Breast Cancer Awareness Global Campaign

Breast cancer awareness drive 2022

breast cancer risk Prevention

While there are no known 100% certain ways to prevent breast cancer, there are certainly approved methods and lifestyle choices that purpose to lower the risk of an occurrence. 

These ways are often centred on reducing your exposure and adherence to risk factors while adopting safe precautionary measures that can boost your chances towards a breast-cancer-free existence.

ABOUT BREAST CANCER

To begin to fight any anomaly or disease we need to first familiarise ourselves with the condition, it's known causes, identifiable signs and symptoms and possible factors that promote it's occurrence.

There are various known types of breast cancer and most of these depend on the site of tumor formation detection amongst other factors.

The most prevalent types are

• DCIS (Ductal Carcinoma in Situ)
• Invasive Breast Cancer (IDC/ILC)
• Triple negative Breast Cancer
• Angiosarcoma of the Breast
• Paget disease of the breast 
• Inflammatory Breast Cancer
• Phyllodes tumours 

The table below will summarise the level of curability of these types and where they arise in the human breast.

DCIS/ Intraductal Carcinoma

About 1 in 5 cases are DCIS. Malignant cells in the duct that have not spread through the lobules and attacked surrouding tissues. (hyperplasia)

Referred to as Stage 0 Breast Cancer.

Treatment and Prognosis 

Nearly all cases are cured and patients exhibit very high recovery rates.

(Image Courtesy of: https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/dcis.html)

Invasive Breast Cancer (IDC/ILC)

There are also other less occurring types of Invasive cancer that make up less than 1/20 of cases.

This is the most common occurring either as invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC).

The most prevalent (8 in 10 cases) is the IDC variant forming from cells lining the milk ducts and metastizing to surrounding breast tissues.

ILC types on the other hand occurs in the breast glands that make milk (lobules). It is more likely to occur in both breasts at a time.

It's progression is from Stage 1-4.

Treatment and Prognosis

Treatability varies depending on the stage of advancement and metastasis away from the breast tissue.
If it spreads to the lymph more treatment options like chemol are involved in addition to surgical tumor removal.

Triple Negative Breast Cancer

Accounting for an average of 12.5% of all cases, TNBC has been detected most in women under 40, black women and those exhibiting BRCA1 gene mutation.
The name triple negative asserts the malignant cells tendency to test negative on the three breast cancer tests hence. (no ER/PR receptors and no HER2 synthesis)

Stage 1-4
(SEER US Chart on treatment and prognosis as a counter reference to the stages)

Treatment and Prognosis

Known to spread fast and often has a low response rate to treatment.
Often leads to a poor prognosis.
Tends to recur.
(Table courtesy of:
https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/triple-negative.html)

The report only doesn't take into account progression, technological advancement or individual response to the treatment.Accounting for an average of 12.5% of all cases, TNBC has been detected most in women under 40, black women and those exhibiting BRCA1 gene mutation.

Angiosarcoma  Of The Breast

Rarely as a complication due to prior radiation treatment, upto 8-10 years after. It may also develop in the arms of patients who had lymphedema as a result.
Purple coloured nodules on skin or a lump may develop on the breast. A Biopsy must be carried out to ascertain cancer.

Treatment and Prognosis

Tend to grow and spread quickly.
Treatment efficacy depends mostly on stage of spread at detection often yielding poor prognosis beyond the regional stage of spread.
Table Courtesy of:
https://www.cancer.org/cancer/soft-tissue-sarcoma/detection-diagnosis-staging/survival-rates.html

The report is only valid from the stage or progression stage at which the cancer is identified from, not all patients exhibit the same response to treatment.

Inflammatory Breast Cancer

Rare form of IDC that accounts for less than 5% of cases. 

Atypical to normal breast cancers, it occurs as a red swelling on the breast area due to skin lymph vessel blockage. Symptoms also include a singular breast that may be larger, more tender, warmer, heavier than the other. Skin on the affected breast is pitted or thickened akin to an orange peel and nipple retraction is observed.

