MALABOG NATIONAL HIGH SCHOOL
MALABOG NATIONAL HIGH SCHOOL
SALVACION, DARAGA, ALBAY
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By:
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A RESEARCH PAPER IN ENGLISH 1V
PRESENTED TO:
MR. JOSELITO V. ORBASE
OUTLINE
TOPIC: BREAST CANCER
I. Introduction
II. Breast cancer define
III. Causes
A. Genetic Factor
B. Environmental factors
C. Risk factors
IV. Symptoms
V. Early Detection
VI. Prevention
A. Breast Self - Examination (BSE)
B. Breast Clock – Examination (BCE)
VII. Conclusion
CHAPTER 1
INTRODUCTION
Breast Cancer constitutes a major public health issue globally with over 1 million new cases diagnosed annually, resulting in over 400,000 annual deaths and about 4.4 million women living with the disease. It is the commonest site specific malignancy affecting women and the most common cause of cancer mortality in women worldwide.(1;2)
There is an international/geographical variation in the incidence of Breast Cancer.
Incidence rates are higher in the developed countries than in the developing countries and Japan. Incidence rates are also higher in urban areas than in the rural areas.
In Africa, Breast Cancer has overtaken cervical cancer as the commonest malignancy affecting women and the incidence rates appear to be rising. (3;4) In Nigeria for example, incidence rate has increased from 13.8–15.3 per 100,000 in the 1980s, to 33.6 per 100,000 in 1992 and 116 per 100,000 in 2001. (5) These increases in incidence are due to changes in the demography, socio-economic parameters, epidemiologic risk factors, better reporting and awareness of the disease. While mortality rates are declining in the developed world (Americas, Australia and Western Europe) as a result of early diagnosis, screening, and improved cancer treatment programs, the converse is true in the developing world as well as in eastern and central Europe.(6-8)
Breast cancer and its treatment constitute a great physical, psychosocial and economic challenge in resource limited societies as found in Africa. The hallmarks of the disease in Africa are patients presenting at advanced stage, lack of adequate mammography screening programs, preponderance of younger pre-menopausal patients, and a high morbidity and mortality. (3;6)
This Review is meant to provide practical guidance for the surgeon working in the developing world. We have relied on the Chapter on Breast Cancer by Bland et al in Schwartz’s Principles of Surgery, 8th Edition. (9)
Material which is of interest but not immediately applicable has been placed in smaller print. In the Recommendations we have followed the principles developed in the Breast Health Global Initiative. (10-12)
STATEMENT OF THE PROBLEM
What is Breast Cancer?
Cancer is a general term that refers to cells that grow and multiply out of control and possibly spread to other parts of the body. There are many different types of breast cancer. Each may have different characteristics, and each one may require a different treatment. 1
© 2000 WebMD, Inc. All rights reserved.
Cancer can cause harm in different ways. Cancer cells take nutrition and space away from normal cells. A lump of cancer cells, called a tumor, can invade or destroy normal tissue. Cancer cells can also spread to other parts of the body. This is called metastasis. 1
Breast cancer is a common cancer among women in the United States and second only to skin cancer, affecting about 178,480 women in the United States in 2007. 2
Most breast cancer begins in the milk ducts. These ducts connect the milk-producing glands (called lobules) to the nipple. Some breast cancer begins in the lobules themselves, and the rest begins in other tissues. The diagram shows where these body parts are within the breast. 3
Risk Factors for Breast Cancer
A risk factor is something that may increase the chance of developing a disease.
The following are risk factors for developing breast cancer 4:
• Female gender
• Increasing age
• Personal history of breast cancer or previous breast biopsies
• Family history
• Genetic factors - cancer causing mutations in BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2) account for 5%-10% of all breast cancer cases
• Hormonal factors, such as earlier age at first period, later age at birth of first child, later age at menopause, having no children
Breast Cancer Stages
A cancer's stage refers to how much the cancer has grown and where it has spread. Staging systems help describe the cancer, so that the doctor can decide what treatments are appropriate.
Understanding Your Breast Cancer Pathology Report
Knowing the biological makeup of the tumor helps the doctor understand how quickly any cancer might grow and what treatments may be best.
What cause it?
The exact cause of breast cancer is not known. Female hormones and increasing age play a part. The chances that you will develop breast cancer increase as you age. In the United States, about 1 in every 8 women who live to be 80 will have been diagnosed with breast cancer at some point in her life.2
Family history also plays a role in the development of breast cancer. You are more likely to have breast cancer if your mother, father, or sister has breast cancer. Also, women who carry certain genes called BRCA1 and BRCA2 are more likely to have breast cancer. If you have a strong family history of breast or ovarian cancer, you may want to be tested for these genes. People who inherit specific changes, or mutations, in one or both of these genes have a greater risk of developing breast cancer.
