Breast Cancer – Causes and Prevention

Breast Cancer – Causes and Prevention

Breast Cancer  – Breast plays a significant role in the life and self-identity of a woman. A breast disorder, whether benefit or malignant, can cause great anxiety and fear of potential disfigurement, loss of attractiveness and even death.

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Breast cancer is one of such disorders that pose a major health problem mostly among women. This Samaria work is specifically on the prevention of breast cancer.

The work is discussed under the following sub-heading
Concept of cancer.
What is breast cancer.
Type of  breast cancer.
Pathophysiology of breast cancer.
Causes/predisposing and protecting factors.
Clinical manifestation

Concept of Cancer

Cancer is a term used for diseases in which abnormal cell divide without control and are capable of invading other tissues: cancer cells spread to other parts of the body through blood and lymph systems. There are more than 100 different type of cancer, most of which are named for the organ or type of cell in which they begin. For instance:
 Carnelian– Are cancer that state in the skin or tissue that cover internal organs.
 Sarcoma – Are cancer that begin in bone, cartilage, fat, muscle, blood vessels or other connective tissue.
 Leukemia– Are cancer that states in blood –forming tissue such as bone –marrow and causes large number of abnormal blood cell to be produced and enter the blood.
Lymphoma and Myeloma– these are cancersv that begin at the central nervous system- they start in the tissue of the brain and spinal cord.

Origin of Cancer

All cancers originate in cell; the body’s   functional unit. The body is up of many cells which grew and divide in a controlled pattern to produce more cells become old or damaged; they die and are replaced with cells.

However sometimes, this orderly pattern of cell growth and division go wrong. The genetic material  (D N A) of a cell  become damaged; producing  mutations that affect normal cell growth and division When this happens, cell do not die when they should and new Ares form when the body dose not need them the extra cell may form a tissue celled a tumor.

There are types of tumor- benign and malignant. Benign tumors are not   cancerous. They can often be removed and, in most cases do not come back. The cells here can not spread to other parts of the body. Malignant tumors are cancerous. Cells here are capable of invading were by tissue and spread to other parts of the body malignant tumors are cancerous. Cells are capable of invading were by tissue and spread to other parts of the body.Some cancer like leukemia do not form tumor.
 What Is Breast Cancer?
Breast cancer is the type of cancer that affect the tissue of the breast, most commonly from the inner lining of the milk ducts or the lobules that supply the ducts with milk. It is major health problem in the world. Though breast cancer affects both men and women, the incidence is higher in females than in males, although males tend to have poorer outcomes due to delay in diagnosis. The incidence is lower in people in less developed countries than those in developed countries.

Breast cancer is the commonest type of cancer among women in Nigeria and globally. It is less common in men. In Nigeria, late presentations of breast cancer cases have also been consistent for decades.

This is probably due to the fact that there is no established national screening program for breast cancer. Awareness of early detection measures of breast cancer such as clinical breast examination and breast self examination is also low. In an environment where late presentation is predominant and where most breast cancers were detected accidentally by women themselves, there is an urgent need for awareness of breast cancer and it’s early detection measures.

In Nigeria, the prevalence of breast cancer is 116 in every 100000 cancer cases and 27,840 new cases were expected to develop in 1999. Recently, observation shows that of non-Hodgkin lymphomas and cervical cancer in Nigeria.

This trend is attributed to several factors such as the acceptance of fine needle aspiration as an accurate diagnostic evaluation. Increased awareness about breast cancer and usefulness of breast self examination majority of breast cancer cases occurs in pre-menopausal women and the mean age of occurrence ranged between 43- 50 years across the nation. (Adebamowo and Ajayi 2006)

The size, stage and rate of growth and other characteristics of the tumor determines the outcome of the treatment. Treatment may include surgery, drugs (hormonal therapy and chemotherapy), radiation and immunotherapy. Surgical removal of the tumor provides the single largest benefit, with surgery alone, being capable of producing a cure in many cases. To increase the likelihood of long term disease-free survival, several chemotherapy regimens are commonly given in addition to surgery. Most forms of chemotherapy kill cells that are dividing rapidity any where in the body, and as result cause temporary hair less and digestive disturbances. Radiation is indicated specially after breast conserving surgery and substantially improves local relapse rates and in many circumstances also over all survival. Some breast cancers are sensitive to hormones such as estrogens and /or progesterone which make it possible to treat than by blocking the effects of this hormone.

