What you need to know about Breast Cancer…. “a comprehensive guide and awareness to the public in Kenya in collaboration with the cancer research team Pandya memorial hospital Kenya”

BREAST CANCER AWARENESS

TOUCH. LOOK. CHECK.

Love your breasts. Be breast aware.

Most cases of breast cancer are found by women noticing unusual changes, taking the initiative and visiting their doctor. The earlier breast cancer is found, the better the chance of beating it – so you can see how important it is to make regular checks.

Being breast aware simply means knowing what your breasts look and feel like normally, being on the lookout for any unusual changes and getting them checked out by your doctor. Lumps are vital to look out for – but there can be other important signs too. And even if you do find a lump, in nine out of ten cases they turn out not to be cancerous. So stay calm – remain in control.

It’s as simple as TLC...

TOUCH your breasts. Can you feel anything unusual? LOOK for changes. Is there any change in shape and texture? CHECK anything unusual with your doctor.

No one knows your body better than you and everyone will have their own way of touching and looking for changes – there’s no special technique and you don’t need any training. It’s good to get into the habit of doing this regularly – maybe when you’re in the bath or shower, or while getting dressed in the morning. You might prefer to do it while standing up or lying down. Either way, the important thing is to be familiar with how your breasts look and feel normally, so you notice anything unusual – and remember to check the whole breast area, including your upper chest and armpits.

You’re never too old for some TLC Whatever your age, it’s good to get into the habit of checking. The risk of breast cancer increases with age, so if you are over 50 the risks are even higher.

So dont just sit there Get up and have your free checkup! Always remeber “prevention is better than cure” so the earlier you go for a checkup the lower the chances of you getting cancer.

Definition

“Breast cancer is an uncontrolled growth of breast cells”. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for

regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus,

which acts as the “control room” of each cell. Normally, the cells in our bodies replace

themselves through an orderly process of cell

growth: healthy new cells take over as old ones

die out. But over time, mutations can “turn on”

certain genes and “turn off” others in a cell. That

changed cell gains the ability to keep dividing

without control or order, producing more cells

just like it and forming a tumor.

A tumor can be benign (not dangerous to health)

or malignant (has the potential to be dangerous).

Benign tumors are not considered cancerous:

their cells are close to normal in appearance, they

grow slowly, and they do not invade nearby

tissues or spread to other parts of the body.

Malignant tumors are cancerous. Left unchecked,

malignant cells eventually can spread beyond the original tumor to other parts of the body.

The breast is a gland that consists of breast tissue supported by connective tissue (flesh)

surrounded by fat. The easiest way to understand how the inside of the breast is formed is by

comparing it to an upturned bush. Its leaves are known as lobules and they produce milk that

drains into ducts that are the branches of the breast tree. These in turn drain into 12 or 15

major or large ducts which empty onto the surface of the nipple, just like the branches of a

tree drain to the trunk.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the

breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-

producing glands, or the ducts, the passages that drain milk from the lobules to the nipple.

Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and

fibrous connective tissues of the breast. Over time, cancer cells can invade nearby healthy

breast tissue and make their way into the underarm lymph nodes, small organs that filter out

foreign substances in the body. If cancer cells get into the lymph nodes, they then have a

pathway into other parts of the body.

Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of

breast cancer:

Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the

nipple. Most breast cancers are of this type.

Lobular carcinoma starts in the parts of the breast, called lobules, that produce milk.

In rare cases, breast cancer can start in other areas of the breast.

Breast cancer may be invasive or noninvasive. Invasive means it has spread from the milk

duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other

breast tissue. Noninvasive breast cancer is called "in situ."

Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is breast cancer in the

lining of the milk ducts that has not yet invaded nearby tissues. It may progress to

invasive cancer if untreated.

Lobular carcinoma in situ (LCIS) is a marker for an increased risk of invasive cancer

in the same or both breasts.

Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes

the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their

cells. They are called estrogen receptor-positive cancer or ER-positive cancer.

Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that

helps cells grow, divide, and repair themselves. When cells (including cancer cells) have too

many copies of this gene, they grow faster. Experts think that women with HER2-positive

breast cancer have a more aggressive disease and a higher risk that the disease will return

(recur) than women who do not have this type.

Although the precise causes of breast cancer are unclear, we know the main risk factors. Still,

most women considered at high risk for breast cancer do not get it, while many with no

known risk factors do develop breast cancer. Among the most significant factors are

advancing age and a family history of breast cancer. Risk increases slightly for a woman who

has had a benign breast lump and increases significantly for a woman who has previously had

cancer of the breast or the ovaries.

