Breast Cancer Awareness Month:dedication to the advancement of promotional health for women and men

October has been designated as Breast Cancer Awareness month.
Photo credit: Click here

Imagine you go for a routine checkup and after a subsequent mammogram you are told the results look suspicious. A biopsy is performed and you are told it tested positive for breast cancer. What would you do? Negative thoughts and fears arise about body image, sexuality, surgery, quality of life, and dying. Informing yourself about the nature of the disease and how to manage those thoughts and fears will help you make important decisions that will get you and your loved ones through the experience.

Anatomy of the Breast
Breast tissue is made up of tubular structures or ducts. When a female reaches puberty, the amount of fat and connective tissue in the breast increases and her ovaries produce estrogen (female hormone), which cause the ducts to grow and milk glands (lobules) to develop at the ends of the ducts. In the male, testosterone is secreted by the testes, which suppresses the growth of breast tissue and development of lobules. The male breast is made up of mostly small, undeveloped ducts and a small amount of fat and connective tissue.

Anatomy of the Breast: 1-Chest wall; 2-Pectoralis muscles; 3-Lobules; 4-Nipple surface; 5-Areola; 6-Lactiferous duct; 7-Fatty tissue; 8-Skin
Photo credit: Click here

Breast Cancer [1][2][3]
When cells grow old, new cells replace them. But sometimes things go wrong and new cells keep forming although the body does not need them and the old cells do not die when they should. The extra cells can form a mass of tissue called a tumor. Tumors are benign (usually removable, non-invasive, do not spread, and non-life threatening) or malignant (can grow back after removal, invasive to other tissues and organs, life-threatening, spreads and invades other organs and tissues to form new tumors—metastasis). Breast cancer cells can be found in lymph nodes near the breast and can spread to other parts of the body (bones, liver, lungs, brain). At this point, the disease is called metastatic breast cancer or metastatic disease.

Although rare, breast cancer can affect men.
Photo credit: Click here

Breast cancer is the uncontrolled growth of cells in breast tissue and is 100 times more common in women than in men. In women, breast cancer is the most common type of cancer and the second most common cause of cancer death (lung cancer is the first) in women between 45 and 55 years old. According to 2009 statistics reported from the American Cancer Society, out of 269,800 cancer deaths in women, 15% are a result of breast cancer. It is estimated that about 12% of women will develop it at some point in their lifetime. In men, although breast cancer is a rare condition, it is responsible for approximately 1% of cancer deaths (about 400 men die from it each year in the United States). In either sex, warning signs of breast cancer can be seen as a lump or other abnormality in the breast and surrounding areas.

Normal (left) versus cancerous (right) mammography image.
Photo credit: Click here

Causes and Risk Factors [1][4][5]
The causes of breast cancer have not been fully elucidated but there is ongoing research to help us understand the underlying mechanisms involved in this disease. Breast cancer is not contagious but there are risk factors that may increase the chance of developing the disease, which include the following:
•   Age and Race: 60+ years of age; more common in Caucasian women.
•   Personal and Family History: Experience with cancer in one breast; relatives who had the disease.
•   Breast and Genetic Changes: Abnormal cell tissue; more dense tissue as opposed to fatty tissue; genetic changes detected through testing (i.e. genes BRCA1- breast cancer susceptibility gene 1, BRCA2- breast cancer susceptibility gene 2)—in normal cells, these genes help stabilize the cell’s DNA and help prevent uncontrolled cell growth; mutation of these genes is correlated with hereditary breast and ovarian cancer.
•   Reproductive and Menstrual History: Age at first pregnancy (increased with later age); never had children (increased); breast-fed the baby (decreased); menstrual period before 12 years old; menopause after 55 years old; menopausal hormonal therapy.
•   DES (diethylstilbestrol): Taken while pregnant (administered between 1940-1971).
•   Weight, Exercise, Drink: Overweight post-menopause, lack of physical activity, drinking alcohol.
•   Radiation Therapy: Radiation exposure to the chest before 30 years of age.
•   Environmental Toxins: Breast cancer studies show that more than 80,000 synthetic chemicals are used in the United States and many of them remain in the environment for years accumulating in body fat and breast tissue. According to reports, compounds that disrupt the hormone production process in endocrine organs and tissues have been shown to affect the risk for breast cancer in humans and mammary cancer in animals:
o   Pesticides (DDT, dieldrin, aldrin and heptachlor; triazine herbicides)
o   Bisphenol (used to make plastics, epoxy resins, dental sealants)
o   Polyaromatic hydrocarbons (combustion byproducts)
o   Cigarette smoke
o   Dioxins and Phthalates (found in plastics)
o   Alkyphenols (chemicals in cleaning products)
o   Metals (copper, cobalt, nickel, lead)
o   Parabens (anti-microbial agents in personal care products)
o   Food additives (given to cattle and sheep to enhance growth)

