Breast Cancer and Its Treatment - Term Paper Example

?Breast Cancer Breast cancer is the most commonly diagnosed cancer among women and is one of the leading causes of cancer related death in them. Cancer in the breast arises because of several molecular alterations at the cellular level, leading to spread and outgrowth of epithelial cells of the breast with uncontrolled growth and immortal features. Among Canadian women, breast cancer accounts for 28 percent of cancer cases. According to Canadian Breast Cancer Foundation (2011), "in 2011, an estimated 23,400 women in Canada will be diagnosed with breast cancer, an increase of 200 from 2010. On average, 450 Canadian women will be diagnosed with breast cancer every week." The rise in public awareness has improved screening and has facilitated earlier diagnosis, at stages when curative therapies and complete surgical resection is possible. All these have improved the survival rates especially in young women. In this essay, breast cancer and the role of Canadian breast cancer program in the management of breast cancer patients in Canada will be discussed. There are several types of breast cancer and the most commonly diagnosed breast cancer is infiltrating ductal carcinoma. This type of tumor accounts for more than 75 percent of breast cancer cases. It infiltrates the surrounding tissue and also metastasizes via lymphatics. There are five subtypes of ductal carcinoma and they are cribriform, papillary, comedo, solid and micropapillary. More often than not, the lesions are a combination of 2 or more subtypes. It is important to note that comedonecrosis in a breast tumor is a risk factor for development of ipsilateral breast cancer (Wright and Moros, 2009). Other types of breast cancer include infiltrating lobular carcinoma, lobular carcinoma in situ, medullary carcinoma, tubular carcinoma, papillary carcinoma, metaplastic cancer, mammary Paget disease and colloid carcinoma. In lobular cancer, the cancer develops from the lobules and this occurs in about 10 percent cases (Buechler and Buechler, 2007). Histologically, the most common type of breast cancer is epithelial tumor (Wright and Moros, 2009). Other histologic types are primary lymphoma, adenocarcinoma and angiosarcoma (Buechler and Buechler, 2007). Breast cancers are asymptomatic in early stages and in several cases they are discovered during the breast screening program. Larger tumors may manifest as masses that are painless. The masses are hard, irregular and fixed to the skin. Discomfort or pain is not the initial manifestation of breast cancer. Other symptoms of lump in the breast are change in size or shape of the breast, skin dimpling, inversion of nipple, discharge from single duct, axillary lump. Symptoms which rise concerns about breast cancer are contour or lump change, ulceration, tethering of skin, dilated veins and edema. Signs of metastatic spread are bone pain, breathing difficulties, abdominal distension, jaundice, localizing neurologic signs, jaundice and altered cognitive function (Swart, 2011). Risk factors for breast cancer development are advanced age, female gender, late age of first parturition, positive family history, atypical hyperplasia lesions in the breast, hormone replacement therapy, lifestyle factors, early menarche and late menopause and genetic predisposition (Wright and Moroz, 2009). The most widely recognized risk factor for breast cancer is family history of breast carcinoma in a first-degree relative. According to Swart (2011), "the lifetime risk is up to 4 times higher if a mother and sister are affected; the risk is approximately 5 times greater in women with 2 or more first-degree relatives with breast cancer; and it is also greater among women with breast cancer in a single first-degree relative, particularly if the relative was diagnosed at an early age (50 y or younger)." There are five stages of breast cancer (Buechler and Buechler, 2007). In stage 0 the breast cancer is noninvasive in nature. The carcinoma is in situ and there is no metastases or lymph node involvement. In stage-1 the tumor size is less than 2 cm and the tumor is not spread from the breast. In stage-2, the cancer is spread to ipsilateral axillary lymph nodes. In stage-3, the tumor is more than 5 cm and more number of lymph nodes are involved. In stage-4 there are metastases (Buechler and Buechler, 2007). Prognostic factors related to breast cancer include size of the tumor, status of axillary lymph node, vascular or lymphatic invasion, patient age, histologic grade, response to neoadjuvant therapy, histologic grades and subtypes and amplification or overexpression of HER2 gene. Prognosis in stages-0 and 1 is above 95 percent and that in stage-4 is 20 percent. Of all the prognostic factors, key determinant of breast cancer prognosis is invasiveness (Wright and Moros, 2009). Noninvasive lesions are mainly limited by basement membrane. Though there has been a rise in the number of breast cancer cases worldwide, deaths related to cancer have decreased because of early detection and improved modalities of treatment. Mammogram is a useful screening and diagnostic test for cancer of the breast. Biopsy and magnetic resonance imaging are useful confirmatory tests (Swart, 2011). Primary treatment for breast cancer is surgery and in those with early stage, the disease is curative. The goals of surgery in breast cancer are "complete resection of the primary tumor with negative margins to reduce the risk of local recurrences, and pathologic staging of the tumor and axillary lymph nodes for providing necessary prognostic information" (Swart, 2011). Other modes of treatment include chemotherapeutic agents, radiation therapy and biologic agents. The Canadian breast cancer program has several attributes, one of which is the Nova Scotia Breast Screening program. The goal of this program is to reduce mortality related to breast cancer among women between 50- 69 years of age by atleast 30 percent in the province of Nova Scotia through mammography (Nova Scotia Breast Screening Program, 2011). The vision of the program is to "provide quality standardized mammography access with timely assessment, informed patient navigation and appropriate follow-up of women who have abnormal mammograms on screening, through diagnostic work-ups in accredited work-up centers, before consideration of surgical alternatives” (Nova Scotia Breast Screening Program, 2011). Thus, breast cancer is one of the common causes of cancer related deaths in women. Screening is the best way to decrease mortality and morbidity related to breast cancer. Women need to be educated about the importance of breast cancer screening to facilitate early diagnosis and management. References Buechler, M., and Buechler, E. (2007). Breast Cancer. Emedicinehealth. Retrieved from http://www.emedicinehealth.com/breast_cancer/page14_em.htm#Authors%20and%20Editors Canadian Breast Cancer Foundation. (2011). BREAST CANCER IN CANADA 2011. Retrieved from http://www.cbcf.org/en-US/About%20CBCF/Media%20Centre/News%20Releases/2011%20Breast%20Cancer%20Stats.aspx Nova Scotia Breast Screening Program. (2010). Nova Scotia Breast Screening Program Annual Report 2010 (2009 Data). Retrieved from http://www.breastscreening.ns.ca/ann_rpt_2010/ Swart, R. (2011). Breast Cancer. Medscape Reference. Retrieved from http://emedicine.medscape.com/article/1947145-overview Wright, M.J., and Moroz, K. (2009). Breast Cancer. Emedicine from WebMD. Retrieved from http://emedicine.medscape.com/article/1276001-overview Read More