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Breast Cancer

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Breast Cancer
Summary
  • It is the most common cancer in women and is the second leading cause of death by cancer in women (lung cancer is the first).
  • In the majority of women, Breast Cancer is first noticed as a lump in the breast.
  • If a lump that may be cancerous is found, your Doctor will order a biopsy where some cells from the lump are removed.
Description

Breast Cancer is cancer that arises in the breast tissue. It is the most common cancer in women and is the second leading cause of death by cancer in women (lung cancer is the first). In the United States, only 1% of cases of Breast Cancer occur in men.1

Breast Cancer may begin in the milk glands or milk ducts, fatty tissue or connective tissue. The majority (90%) of Breast Cancers begin in the milk glands or ducts.2


Cause

Risk factors for Breast Cancer include:3

  • Age - chances of developing Breast Cancer increase as women grow older.
  • Family history of Breast Cancer. The risk of developing Breast Cancer doubles or triples if a first-degree relative (parent, sibling or child) has had Breast Cancer.
  • Women who have had in situ Breast Cancer (contained entirely in the breast duct) or invasive Breast Cancer (where the cancer can spread to other tissues) are at higher risk of having Breast Cancer develop again, often in the other breast.
  • Women who began menstruation early or who had an early menopause or a late first pregnancy are at higher risk of developing Breast Cancer.
  • Women taking oral contraceptives or who are on hormone replacement therapy may be at slightly higher risk.


Signs & Symptoms

In the majority of women, Breast Cancer is first noticed as a lump in the breast. The lump usually feels quite different from the surrounding breast tissue and cannot be felt in the same place on the other breast. In the early stages the lump may be quite moveable under the skin. In more advanced stages, the lump is fixed to the chest wall or skin and is difficult to move. There may also be small bumps or ulcers on the breast skin or a change in the texture of the skin (which resembles the skin of an orange, although not orange in colour). Sometimes there will be breast pain without a lump or the breast may be enlarged.4


Diagnosis

If a lump that may be cancerous is found, your Doctor will order a biopsy where some cells from the lump are removed via a needle attached to a syringe (aspiration biopsy) or a small piece of tissue is removed (incisional biopsy) or the whole lump will be removed (excisional biopsy). If cancer cells are found, more tests will be performed to determine the nature of cancer present, as this will affect the type of treatment used.5 See the Breast Cancer Diagnosis topic on the Healthpoint for further information.


Treatment

Treatment will depend on the type of Breast Cancer present - how fast it grows, if it is likely to spread and what effect treatment will have. Treatment can include surgery, radiation therapy, chemotherapy and hormone-blocking drugs or a combination of these treatments. Ask your Doctor to clearly outline all the treatment options available for the type of Breast Cancer you have.6

See the Breast Cancer Treatment , Breast Surgery, Breast Cancer - Chemotherapy , Breast Cancer - Radiation Therapy , Breast Prosthesis and Breast Reconstruction topics on the Healthpoint for further information.

  • Management

    Always consult your Doctor for diagnosis and advice. In no way is this information intended to replace the advice of a medical practitioner.

    The Royal Australian College of General Practitioners (Australia) recommends that women aged 50-69 have a mammogram every 2 years. Women who have a family history of Breast Cancer should see their Doctor to discuss genetic screening. There is a small benefit in mammogran screening for women aged 40-49, however, it needs to be weighed against other factors such as age, family history, personal concerns, personal assessment of possible risks of mammography such as anxiety, inconvenience, cost and discomfort.7 BreastScreen Australia is a national mammographic screening programme that provides free mammograms for women throughout Australia at various screening units across the country. BreastScreen is targeted specifically at women aged 50-69, although women aged 40-49 and 70 years and older are able to use this free service.8 9

    The Royal Australian College of General Practitioners (Australia) recommends that women who have a moderate to high risk of Breast Cancer should have regular clinical breast examinations performed by their Doctor. The College recommends that women should be encouraged to know their breasts and what is normal for them and to report any breast changes to their Doctor immediately.10


