exposure to one form of radiation or the other are more likely to suffer for cancer than those who were not. For example, exposure to radiation treatment such as chest x-ray as a child or young adult will increase the risk of breast cancer.
- Obesity: Being Obese increases one’s risk of having breast cancer. It means that people who are obese are at higher risk of developing breast cancer than those who are not.
- Beginning period at a younger age: People (women) who begin their period before age 12 increases their risk of having breast cancer.
- Late Menopause: Women who enter their menopause later are more likely to develop breast cancer than those who enter their at a normal age for menopause.
- Delayed child bearing: Women who give birth to their first child after 35 years may have an increased risk of breast cancer those at a younger age, (Mayo Clinic, 2013).
- Race/Ethnicity: American Cancer Society (2013-2014) stated that breast cancer incidences rate is higher in non-Hispanic white women than African American women for most age groups. However, African American women have a higher incidence rate before 40 and are more likely to die from breast cancer at every age.
Mandal (2014) stated that breast cancer can be classified on the basis of four schemes. Each of these schemes classifies the cancer based on different criteria and serves a different purpose. These are;
2.6.1 Classification based on Pathology:
Here, the classification is based on its cellular structure and microanatomy. This is the commonest for classification of the breast cancer.
2.6.2 Classification according to grads:
This classification is also based on cellular structure. The cancer cell is compared with the normal cell. A well-differentiated tumor for example is classified as low grade and resembles normal tissue. A “poorly differentiated” tumor is composed of disorganized cells and, therefore, does not look like normal tissue and is termed high grade. Some are “moderately-differentiated or intermediate grade as well”. 2.6.3 Classification based on stage of cancer:
This is the most commonly used scheme of determining the stage of cancer and the INM staging that takes into account the Tumor size, Lymph Node involvement and metastasis or spread of the cancer, (Mandal, 2014).
2.6.4 Classification based on Histological Appearance:
Breast cancer is usually, but not always, primarily classified by its histological appearance. Some of the histological types include:
- Ductal Carcinoma in situ (DCIS)
This signifies a very early form of cancer that has not spread. DCIS is a type of early breast cancer inside of the ductal system that has not attacked the nearby tissue it is one of the common type of non-invasive cancer.
- Infiltrating or invasive ductal carcinoma (IDC)
This is the most common type of breast cancer, it starts in the milk ducts and spread to surrounding tissues. This can also spread to other parts of the body via lymph channels and blood stream.
- Medullary Carcinoma
This forms around 15% of all breast cancers. It effects middle aged women more commonly and the cellular histology resembles the medulla (grey matter) of the brain.
- Lobular Carcinoma in situ (LCIS)
This is a rare form of non-invasive tumor. It usually does not develop into invasive cancer. LCIS is more of a “maker” or signal that breast cancer may develop. LCIS has recently been renamed lobular neoplasia.
- Infiltrating Lobular Carcinoma (ILC)
This is the second most common type of breast after invasive ductal carcinoma. The cancer begins in the lobules or lobes and spreads to other parts of the body. There is initial appearance of a thickening in the upper-outer section of the breast. These are usually positive for estrogen and progesterone receptors and thus may be treated successfully with hormone therapy.
- Tubular Carcinoma
The cancer cells appear like tiny tubules. This type of breast cancer is typically found in women aged 50 and above. This tumor responds well to treatment.
- Mucinous Carcinoma or Colloid
This is rare type of invasive breast cancer that rarely spreads to the lymph nodes. The cancer cells produce mucus and these cells are distinct from normal cells under a microscope. The mucous and cancer cells combine to form jelly-like tumors.
- Paget’s Disease
This leads to an eczema-like change in the skin of the nipple. There is itchiness, scaling and oozing discharge from the nipple. 90% of the women who experience these symptoms have an underlying breast cancer. Paget’s Disease can occur at any age but will more likely occur in women who are in their 50s.
- Triple Negative Breast Cancer
Breast tumor that is negative for estrogen receptor. (ER), progesterone receptor (PR) and HER2/neu proteins.
- Metastatic Breast Cancer
This is a later stage of breast cancer when it has spread to other organs like liver, brain, bones etc.
2.7 Symptoms of Breast Cancer
According to American Cancer Society (2013-2014) and Wikipedia, the following symptoms are very common with breast cancer. The first noticeable symptom of breast cancer is typical of a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the women feels a lump. American cancer society (2013-2014) remarked that breast cancer typically produces no symptoms when the tumor is small and most easily cured. Therefore, it is very important for women to follow recommended screening guidelines for detecting breast cancer at an early stage.
