Breast Cancer

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The most important sign of a breast cancer is feeling a lump. It will feel like a pea or marble under the skin.

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Breast Cancer Symptoms. Most lumps are NOT cancer. Fibroadenomas and lumpy breast tissue are common benign causes of a palpable lump in the breast. Nonetheless, a lump must never be taken forgranted -  the only reliable way to differentiate a malignant from benign lump is with imaging and biopsy if necessary.

 

A developing area of skin thickening, nipple retraction, bloody nipple discharge may also represent a cancer and must be checked out

Only around 50% of breast cancers are palpable. That is why a mammogram is so important – even if you don’t feel any lumps or other breast symptoms, you may still have a breast cancer. Mammograms can show most of these even if they’re very small.

Yes. There are two main groups, ductal and lobular cancer. The cancers are further divided into hormone responsive and non responsive types. Every breast cancer is slightly different based on the hormone receptors, grade and growth rate. Treatments are individualised based on the specific characteristics of a cancer.

DCIS stands for Ductal Carcinoma In Situ. This is a “sleeping cancer”. It is one of the earliest stages of breast cancer. Not all of these lesions develop into cancer but enough of them will which makes it a dangerous condition that must be treated.

DCIS is most often identified on mammogram as a group of tiny microcalcifications. Microcalcifications are specks of calcium “gravel” or powder that are often visible on mammogram pictures.

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DCIS: Microcalcifications (tiny white spots) represent cancer cells within the ducts i.e. a “sleeping cancer” or pre-cancer. These microcalcifications are often the only sign of a developing cancer, and mammogram is the only modality that accurately shows them.

There are two known genes related to high risk of breast and ovarian cancer – BRCA 1 and BRCA 2. These genetic mutations occur in only 0.2 – 0.3% of all women. Only those women with strong family histories of breast and/or ovarian cancers need consider the test.  

Breast examination is sometimes difficult to do on account of lumpy breast tissue or big breasts. Only around 50% of cancers are palpable. Often it is only the large or superficial cancers that can be felt. DCIS is hardly ever palpable. Therefore to catch cancers as early as possible, screening mammograms are strongly advised.

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Physical examination: Either by yourself, preferably once a month, or by your doctor at your annual appointment

Although you are at a higher risk of getting breast cancer if there is a family history, most breast cancers occur in women with no family history! 80% of breast cancers are spontaneous i.e. no known risk factors evident.(risk factors are family history, abnormal cancer genes – BRCA, obesity, not having had children, hormone replacement, dense breast tissue and alcohol abuse.)

Maybe there are other factors involved such as environment, hormones in food or exposure to unknown toxins. But at this time, we have no evidence of this, so you can’t avoid what you don’t know!

  • Family history is the most important
  • Previous biopsy that should abnormal cells even though not a cancer. These are called high risk lesions and have a higher chance of developing into cancer than ordinary tissue (ADH, LCIS) – make sure you always receive and understand results from your biopsy!
  • Not having children or having a first child over 40
  • Long term hormone replacement therapy (HRT)
  • Obesity
  • Ashkenazi Jewish or Afrikaans heritage
  • Previous breast cancer
  • Dense breast tissue. This is a description of the density of glandular tissue in your breasts, compared to background fat. It is usually determined from your mammogram.
  • Keep in mind: for 80% of breast cancers, there are NO known risk factors!!

Surgery: mastectomy (whole breast removed) or lumpectomy (the cancer lump with surrounding tissue removed but most of breast left behind)

Radiation Therapy: A special powerful x-ray beam is used to eliminate any residual cancer cells in the remaining breast tissue/chest wall/underarm.

Chemotherapy: Cancer killing medication of different types. Administered in multiple doses over ±6 months

Ant-Hormone/Endocrine Treatments: Tamoxifen or other similar drugs that block oestrogen and progesterone from stimulating cancers. These drugs are sometimes taken for many years after the cancer is initially treated.

Ideally, breast cancer should be managed by a team of specialist doctors ie a Multi-Disciplinary Team (MDT). This is usually comprised of  breast surgeons, radiation and medical oncologists, radiologists, pathologists and plastic surgeons.

Usually, a person is diagnosed by  radiologist and pathologist (radiologist may find the lump on mammogram/ultrasound, followed by a biopsy which is interpreted by the pathologist, following which they are referred to the breast surgeon. The surgeon will put together the reports and results as well as interview and examine the patient. The case will then be presented to the rest of the multi-disciplinary team for discussion and consensus on best treatment approach.

Some patients receive chemotherapy first, in order to shrink a cancer prior to surgery.

Some have surgery first

Reconstruction is a part of the treatement discussion from early on.

All treatment decisions are taken in consultation between the various doctors and the patient/their family. It is imperative that patients and families are well informed at all times. They must, based on a good understanding of diagnosis, treatment and long term outcomes, decide on the path they wish to follow.

Diagnosing and treating breast cancer .. A team approach

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After cancer diagnosis .. Treatment options vary from patient to patient and treatment plans are individualised to best treat a particular cancer depending on type of cancer and stage (size and spread)

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