    Lifestyle

    Diet Hints
    • Soy products contain substances called phytoestrogens , which may help fight Breast Cancer11. Soy foods include soy milk, tofu, tempeh and soy beans.
    • A diet high in fruits and vegetables and low in meat is associated with a lower risk of Breast Cancer.12 13
    • Obesity and a high fat diet may increase the risk of Breast Cancer14.
    • A diet high in fibre, fruits and vegetables may have a protective effect against cancer15. Try to include at least 5 servings of fresh fruit and vegetables in the diet each day.
    • Fruits and vegetables which are orange in colour (e.g. carrots, oranges, sweet potatoes etc.) are good sources of beta-carotene . This antioxidant may help to protect the body against cell damage and reduce the risk of Breast Cancer16.
    • Replacing saturated fats with poly- and monounsaturated fats may reduce the risk of Breast Cancer17. Most animal fats are saturated fats. Most vegetable oils are either mono- or polyunsaturated fats. Cold-pressed virgin olive oil is thought to be the best oil for cooking18. See the Fats or Lipids topic on the Healthpoint for further information.
    • Regular alcohol consumption is a risk factor for Breast Cancer19. Most cancer organisations recommend that women that drink limit their consumption to 1-2 glasses per day or cease drinking altogether.
    • For dietary advice during cancer therapy, see the Cancer - Chemotherapy and Cancer - Radiotherapy topics on the Healthpoint for further information.


    Vitamins/Minerals/Herbs

    Always consult your Doctor before taking any dietary supplements for advice on any possible side effects or drug interactions. This is particularly important during cancer therapy, as many chemotherapy drugs act by blocking the effects of certain vitamins.

    • Carotenoids supplements may help fight the growth of Breast Cancer cells20.
    • Phytosterols (plant sterols) may offer protection against Breast Cancer21. It is believed they help boost the immune system and interfere with the growth of cancerous tumours.
    • Pycnogenol (a flavonoid supplement derived from pine trees) may help destroy cancerous breast tissue, without harming normal tissue22.
    • Retinoic Acid, a substance similar to vitamin A , may destroy cancerous Breast cells23.  
    • Huanglian, a Chinese herbal extract, has been found to have cancer-fighting properties24.  
    • Rosemary extracts have been found to increase the susceptibility of cancerous cells to chemotherapy drugs25.
    • Podophyllum hexandrum, a Himalayan herb, has been found to have anti-cancer properties and also to help protect normal cells against the damaging effects of radiotherapy26.
  • Pharmacist's Advice

    Ask your Pharmacist for advice.

    1. Follow the diet hints.
    2. Quit smoking. Ask your Pharmacist for information and products designed to help you quit.
    3. Your Pharmacist can offer advice about the side effects of chemotherapy and radiotherapy. Your Pharmacy stocks a range of low irritant skin washes, mouthwashes etc.
    4. Discuss any medications you may be taking with your Pharmacist . He/she can advise you about their effects and any potential problems or side effects.
    5. Recent studies indicate that strenuous exercise in youth might provide life-long protection against Breast Cancer and that even moderate physical activity as an adult can lower breast cancer risk27.
    6. See the Vitamins/Minerals/Herbs section of this topic and ask your Pharmacist for advice on the supplements recommended.


