The reason is not far-fetched going by the number of people afflicted by the disease. According to the WHO,
“There are about 1.38 million new cases and 458 000 deaths from breast cancer each year. The disease is also the most by far the most common cancer in women worldwide, both in the developed and developing countries.
“Currently, there is not sufficient knowledge on the causes of breast cancer, therefore, early detection of the disease remains the cornerstone of breast cancer control. When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option. In such cases, palliative care to relieve the suffering of patients and their families is needed.”
In Nigeria, the statistics on the disease incidence and prevalence is limited, however, a report credited to WHO in the Vanguard states that over 100,000 Nigerians are diagnosed with cancer annually, of which 80,000 die from the disease.
Take a look at the image below. It is the 2014 Nigeria country profile for cancer according to the WHO. It can be seen that breast cancer accounted for
[bctt tweet=”Breast Cancer Awareness Month! Did you know that breast cancer accounts for 34.2% of all cancer diagnosed in women in Nigeria? ” username=”sidomex”]
Furthermore, according to WHO, 27,304 people were diagnosed with breast cancer in Nigeria in 2014.
From the ongoing, it is easy to see the need for raising awareness of breast cancer. So, we have gathered the available information to help explain breast cancer, types, causes, treatment and prevention strategies. It is our sincere hope that you would find value in this article and that you would be spurred to taking actions to help fight the disease.
Breast Cancer Explained
Cancer is a cell disease and our cells are our body’s building block. Our cells grow, multiply and die in an orderly manner, they help us to replace worn-out tissues and also to heal injuries. However, sometimes, our cells do not grow and die in the normal way. When this happens, the cells begin to form a tumour, in the breast, this tumour appears on an X-ray or can be felt as a lump.
Breast cancer begins when the breast cells grow out of control, the cancer cells get into the blood or lymph and is carried into the breasts. The lymph nodes are bean-like in nature, designed to protect our bodies against diseases and infection. Thes lymph nodes can be found almost everywhere in our bodies, but the ones that carry cancer cells to the breast can be found either in the armpit (majorly) or the sternum (breastbone) few times.
Changes in the DNA can cause normal breast cells to become cancerous. Some DNA changes are inherited and can greatly increase the risk of getting breast cancer. Cancer can also start with other lifestyle-related risk factors, such as what you eat, how much you exercise, hormones. All these can increase the chances of developing breast cancer (no research has been able to fully explain exactly how some of these risk factors cause normal cells to become cancer). Breast cancers can begin in any part of the breast: the ducts, the lobules, or in some cases, the tissue in between.
Types of Breast Cancer
There are different types of breast cancer, but they fall under two major types: invasive and non-invasive breast cancer.
Ductal Carcinoma In Situ (DCIS)
Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer type. Ductal means that it (cancer) starts inside the milk ducts, carcinoma means cancer that starts in the skin or other tissues that covers the internal organs, and In situ means “in its original place. DCIS is called “non-invasive” because it hasn’t spread beyond the milk duct. DCIS is not malignant or life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer.
If diagnosed with DCIS, there is a higher risk for cancer to come back, or there can be the development of new breast cancer than a person who has never had breast cancer before. After an initial diagnosis of DCIS, recurrences may occur between 5-10 years and there is a 30% chance of this recurrence. It is advised that a lumpectomy (breast-conserving surgery) be done alongside radiation (this is to reduce the risk of recurrence in the future), a mastectomy (removal of the breasts) or hormonal therapy after a lumpectomy as treatment. Chemotherapy is not really needed for DCIS. Generally, DCIS have no signs and symptoms, only a small amount of people may have a lump or discharge from the nipple.
Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma also known as infiltrating ductal carcinoma is the most common type of breast cancer in women. Most of the breast cancers are IDC. This means that cancer has “invaded” or spread to the surrounding breast tissues, it refers to cancer that has broken through the walls of the milk duct and has started to invade the tissues of the breast. Over time, IDC can spread to the lymph nodes and other areas of the body.
Although invasive ductal carcinoma can affect women at any age (18 reasonably), it is more common as women grow older. IDC can also affect men.
Symptoms of Breast Cancer
Symptoms of breast cancer are not the same for all women, it usually starts from the breast region with thickened tissues or lump in the breasts and sometimes under the armpit. Some of the reported symptoms include: having pains under the arm or breasts that do not change with the monthly cycle, redness of the skin of the breast, rashes around the nipples, discharge (blood-like) from the nipple, having an inverted nipple, a sudden change in the size or shape of the breast, peeling on the breast or nipple. These symptoms of breast cancer also vary among women. Most lumps noticed are not cancerous, but if you notice any, it is best to it checked by a doctor.
Stages of Breast Cancer
There are four major stages of breast cancer; Stages zero to four (0-4). The particular stage of breast cancer is determined by cancer’s characteristics, which help to determine the outcome of the disease and the possible trials and treatment that will be good for the patient. Stage IV (4) cancers describe invasive cancers that have already spread throughout other parts of the body, while the stage 0 cancer is used to describe non-invasive cancers that are, cancers that stay in their original location.
