Breast cancer: Risk factors and Treatment

Breast cancer: Risk factors and Treatment

Among the most common cancers in women, breast cancer has a sad record. In Italy, 1 in 8 women develop breast cancer during their lifetime. Not everyone knows what the best forms of prevention are and, once a suspicious lesion is discovered, many do not know what to do and to whom it is best to contact.

Correct information , which targets specialized treatment centers, means 18% more survival for the woman diagnosed with breast cancer .

We try to learn more about breast cancer to understand how to fight it and address it through prevention strategies , early diagnosis and more appropriate therapeutic approaches .

Breast cancer: what it is

Breast cancer, or breast cancer, is a formation of tissue composed of cells that grow in an uncontrolled way inside the mammary gland. Four stages of tumor development can be identified:

 Stage 1, or early stage,  the tumor is confined to the adipose tissue of the breast;

 Stage 2 is one in which the malignancy is also widespread in the immediate vicinity;

 Stage 3 : when the tumor has spread to the underlying tissues of the chest wall;

 Stage 4  we speak of metastatic or advanced breast cancer, because it is spread to other parts of the     body.

The stage at which the tumor is found at the time of diagnosis naturally influences therapy and prognosis. There are different types of cancer, characterized by a different growth rate and different responses to treatment.

Breast cancer: risk factors

According to statistics,  breast cancer is the most frequent and affects one in 8 women: in 2018.  High numbers, definitely, but today it is possible to prevent or, in any case, to diagnose this pathology in very early stages . The important thing is not to miss the recommended appointments and tests. Thanks to screening for early diagnosis, women who overcome this disease are increasingly numerous. Indeed, it is possible to identify some important risk factors, some of which can be modified, others not:

Non-changeable risk factors . Among these age (most breast cancers affect women over 40) and constitutional genetic factors (about 5-7 percent of breast cancers are hereditary, linked to the presence in the DNA of mutations of some genes).

Modifiable risk factors.  The  lifestyles harmful (poor supply of fruit and vegetables and high in animal fat, smoking, sedentary lifestyle).

Then there are also protective factors: a short fertile period (first late menstruation and early menopause) and a pregnancy at a very young age are protective, as is breastfeeding for over a year.

The role of hormones in breast cancer

Hormones, and in particular estrogens , play a key role in regulating fertility-related processes and can influence the risk of developing certain types of cancer . It all begins with the first menstrual cycle which causes profound periodic changes during the fertile period and until the advent of menopause, which establishes new hormonal balances. Every phase of a woman’s life is therefore characterized by a precise hormonal picture and therefore also the risk of cancer changes with age.

The changes phase by phase

Between the ages of 20 and 40 , for example, the use of the contraceptive pill and any pregnancies are the most important events from the hormonal point of view . In particular the hormones taken with the pill could decrease the risk of ovarian cancer (of which they are, in fact, the only preventive means) at the cost of a very slight increase in the risk of breast cancer (more with the old high dose pills than with the current ones, at low dosage). The  pregnancies , which generate a blocking the production of estrogen, have a protective effect on breast cancer and ovary.  

The age group between 50 and 60 is generally characterized by a real earthquake from the hormonal point of view: menopause . The ovaries stop producing hormones, so the body is less exposed to the action of estrogen, generally responsible for an increased risk of cancer. In this sense estrogen-based replacement therapy based on estrogen , used to counteract the negative effects of menopause (hot flushes and osteoporosis),  appears to be a risk factor for some cancers such as endometrium and breast .

Symptoms

There are some signs that you need to pay attention to because they could be a sign of breast cancer:

  • increase in consistency of the breast on palpation, due to the presence of nodules
  • small indentations of the skin
  • serous or blood secretions and eczematous lesions in the nipples
  • swollen lymph nodes in the armpit.

The main objective would be to be able to diagnose the cancer before it has symptoms, but it is still essential to seize these signals in a timely manner, in order to be able to immediately set up an adequate therapy.

Breast cancer: what is prevention and when to start it

The prevention must start from the age of 20 . The first thing to be taught to young women is breast self-examination , which must be performed regularly every month . It is essential, then, to continue with annual breast checks performed by the gynecologist or a specialist breast specialist. Furthermore, ultrasound must be accompanied by a  two-year mammography after 50 years , only if necessary in young women.

Breast examination: what is it?

The breast examination consists of a complete clinical examination of the breast by a specialized doctor (observation and palpation). It is a simple and painless method, carried out without resorting to particular tools. The breast examination is not sufficient to formulate a precise diagnosis, but it is useful for preventing and clarifying situations that may appear suspicious.

The breast examination also makes use of the patient ‘s medical history: the doctor collects the information ( presence of cases of breast cancer in the family, age of onset of the first menstrual cycle and menopause, pregnancies, nutrition, hormonal therapies with oral contraceptives, therapies hormone replacement in menopause, etc …).