Worldwide, breast cancer comprises 22.9% of all cancers in women. In 2008, breast cancer caused 458,503 deaths world wide (13.7% of cancer deaths in women).
Prognosis and survival rates vary greatly depending on the type of cancer, staging and treatment, and geographical location of the patients. Survival rates in western world are very good.
For instance, overall, more than eight (8) out of ten (10) women (84%) in England that are diagnosed with the disease survived it for at least 5 years. In the developing countries, however, survival rates are much poorer. Currently, statistics show that over an entire life time, a woman’s risk of developing breast cancer is 1 in 8. Approximately 80% of breast cancer is diagnosed after the age of 50.

Breast cancer, like other forms of cancer, is the outcome of unstapled environmental and hereditary factors. Some of the factors include.

•    Lesions to DNA such as genetic mutation, mutation that can lead to breast cancer have been experimentally linked to estrogen exposure.
•    Failure of immune surveillance, a theory in which the immune system remove malignant cells throughout one’s life.
•    Abnormal growth factor signaling in the interaction between stoma cells and epithelial cells can facilitate malignant cell growth.
•    Inherited defects in DNA repair genes such as “BRC A-1 and BRC A -2”.

Types of Breast Cancer

Basically, breast cancer is classified as non-invasive breast cancer and invasive cancer Non-invasive breast cancer is the type of breast cancer that does not invade the basement membranes of the breast. This is further divided into ductal carcinoma in situ and lobular carcinoma in situ.

Ductal carcinoma in situ is characterized by proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue. Lobular carcinoma in situ is characterized by proliferation of malignant into the surrounding tissue.

Invasive breast cancer is the type of breast cancer that invades other tissue. Two major forms of invasive breast cancer are –infiltrating ductal carcinoma and infiltrating lobular carcinoma. Other minor forms are modularly carcinoma, mucinous carcinoma, tubularductal, carcinoma, inflammatory carcinoma and Paget disease. Infiltrating ductal carcinoma accounts for 75% of all cancer cases. It is characterized by penetration of the wall of the duct by the cancer cells and spread to areas out side the duct. They often form a solid irregular mass in the breast. Infiltrating lobular carcinoma accounts for 5 to 10% of the cancer cases. It is characterized by penetration of the wall of the lobule and spread to areas outside the lobule .the tumor once from the lobular epithelium and occurs as area of ill –defined thickening in the breast.

Staging of Breast Cancer

Staging of breast cancer is essential in making accurate diagnosis of breast cancer because it shows the size, extent and degree of metastasis. There are five stages of breast cancer:-
Stage O: – non invasive carcinoma (lobular carcinoma in situ or ductal carcinoma in situ). Cancer has not in voided the surrounding breast tissue.
Stage I: – The tumor is not more than 2cm in size and cancer cell have not spread beyond the breast.
Stage II: – Either the tumor has spread to the lymph nodes under the arms but the tumor is less than 2cm in size or the tumor has not spread to the lymph nodes under the arms but is greater than 5cm in size, or the tumor is between 2 and 5cm and may or may not have spread to the nodes.
Stage III: – the tumor is greater than 5cm in size and has spread to the lymph nodes under the arms.
Stage IV: – the cancer cell has spread to other parts of the body. (Metastatic cancer).

Pathophsiology of Breast Cancer

Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene- Normal cells divides as many times as needed and stop. They attach to other cells and stay in place in tissue. Cells become cancerous when mutations destroy their ability to stop dividing to attach to other cells and to stay where they belong.
Normal cells will commit suicide (apoptosis) when they are no longer needed. Until them, they are protected from cell suicide by several protein cluster and path ways. Sometimes, the genes along these protective pathways are mutated in a way that it times them permanently “on” rending the cells in capable of committing suicide when it is no longer needed.

This is one of the steps that curse cancer with other mutations. Normally, the PTEN protein turns off the pi3k/AKT pathway when the cell is ready for cell suicide. In some breast cancer, the gene for the PTEN protein is mutated, so the PI3K/AKT pathway is such in the “on” position, and the cancer cell does not commit suicide.