A woman whose mother, sister, or daughter has had breast cancer is two to three times more

likely to develop the disease, particularly if more than one first-degree relative has been

affected. Researchers have now identified two genes responsible for some instances of

familial breast cancer. These genes are known as BRCA1 and BRCA2. About one woman in

200 carries the genes. Having one of them predisposes a woman to breast cancer but does not

ensure that she will get it.

A link between breast cancer and hormones is gradually becoming clearer. Researchers think

that the greater a woman's exposure to the hormone estrogen, the more susceptible she is to

breast cancer. Estrogen tells cells to divide; the more the cells divide, the more likely they are

to be abnormal in some way, possibly becoming cancerous.

A woman's exposure to estrogen and progesterone rises and falls during her lifetime,

influenced by the age she starts and stops menstruating, the average length of her menstrual

cycle, and her age at first childbirth. A woman's risk for breast cancer is increased if she starts

menstruating before age 12, has her first child after 30, stops menstruating after 55, or has a

menstrual cycle shorter or longer than the average 26-29 days. Current information indicates

that the hormones in birth control pills probably do not increase the risk. Some studies suggest

that taking hormone replacement therapy after menopause may increase risk, especially when

taken for more than five years. The jury is still somewhat out on this matter though. Heavy

doses of radiation therapy may also be a factor, but low-dose mammograms pose almost no

risk.

The link between diet and breast cancer is debated. Obesity is a noteworthy risk factor, and

drinking alcohol regularly -- more than a couple of drinks a day may promote the disease.

Many studies have shown that women whose diets are high in fat are more likely to get the

disease. Researchers suspect that if a woman lowers her daily calories from fat to less than

20%-30% her diet may help protect her from developing breast cancer

Signs & symptoms of breast cancer

Early breast cancer usually doesn't cause pain. In fact, when breast cancer first develops, there

may be no symptoms at all. But as the cancer grows, it may cause changes that you should

watch for:

A lump or thickening in or near the breast or in the underarm area

A change in the size or shape of the breast

Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast

Ridges or pitting of the breast, making the skin look like the skin of an orange

A change in the look or feel of the skin of the breast, areola or nipple such as warmth,

swelling, redness or scalines

Cancer stages is based on four characteristics:

1. the size of the cancer

2. whether the cancer is invasive or non-invasive

3. whether cancer is in the lymph nodes

4. whether the cancer has spread to other parts of the body beyond the breast

Terms used to describe the stages of breast cancer

Local: The cancer is confined within the breast.

Regional: The lymph nodes, primarily those in the armpit, are involved.

Distant: The cancer is found in other parts of the body as well.

Stages of Breast Cancer

Stage 0- Cancer cells

remain inside the breast

duct, without invasion

into normal adjacent

breast tissue.

Stage I- Cancer is 2

centimeters or less and is

confined to the breast

(lymph nodes are clear).

Stage IIA- No tumor can

be found in the breast,

but cancer cells are

found in the axillary

lymph nodes (the lymph

nodes under the arm)

OR

the tumor measures 2

centimeters or smaller

and has spread to the

axillary lymph nodes

OR

the tumor is larger than 2

but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB-The tumor is larger than 2 but no larger than 5 centimeters and has spread

to the axillary lymph nodes

OR

the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA-No tumor is found in the breast. Cancer is found in axillary lymph nodes

that are sticking together or to other structures, or cancer may be found in lymph

nodes near the breastbone

OR

the tumor is any size. Cancer has spread to the axillary lymph nodes, which are

sticking together or to other structures, or cancer may be found in lymph nodes near

the breastbone.

Stage IIIB-The tumor may be any size and has spread to the chest wall and/or skin of

the breast

AND

may have spread to axillary lymph nodes that are clumped together or sticking to other

structures, or cancer may have spread to lymph nodes near the breastbone.

Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC-There may either be no sign of cancer in the breast or a tumor may be any

size and may have spread to the chest wall and/or the skin of the breast

AND

the cancer has spread to lymph nodes either above or below the collarbone

AND

the cancer may have spread to axillary lymph nodes or to lymph nodes near the

breastbone.

Stage IV-The cancer has spread — or metastasized — to other parts of the body.

Breast cancer treatment

Breast cancer is a complicated disease. Every woman's case is distinct. There is no single

"best" treatment. No matter what treatment reccomened, you will need regular checkups to

make sure that you're staying healthy.

Doctors evaluate a woman's breast cancer in part by determining how large the tumor is and

how far it's spread.