Studies show that menopausal women who take hormone therapy with estrogen and progestin have an increased risk of breast cancer. Women who take estrogen alone may have a slightly increased risk.1, 8
Many people believe that only women have breast cancer. But, although rare, about 1% of all breast cancer occurs in men. Most men who have breast cancer are older than 65, but it can appear in younger men. For this reason, any breast lump in an adult man is considered abnormal.7
What are the symptoms?
Symptoms
The first sign of breast cancer is often a painless lump. But early breast cancer is often found on a mammogram before a lump can be felt.
Other symptoms of breast cancer may not appear until the cancer is more advanced. These include:
• A thickening in the breast or armpit.
• A change in the size or shape of the breast.
• Changes in the skin of the breast, such as a dimple or skin that looks like an orange peel.
• A change in the nipple, such as scaling of the skin or a nipple that turns in.
• A green or bloody fluid that comes from the nipple.
• A change in the color or feel of the skin around the nipple (areola).
About 1% of breast cancer occurs in men. Although most men diagnosed with breast cancer are older than 65, the disease can appear in younger men. For this reason, any breast lump in an adult male is considered abnormal.7
Inflammatory breast cancer is a specific type of breast cancer that involves the skin of the breast. It occurs when breast cancer cells form "nests" and block the lymphatic drainage from the skin of the breast. Symptoms include redness, tenderness, and warmth. Thickening of the skin of the breast (an orange-peel appearance), rapid breast enlargement, and ridging of the skin of the breast may also be present. Some women may also develop a lump in the breast. For more information, see the topic Inflammatory Breast Cancer.
How can I prevent breast cancer?
Prevention
You cannot control some things that put you at risk for breast cancer, such as your age and being female. But you can make personal choices that lower your risk of breast cancer. If you are at high risk for getting breast cancer, your doctor may also offer you certain medical treatments that can help prevent breast cancer.
Female hormones
Hormones change the way cells within the breast grow and divide. The years when you have a menstrual cycle are your high-estrogen years. Experts think that the longer you have higher estrogen, the more risk you have for breast cancer.4 This includes taking hormones after menopause.1, 26
• Avoid long-term, high-dose hormones after menopause. If you use hormone therapy for menopause symptoms, use a low dose for as short a time as possible. This includes estrogen-progestin and estrogen-testosterone.1, 3 Using estrogen by itself may slightly raise breast cancer risk.1
• Breast-feed. Breast-feeding may lower your breast cancer risk. The benefit appears to be greatest in women who breast-fed for longer than 12 months or who breast-fed several children.27
• Strive for a healthy weight. Extra fat cells make extra estrogen, which raises your breast cancer risk.4 Getting regular exercise and watching what you eat can help.
Having a full-term pregnancy before age 30 also lowers your breast cancer risk.10
Healthy food and exercise
• Eat a healthy diet with plenty of fruits, vegetables, and whole grains. A low-fat diet with limited red meat may lower your breast cancer risk.28, 29, 30
•
Methods of detecting Breast Cancer
1. Breast Self-Examination (BSE) once a month. This can be aided by "Can-Scan".
Recommendation for BSE
Once a month for women from age 40 onwards.
1.
|When should one do BSE? |
|It should naturally be done when the breast is smaller in women having menstruation, i.e. just after the period. In post menopausal |
|women it can be done on a fixed day of each month. |
| |
o Complete steps for conducting BSE are given in CanScan. CanScan also predicts broadly, risk of Breast cancer.
2. Examination by health worker/doctor.
3. Mammography, usually after 50 years of age, periodically.
o It is an X-ray of the breast Screening mammography is key to early detection, i.e. looking for cancer in a woman who has no obvious symptom of disease.
4. Ultrasonography and FNAC (Fine Needle Aspiration Cytology).
o Ultrasonography scanning is now a part of breast examination. It is helpful to find precisely the site for FNAC and biopsy. It can differentiate between cyst and solid lesion. It can be done easily, a number of times, with no radiation.
o FNAC can be done conveniently without even local anaesthesia by a disposable syringe attached with a fine needle. The aspirates are spread over slides and examined under microscope for abnormal cells.
5. Biopsy: It means examination of tissue under microscope.
o The tissue from the suspicious area can be achieved by various methods. It is usually done in clinic under local anaesthesia by a specially designed instrument. It confirms the diagnosis of breast cancer.
CHAPTER 111
Summary
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
CONCLUSION
Management of breast cancer is a major challenge in resource limited countries.
Efforts should be geared towards early diagnosis, prompt and standardized treatment to reduce the burden of advanced disease in African women, majority of who are worse hit in the most productive part of their life time.