Some mutation associated with cancer, such as p53, BRCA-1 and BRCA-2, occur in mechanizing to correct error in DNA. These mutations are either inherited or acquired at birth.

Presumably, they allow further mutations which allow uncontrolled division, lack of attachment and metastasis to distant organs.

The uncontrolled cell divisions cause pain, redness slain irritation etc.

Causes/Risk and Protective Factors.

Breast cancer is not caused by a known single entity but a combination of normal, genetic and environment factors.
Risk Factors
Risk factors for developing breast cancer can be non-genetic or genetic factors or hormonal factors.
Non Genetic Risk Factors
Sex and age:
– women are more at risk for breast cancer than the men gender; 99% of breast cancer cases are seen in women. Also the risk of breast cancer increases as the age increases; the greatest risk is after the age of 50.
Personal history of breast cancer: – after treating somebody for breast cancer, there is a significant risk that she may develop breast cancer in the same or opposite breast.
Exposure to radiation: – receiving radiation therapy especially during the adolescence and early adulthood increases the risk of breast cancer. This is as a result is still developing.
Obesity: – obesity increases the risk of breast cancer especially in post menopausal women.v
High-fat intake: – diet rich in fat has been shown to increase breast cancer risk in post menopausal women.
Alcohol intake: – increasing alcohol intake increase the risk of breast cancer.

Genetic Risk Factors

Family history of breast cancer; having a family member with the disease (especially first- degree relative) increases the risk. The risk is more if the person is diagnosed before menopause.
Genetic mutations: mutation in BRCA-I and BRCA -2 (the tumor suppressor genes that normally function to identify damaged DNA and thereby restrain abnormal cell growth) are responsible for the majority of hereditary breast cancer.

Hormonal Risk Factors
1)    Early menarche
2)    Late menopause
3)    Null parity
4)    Hormone replacement out therapy.

Protective Factors
Certain factors have been found to be protective in relation to developing breast cancer. These protective factors include.
Regular exercise
Proper breast feeding
Selective estrogen receptor modulator
Aromatize inhibitor.

Clinical Manifestations

The first noticeable symptom of breast cancer is typically a lump that feeds different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the women feeds a lump. The earliest breast cancers are detected by a mammogram. A lump found in lump modes coated in the can also indicates breast cancer. Indications for breast cancer other a lump may include thickening different from the other breast tissue, one breast becoming large or lower, a nipple changing position or shape or becoming inverted, skin dimpling, a rash on or around the nipple, discharge from nipple, constant pain in parts of the breast or armpit, and swelling beneath the armpit or around the collar bone. Pain is an unreliable tool in determine the presence or absence of breast cancer, but may indicate other breast health issues:
Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth, and reduces through out the breast, as well as an orange-peel texture to the skin referred to as “paean de orange” the absence of a discern nibble lump delays detection dangerously.
Another reported symptom complex of breast cancer is pagets disease of the breast. This syndrome presents as eczematous skin changes such as reduces and mild flaking of the nipple (skin). As pagets advance, symptom may include tingling, itching, increased sensitivity burning and pain. There may also be discharge from the nipple. Approximately, half of women diagnosed with paget’s also have a lump in the breast.
In rare cases, what initially appears as a fibro adenoma could infect be a phyllodes tumor.
Occasionally, breast cancer presents as metastatic disease that is cancer that have spread beyond the original organ.
Others include;
Non- tender lesions
Skin irritation
Skin dimpling
Skin ulceration
Clinical staging
Chest x-rays
Computed tomography (CT)
Magnetic resonance imaging (MRI).
Complete blood count (CBC)
Tumor markers.

Breast Cancer Prevention

Prevention is an action taken to low the chances of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. This will lower the number of deaths caused by cancer to prevent cancer from occur; we have to look at the risk of breast but does not prevent it. It has been shown that changing lifestyle or eating habit, avoiding things known to canes cancer and larking medications to treat precancerous conditions can help in preventing cancer.
Generally, Breast cancer prevention is divided into: – primary prevention and secondary prevention.

