This news may cheer you up!
Breast cancer has very low incidence in developing countries, but it strikes one woman out of nine in a rich and heavily industrialized country. There is enough scientific evidence to show that, diet rich in fat and high in calories together with affluent life styles, greatly influence the growth of breast cancer. How a woman's body handles her own sex hormones is also an important factor. A woman with a blood relative having breast cancer, history of fibrocystic disease in breast and a carrier for BRCA 1 and BRCA 2 genes has an increased risk. The information from breast cancer patients on Tamoxifen having a low incidence of breast cancer in the opposite breast has paved the way for breast cancer prevention trials using Tamoxifen. This has indeed proved that over 45% of the women with high risk had successful prevention.
Your own cells against you:
Cancer in the breast develops from the normal cells lining the milk ducts. Under the combined attack of internal and external cancer-producing agents, these cells turn into malignant ones. Once they become malignant, they get the property of dividing and multiplying continuously, leading to the formation of a tumorous mass. They also tend to become immortal without going through the natural process of programmed cell death. As the tumor mass grows further, some cells get dislodged from the parent tumor into the blood stream to settle down in
"fertile soil" such as lungs, liver, and bones. There these cells grow in their turn into secondary cancers. The cancer cells look like normal cells, but they have additional features with aggressive behavior. The pathologists call most cancers in breasts as ductal carcinoma, as they arise from milk ducts.
Why do the cells in the breast misbehave?
The cells lining the milk ducts are always in a state of flux, dividing, shedding away and self-renewing. This is a natural process; therefore these cells are rendered more susceptible to the influence of cancer producing substances such as chemicals, hormones and other environmental factors. The age-old belief that sex hormone has a role in cancer growth has important bearings. A young girl having an early onset of menses and a woman having delayed menopause have increased risk for developing breast cancer. This is due to the prolonged action of sex hormones on breast cells. A woman who has never borne a child also has added risk, as her breast is deprived of the natural hormonal influences. Occasionally, a malignant transformation may take place in a benign precancerous breast disease such as fibrocystic disease. In the West, breast cancer has a late onset after the age of 50 years, whereas in the Far East and Middle East, the onset is early (below 35 years of age).
"Small is beautiful" and also curable:
With the advent of modern technique of digital mammography, breast cancer is diagnosed in size smaller than 1 cm. Indeed we are able to see the tumor even before we feel it. Today more and more ductal cancer in situ are diagnosed, leading to progressive reduction in mutilating surgery. This in turn has pushed the cure rates of breast cancer to 90 %.
Enhanced awareness, mammography, and regular self-examination have resulted in early diagnosis and cure. Mammography is quite safe and life saving.
All out attack on cancer:
Attack the cancer regardless and save the patient is the guiding principle of an Oncologist. At the same time " do no harm" to the patient is the by - word. Today we have advanced so much so that we could, 'tailor' the treatment to a given patient. The biopsy of a lump confirms the diagnosis and adequate surgery comes next in importance. Then, steps in the pathologist who will tell the oncologist whether surgery has been complete, how serious is the cancer, how big it is, and how many lymph nodes in the axilla are involved. By special staining methods, he will be able to tell us whether the tumor cells are sensitive to hormones. From this information, oncologist will be able to decide whether a patient has high risk or low risk. A tumor, which has a large size, with large number of lymph nodes in the axilla, high grade and positive surgical margins, will have to receive radiation and chemotherapy in proper sequences.
In a patient with high risk factors, the cancer cells already have a chance to spread to other parts of the body. In this situation systemic chemotherapy will be of greater importance. The chemotherapy has to be initiated as soon as the operation wound heals. The patient will be told about the good and the bad effects of drugs. We are better off today as we have more selective drugs to control treatment-related sickness, we also possess drugs which stimulate the blood cells, when they drop below critical levels. The patient, however, has to be in touch with the oncologist all the time. The courses of radiation and chemotherapy are considered as adjuvant to primary surgical treatment. Occasionally a patient may come with advanced cancer beyond the scope of surgery. Such a patient will have chemotherapy as the first line treatment to reduce the size of tumor and render it operable. This approach is termed as neoadjuvant chemotherapy. This helps the surgeon to do a breast- conserving operation. If the breast cancer is positive for hormonal receptors, the patient will require Tamoxifen or Letrozole.
In nutshell, the treating surgeon, oncologist and radiotherapist will form a collective team to look after the best interest of a patient. It is ideal to have a Tumor Board to take joint decisions regarding the right sequences of therapy suiting the needs of a patient.
Towards bright future with greater hope:
Hope has kept us going so far. The current research break-through such as human genome research, selective targeting therapy with newer chemicals and biological agents, together with cure-oriented research, twenty first century will be able to foresee the breast cancers as no more a mystery, but as a realistic goal for cure. During the last decade the overall mortality in breast cancer has dropped by 30% worldwide, promising further progress.
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