Introduction to Breast Cancer
We want to note that not all breast disease or lump is Breast Cancer, there are many benign diseases that affect the breast. These include Duct ectasia, Periductal Mastitis, Galactorrhea, Intraductal Papilloma, Fibroadenoma among others.
Breast cancer is the Malignant disease of the breast.
Breast Cancer is so common that it affects 1 in every 9 women, that is about 10%.
The peak age of Breast Cancer is 40 – 60 years of age.
Breast cancer has insidious development meaning that it remains silent for long (2-7 years) before showing any clinical features hence the need of screening for early diagnosis and treatment.
Breast cancer contributes to 23.3% of all cancer deaths in Kenya. This is attributed to late diagnosis and inaccessibility to treatment.
Risk factors of Breast Cancer
Major Risk factors of Breast Cancer – being a woman as it is far most common in women than men, less common in under 30 and over 52 years of age, family history of breast cancer, cancer in the opposite breast and previous breast diseases.
Minor Risk factors of Breast cancer – prolonged estrogen exposure, early menarche, late menopause, taking long before having the 1st child (above 30 years), oral contraceptive pills or hormone replacement therapy, high fat and cholesterol diet, excessive alcohol and cigarette smoking, obesity, not having children.
As noted earlier that Breast Cancer remains silent for long before showing any clinical features.
A lump may be noted – usually hard, painless, immobile and fixed.
Skin changes of the breast – wound or abscess.
Signs of metastasis or the spread of the disease to other parts of the body such as breathing problems, backache, abdominal pain or jaundice etc.
Diagnosing Breast Cancer
Your doctor will take a full history of the disease and then examine you fully.
Imaging such as Ultrasound (less than 35 years) or mammogram may be ordered.
Fine needle Aspirate (FNA) or Biopsy taken for Histopathology to confirm diagnosis using a pathologist. A sample of cells or tissue is taken to the pathologist to confirm diagnosis.
Management of Breast Cancer
Your doctor would advise you on the available options of treatment of Breast Cancer depending on the stage of the disease.
Surgery – diseased tissue removal or lumpectomy, removing quadrant of the breast (Quadratectomy), half or full breast removal and including the axillary lymph nodes.
Radiotherapy – Radiation used to kill the tumor cells.
Chemotherapy – drugs that are toxic to tumor cells are used such as methotrexate for 6 months monthly cycle.
Hormone therapy – Tamoxifen or leutenizing Hormone releasing hormone for pre-menopausal and tamoxifen or anastrazole for post-menopausal.
For Advanced disease – only supportive management is used such as pain relief, hematinics and blood transfusions, hydration and antibiotics for superimposed infection.
Screening/Prevention of Breast Cancer
Breast self-examination monthly for women over the age of 18 years.
For women over 40 years of age annual mammography.
Tamoxifen has been used in those who are high risk.
Lifestyle modifications- diet, alcohol and cigarette smoking should be stopped.
Prophylactic mastectomy whereby the breasts are removed for those who have a very high risk noted in their families and they ask for it.
Breast cancer in men
Breast cancer in men is less common than in women but it is very aggressive since men don’t have breast tissue like that of women hence the disease spreads faster and the prognosis in men is usually very poor.
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