Stage 0
Stage 0 as stated above is used to describe cancers such as DCIS. In this stage, there is no evidence of cancer cells breaking out of the part of the breast in which they started, or getting through to or invading other normal tissue or other parts of the body.
Stage I
Stage I describes cancer cells that are already breaking through normal tissues surrounding the breast (invasive breast cancer). Stage I is divided into stages IA and IB. In stage IA the tumour measures up to 2 centimetres (cm) and cancer have not spread outside the breasts and no lymph nodes are yet involved while in stage 1B, there is no tumour yet in the breast, instead, smaller groups of cancer cells larger than 0.2 millimetres (mm) but not larger than 2 mm are found in the lymph nodes. Sometimes a tumour may be found in the breast.
Microscopic invasion is possible in stage I breast cancer. In microscopic invasion, the cancer cells have just started to invade the tissue outside the lining of the duct or lobule, but the invading cancer cells can’t measure more.
Stage II
This stage is divided into 2 major categories: IIA & IIB.
Stage IIA explains invasive breast cancer where no tumour can be found in the breast but can be found in 1 to 3 axillary lymph nodes under the arm or near the breastbone, the tumour has spread to the axillary lymph nodes, but if the cancer tumour measures between 2-5cm and has not spread to the lymph nodes or other parts of the body away from the breast or if a tumour is hormone-receptor-positive. This can be classified as stage IIA cancer.
Stage IIB describes invasive breast cancer where a tumour is larger than 2cm but not larger than 5cm or small groups of breast cancer cells larger than 0.2mm but not larger than 2mm are found in the lymph nodes, the tumour has spread to 1 to 3 axillary lymph nodes near the breastbone, the tumour is larger than 5 cm but has not spread to the axillary lymph nodes. This can be said to be or classified as stageIIB cancer.
Stage III
Stage III is divided into IIIA, IIIB & IIIC.
Stage IIIA describes invasive breast cancer in which either no tumour is found in the breast, or a tumour may be any size, the tumour is larger than 5cm small groups of breast cancer cells that are larger than 0.2mm but not larger than 2mm are found in the lymph nodes, a tumour is larger than 5cm and cancer has spread to 1-3 axillary lymph nodes or to the lymph nodes near the breastbone.
Stage IIIB describes invasive breast cancer in where a tumour can be any size and has spread to the chest wall and skin of the breast, and has also caused swelling or ulcer, may have spread to up to 9 axillary lymph nodes near the breastbone.
Inflammatory breast cancer is considered at least stage IIIB. Features of inflammatory breast cancer include:
- reddening of a large part of the breast skin.
- the breast feels warm and may be swollen at times.
- cancer cells have spread to the lymph nodes and may be found in the skin too.
Stage IIIC describes invasive breast cancer where there may not be any sign of cancer in the breast. If there is a tumour in the breast, it could be any size and may have spread to the chest wall & the skin of the breast, to lymph nodes above or below the collarbone or the lymph nodes near the breastbone.
Stage IV
Stage IV cancer is a type of invasive breast cancer that has spread beyond the breast and lymph nodes unto other organs or parts of the body, such as the lungs, other distant lymph nodes, skin, bones, liver, or the brain. Stage IV cancer can be described as “advanced”. Cancer may be stage IV at first diagnosis and it is called “de novo”, or cancer at this stage can be a recurrence of a previous breast cancer that has spread to other parts of the body.
Breast Cancer Diagnosis
There are several tests and examinations that can be used to diagnose breast cancer, some of them include:
Breast Examination
This is a procedure that is used to detect early cancer (this cannot be used to detect every type of cancer). This can be done by either you or by a doctor. Your doctor can help check both of your breasts and lymph nodes in your armpit for the feeling of any lumps or other abnormalities. Breast examination can be done in front of your mirror. Most women have some lumps or lumpy areas in their breasts all the time and most breast lumps are not cancer lumps or some of it turns out to be benign (not cancer). When you examine your breasts, there are few things to look out for before calling the attention of your doctor: Dimpling, wrinkling, reddening, bulging of the skin, inverted nipple, rashes, or swelling. You can either check it out in the shower, lying down or standing with your arms raised.
Mammogram
A mammogram is an X-ray picture of the breast that doctors use to screen for early signs of breast cancer and detect an abnormality in the breasts. Mammograms can be used to check for further abnormalities and evaluation if anyone is seen during screening.
Breast Ultrasound
Ultrasounds use high-frequency sound waves to produce images of structures deep within the body. Breast Ultrasound may be used to determine whether a newly discovered breast lump is a solid mass or a fluid-filled cyst, and to check for other tumours or abnormalities.
Biopsy
A biopsy is a tissue examination from a living body to discover the presence, cause, and extent of a disease. It is the only sure way to diagnose for breast cancer. During a biopsy, the doctor uses a needle device along-side an X-ray or another imaging test to extract a core of tissue from the suspected area. The sample of the extracted tissue is sent for analysis where it will be determined whether the cells are cancerous or not. A biopsy sample also determines the type of cells involved in breast cancer, the extent and whether the cancer cells have hormone receptors or other receptors that may influence treatment options.