Indications of breast cancer other than a lump may include thickening different from the other breast tissue, one breast becoming larger or lower, a nipple changing position or shape or becoming inverted, skin puckering dimpling, a rash on or around a nipple, discharge from nipples, constant pain in part of the breast or armpit and swelling beneath the armpit or around the collarbone. Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well an orange peel texture to the skin referred to as peau d’ orange; as inflammatory breast cancer does not show as a lump, there is sometimes a delay in diagnosis.
Another reported symptom complex of breast cancer is Paget’s disease of the breast. This syndrome presents as skin changes resembling eczema, such as redness, discoloration, or mild flaking of the nipple skin. As Paget’s disease of the breast advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. In rare cases, what initially appears as a fibro-adenoma (hard, movable non-cancerous lump) could in fact be a phylodes tumor. Occasionally, breast cancer presents as metastic disease that is, cancer that has spread beyond the original organ. The symptom will depend on the location of metastasis. Common sites include bone, liver, lung and brain.
2.8 Ways of Detecting Breast Cancer/Diagnosis
Most types of breast cancer are easy to diagnose using very simple and non-complicated approaches. There are, however, types of breast cancers that require specialized laboratory examinations. The following methods have been identified.
- Breast Self Examination: American Cancer Society (2013-2014) advised that all women should become familiar with appearance and feel of their breasts and report any changes promptly to their physicians. Although the American can society no longer recommends that all women perform monthly breast self examinations (BSE) women should be informed about the potential benefits and limitations associated with BSE.
Just as the name suggest, it involves person or persons (women) examining her breast to determine whether is there is presence of lump or any physical change on the breast. It is urgently being advised that women who wishe to perform periodic BSE should receive instruction her health care provider and/or have her technique reviewed periodically. Ani (2005:17) quoted white and Duncan (2004) five ways of achieving good breast self examinations. These include:
- Standing in forth of a minor, check breast for puckering. Dimpling, scariness or discharge from nipples.
- Clasp hands behind head and press hands forward, watching for changes in the shape or contour of breast. Press hands on lips and bend towards mirror while pulling shoulder and allow forward.
- Gently squeeze each nipple, looking for discharge.
- Raise one arm and use fingers of other hand to check breast for lumps or masses under skin. Use a pattern of motion (circular up and down etc) to cover entire breast.
- Repeat number 4 above while lying flat with one over head.
- Mammography: Bray, McCarron and Parkin (2004) stated that mammographic screening for women aged 50-69 years is effective in reducing breast cancer mortality, and reductions in mortality have been observed where screening has been introduced. Mammography is a low-dose x-ray procedure that allows visualization of the internal structure of the breast. Dedicated mammography units used today result in higher-quality images with a considerably lower x-ray dose than the general-purpose x-ray equipment used in the past. Conventional (film) mammography has been largely replaced by digital mammography, which appears to be even more accurate for women younger than age 50 and for those with dense breast tissue. However, Mercola (2014) point out that the primary hazard of mammography is ionizing radiation that may actually increase one’s cancer risk. According to 2010 study, annual screening using digital or screen-film mammography on women aged 40-80 years is associated with induced cancer incidence and fatal breast cancer rate of 20-25 cases per 100,000. This means annual mammograms cause 20-25 cases of fatal cancer for every 100,000 women getting the test. But now, with the new improved 30 TOMOSYNTHESIS Mammogram, women will be exposed to even more radiation without any apparent harm.
- Magnetic Resonance Imaging (MRI): Magnetic resonance imaging uses magnetic fields instead of x-rays to produce very detailed, cross-sectional images (usually gadolinium DTPA) that are injected into a vein in the arm before doing the examination to improve the ability to capture detailed images of breast tissue. American Cancer Society (2013-2014) noted that a panel report in 2007 recommended that annual magnetic resonance imaging (MRI) screening should be used in addition to mammography for women at high lifetime risk (20-25% or greater) beginning at 30 years of age.
However, MRI is more expensive than mammography.
- Breast Ultrasound: Breast ultrasound is sometimes used to evaluate abnormal findings from a screening or diagnostic mammogram or physical examination some studies have suggested that ultrasound may detect more cancer than mammography alone when screening women with dense breast tissue. Mercola (2014) stated that screening by ultrasound catches cancers missed by mammography.
- Biopsy: Other options for biopsy include a core biopsy or vacuum-assisted breast biopsy, which are procedures in which a section of the breast lump in removed for histological study; or an exisional biopsy, in which the entire lump is removed for that same purpose.
- Treatment of Cancer
According to American Cancer Society (2013-2014), treatment decisions are made by the patient and the physician after consideration of the optimal treatment available for the stage and biological characteristics of the cancer, the patient’s age and preferences, and the risks and benefits associated with each treatment protocol. Most women with breast cancer will have some type of surgery. Surgery is often combined with other treatments such as radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy in addition to drugs.