Our knowledge about breast cancer is evolving, but is still limited with respect to its etiology and biology, and with respect to its features in individual countries and
cultures.
Further research is needed to understand the role of genetics and environment in the etiology of breast cancer in Africa.
Average life expectancy will increase by 10 years in 2020 AD. The global incidence of cancer is soaring due to rapidly ageing population in most countries. By the year 2020 there will be 20 million new cancer cases each year. But incidence of cancer may be controlled by certain precautionary and prophylactic measures. Cancer screening and prophylactic drug like Tamoxifen (chemoprevention) have been proved useful in Breast Cancer. Avoidance of smoking will decrease tobacco related diseases. Some vaccines are helpful in prevention of some cancers.
RECOMMENDATIONS
In high-resource countries, evidence-based guidelines outlining optimal approaches to early detection, diagnosis, and treatment of breast cancer have been defined and
disseminated. These guidelines unfortunately are not applicable in countries with resource constraints as they are not economically feasible or culturally appropriate.
The following recommendations might be considered appropriate in the resource-poor countries of Africa. Following the Breast Health Global Initiative we have stratified the recommendations into Basic, Limited, Enhanced and Maximal. (10-12;138)
BIBLIOGRAPHY
A: BOOKS
1) Veronesi U, Boyle P, Goldhirsch A, Orecchia R, Viale G, Veronesi U, et al. Breast cancer.[see comment]. [Review] [160 refs]. Lancet 2005 May 14;365(9472):1727-41.
(2) Parkin DM, Bray F, Ferlay J, Pisani P, Parkin DM, Bray F, et al. Global cancer statistics, 2005. CA: a Cancer Journal for Clinicians 2005 Mar;55(2):74-108. Abstract Only
(3) Vorobiof DA, Sitas F, Vorobiof G, Vorobiof DA, Sitas F, Vorobiof G. Breast cancer incidence in South Africa. [Review] [16 refs]. Journal of Clinical Oncology 2001 Sep 15;19(18 Suppl):125S-7S.
(4) Omar S, Khaled H, Gaafar R, Zekry AR, Eissa S, el-Khatib O, et al. Breast cancer in Egypt: a review of disease presentation and detection strategies. [Review] [44 refs]. Eastern Mediterranean Health Journal 2003 May;9(3):448-63.
(5) Adebamowo CA, Ajayi OO, Adebamowo CA, Ajayi OO. Breast cancer in Nigeria. [Review] [74 refs]. West African Journal of Medicine 2000 Jul;19(3):179-91.
(6) Adesunkanmi AR, Lawal OO, Adelusola KA, Durosimi MA, Adesunkanmi ARK, Lawal OO, et al. The severity, outcome and challenges of breast cancer in Nigeria. Breast 2006 Jun;15(3):399-409.
(7) Hisham AN, Yip CH, Hisham AN, Yip CH. Overview of breast cancer in Malaysian women: a problem with late diagnosis. Asian Journal of Surgery 2004 Apr;27(2):130-3. Abstract Only
(8) Parkin DM, Bray F, Ferlay J, Pisani P, Parkin DM, Bray F, et al. Global cancer statistics, 2005. CA: a Cancer Journal for Clinicians 2005 Mar;55(2):74-108. Abstract Only
(9) Kirby I.Bland ea. The Breast. Schwartz's Principles of Surgery 8th edition. 2007.
Ref Type: Generic
(10) Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, et al. Breast Cancer in Limited-Resource Countries: An Overview of the Breast Health Global Initiative 2005 Guidelines. The Breast Journal 2006;12(s1):S3-S15.
B: Internet Sites
1. Altman R, Sarg MJ. The Cancer Dictionary-Revised Edition. New York, NY: Checkmark Books; 2000.
2. American Cancer Society Website. Overview: breast cancer - how many women get breast cancer? Available at: Accessed September 2, 2008.
3. American Cancer Society Website. Overview: breast cancer-what is breast cancer? Available at: Accessed September 2, 2008.
4. American Cancer Society. Breast Cancer Facts & Figures 2005-2006. Atlanta, Ga: American Cancer Society, Inc; 2005.
ACKNOWLEDGMENT
As the Chinese proverbs: “ When you drink from the stream, remember the spring” goes, the Researcher would like to thank the following persons.
First, to my English teacher Mr. Joselito Orbase___ Thank you for being you – your’e a wonderful person. You were there when I needed you to confide in and ask advice from. Through you, I began to understand & even like myself.
Second, to my loving parents____ Thank you for the support that you spend to me for all my requirements in school. Thank you for taking care of me & for loving me always.
And most of all__ to our Almighty God for making this research paper a possibility.
The Researcher,
A.L.S[pic][pic][pic][pic][pic][pic][pic][pic][pic]
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