It is undetectable on mammograms due to absence of a lump and aggressive in it's spreading and growth. Diagnosis oft happens when it has already spread locally meaning it is almost always caught at stage 3.

It has been shown to have affinity to attack overweight women, tends to develop more in black women than whites and those who are under 40.

Treatment and Prognosis

As its symptoms may easily pass for mastitis, it is better to first treat with antibiotics but if no improvement appears after a week then a cancer biopsy should be carried out. But if these symptoms occur yet you are not lactating, pregnant and have been through menopause, do consult professional medical assistance.

As it is hard to detect, it often leads to a worse prognosis than normal types of Invasive Ductal Carcinoma due to likelihood of metastasis to distal parts of the body. Hence difficult to treat.

Image Courtesy Of: https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/inflammatory-breast-cancer.html

Paget Disease of the Breast

This is a rare condition that affects the skin around the nipple and areola region of the breast. Usually (avg 85% of cases) it is affliated to Ductal Carcinoma in Situ (DCIS) and Invasive Ductal Carcinoma (IDC). It causes the areola skin region to look crusty, scaly and red accompanied to a yellow discharge or bleeding from the nipple. 

The nipple may be flat or inverted in some cases. A medical examination is necessary to determine if it is just eczema or cancer. It is usually found on one breast which is probably harbouring a tumour. 

Treatment and Prognosis

Treatment of this disease is done either by mastectomy or breast conserving surgery (BCS) that is followed by radiotherapy for the entire breast and complete removal of the areola and nipple.

Prognosis is usually very promising of full recovery if the cancer has not spread to the breast tissue and there is no lump. However if invasive cancer is found a check of the lymph nodes under the arms follows. In  this case it is treated like other types of invasive ductal carcinoma as per stage of spread.

Phyllodes Tumours of the Breast

Phyllodes tumors are a rare cancer that originate in breast connective tissue (stromal) instead of the ducts or glands (lobules). Only a few cases of phyllodes are malignant while the most tumors being benign or bordeline (exhibiting both malignant and benign traits). These tumors mostly get women in their 40s but are more likely to attack women with the inheritable Li-Fraumeni syndrome.

They occur as a firm painless or at times painful lump in the breast tissue oft growing large enough to stretch skin around it. The tumor is removed and a biopsy determines its nature whether malignant or benign. Benign phyllodes tumors have no correlation with increased chances of breast cancer and similarly malignant phyllodes do not relate to increased risk other types of breast cancer though the latter may invoke the need for observation.

Treatment and Prognosis

If found to be benign, an excisional biopsy will do the trick especially if it manages to expel the entire tumor. 

For borderline and malignant tumors, partial mastectomy or lumpectomy may be done if no vital parts of the breast have been engulfed by the tumor. If that is not the case a full mastectomy is performed. Radiotherapy may follow in cases where the entire tumor was not removed. Malignant phyllodes are unresponsive to convectional chemol or hormone therapy unlike normal breast cancer types. 

Prognosis of malignant phyllode tumors is expectant of recurrence and therefore the patient should be monitored over time. 

RISK FACTORS & PREVENTION OF BREAST CANCER 

There are certain pre-dispositions that run in families genetics that increase the chances of getting breast cancer in one's lifetime. These can be termed as risk factors though they do not necessarily fully ascertain an individual of a future cancer development at any point in life. 

Risk factors can be subject to change such as lifestyle related exposures to the factors that promote cancer development, however, some cannot be altered and are natural presets such as family history and aging over time.

Before we dive into healthy life choices and actions let us note that predisposition to cancer can be first and foremost caught by having a strong family history. If evidence is of risk factors is found, then genetic testing and counselling is a mandatory and vital step to figuring out preventive options. 

Some vital natural (unchangeable) risk factors women should consider are:

• Aging
• Close relatives who have had breast cancer
• Previous diagnosis of Invasive Breast Cancer, Ductal Carcinoma in Situ or Lobular Carcinoma in Situ
• Previous diagnosis with Atypical Lobular Hyperplasia (ALH) or Atypical Ductal Hyperplasia (ADH)
• Genetic mutations linked to cancer such as BRCA1 orBRCA2 gene mutation

There's a brief table showing preventive measures for natural risk factors below.