Primary Prevention: this focuses on programs engaged in to educate the public on how to prevent     breast cancer before it starts. Primary prevention involves  the following
Health education: the public especially the high risk women should be educated on the need to avoid all known carcinogens patients should be encourage to participate in cancer preventing programs and also to adopt healthful life style .
Chemoprevention: this involves the use ofv medication to reduce breast cancer for instance; tamoxifer has been proven effective in reducing the incidence of breast     cancer by 49% in post menopausal women.
Prophylactic Mastectomy: total mastectomy may be carried out in women with a very strong familial history of breast cancer or BRCA gene mutation to prevent the occurrence of breast cancer.

Secondary Prevention: this involves long term surveillance. This method focuses on early detection of breast cancer. Women at high- risk are placed on constant screening. In addition to breast self examination, clinical breast examination should be performed twice yearly starting from 25years of age. Mammography may also done as early as 25 years of age.

There are ten (10) steps that can be taken to prevent breast cancer- they are
1.    Maintaining a healthy body weight throughout life, weight gain in mid life, independent of body mass index has been shown to significantly increase the risk of breast cancer.
2.    Exercise regularly for the rest of your life. About 30mins or more of moderate aerobic exercise provides powerful protection against breast cancer.
3.    Increase consumption of fruits and vegetable to about seven or more serving daily. Fruit such as citus, barriers and cherries and vegetables such as cruciferous vegetables, dark leafy green vegetables, carrots and tomatoes contains flavones which reduce the risk of breast cancer.
4.    Reduce fat intake: excessive fat in the diet increase the     risk of breast cancer. Consuming more of omega-3 fats     especially from oily fish (salmon, tuna, mackerel, sardines) and monounsaturated oils (olive oil, nut/seeds,     avocado) reduce cancer risk as they contain potential     anti cancer properties.
5.    Avoid alcohol in take: studies have shown that alcohol intake is the most established dietary risk factor for     breast cancer. Consuming more than two servings of alcohol in a day increases breast cancer risk by as much as 20- 25%.
6.    Take moderate carbohydrates; consuming food with high glycerin index like while rice, white potatoes trigger     hormonal changes that promote cellular growth in breast     tissue.
7.    Minimize exposure to estrogen avoid taking estrogen: medications unless medically indicated. Also avoid     estrogen-like compounds such as pesticides and     industrial chemicals as they play a fundamental in development of breast cancer. Also breast feeding properly will reduce exposure to endogenous estrogen.
8.    Consume whole say products regularly. Soy products such as roasted soy, nuts and soy milk reduce the risk of breast cancer.
9.    take vitamin supplement daily.
10.    Maintain a positive mental outlook engage in self-    nurturing behaviors regularly. Develop rich, warm and mutually beneficial relationship with family and friends     and get adequate sleep (7-8hour per night).
Cancer is a term used for disease in which abnormal cells grow and divide without control and spread to other tissues. It starts in a cell which is the basic unit of life. Cancer developed as a result of damage to the genetic material (DNA) producing mutations that effect normal cell growth and division.

Breast cancer is a major health problem in the world, it affects both men and women but the rate is higher in women than men. There are two major type of breast cancer- invasive and non-invasive breast cancer. Breast cancer is caused by a combination of many factors, combination of risk factors and protective factors play a role in the development of breast cancer. Its clinical manifestation includes pain, non- tender breast lesion, skin irritation dumping and skin ulceration. It can be disabused by mammography, clinical staging and tumor makers etc.

Breast cancer prevention strategies are aimed at reducing the occurrence (primary prevention) or early detection of the disease (secondary prevention).
A ten- step approach towards preventing breast cancer has been developed and they include:
1.    Maintenance of a healthy body weight.
2.    Regular exercise.
3.    Increasing fruits and vegetable consumption.
4.    Reducing fat intake.
5.    Avoiding alcohol.
6.    Consuming moderate carbohydrate.
7.    Minimizing exposure to estrogen.
8.    Consuming whole soy products.
9.    Taking vitamin supplement.
10.  Maintaining a positive mental outlook.

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  1. Dr.Emmanuel Uba says:

    Herbal remedy is another key factor in the management of breast cancer.Our claims of possessing potent and safe regimens to thwart the mechanism of breast cancer.various victims have experienced these systematic approaches

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