Anguilla like many other countries throughout the world uses the month of October each year to highlight breast cancer. Almost everyone in Anguilla knows someone who has or had this condition but, fortunately, today more individuals with this cancer are having greater survival rates. Thanks to greater awareness of the disease, more early diagnosis and better treatment options.
What causes breast cancer?
It is not clear what causes breast cancer. Doctors know that breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. The cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.
Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). It may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells within the breast.
Researchers have identified things that can increase your risk of breast cancer. But it is not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It is likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.
Risk factors for breast cancer
The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it is about 100 times more common in women. Other top risk factors include being over age 55 or having a close relative who has had the disease. It must be pointed out that up to 80% of women with breast cancer have no family history of the illness.
Breast cancer genes
Some women have a very high risk of breast cancer because they inherited changes in certain genes. The genes most commonly involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have up to an 80% chance of getting breast cancer at some point in life. Other genes may be linked to breast cancer risk as well.
Other risk factors
Being overweight, getting too little exercise, and drinking more than one alcoholic beverage per day can raise the risk of developing breast cancer. Some forms of postmenopausal hormone therapy can also boost your risk. But the risk seems to go back to normal after these medications are stopped. Among survivors, good lifestyle choices may be helpful. Recent studies suggest that physical activity may help lower the risk of a recurrence.
What are the symptoms of breast cancer?
There are often no symptoms of breast cancer, but sometimes women may discover a breast problem on their own. Signs and symptoms to be aware of may include:
• A breast lump or thickening that feels different from the surrounding tissue
• Bloody discharge from the nipple
• Change in the size or shape of a breast
• Changes to the skin over the breast, such as dimpling
• Inverted nipple
• Peeling, scaling or flaking of the nipple or breast skin
• Redness or pitting of the skin over your breast, like the skin of an orange
Breast pain can also be a symptom of cancer, but this is not common.
Signs of inflammatory breast cancer
Inflammatory breast cancer is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick, red, and may look pitted — like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.
When to see a doctor
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor.
Breast cancer and mammograms
The earlier breast cancer is found, the easier it is to treat. And mammograms, X-rays of the breast, can detect tumors before they are large enough to feel. Various organizations have different recommendations on the timing and frequency of mammograms. The American Cancer Society recommends yearly mammograms beginning at age 40 for women at average risk. The U.S. Preventive Services Task Force recommends a screening mammogram every two years from age 50 to 74. It also notes that, before age 50, each woman should check with a doctor to find out what screening schedule is right for her, considering the potential benefits and harms.
Breast Ultrasound and MRI
Besides a mammogram, your doctor may order additional imaging with breast ultrasound. An ultrasound can help determine the presence of cysts, fluid-filled sacs that are not cancer. An MRI may be recommended along with a mammogram for routine screening in certain women who have a higher risk of breast cancer.
Breast self-exams
It was once widely recommended that women check their own breasts once a month. But studies suggest these breast self-exams play a very small role in finding cancer. The current thinking is that it is more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule. If you want to do breast self-exams, be sure to go over the technique with your doctor.
Finding a breast lump
If you find a breast lump it is important to recognize that eighty percent of breast lumps are not cancerous. Lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it is found the better. And if it’s not, testing can give you peace of mind.
The only sure way to determine whether a lump is cancer is to do a biopsy. This involves taking a tissue sample for further examination in the lab. The results will show whether the lump is cancer and, if so, what type. There are several forms of breast cancer, and treatments are carefully matched to the type of cancer.
Hormone-sensitive breast cancer
Some types of breast cancer are fueled by the hormones oestrogen or progesterone. A biopsy can reveal whether a tumour has receptors for oestrogen (ER-positive) and/or progesterone (PR-positive). About two out of three breast cancers are hormone sensitive. There are several medications that keep the hormones from promoting further cancer growth.
HER2-positive breast cancer
In about 20% of patients, breast cancer cells have too many receptors for a protein called HER2. This type of cancer is known as HER2-positive, and it tends to spread faster than other forms of breast cancer. It’s important to determine whether a tumor is HER2-positive because there are special treatments for this form of cancer.
Breast cancer treatment
Treatment of breast cancer will vary from one patient to another and will also depend on a number of factors such as the stage of the cancer and other clinical features. If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body.
Breast cancer is treated using a combination of surgery, chemotherapy and/or radiotherapy. Surgery is usually the first type of treatment you will have, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments.
The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor will discuss the best treatment plan with you.
In a small proportion of women, breast cancer is discovered after it is spread to other parts of the body (metastasis). Secondary cancer, also called advanced or metastatic cancer, is not curable, so the aim of treatment is to achieve remission (symptom relief).
Hormone therapy is an effective treatment for women with ER-positive or PR-positive breast cancer. These are cancers that grow more rapidly in response to the hormones oestrogen or progesterone. Hormone therapy can block this effect. It is most often used after breast cancer surgery to help keep the cancer from coming back. It may also be used to reduce the chance of breast cancer developing in women who are at high risk.
Targeted therapies are newer drugs that target specific properties within cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted therapies can stop this protein from promoting the growth of cancer cells. These drugs are often used in combination with chemotherapy. They tend to have milder side effects compared with chemotherapy.
Living with breast cancer
There is no doubt that cancer is a life-changing experience. The treatments can take a toll on you. You may have trouble managing daily chores, work or social outings. This can lead to feelings of isolation. It is crucial to reach out to friends and family for support. Many people choose to join a support group – either locally or online.
Conclusion
Breast cancer continues to affect individuals in Anguilla. Early diagnosis has resulted in improved survival rates from this very common cancer in women. Women are encouraged to be aware of changes in their breast, and if they have any concerns they should make an appointment to see their doctor. Not all breast lumps are cancerous, but if you should notice a breast lump bring this to the attention of your healthcare provider so that breast cancer can be ruled out or treated effectively.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