- Surgery: The primary goals of breast cancer surgery are to remove the cancer from the breast and to determine the stage of the cancer. Surgery involves the physical removal of the tumor, typically along with some the surrounding tissue. Surgical treatment for breast cancer involves breast-conserving surgery (BCS), whose name depends on the part removed. When the whole breast is removed, it is called mastectomy. When removal involves just one quarter of the breast, it is called Quadarntectomy, and Lumpectomy when only a small part of the breast is removed. Once the tumor has been removed, if the patient desires, breast reconstruction surgery, a type of plastic surgery, may then be performed to improve the aesthetic appearance of the treated site. Alternatively, women use breast prostheses to stimulate a breast under clothing, or choose a flat chest. Nipple/aerola prostheses can be used at any time following the mastectomy.
- Medication: Drugs used after and in addition to surgery are called adjuvant therapy. According to Wikipedia encyclopedia, there are currently three main groups of medications used for adjuvant breast cancer treatment: hormone-blocking agent, chemo therapy, and monochonal antibodies. Hormonal blocking therapy: some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progresterone receptors (PR+) on their surface. These ER+ cancers can be treated with drugs that either block the receptors, e.g. tamoxifen (Nolvadex), or alternatively block the production of estrogen with a aromatase inhibitor, eg. Anastrozole (Arimidex) or Letrozole (Femara).
- Chemotherapy: Chemotherapy is predominantly used for cases of breast cancer in stages 2-4, and is particularly beneficial in estrogen receptor-negative (ER-) disease. The chemotherapy medications are administered in combinations, usually for periods of 3-6 months. One of the most common regimens is known as “CAT”, combines cyclophosphmide with doxorubicin (Adriamyecin). Most chemotehraphy medications work by destroying fast-growing and/or fast-replicating cells, either by causing DNA damage upon replication or by other mechanisms.
- Monodonal Antibodies: Trastuzumab (Herceptin), a monoclonal antibody to HER2 (a cell receptor that is especially active in some breast cancer cells) has improved the 5-years disease free survival of stage 1-3 HER2 causes cellular growth and division; in the absence of stimulation by the growth factors the cell will normally stop growing. Traztuzumab prevents growth factor from being able to bind to and stimulate the receptors, effectively blocking the growth of the cancer cells.
- Radiation Therapy: Radiation therapy is the use of high-energy beams or particles to kill cancer cells. Wikipedia and American Cancer Society stated that radiation may be used after potentially curative surgery to destroy microscopic tumor cells that may have escaped surgery. Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventionally, radiotherapy is given after the operation for breast cancer. It can also be given at the time of operation on the breast cancer intraoperatively.
2.10 Complication of Breast Cancer
Burkhead (2010) maintained that complications related to breast cancer usually develop as side effects of treatment. For example, side effects may occur with any chemotherapy drug. Depending on slight differences in regimens, in the drugs themselves, and in the individuals involved, some may experience side effects and others not from the same chemo protocol.
Under Chemotherapy, the digestive tract and the hair are often involved in side effects because, like cancer cells their cells rapidly divide and thus are somewhat damaged as the cancer cells are killed off. This is why nausea and vomiting are such common and prominent effects of chemotherapy. Again, low blood counts, which can cause fatigue, easier bruising, or infection, are common because the dividing cells of the bone marrow are also prone to damage by chemotherapy agents. In rare instances, chemotherapy can cause heart damage or trigger another cancer such as Leukemia. Others include depression, fear sadness, or feelings of isolation also may serve to make completion chemotherapy a difficult time for many, women.
Under Radiation and Hormone therapy other treatments, particularly radiation and hormone therapies, can also result in rare or more serious side effects. The side effects of radiation therapy start slowing. Over time, become debilitating. It can result in inflamed lung tissue, heart damage, or secondary cancers canenorge. A possible long-term effect of the lowered estrogen that comes from hormone therapy is a significantly greater risk for osteoporosis.
Breastcancer.org: “Surgery risks”. (2012) pointed out that every surgery has the risk of complications. Infection including redness and/or swelling of the incision with pus or foul-smelling drainage, perhaps with fever. Antibiotics can be used to treat post-surgical infections. Lymphedema, swelling of the arm and/or hand on the side of the surgery due to the removal of the lumph nodes under the arm. Lymphedema often goes away on its own, but sometimes requires treatment. Treatments are usually provided by physical or occupational therapists and include manually draining the fluid, caring for the skin and exercising the arm.
Seroma, a situation where fluids are accumulated in the location of the surgery can occur. Most of the time, the fluids are absorbed by the body. However, the area may be drained, using a needle, if it does not go away on its own. Other complications may include stiffness of the shoulder and possible numbness or altered sensation in the upper arm or armpit.