Breast Cancer and Elderly Women - Book Report/Review Example

Breast Cancer and Elderly Women There are a great many advantages to getting older, but one of the disadvantages is that the chances of cancer developing are significantly increased. Mukherjee (2010), in his book on cancer titled The emperor of all maladies: A biography of cancer, makes a clear correlation between age and an observed increase in cancer. The book eloquently discusses the history of cancer, correlating an older population with a higher rate of cancer, thus suggesting that the age of cells is relevant to the increased risks of cancer. Cancer is defined by cells that develop with mutated properties. However, these cells can be divided into multiple varieties of cancer. Breast cancer is a form that primarily attacks women and because of its connection to sexuality is often also a social issue as much as it is a medical issue. The effects of aging on women, through hormonal changes and bone mineral density changes, create higher risks for elderly women for developing breast cancer. Aging, while a process that every living thing experiences in every moment of life, comes with a long list of problems that occur when cells stop regenerating in a way that retains their original structure. This is a good thing when one is an infant, as life progresses through youth and towards adulthood. However, past the early twenties, age becomes a bloating membrane of issues that can burst from one side or the other, highly unpredictable and certainly never expected by the one who is growing older. Age is a physical manifestation, that does not always touch the internal being, revealing itself on the exterior through lines and lessoning muscle tone, but the internal physical self is subject to the aging of the cells, the exterior only showing a glimmer of the changes that can go on inside the growth of cells. One of the central elements of the biography of cancer that Mukherjee (2010) has constructed is that aging promotes the growth of cancerous cells, thus the first instigator of cancer is simply a part of the effects of aging. Mukherjee (2010) compares the desires of people to not age to the personified desire of the cancer cell. He states that “If we seek immortality, then so, too, in a perverse sense, does the cancer cell” (p. 6). A cancer cell is a cell that has mutated, adapted in order to increase its life. The problem, of course, is that the cancer cell no longer functions the way it is intended, becoming a parasite, a blockage, or an inconvenient mass of tissue that will continue to grow and interrupt the function of the body until it consumes the body in which it has grown. Cancer grows and that is the biggest problem with it, that it grows where it should not, interferes where the function of the tissue or fluids should be specifically regulated, and becomes a rebellion within the body that fights to flourish and grow, eventually taking the life of the host. The one thing that best describes the relationship between the cancer and age is that both the body and the cancer tumble towards the future in competition, one eventually winning out over the other. The cancer that most often affects women is breast cancer which is consequently the second highest cause of death from cancer in the United States. Crooks and Baur (2011) have suggested that a woman dies from breast cancer in the United States at the rate of one every twelve minutes. According to McCrary (2004), on average 215,990 women are diagnosed with breast cancer in the United States each year, with 40,110 likely to die from the disease. However, across the United States there are over 2 million women alive who have survived breast cancer. Women will survive at a rate of 97% if the diagnosis comes early. However, 82% of the diagnosis of breast cancer is heard by women who are over the age of fifty (p. 15). Therefore, the best defense for breast cancer is to aggressively and diligently watch for signs of the disease, especially once one has past the fifty year mark. Because of the social ramifications and the high death rate, breast cancer represents an emotional topic for women. Fear has created a great deal of decisions that might be premature or dictated by generalizations. According to Grady (1991), fears of HRT (hormone replacement therapy) causing breast cancer has caused a great many women to refuse HRT when it could be beneficial to the effects of aging. Buist (2001) suggests that while estrogen is not mutagenic, an overabundance of estrogen introduced to breast tissue through early menarche, late age pregnancy, or menopause, has suggested some predilection towards breast cancer (p. 213). Because of these correlations, it might not be unreasonable to believe that HRT can affect the incidence of breast cancer, thus the fears that some women have against using HRT might be justified. With correlations to HRT, it is natural to understand that the level of changes that take place within the hormone balance of women as they age can be a causal factor to breast cancer. Changes that are naturally expected in progesterone and estrogen levels can be linked to higher incidents of breast cancer. According to Buist et al (2001), early menarche, menopause at a late age, or pregnancy at a late age can contribute to breast cancer (p. 213). In addition to these causes, Ganry et al (2004) has determined that high bone mineral density (BMD) in older women is consistent with the development of breast cancer, but whether or not it is a consequence of breast cancer or a risk factor is unclear from this study (p. 785). However, Zmuda et al (2001) came to the conclusion that older women with high BMD had a higher rate of risk for breast cancer, especially later stage tumors, than did women with lower BMD. Their conclusions suggest that there is a relationship between osteoporosis and breast cancer. According to Masoro and Austad (2006) cancer “results from a series of genetic changes that, over time, confer unique properties to a cell that lead to a progression of normalcy to malignancy” (p. 116). They go on to describe that there are