Breast-conserving surgery is often appropriate for earlier-stage invasive breast cancers if the

cancer is small enough, although mastectomy is also an option. If the cancer is too large, a

mastectomy will be needed, unless pre-operative (neoadjuvant) chemotherapy can shrink the

tumor enough to allow breast-conserving surgery. In either case, the lymph nodes will need to

be checked and removed if they contain cancer. Radiation will be needed for almost all

patients who have breast-conserving surgery and some who have mastectomy. Adjuvant

systemic therapy after surgery is typically recommended for all cancers larger than 1 cm

(about 1/2 inch) across and for some that are smaller.

Stage I

These cancers are still relatively small and have not spread to the lymph nodes or elsewhere.

Local therapy: Stage I cancers can be treated with either breast-conserving surgery

(lumpectomy, partial mastectomy) or modified radical mastectomy. The lymph nodes will

also need to be evaluated, with a sentinel lymph node biopsy or an axillary lymph node

dissection. Breast reconstruction can be done either at the same time as surgery or later.

Radiation therapy is usually given after breast-conserving surgery. Women may consider

breast-conserving surgery without radiation therapy if all of the following are true:

They are age 70 years or older.

The tumor was 2 cm or less across and it has been completely removed.

The tumor contains hormone receptors and hormone therapy is given.

None of the lymph nodes that were removed contained cancer.

Some women who do not meet these criteria may be tempted to avoid radiation, but studies

have shown that not getting radiation increases the chances of the cancer coming back.

Adjuvant systemic therapy: Most doctors will discuss the pros and cons of adjuvant

hormone therapy (either tamoxifen or an aromatase inhibitor) with all women who have a

hormone receptor–positive (estrogen or progesterone) breast cancer, no matter how small the

tumor. Women with tumors larger than 0.5 cm (about 1/4 inch) across may be more likely to

benefit from it.

If the tumor is smaller than 1 cm (about 1/2 inch) across, adjuvant chemotherapy (chemo) is

not usually offered. Some doctors may suggest chemo if a cancer smaller than 1 cm has any

unfavorable features (such as being high-grade, hormone receptor–negative, HER2-positive,

or having a high score on one of the gene panels). Adjuvant chemotherapy is usually

recommended for larger tumors.

For HER2-positive cancers, adjuvant trastuzumab (Herceptin) is usually recommended as

well.

Stage II

These cancers are larger and/or have spread to a few nearby lymph nodes.

Local therapy: Surgery and radiation therapy options for stage II tumors are similar to those

for stage I tumors, except that in stage II, radiation therapy may be considered even after

mastectomy if the tumor is large (more than 5 cm across) or the cancer cells are found in

several lymph nodes.

Adjuvant systemic therapy: Adjuvant systemic therapy is recommended for women with

stage II breast cancer. It may involve hormone therapy, chemotherapy, trastuzumab, or some

combination of these, depending on the patient's age, estrogen-receptor status, and HER2/neu

status. See the following section for more information on adjuvant therapy.

Neoadjuvant therapy: An option for some women who would like to have breast-conserving

therapy for tumors larger than 2 cm (about 4/5 inch across) is to have neoadjuvant (before

surgery) chemotherapy, hormone therapy, and/or trastuzumab to shrink the tumor.

If the neoadjuvant treatment shrinks the tumor enough, women may then be able to have

breast-conserving surgery (such as lumpectomy) followed by radiation therapy, as well as

hormone therapy if the tumor is hormone receptor-positive. Further chemotherapy may also

be considered. If the tumor does not shrink enough for breast-conserving surgery, then

mastectomy may be required. This may be followed by different chemotherapy. Radiation

therapy may be needed if the tumor is large (more than 2 inches across) or if lymph nodes

contain cancer. The radiation is usually given after surgery. Also, hormone therapy may be

given if the tumor is hormone receptor–positive. Hormone therapy can be given both before

and after surgery. A woman's chance for survival from breast cancer does not seem to be

affected by whether she gets her chemotherapy before or after her breast surgery.

Stage III

Local treatment for some stage IIIA breast cancers is largely the same as that for stage II

breast cancers. They may be removed by breast-conserving surgery (such as lumpectomy)

followed by radiation therapy, or by modified radical mastectomy (with or without breast

reconstruction). Sentinel lymph node biopsy or axillary lymph node dissection is also done.

Radiation therapy may be used after mastectomy if the tumor is large (more than 5 cm across)

or is found to have spread to several lymph nodes. Neoadjuvant therapy may be an option for

some women who would like to have breast-conserving therapy.