LIFESTYLE PREVENTATIVE MEASURES

Research into the human daily habits and intake has uncovered several factors that increase the risk of breast cancer in women.

Lets take a look at the DONT's as concerns Lifestyle choices:

1. Alcohol consumption 
   Drinking alcohol has been attributed to putting women at risk of breast cancer. 
   Research showed that the risk for a woman who drank one drink a day was between 7-10% but rose by 20% when the drinks were increased to 2 or 3. 
   This is certainly a cause for alarm especially amongst the millenial generation. Limit drinking and opt for malt drinks or other non-alcoholic alternatives the next time the girls call you out for a mid week dinner to plan for the weekend. A glass of red wine also could go a long way to keep you within your limits while keeping your risk low.
   
   
2. Being Overweight / Obese  
   As you may already know, before menopause it is the ovaries in the female body that are responsible for making the bulk of the estrogen in the female body. 
   However after menopause, the tide shifts and the ovaries stop producing estrogen leaving the task mostly to fat cells. 
   The more fat stored corresponds to a higher secretion of estrogen raises the risk of getting breast cancer. (Read more on weight effects on breast cancer risk here)
   
   Blood insulin levels tend to be higher in overweight individuals and these spiked levels have been attributed to lead to various types of cancer including that of the breast.  
   
   
3.  Inactivity or body complacency  
   A lack of physical exercise amounts to aid the body in regulating hormone levels, body weight and potential risks of inflammation. 
   It is recommended alternating routines of moderate and high intensity activities spanning 150-300 minutes and 75-150 minutes respectively. 
   Exceeding the upper limit is encouraged to boost the overall effect.
   
   
4.  Child Bearing Age 
   The risk of women who have had children over the age of 30 is slightly higher than for women who got pregnant earlier, never got pregnant or had more pregnancies in their life research has shown.  
   Though still a highly complex phenomena you can learn more here.
   
   
5. Time spent Breastfeeding  
   Women who have breastfed have a lower risk of cancer than other women especially for those who have done it for more than a year.
   This  to the reduced number of total menstrual cycles that they go through similar to women who may start their menses when they are older or get early menopause.
   Lactation and Breast pumping consistently exfoliates the breast tissue and the epithelial apoptosis at the end of a long breastfeeding period eliminates cells with DNA damage and Mutations hence reducing breast cancer risk.
   
   
6.  Use of Birth Control methods  
   Research has shown that most of the hormone altering contraceptive solutions for women are attributed with a rise in the risk of breast cancer. 
   These methods include hormone releasing IUDs, birth control shots (depo-provera), and oral contraceptives. 
   For oral pills the risk is seen tolower down to normal after 10 years of discontinuation.
   
   
7. Menopausal Hormone Therapy 
   Known also as Post-menopausal hormone therapy(PHT) or Hormone Replacement Therapy(HRT), this treatment is meant to reduce the occurrence of menopausal symptoms including the infamous osteoporosis. 
   However, Combined Hormone Therapy(CHT) that replaces both progesterone and estrogen, has been attributed to increase in getting advanced breast cancer often after about 4 years of use. This risk reduces after 5 years of discontinuation but not entirely. 
   Estrogen therapy alone does not attribute much to breast cancer, but it may raise alarms for uterine cancer.
   
   8. Breast Implants 
   Breast implants are associated with scar tissue around the area of implantation. 
   They are specifically attributed to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and other forms of cancer like squamous cell carcinoma. 
   On this matter, the risk to reward ratio is anyone's guess. 
   
   Find out more about devices used to keep your breasts healthy and less prone to cancer at home below 

(Recent experiments have shown the emergence of mild and low intensity Electrotherapy as a competent option to prevent breast hyperplasia, as well as lumping, further making its way into pain relief for patients with lymphedema. These prevention and symptom relieving properties might offer insight in yielding a physical solution in preventing such developments turning cancerous in women such as electrotherapy breast pumps being distributed globally.)