Breast Magnetic Resonance Imaging (MRI).
MRI is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. It is used for breast cancer to create pictures of the interior of the breast. An injection of dye is administered to the patient before MRI. It is an imaging test but doesn’t use radiation to create the images.
Other tests like a full blood count and bone tests, can be used to determine the stage of cancer.
Breast Cancer Treatment
Your doctor determines the type of treatment depending on the size, grade, and stage of cancer as diagnosed and whether or not the cancer cells are sensitive to your hormones. There are many options for breast cancer treatment.
Surgery (Operation)
There are different types of surgery that can be carried out for the treatment of breast cancer:
Lumpectomy
Lumpectomy means removing breast cancer. Although this type of operation is recommended for people with smaller tumours, people with larger tumours may require chemotherapy before undergoing a lumpectomy to shrink a tumour for easier removal.
Mastectomy
This is a kind of operation for total removal of the breast tissues (lobules, ducts, fatty tissues and some skin including the nipple and areola). A mastectomy can either be simple or total.
Removing both breasts is also called contralateral prophylactic mastectomy. If cancer is found in one breast, the other healthy breast may be removed especially when there is a strong family history of breast cancer.
Surgery comes with risks of pain, bleeding, infection, and swellings. There can be a breast reconstruction (silicone or water) after surgery, but it is advised that it be discussed with the doctor.
Sentinel Node Biopsy
This means the total removal of a limited number of lymph nodes if cancer has spread to the lymph nodes. If cancer is not found in it, the chances of finding cancer in other lymph nodes are slim and need not be removed again.
Axillary Lymph Node Dissection
This means the removal of several of the lymph nodes.
Radiation Therapy
A radiation process is one that involves the use of high powered beam energy such as X-rays and protons to kill cancer cells. Radiation therapy has two different methods, the external beam radiation in which the energy beam is aimed at the body (using the machine) and the brachytherapy in which the radioactive materials can be placed inside the body. The external beam radiation is used after a lumpectomy, while the brachytherapy may be an option after a lumpectomy if there is a low risk of breast cancer recurrence. Larger breast cancers or tumours may require radiation even after a mastectomy. Radiation treatment is totally dependent on the doctor and the level. Radiation usually lasts from 3days to 6 weeks.
Serious side effects are rare but could include rash (where the radiation is aimed) and fatigue.
Chemotherapy
This can be recommended to try to control cancer and decrease cancer-causing symptoms. Chemotherapy involves the use of drugs to kill fast-growing cancer cells. Chemotherapy is usually recommended when cancer has a high risk of spreading or returning, it decreases it’s chances and is administered before surgery to help shrink a tumour.
Chemotherapy can also be used in women whose cancer has spread to other parts of the body.
The effect is usually dependent on the drugs received. Common side effects include hair loss, nausea, vomiting, and fatigue, only on rare occasions will chemotherapy cause premature menopause and infertility, or damage the heart and kidney.
Hormone therapy
Hormone therapy is often used to treat breast cancers that are sensitive to hormones (either the progesterone or estrogen). This therapy can be used either before or after surgery. Surgery can also be carried out to stop the production of hormones in the ovaries, and medications such as aromatase inhibitors and selective estrogen receptor modulators can be administered.
Side effects depend on the treatment: night sweats, vaginal dryness. Blood clots and bone thinning are very rare.
Other types of treatment include the Targeted therapy drug and supportive palliative care. The former help attacks abnormalities with cancer cells but there has to be a test carried out to determine if there might be any benefit from the targeted drugs. It can be used before surgery to slow down the growth process of a tumour or after a surgery to control recurrences.
The latter focuses on the provision of relief from pain or any other symptom of serious illness. Specialists provide extra support that complements your ongoing care. It can be used while undergoing aggressive treatments, such as surgery, chemotherapy or radiation therapy. This type of treatment is used alongside all of the other appropriate treatments, this can make people with cancer feel better and live longer. There are specially trained doctors and nurses for this procedure.
Breast Cancer Prevention
Breast cancer risks reduction begins with healthy habits and regular exercise. Here are a few things you could do to reduce the risks:
- Limitation of alcohol intake,
- Weight control,
- Total abstinence from smoking especially in premenopausal women,
- Breastfeeding,
- Regular exercise,
- Reduction of doses of hormone therapy drugs,
- Avoidance of exposure to radiation and environmental pollution,
- Maintaining a healthy diet and finally, a
- Awareness of breast cancer detection.
Last words
If you notice any change in the breasts, such as a new lump or skin changes, consult your doctor immediately. If there is a family history of breast cancer ask the doctor when to begin mammograms and other screenings.
Breast cancer is a killer, please share this article with friends and on your social network. Knowledge as they is power.
Resources
Information used in this article are from the following websites. Feel free to visit them as well as their associated links to learn more.
This is an amazing article. It perfectly captures the most important information about beast cancer. maybe now,the rate of mortality due to this disease will reduce
This is so educative