two types of mutations: replicative stress and exposure to damaging extrinsic factors. Extrinsic insults will eventually affect stem cells, which are cells that are responsible for important life-long tissue repair and replenishment. Changes in cells occur in relationship to both intrinsic and extrinsic events and will lead to an accumulation of cell damage. Most cells have a limited cell life, short-termed and therefore damage will have little long term effects to the body. Stem cells, on the other hand, self-renew and with accumulations of damage, will diminish organ and tissue functions (Signer, 2008, p. 14). In breast cancer, cells can be divided by population types: a stem cell-like population and a transit amplifying type cell population. Tumors that are malignant most often have both types of cancerous cells. This quite possibly indicates that the damaged stem cells, which initiate the tumor, attract the non-stem cells. When mouse breast cancer tumors were examined, they also showed this fractionalization, thus suggesting that both cell types are involved in creating the cancerous growth (Majumder, 2009, p. 15). Growth of a breast cancer tumor can be seen as the product of stimulation by hormones that cause cells to divide abnormally that can no longer repair, which then affects the cells that they would normally assist in repair and rejuvenation. This is particularly relevant to elderly women as their bodies are changing through the breaking down of hormone systems that were intended for child birth. As eggs have grown older, the cycles of menses are no longer relevant and menopause soon begins to affect a woman as she begins to watch as the sexual side of her body begins to betray her. Research suggests that the flood of hormones within the body, specifically estrogen and progesterone, can stimulate breast tissues towards mutation of the cells (Buist et al 2001: Ganry et al 2004). Not only does the betrayal of her sexual identity through the experience of menopause have the possible consequence of making her uncomfortable through a host of menopausal symptoms, her body becomes ripe for the development of a cancer that attacks her breasts, a core part of her physical representation of sexuality. The issue about breast cancer is that it is as much socially relevant as it is medically relevant to its impact upon a woman. Women tend to create a sense of identity that is framed through their sexuality which is represented by their breasts. Therefore, when a woman faces the idea that she is suffering from a disease that is attacking a representation of her identity, the social ramifications can be significant. The fear of breast cancer among women is such that even the suggestion of hormone replacement therapy (HRT) being relevant to the development of cancer has significantly decreased the number of women willing to participate in HRT, even when hormonal imbalances have significantly affected the quality of their life (Grady, 1991). According to Mukherjee (2010), the most popular form of breast cancer detection is not as significantly accurate as one might expect. The rate of false positive and false negative results means that there are too many incidents of breast cancer being missed at an earlier point of the development. (p. 302). A gene has been detected that can predict that breast cancer is most likely to occur. In 5-10% of women, breast cancer will develop due to a flaw in a specific gene, now detectable by medical examination. In women who show this flaw, 85% will have breast cancer, and a significant portion will have ovarian cancer. Revealing the gene flaw allows a woman to take cancer preventative pharmaceuticals, or to have a mastectomy to remove the breasts in order to prevent the possibility of the development of a tumor (Crooks & Baur, 2011, p. 81). In this case, the fear of cancer is far greater than the fear of losing an aspect of sexuality by removing the breasts. With advances in reconstructive surgery, this can provide peace of mind for a woman who has been determined to have the flawed gene. According to Mukherjee (2010), “Old age inevitably drags cancer with it, like flotsam on a tide. A nation with a larger fraction of older citizens will seem more cancer ridden than a nation with younger citizens, even if actual cancer mortality has not changed” (p. 230). If experiencing the changes of getting older for a woman results in hormonal shifts that cause breast cancer, then a population that lives longer will more than likely experience a higher rate of breast cancer. However, the incidence of breast cancer, the high rate of mortality, warrants attention and research, which up until the 1970s was short in coming, the radical procedures defining the death of female sexuality for many older women who lost, not only their reproductive systems to menopause, but their breasts to radical mastectomies that took all semblance of the female shape and drove it into disfigurement. In describing the radical mastectomy, Mukherjee (2010) describes the surgery using words like “disfiguring” and “morbid”. He describes the procedure by saying it is an “extraordinarily morbid, disfiguring procedure in which surgeons removed the breast, the pectoral muscles, the axillaries, the chest wall, and occasionally the ribs, parts of the sternum, the clavicle, and the lymph nodes inside the chest” (p. 194). He quotes Haagensen from 1956 that “In my own surgical attack on carcinoma of the breast…I have followed the fundamental principle that the disease, even in its early stage, is such a formidable enemy that it is my duty to carry out as radical an operation as the…anatomy permits” (p. 194). The radical mastectomy, however, although an aggressive treatment creates problems with gender identity and social connectivity, thus inciting Mukherjee to use such strong language about the procedure. However, the radical mastectomy, developed and promoted as a cure for breast cancer by William Halstead in the early 20th century, was attacked in the 1970s as socio cultural issues began to examine the radical nature of the way in which this cancer was