Breast cancer

Signs and Symptoms

According to the National Cancer Institute, breast cancer is often accompanied by the following signs and symptoms:

• A lump or thickening in or near the breast or in the underarm area
• A change in the size or shape of the breast
• Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
• Ridges or pitting of the breast (the skin looks like the skin of an orange)
• A change in the way the skin of the breast, areola, or nipple looks or feels (warm, swollen, red, or scaly)

What Causes It?

Risk factors you cannot change include:

• Age and gender. Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer than men.
• Family history of breast cancer. You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20% to 30% of women with breast cancer have a family history of the disease.
• Genes. Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you will have a higher risk of developing breast cancer. Women with one of these defects have up to an 85% chance of getting breast cancer sometime during their lives.
• Menstrual cycle. Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk of breast cancer.
• Dense breasts. More fibrous breast tissue has been associated with an increased risk of breast cancer.

Other risk factors include:

• Alcohol use. Drinking more than 1 glass of alcohol a day may increase your risk for breast cancer. Research shows that the risk of breast cancer is related to the amount of alcohol consumed, and that even light drinking was associated with a 10% increased risk.
• Childbirth. Women who have never had children, or who had them only after age 30, have an increased risk of breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
• DES. Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to women during the 1940s to 1960s.
• Hormone replacement therapy (HRT). You have a higher risk of breast cancer if you received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.
• Obesity. Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which may fuel the development of breast cancer.
• Radiation. If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk of developing breast cancer. The younger you started such radiation, and the higher the dose, the higher your risk; especially if the radiation was given when a female was developing breasts.
• Low levels of Vitamin D. Some studies suggest that low levels of vitamin D are associated with an increased risk of breast cancer.

Breast implants, power lines, computer terminals, antiperspirants, and underwire bras do not raise your risk of breast cancer. There is no evidence of a direct link between breast cancer and pesticides.

The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer.

Who is Most At Risk?

People with the following conditions or characteristics are at a higher than average risk for developing breast cancer:

• Women (over 99% of cases)
• Increased age
• History of cancer in one breast
• History of benign breast disease
• Never giving birth, or first pregnancy after age 30
• Family history (first degree relative) of breast cancer (significant for premenopausal women)
• Early onset of menstruation and late menopause
• High doses of ionizing radiation before age 35
• History of cancer of the colon, thyroid, endometrium, or ovary
• Diets high in animal fat, excessive alcohol consumption, and obesity
• Alterations in certain genes

Despite the relevance of risk factors, 70% to 80% of women with breast cancer have none of the known risk factors.

What to Expect at Your Provider's Office

If you have symptoms associated with breast cancer, see your health care provider immediately. Your provider can help make a diagnosis and help you determine which treatment or combination of therapies will work best for you.

Your provider will do a breast exam and run some laboratory tests, including:

• A study of breast tissue and genetic testing
• Imaging techniques such as mammography, ultrasound, magnetic resonance imaging (MRI)
• Methods that help distinguish a cyst from a tumor or make a distinction between cancerous and noncancerous disease.

Studies suggest that ultrasound is also effective for differentiating between a cystic (dense) breast mass and a solid (cancerous) tumor. Nuclear imaging techniques like positron emission tomography (PET) and single photon emission tomography (SPECT) may help physicians monitor the growth of tumors. Your doctor may also recommend a surgical biopsy to determine which type of breast cancer you have.

Treatment Options

Prevention

Early detection is important. Annual gynecologic exams play a big role in early detection. Some health authorities recommend mammography every 1 to 2 years for women 40 years of age and older. The United States Committee on Preventive Task Force has suggested that women should not begin screening until age 50 due to false positive rates. However, most health care authorities, including the American College of Obstetricians and Gynecologists (ACOG) strongly disagree. In some cases, mammography may be used in conjunction with ultrasound and other diagnostic modalities. Until there is a consensus, mammography screening should be personalized according to the woman's:

• Age
• Breast density
• Family history
• Other risk factors

Clinical breast exams should be performed every 1 to 3 years up to the age of 40 and then annually after that. Most authorities also recommend monthly breast self exams. Regular exercise, maintaining a healthy weight, limiting alcohol intake, and limiting postmenopausal hormone therapy may help prevent breast cancer.

Exercise alone reduces the risk for breast cancer by 25% to 30%, and the association seems strongest for those who engage in moderate rather than extreme forms of physical activity. Women who breastfed their babies are also at lower risk of developing breast cancer. Some women who are at high risk of developing breast cancer may choose to take preventive drugs, such as tamoxifen and raloxifene.

Treatment Plan

Treatment options depend on the:

• Size and location of the tumor
• Results of lab tests
• Stage, or extent, of the disease

Along with the patient's age and menopausal status, general health, and breast size.

Drug Therapies

Your health care provider may prescribe one or more of the following therapies:

• Radiation therapy. The use of high energy x-rays to kill cancer cells and prevent them from growing.
• Chemotherapy. The use of drugs to kill cancer cells.
• Hormonal therapy. Which keeps cancer cells from getting the hormones they need to grow.
• Antitumor antibiotics.
• Antiestrogens. Such as tamoxifen and raloxifene, which block estrogen from reaching breast cancer cells, reducing the risk of recurrence.
• Monoclonal antibodies. To block the protein receptor that is produced in large numbers in women who have breast cancer.
• High dose progestogens (steroid hormones).
• Non steroidal anti-inflammatory drugs (NSAIDs). Which may reduce features of breast cancer and play a role in the prevention and treatment of the disease.
• Immunotherapy. To help unleash the immune system to better fight the disease.