Surgery is usually followed by adjuvant systemic chemotherapy, and/or hormone therapy,

and/or trastuzumab.

Stage III cancers are often treated with neo adjuvant chemo (chemotherapy before surgery).

Then a mastectomy is done, usually with removal of the axillary lymph nodes (an axillary

lymph node dissection). Reconstruction may be done as well. Breast-conserving surgery may

be an option for some women. Surgery is followed by radiation therapy, even if a mastectomy

is done. Adjuvant chemotherapy may also be given, and adjuvant hormone therapy is offered

to all women with hormone receptor–positive breast cancers.

Adjuvant therapy for stages I to III breast cancer

Adjuvant drug therapy may be recommended, based on the tumor's size, spread to lymph

nodes, and other prognostic features. If it is, you may get chemotherapy, trastuzumab

(Herceptin), hormone therapy, or some combination of these.

Hormone therapy: Hormone therapy is not likely to be effective for women with hormone

receptor-negative tumors. Hormone therapy is frequently offered to all women with hormone

receptor–positive invasive breast cancer regardless of the size of the tumor or the number of

lymph nodes involved.

Women who are still having periods and have hormone receptor–positive tumors can be

treated with tamoxifen, which blocks the effects of estrogen being made by the ovaries. Some

doctors also give a luteinizing hormone-releasing hormone (LHRH) analog, which makes the

ovaries temporarily stop functioning. Another (permanent) option is surgical removal of the

ovaries (oophorectomy). If the woman becomes post-menopausal within 5 years of starting

tamoxifen (either naturally or because her ovaries are removed), she may be switched from

tamoxifen to an aromatase inhibitor.

Sometimes a woman will stop having periods after chemotherapy or while on tamoxifen. But

this does not necessarily mean she is truly post-menopausal. The woman's doctor can do

blood tests for certain hormones to determine her menopausal status. This is important

because the aromatase inhibitors will only benefit post-menopausal women.

Women no longer having periods, or who are known to be in menopause at any age, and who

have hormone receptor–positive tumors will generally get adjuvant hormone therapy either

with an aromatase inhibitor (typically for 5 years), or with tamoxifen for a few years followed

by an aromatase inhibitor for a few more. For women who can't take aromatase inhibitors, an

alternative is tamoxifen for 5 years.

As mentioned before, there are still many unanswered questions about the best way to use

these drugs. For example, it's not clear if starting adjuvant therapy with one of these drugs is

better than giving tamoxifen for some length of time and then switching to an aromatase

inhibitor. Nor has the optimal length of treatment with aromatase inhibitors been determined.

Studies now under way should help answer these questions. You might want to discuss these

newer treatments with your doctor.

If chemotherapy is to be given as well as a general rule, hormone therapy is started after

chemotherapy is completed.

Chemotherapy: Chemotherapy is usually recommended for all women with an invasive

breast cancer whose tumor is hormone receptor-negative, and for women with hormone

receptor-positive–tumors who may get additional benefit from having chemotherapy along

with their hormone therapy, based on the stage and characteristics of their tumor.

Adjuvant chemotherapy can decrease the risk of the cancer coming back, but it does not

remove the risk completely. Before deciding if it's right for you, it is important to understand

the chance of your cancer returning and how much adjuvant therapy will decrease that risk.

The specific drug regimens and the length of treatment are often determined by the stage and

grade of the cancer. The typical chemotherapy regimens are listed in the chemotherapy

section. The length of these regimens usually ranges from 4 to 6 months. In some cases, dose

dense chemotherapy may be used.

Trastuzumab (Herceptin): Women who have HER2-positive cancers are usually given

trastuzumab along with chemotherapy as part of their treatment.

A common chemotherapy regimen is doxorubicin (Adriamycin) and cyclophosphamide

together for about 3 months, followed by paclitaxel (Taxol) and trastuzumab. The paclitaxel is

given for about 3 months, while the trastuzumab is given for about 1 year.

A concern among doctors is that giving the trastuzumab so soon after doxorubicin may lead to

heart problems, so heart function is watched closely during treatment with tests such as

echocardiograms.

To try to lessen the possible effects on the heart, doctors are also looking for effective

chemotherapy combinations that don't contain doxorubicin. One such regimen is called TCH.

It uses the chemotherapy drugs docetaxel (Taxotere) and carboplatin given every 3 weeks

along with weekly trastuzumab (Herceptin) for 6 cycles. This is followed by trastuzumab

every 3 weeks for a year.

Stage IV

Stage IV cancers have spread beyond the breast and lymph nodes to other parts of the body.