Some risk factors are avoidable and others are not. Many women with breast cancer do not have a family history of the disease and most have no clear risk factors. If you think you may be at risk, you should discuss it with your doctor. Your doctor may be able to suggest ways to reduce your risk and can help you develop a screening plan.

Signs of breast cancer.
Photo credit: Click here

Screening, Signs and Symptoms [1]
Presently, there are a few screening tests that can help doctors find and treat breast cancer early. They include:
•   Mammogram: Screening technique designed to detect masses or microcalcifications in breast tissue in the early stages; involves a process of using low-dose amplitude-x-rays to examine the breast and can help with early diagnosis of the disease; recommended for women in their 40s and older every 1-2 years; under 40, with risk factors.
•   Clinical Breast Exam: Health care professional checks for size, rash, dimpling, abnormalities; nipples are checked for fluid; breast, underarm, collarbone area checked for lumps (usually the size of pea before it can be detected).
•   Breast Self-Exam: Should be done on a monthly basis to check for lumps, changes, abnormalities in the breasts.

Common signs and symptoms of breast cancer include:
•   Nipple tenderness, discharge
•   Lump or thickening in or near the breast or the underarm area
•   Changes in the look, size or shape of the nipple or breast
•   Nipple turned inward into the breast
•   Scaly, red, swollen, ridged, or pitted skin of the breast, areola, or nipple

Diagnosis [1][6]
If you are experiencing symptoms of breast cancer or had a screening test that suggests you have the disease, various tests are run to confirm the diagnosis.
•   Clinical Breast Exam: Lumps that are soft, smooth, round, and movable are likely to be benign; hard, oddly shaped lump, feels firmly attached within breast is more likely to be cancer.
•   Diagnostic Mammogram: Involves special techniques and more views than screening mammograms.
•   Ultrasound: Device sends out sound waves that bounce off tissues; computer uses echoes to create a picture, which may show if a lump is solid or filled with fluid; a cyst is a fluid-filled sac and not cancer; a solid mass may be cancer.
•   Magnetic resonance imaging (MRI): Makes detailed pictures of breast tissue.
•   Biopsy: Fluid or tissue is removed from the breast; pathologist determines if there are cancer cells and what type; most common type of breast cancer is ductal carcinoma (abnormal cells found in duct lining); lobular carcinoma is another type (abnormal cells found in lobules).
•   Hormone receptor test: Indicates whether the tissue has certain hormone receptors; tissue with these receptors needs hormones (estrogen or progesterone) to grow.
•   HER2 test: Indicates whether the tissue has human epidermal growth factor receptor-2 (HER2—a protein) or the HER2/neu gene; too much protein or too many copies of the gene in the tissue increases the risk of recurrence of breast cancer post-treatment.

Vertical section through a breast removed for a locally advanced 7 cm tumor that had ulcerated through the skin surface (top of image). In the fresh state, the tumor (white area) was soft, well-demarcated, and dark grey.
Photo credit: Click here

Stages [1]
If you are diagnosed with breast cancer, your doctor will determine the stage of the disease in order to set up your treatment plan. Stages include the following:
•   Stage 0: Carcinoma in situ
   o   Lobular carcinoma in situ (LCIS): abnormal cells in lobule lining; seldom becomes invasive.
   o   Ductal carcinoma in situ (DCIS): abnormal cells are in duct lining; aka intraductal carcinoma; cells have not spread.
•   Stage I: Early stage of invasive breast cancer; cancer cells have not spread.
•   Stage II: Tumor ranges from 2 cm+; may or may not have spread to lymph nodes.
•   Stage III: Locally advanced cancer.
Stage IIIA: Tumor is +/- 5 cm and spread to lymph nodes.
Stage IIIB: Tumor has grown into chest wall or skin of breast; spread to lymph nodes. NB: Inflammatory breast cancer is a rare type of breast cancer; the breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When this type of breast cancer is diagnosed, it is at least Stage IIIB, although it can be more advanced.
Stage IIIC: Tumor of varying size has spread to lymph nodes behind breastbone and under arm; lymph nodes under or above collarbone.
•   Stage IV: Distant metastatic cancer; spread to other parts of the body.