treated. Changes in the concept of gender and power created a discourse on the power of the surgeon to impose his will of complete removal of all tissue against the needs of the patient to not be so radically mutilated. Through creating an aggressive dialogue with the medical community, the importance of breasts to women began to become understood, the radical and disfiguring nature of the surgery changing to meet the overall needs of the patient through developments in surgical procedure. Women didn’t want to trade their health for vanity, but the invasiveness and negatively transformative nature of the radical procedure warranted research into less extensively damaging treatment (Kasper & Ferguson, 2002, p. 27). The seeming immortality of cancer cells in comparison to normal cells is a terrifying concept. Cancer cells fight harder than normal cells to survive. They do not belong where they have grown, thrusting themselves onto the host with evil intent and taking the function of what should be occurring within a cell and turning it inert. Cells that are cancerous are almost possessed, angrily multiplying like ants overrunning a hill, but then refusing to act the way in which their original programming intended, rebelliously and collectively sticking their tongues out and stomping their feet in order to cling to the nearest organ or tissue. Instead, however, of acting like lazily within their refusal to work, they form teams of explorers, spreading wildly and indiscriminately, not realizing that in killing the host, they are killing their way of survival. However, all they need is an environment and they do not have respect for how that is accomplished. Mukherjee (2010) describes a microscope view of cancer cells as, ”bloated and grotesque, with a dilated nucleus and a thin rim of cytoplasm, the sign of a cell whose very soul has been co-opted to divide and to keep dividing with pathological monomaniacal purpose” (p. 339). These cells were special- and at the same time all too frightening. Reading about these cells is like reading prophesies of doom, cancer having a power that humans only dream of. Mukherjee (2010) is looking at cells from a woman who has died, her cancer still held within the cells that he is observing. The cells are alive, even in their grotesque form - and they have survived for 30 years past the death of the woman from whom they were attained. He states “The cells, technically speaking, are immortal. The woman from whose body they were once taken has been dead for thirty years” (p. 339). Cancer steals from a woman that which helps to define her sexual presence within the world. At a time when hormones begin to betray her to the aging of her reproductive system, she also becomes most vulnerable to damage to her breast tissue that can turn against her, ravaging her system and possibly taking her life. In treatment, through chemotherapy, it is possible that she will lose her hair. Her appetite will be gone, and the pain will be like none other she has ever experienced. Finally, she might lose her breasts, the tissue surgically removed, leaving her scarred, or repaired, either one transforming her physically into someone she will not easily recognize in the mirror. As much as it attacks the health of a woman, it attacks the identity of a woman, and 82% of the time it is past the age of 50 when she is already struggling to recognize the girl she once was in the woman who has past her sexual relevancy. Mukherjee (2010) tells the story of cancer by expressing the details of the history of studying the disease, stories of those who have gone through the experience, and by using beautiful, heartbreaking, and sometimes terrifying language by which to descriptively explore its nature. In his discussion of cancer, specifically breast cancer, the suggestion of the link between age and affliction inspired further research on the topic. The research shows that woman past the age of 50 have a higher rate of developing breast cancer than younger women and this is directly connected to the experiences of growing old as a woman. It explains a great deal about the disease and the reasons why it is primarily in women, even though men share similar tissue in their chest. That cancer cells have the power to survive and continue to grow and multiply for thirty years past the death of the contributor is daunting. Mukherjee (2010) manages to express the nature of cancer and the human fear of it in a way that inspires, terrifies, and promotes further inquiry. References Buist, D. S. M., A. Z. LaCroix, W. E. Barlow, E. White, J. A. Cauley, D. C. Bauer & N. S. Weiss. (2001). Bone mineral density and endogenous hormones and risk of breast cancer in post-menopausal women (United States). Cancer Causes & Control. 12(3): pp. 213- 222. Crooks, R., & Baur, K. (2011). Our sexuality. Belmont, Calif: Wadsworth. Ganry, O., C. Baudoin, P. Fardellone, J. Peng, & N. Raverdy. (2004). Bone mass density and risk of breast cancer and survival in older women. European Journal of Epidemiology. 19(8): pp. 785-792. Grady, D. & V. Ernster, (1991). Invited commentary: Does hormone replacement therapy cause breast cancer? American Journal of Epidemiology. 134, pp. 1396-1400. Kasper, A. S., & Ferguson, S. J. (2002). Breast cancer: Society shapes an epidemic. New York: Palgrave. Masoro, E.J., & S. N. Austad. (2006). Handbook of the biology of aging. Amsterdam: Elsevier Academic Press. Majumder, S. (2009). Stem cells and cancer. Dordrecht: Springer. McCrary, E. (October 2004). Fighting breast cancer in Georgia. Atlanta Magazine. Accessed from http://books.google.com/books?id=FOECAAAAMBAJ&pg=RA1-PA15- IA1&dq=percentage+of+breast+cancer+diagnoses+after+age+60&hl=en&ei=YgqRTaifF YTp0gGzj_TWDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CEQQ6AEwA A#v=onepage&q&f=false Mukherjee, S. (2010). The emperor of all maladies: A biography of cancer. New York: Simon & Schuster. Zmuda, J. M., J. A. Cauley, D. C. Bauer, S. R. Cummings, L. H. Kuller, & B. Ljung. (2001). Bone mass and breast cancer risk in older women. Journal of the National Cancer Institute. 93(12): pp. 930-936. Read More