Breast cancer, one of the most common cancers among women globally, involves the growth of malignant cells in the breast tissue.
Causes
- Genetic Factors: BRCA1 and BRCA2 gene mutations significantly increase the risk.
- Hormonal Factors: Prolonged exposure to estrogen, such as early menstruation, late menopause, and hormone therapy post-menopause.
- Reproductive History: Late or no pregnancies and not breastfeeding can increase risk.
- Age: Higher risk as women age, particularly after 50.
- Family History: A family history of breast cancer increases risk.
- Personal Health History: Having previous breast cancer or certain non-cancerous breast diseases.
- Lifestyle Factors: Obesity, lack of physical activity, and alcohol consumption.
- Radiation Exposure: To the chest area, especially during childhood.
Diagnosis
- Clinical Breast Exam: Examination of the breasts and underarm areas for lumps or changes.
- Mammography: X-ray imaging of the breast used for screening and diagnostic purposes.
- Ultrasound: Used to distinguish between solid masses and fluid-filled cysts.
- Biopsy: Removal of a tissue sample for examination under a microscope.
- MRI: For further evaluation in certain cases.
Differential Diagnosis
- Benign Breast Conditions: Such as fibrocystic changes, fibroadenomas, or cysts.
- Lymphoma or Sarcoma of the Breast: Rare cancers that originate in breast tissue.
- Metastasis from Other Cancers: Secondary cancers that have spread to the breast.
Management
- Surgery:
- Lumpectomy: Removal of the tumor and a small margin of surrounding tissue.
- Mastectomy: Removal of one or both breasts, sometimes including nearby lymph nodes.
- Reconstructive Surgery: Post-mastectomy to rebuild the breast.
- Radiation Therapy: Typically follows lumpectomy to eliminate remaining cancer cells.
- Chemotherapy: Systemic treatment to kill cancer cells, often used in more advanced stages.
- Hormone Therapy: For cancers that are hormone receptor-positive, to block the effects of estrogen or progesterone.
- Tamoxifen: This drug blocks estrogen receptors on breast cancer cells. It is often used for premenopausal women.
- Aromatase Inhibitors (AIs): Drugs like letrozole, anastrozole, and exemestane are AIs. They lower estrogen levels by stopping the enzyme aromatase from changing androgens into estrogen. AIs are commonly used in postmenopausal women.
- Ovarian Suppression: In premenopausal women, ovarian suppression using drugs like goserelin can be used alongside other hormonal therapies.
- Targeted Therapy: Drugs that specifically target cancer cell characteristics, such as HER2-positive cancers
- Trastuzumab (Herceptin)
- Tyrosine Kinase Inhibitors
- Triple Negative: This refers to breast cancer that does not have oestrogen, progesterone or HER2 receptors so rely on ordinary chemo/resection/XRT
- Immunotherapy: Utilizes the body’s immune system to fight cancer.
- Ongoing Monitoring and Support: Regular follow-ups and support, including mental health care.
- Genetic Counseling: For those with a family history or genetic predisposition.
- Lifestyle Changes and Rehabilitation: Diet, exercise, and lifestyle adjustments post-treatment.
Prevention and Early Detection
- Regular Screening: Following recommended guidelines for mammography
- 2 yearly from 50-74
- Self-Exams: Awareness of breast changes.
- Risk Reduction Strategies: Healthy lifestyle, considering risk-reducing surgery or medication for high-risk individuals ie BRCA1/BRCA2
Conclusion
The management of breast cancer depends on the stage, type, and individual patient factors. With advancements in treatment and increased emphasis on early detection, survival rates have improved significantly. Personalized treatment plans and supportive care are essential components of breast cancer management. Regular monitoring and follow-up care are crucial for detecting any recurrence and managing long-term effects of treatment.