Inflammatory Breast Cancer
Video credit: Click here

Treatment [1]
It is important to be informed about cancer and if you do have the disease, it can make a difference for you to have an interactive part in making decisions about your treatment plan and medical care. It is very stressful to learn you have breast cancer and is important to ask questions and, if necessary, seek out specialists in the field and get a second opinion. Treatment of breast cancer is by either local (surgery or radiation—destroys/removes cancer in the breast) or systemic therapy (chemotherapy, hormone therapy, biological therapy—enters bloodstream to destroy/control cancer throughout the body). Side effects are common since cancer treatments damage healthy cells and tissues along with the cancerous cells. Your treatment options depend on the stage of your disease and other factors.
Surgery: The most common treatment for breast cancer includes
   •   Breast-sparing surgery: Removes the cancer not the breast; aka breast-conserving surgery, lumpectomy, segmental mastectomy, partial mastectomy.
   •   Mastectomy: Breast removal and, typically, removal of lymph nodes under the arm; radiation therapy may follow surgery.
Studies have reported equal survival rates for breast-sparing surgery (with follow up radiation therapy) and mastectomy for Stage I and Stage II breast cancer. Breast reconstruction is a type of plastic surgery to rebuild or reshape the breast and may be done at the same time as a mastectomy or later. Healing time post-surgery differs for each person. Numbness and tingling in the chest, underarm, shoulder, and upper arm, pain, disequilibrium, and weakness are a few side effects that can be managed through following of proper guidelines, which includes exercise to reduce stiffness and pain. You will also need to provide extra special care for the side of your body that was subjected to surgical procedure.
Radiation therapy: Uses high-energy rays to kill cancer cells. Side effects include red, dry, tender, heavy, tight and itchy skin, and tiredness. These problems typically disappear over time. Toward the end of treatment, your skin may become moist with an oozing effect but exposing this area to air as much as possible can help the skin heal.
Chemotherapy: Uses anticancer drugs (pill form or IV) to kill cancer cells; affects cancer cells and other cells that divide rapidly:
   •   Blood cells: Important for fighting infection, blood clotting, and O2 distribution; drugs can increase the risk of infections, bruising or bleeding, and feelings of lethargy; some women have developed leukemia years post-treatment.
   •   Hair root cells: Hair loss; re-growth may exhibit a change in color and texture.
Side effects include loss of appetite, nausea and vomiting, diarrhea, mouth and lip sores. Some drugs used for breast cancer can cause tingling or numbness in the hands or feet but usually disappears post-treatment. Some may weaken the heart and cause damage to the ovaries. Side effects can be controlled but persistent problems need to be addressed with your doctor.
Hormone therapy: Inhibits cancer cells from obtaining or using the natural hormones (estrogen and progesterone) they need to grow; lab tests indicate if a breast tumor has hormone receptors and, if so, may indicate need for hormone therapy, which includes drugs or surgery:
   •   Drugs: Tamoxifen blocks estrogen; aromatase inhibitor blocks estradiol (form of estrogen); pre-menopausal women may get this drug—stops ovaries from making estrogen.
   •    Surgery: Pre-menopausal women may have surgery to remove the ovaries (the main source of estrogen; ovaries produce less estrogen post-menopause).
Side effects may include hot flashes, vaginal discharge or dryness, skin irritation around the vagina, itching, irregular menstrual periods, headaches, fatigue, nausea, vomiting, and skin rash. Tamoxifen can cause uterine cancer but not all women experience side effects. Regular pelvic exams are a good preventative screening plan.
Biological therapy: Helps immune system fight cancer; Herceptin® (trastuzumab) is a monoclonal antibody (produced in a lab) that binds to cancer cells and is administered to women whose cancer has spread and lab tests show that the tumor has too much of a specific protein, HER2; inhibition of HER2, slows or stops growth of cancer cells. Side effects diminish after the initial treatment but may include fever, chills, pain, weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes.
Alternative Treatment: Acupuncture, massage therapy, herbal products, vitamins, special diets, visualization, meditation, spiritual healing. Check with your doctor to see if these options are suitable as an alternative or as a part of your current treatment plan for your specific case.
Exercise and Nutrition: Stay physically active; walking, yoga, swimming, and other forms of physical activity builds strength, increases energy levels, relieves stress, reduces nausea and pain and makes treatment more manageable.
Follow-up Care and Support: Cancer sometimes returns because undetected cancer cells remained somewhere in the body post-treatment; periodic monitoring for recovery and recurrence checks aid in early detection; seek resources for concerns about treatments and managing side effects, hospital stays, and medical bills; health care professionals can answer questions about treatment, working, or other activities; social workers, counselors, members of the clergy, and people who have or had the disease can be helpful if you want to talk about feelings or concerns.