Surgical and Other Procedures

Surgery is the most common treatment for breast cancer. The choice of surgeries includes the following:

• Mastectomy. Removal of the breast, or as much of the breast tissue as possible. This treatment may be followed by breast reconstruction.
• Lumpectomy. Removal of the tumor and a small amount of tissue around it, usually followed by radiation therapy. Doctors are also increasingly offering a single dose of radiation during lumpectomy called intraoperative radiation therapy, or IORT.
• Segmental, or partial, mastectomy. Removal of the tumor and a small amount of tissue around it, as well as the lining of the chest muscles below the tumor and some of the lymph nodes under the arm. It is usually followed by radiation therapy.

Complementary and Alternative Therapies

A comprehensive treatment plan for breast cancer may include a range of complementary and alternative therapies. Many naturally-oriented doctors believe that nutritional supplementation and herbal medications are important for cancer patients. Other doctors are concerned that certain supplements may interfere with conventional cancer therapies. It is important that people educate themselves and inform all of their providers about the therapies they are using. The risk of recurrent breast cancer and death is higher among people who do not receive conventional treatment. CAM therapies did not alter this risk and should not be used as a substitute for standard treatment.

Psychotherapy and support groups may help improve quality of life and survival. CAM therapies such as reflexology, yoga, and spiritual healing have been shown to improve quality of life among people with breast cancer. Make sure all of your doctors know about every therapy you are using, including any supplements you are taking. Work with specialists, keep all of your doctors informed, and know that new research on the risks and benefits of complementary and alternative therapies in cancer medicine are becoming available all the time.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Eat a diet rich in whole foods, including quality proteins, fat, and carbohydrates, with an emphasis on maintaining body weight.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Exercise, if possible, 5 days a week. Speak to your physician to find a regimen that is right for you.

You may address nutritional deficiencies with the following supplements. Work with a doctor who has expertise in natural therapies for cancer care before using any supplements. Remember to inform all of your providers about any natural therapies or supplements you are using.

• Probiotic supplement (containing Lactobacillus acidophilus). 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results. Speak to your doctor to determine whether these supplements are appropriate for you. Probiotics may not be recommended in severe cases of immunosuppression.
• Omega-3 fatty acids. Such as fish oil, 1 to 2 capsules or 1 tbsp. (15 mL) of oil 1 to 2 times daily, to help reduce inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources. Omega-3 fatty acids can increase the blood-thinning effects of certain medications, including Coumadin and aspirin, and may increase the risk of bleeding in general. Speak with your provider.
• Melatonin. 2 to 6 mg at bedtime, for immune support and sleep. Higher doses may be needed in breast cancer. Melatonin may interact with a variety of medications, including but not limited to, sedatives, psychiatric medications, blood-thinning medications, and blood pressure medications. Ask you provider.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should talk to your provider before starting treatment.

• Hibiscus syriacus. Studies suggest hibiscus syriacus may inhibit breast cancer cell growth. Speak to your doctor.

Homeopathy

An experienced homeopath considers both your symptoms and constitutional type to create an individualized treatment regimen. Work only with a knowledgeable prescriber. Some of the most common homeopathic remedies that may treat symptoms associated with breast cancer are the following:

• Arsenicum. For anxiety and nausea, with restlessness and burning pains.
• Ipecac. For nausea unrelieved by vomiting.
• Nux vomica. For sharp abdominal pains with anger and collapse.

Acute dose is 3 to 5 pellets of 12X - 30C every 1 to 4 hours until symptoms are relieved.

Acupuncture

While acupuncture is not used as a treatment for cancer itself, studies show it can be a valuable therapy for symptoms associated with cancer and the side effects of chemotherapy. In a study of 104 women with breast cancer and nausea from chemotherapy (all of whom were taking antinausea medication), women treated with acupuncture had fewer attacks of nausea than women who received the medication alone.

Other studies suggest that acupuncture can help alleviate fatigue and cognitive dysfunction in breast cancer patients undergoing chemotherapy. Acupuncture may also help eliminate pain and hot flashes caused by tamoxifen (a breast cancer medication). One study found that acupuncture markedly improved breathlessness in women with late stages of breast cancer. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness and chemotherapy-induced nausea and vomiting. People can learn how to treat themselves using this technique.

Some acupuncturists prefer to work with people with breast cancer only after they have completed conventional medical cancer therapy. Others will provide acupuncture and herbal therapy during active chemotherapy or radiation. Acupuncturists treat people with breast cancer based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Prognosis and Possible Complications

Most complications result from surgery, radiation, chemotherapy, or use of the drug tamoxifen, which is effective in preventing recurrence but may increase a woman's risk of developing endometrial cancer and blood clots. Other potential complications include:

• Restricted shoulder movement
• Increase in size of operative scar
• Inflammation of connective tissue in the affected arm
• Cancerous tumor of the lymphatic vessels in the affected arm
• Accumulation of fluid in the breast; swelling of tissue in the arm
• Discoloration of the skin from radiation, or a red spot
• Inflammation of the lung from radiation
• Death of the fat cells underlying the breast tissue
• Recurrence of the disease

Women with breast cancer are also at significantly increased risk of progressive cardiovascular disease and osteoporosis. The prognosis for breast cancer patients depends primarily on the stage, or extent, of the disease at the time of the initial diagnosis. With increased early detection rates and improved treatments, the 5-year survival rate is greater than 85%.

Following Up

Breast cancer patients should see their health care provider every 3 months for 18 months to 4 years, then every 6 months thereafter.

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