Although surgery and/or radiation may be useful in some situations they are very unlikely to

cure these cancers, so systemic therapy is the main treatment. Depending on many factors,

this may consist of hormone therapy, chemotherapy, targeted therapies like trastuzumab

(Herceptin) or lapatinib (Tykerb), or some combination of these treatments.

Trastuzumab may help women with HER2-positive cancers live longer if it is given with the

first chemotherapy for stage IV disease. It is not yet known whether it also should be given at

the same time as hormone therapy, or how long a woman should remain on therapy.

When to see a doctor

Although the majority of breast changes don't turn out to be cancer, make an appointment to

see your doctor if you find a lump or other change in your breast. Even if you've just had a

mammogram with normal results, it's still important to have your doctor evaluate any

changes.

The thought of breast cancer treatment can stir up many feelings: • You may be afraid of treatment side effects.

• You may be anxious about whether you can work at your job or care for your family

during your treatment.

• If you have young children, you may be worried about how to tell them about what’s

happening to you.

• You may be concerned that the treatment won’t work and you should have chosen a

different one.

• You may worry about how you’ll make time for treatment or how you’ll manage getting

back and forth to your appointments.

• You may be afraid of being unable to care for yourself and needing help from others.

• You may worry about how you are goingto pay for treatment.

Prevention

Tamoxifen is approved for breast cancer prevention in women aged 35 and older who are at

high risk. Discuss this with your doctor.

Women at very high risk for breast cancer may consider preventive (prophylactic)

mastectomy. This is the surgical removal of the breasts before breast cancer is ever diagnosed.

Possible candidates include:

Women who have already had one breast removed due to cancer

Women with a strong family history of breast cancer

Women with genes or genetic mutations that raise their risk of breast cancer (such as

BRCA1 or BRCA2)

Your doctor may do a total mastectomy to reduce your risk of breast cancer. This may reduce,

but does not eliminate the risk of breast cancer.

Many risk factors, such as your genes and family history, cannot be controlled. However,

eating a healthy diet and making a few lifestyle changes may reduce your overall chance of

getting cancer.

There is still little agreement about whether lifestyle changes can prevent breast cancer. The

best advice is to eat a well-balanced diet and avoid focusing on one "cancer-fighting" food. It

is likely recommend that people:

Choose foods and portion sizes that promote a healthy weight

Choose whole grains instead of refined grain products

Eat 5 or more servings of fruits and vegetables each day

Limit processed and red meat in the diet

Do not drinking alcohol at all

Conclusion

So many women you know may have had breast cancer — friends and neighbors, coworkers,

relatives. It seems as if every time you turn around, breast cancer is being talked about in the

newspaper or on TV. You may be fearful of developing breast cancer for the first time or of

receiving a diagnosis after a mammogram or other testing. If you’ve had breast cancer, you

may be fearful of a possible recurrence or even of the possibility that breast cancer could take

your life.

Even though you may have some of these fears, you are not necessarily going to get breast

cancer. If you have had breast cancer before, it doesn’t mean that the cancer will recur. Still,

it's normal to have concerns about a disease that you hear about and see around you relatively

often — and that you may have experienced yourself or through a loved one. Don't let the

discussion of fear in this section feed into your own fears.

The following below are some inspirational cancer quotes

My cancer scare changed my life. I'm grateful for every new, healthy day I

have. It has helped me prioritize my life. ~Olivia Newton-John

During chemo, you're more tired than you've ever been. It's like a cloud

passing over the sun, and suddenly you're out. You don't know how you'll

answer the door when your groceries are delivered. But you also find that

you're stronger than you've ever been. You're clear. Your mortality is at

optimal distance, not up so close that it obscures everything else, but close

enough to give you depth perception. Previously, it has taken you weeks,

months, or years to discover the meaning of an experience. Now it's

instantaneous. ~Melissa Bank

We "need" cancer because, by the very fact of its incurability, it makes all other

diseases, however virulent, not cancer.

The most important thing in illness is never to lose heart. ~Nikolai Lenin

Feed your faith and your fears will starve to death

I don't think of all the misery but of the beauty that still remains. ~Anne Frank

Never, never, never give up. ~Winston Churchill

Do not be afraid of tomorrow; for God is already there.

Once you choose hope, anything's possible. ~Christopher Reeve

It's not the years in your life that count. It's the life in your years. ~Abraham

Lincoln

Cancer is a disease like any other treat it. – Khalil Bockle

When life challenges you don’t say “why me?” but instead say “try me” - Khalil

bockle