The Cancer Tree (Camptotheca acuminata)--tupelo family, aka Happy Tree/Tree of Life—has the anticancer compound camptothecin, found in the tree’s bark. The resulting drugs, topotecan and irinotecan hydrochloride are useful in treating breast cancer, and many other types of cancers. The compounds, which have antiviral as well as anti-tumor properties, are also used for the treatment of AIDS.
Photo credit: Click here

Research [1]
What is currently being done to better understand and prevent breast cancer? There are ongoing clinical trials and studies to determine new ways to prevent, detect, and treat breast cancer.
•   Prevention: A study called STAR (Study of Tamoxifen and Raloxifene) to study the effects on lowering hormone levels or preventing their effect on breast tissue cells.
•   Detection, Diagnosis, Staging: Combinations of mammograms and ultrasound, positron emission tomography (PET), detection of tumor markers in blood, urine, and bodily fluids, ductal lavage (collection of cells through a catheter into the milk duct opening on the nipple to check for cancer cells).
•   Treatment: Ongoing research for treatment to include different types of surgery, extended radiation therapy to cover more surface area, chemotherapy with new anticancer drugs, new hormonal and biological therapy with cancer vaccines to aid the immune system in killing cancer cells.

The latest news report published this month: [7]
Major breast cancer breakthrough announced at BC cancer agency
BC scientists first in world to decode genetic evolution of a breast cancer tumour
VANCOUVER, Oct. 7 /PRNewswire/ - For the first time in history, BC Cancer Agency scientists in British Columbia, Canada have decoded all of the three billion letters in the DNA sequence of a metastatic lobular breast cancer tumour, a type of breast cancer which accounts for about 10 per cent of all breast cancers, and have found all of the mutations, or "spelling" mistakes that caused the cancer to spread.

This recent finding will optimize early detection procedures, diagnosis, and treatment plans.

When we are faced with a health challenge, it is important to seek information and reach out for help. Being informed can provide an advantage, especially for early detection of disease. If we are visited by breast cancer, we can choose to reach out to the many resources available today that provide us with the means to deal with the disease in terms of diagnosis and treatment. We can also enhance our present life skills or learn new ones to help us cope and continue to lead a quality life. If we find ourselves living with the disease, we strive to not let it conquer us and deprive us of our precious time here on earth. Being aware of breast cancer is important for both women and men as it can lead to early detection and improve the quality of life; and it can help save lives, too.

Raising awareness: Public Relations advertisement raises awareness of breast cancer; Crossing the finish line at a breast cancer awareness fundraising 3-day walk in Atlanta.
Photo credit: (1) (2)

Reference links:
1.   http://www.medicinenet.com/breast_cancer/article.htm
2.   http://www.medicinenet.com/male_breast_cancer/article.htm
3.   http://www.cancer.org/docroot/PRO/content/PRO_1_1_Cancer_Statistics_2009_Presentation.asp
4.   http://www.drugs.com/news/environmental-toxins-radiation-may-tied-breast-cancer-11415.html
5.   http://www.cancer.gov/cancertopics/factsheet/risk/brca
6.   http://en.wikipedia.org/wiki/Mammography
7.   http://www.prnewswire.com/news-releases/major-breast-cancer-breakthrough-announced-at-bc-cancer-agency-63694862.html