  • Notes

    Organisations & Support Groups

    Australian Cancer Society - (02) 9036 3100


    References

    1. Mary Buechler and Elizabeth Buechler. Cancer, Breast. eMedicine Consumer Journal, January 28 2001, Volume 2, Number 1. [cited 2001 Dec 11]. Available from: URL: http://www.emedicine.com/aaem/topic82.htm.
    2. Merck Manual Home Edition. Breast Cancer. [cited 2001 Dec 11]. Available from: URL: http://www.merckhomeedition.com/interactive/data/s22/c238/2223807.htm.
    3. Beers M H and Berkow R. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, N.J: Merck Research laboratories; 1999.
    4. Beers M H and Berkow R. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, N.J: Merck Research laboratories; 1999.
    5. Merck Manual Home Edition. Breast Cancer. [cited 2001 Dec 11]. Available from: URL: http://www.merckhomeedition.com/interactive/data/s22/c238/2223807.htm.
    6. Merck Manual Home Edition. Breast Cancer. [cited 2001 Dec 11]. Available from: URL: http://www.merckhomeedition.com/interactive/data/s22/c238/2223807.htm.
    7. National Preventive and Community Medicine Committee of The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practise. 5th ed. Journal of The Royal Australian College of General Practitioners. 2002 May (Special Issue).
    8. BreastScreen Australia. Who should have a mammogram? [cited 2002 Oct 15]. Available from: URL: http://www.breastscreen.info.au/who/index.htm.
    9. Australian Department of Health and Ageing. Population Health. BreastScreen Australia. [cited 2002 Oct 15]. Available from: URL: http://www.health.gov.au/pubhlth/strateg/cancer/breast/.
    10. National Preventive and Community Medicine Committee of The Royal Australian College of General Practitioners. Guidelines for preventive activities in general Practise. 5th ed. Journal of The Royal Australian College of General Practitioners. 2002 May (Special Issue).
    11. Nakagwa, H. et al. Effects of genistein and synergistic action in combination with eicosapentaenoic acid on the growth of breast cancer cell lines. J Cancer Res Clin Oncol 2000 Aug;126(8):448-54.
    12. Ritter MM et al. Effects of a vegetarian life style on health. Medizinische Klinik II, Klinikum Grosshadern der Universitat Munchen. Fortschr-Med. 10 Jun 1995. 113 (16). pp 239-42.
    13. Gandini, S. et al. Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer 2000 Mar;36(5):636-46.
    14. Deslypere JP. Obesity and cancer. Department of Endocrinology, University Hospital, Pintelaan, Ghent, Belgium. Metabolism. Sep 1995. 44 (9 Suppl 3). pp 24-7.
    15. Steinmetz KA, et al. Vegetables, fruit, and cancer prevention: a review. J Am Diet Assoc. 1996 Oct; 96(10): 1027-39. 
    16. Dietary Factors In Breast and Endometrial Cancer. Journal of the National Cancer Institute. 1996. Edition 88. pp 340-348.
    17. Trichopoulou A, et al. Consumption of olive oil and specific food groups in relation to Breast Cancer risk in Greece. Department of Nutrition and Biochemistry, Athens School of Public Health, Greece. J-Natl-Cancer-Inst. 1995 Jan 18. 87 (2). pp 110-6.
    18. Erasmus U. Monounsaturated Oils. Fats That Heal and Fats That Kill. 1995.
    19. Breast Cancer. Mayo Foundation for Medical Education and Research. Last updated Feb 10 2000. [cited 6 Feb 2001]. Available at URL: http://www.mayohealth.org.
    20. Nesaretnam, K. et al. Effect of a carotene concentrate on the growth of human breast cancer cells and pS2 gene expression. Toxicology 2000 Oct 26;151(1-3):117-26.
    21. Awad AB et al. Inhibition of growth and stimulation of apoptosis by beta-sitosterol treatment of MDA-MB-231 human breast cancer cells in culture. Int J Mol Med. 2000 May;5(5):541-5.
    22. Huynh, H. & Teel, R. Selective induction of apoptosis in human mammary cancer cells (MCF-7) by pycnogenol. Anticancer Res 2000 Jul-Aug;20(4):2417-20.
    23. Prakash, P. et al. Retinoids, carotenoids, and human breast cancer cell cultures: a review of differential effects. Nutr Rev 2000 Jun;58(6):170-6.
    24. Li, X. et al. Huanglian, A chinese herbal extract, inhibits cell growth by suppressing the expression of cyclin B1 and inhibiting CDC2 kinase activity in human cancer cells. Mol Pharmacol 2000 Dec;58(6):1287-93.
    25. Plouzek, C. et al. Inhibition of P-glycoprotein activity and reversal of multidrug resistance in vitro by rosemary extract. Eur J Cancer 1999 Oct;35(10):1541-5.
    26. Goel, H. et al. Antitumour and radioprotective action of Podophyllum hexandrum. Indian J Exp Biol 1998 Jun;36(6):583-7.
    27. Risk factors, prevention, and causes of breast cancer. 1998 American Cancer Society, Inc. 1996-2001 WebMD Corporation.
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