Young women and breast examination

The periodic visit by the senologist is not necessary for younger women. It is sufficient to perform regular breast self-examination : at least once a month between the seventh and fourteenth day of the cycle.

In case of doubt, it is the general practitioner or gynecologist who advises a specialist breast examination , during which, thanks also to other examinations such as ultrasound, it is possible to distinguish between malignant and benign breast diseases and, if necessary, set the more correct therapy. The annual visit is strongly recommended after the age of 40, while after 50 the mammography is also necessary.

Self-examination

Self-examination is an exam that every woman can do at home . It allows to know deeply the normal appearance and structure of the breast and to be able to catch any change early. The exam takes place in two phases:

observation  allows to identify mutations in the shape of the breast or nipple;

the  palpation  can to discover the presence of small nodules that were not there before.

When we talk about self-examination, we only think of a test to find nodules in the mammary gland. In reality, thanks to this examination, other signs can emerge that must push to consult a doctor, such as retractions or changes in the skin , fluid leaks from the nipples and changes in the shape of the breast. 

Respecting the timing of self-examination is important. The structure of the breast is modified according to monthly hormonal changes and it could consequently create, in some cases, confusions or false alarms .

It is good to remember that, in addition to hormones, age, body weight, familiarity and the use of oral contraceptives also influence the structure of the breast . Sometimes, especially in young women, the structure is particularly dense and difficult to evaluate correctly with self-examination.

Between the ages of 40 and 50 the incidence (ie the number of new cases) of breast cancer increases rapidly . Women in this age group cannot renounce self-examination as a means of prevention .

Self-examination and menopause

With the onset of menopause , the exam can be performed indifferently at any time of the month. It must be carried out regularly, especially by the over 60s, since the peak incidence (number of new cases) of breast cancer is between 65 and 70 years.

Self- examination is an important test for breast cancer prevention . But it must be associated , starting at the age of 45-50, or even earlier in the case of familiarity or alterations, with more precise breast examinations and instrumental examinations , such as ultrasound or mammography.

Breast self-examination: how to do it

Let’s see how to perform a correct self-examination. First of all try to carry out this self-diagnosis one week after the end of the cycle (the phase in which the breast is less painful and turgid). Mark the date on the calendar so you can repeat the check after one month. It is very important to get acquainted with your body and try to control it at regular intervals and under the same conditions.

Step 1

Start the tête-à-tête with the mirror. Remember: this must become a moment of positive confrontation, you must turn the mirror from a bitter enemy into an indispensable ally! Stand in front of a mirror, arms high behind your head, and check that there are no irregularities on the skin.

Step 2

Lie on your back, bring one arm up under your head, and with the other begin self-examination: with fingers joined to the plate, make a circular movement, going up towards the nipple drawing an imaginary spiral on the breast.

Step 3

Continue the palpation up to the armpit, without forgetting the nipples.

Step 4
With a slight squeezing of the nipple, check that there are no secretions.

What should you watch out for?

To the  shape of the breast : if it seems changed, if the breast appears to be enlarged or reddened.

Consistency : if areas of hard consistency are present.

To the  skin  of the breast and of the areola: if it has undergone modifications, it is reddened, irritated or thickened.

At the  nipple : if it has recently retracted, if there is secretion at the squeezing and if the areola has crusts or irritations.

At  post palpation : if a swelling appears.

Instrumental examinations: what they are and when to perform them

Fortunately, women have many tests that can be performed for the early diagnosis of breast cancer: in particular mammography , ultrasound and MRI.

Between the ages of 20 and 40  it is generally not necessary to undergo special examinations. An annual breast examination is sufficient for a gynecologist or an experienced doctor. Only in special cases, for example in case of familiarity or discovery of nodules, it is possible to further analyze the analysis with an ultrasound or a biopsy (needle aspiration) of the suspicious nodule. The mammography is not recommended because too dense structure of breast tissue in this age group would make little results clear and legible.

Between the ages of 40 and 50  , women with cases of breast cancer in the family should begin to undergo mammography , better if it is associated with an ultrasound scan.

Between the ages of 50 and 69,  the risk of developing breast cancer is quite high. As a result, women in this age group must undergo a mammographic check every two years .

In women with a positive genetic test for BRCA1 or 2 (mutations of these genes increase the risk of developing breast and ovarian cancers)  a six-month ultrasound and an annual resonance is indicated, even at a young age.

The other diagnostic techniques

In addition to mammography, other diagnostic techniques are also available today . For example, magnetic resonance (still limited to selected cases), PEM (a positron emission tomography – PET – specific for breasts). Finally a new examination, called the Pap smear test, which consists of the introduction of liquid into the galactophore ducts (the channels through which the milk passes) and the subsequent collection of this liquid that also carries some cells. It thus becomes possible to identify which of the leaked cells have pretumoral characteristics, allowing a very early diagnosis of breast cancer. 

Genetic tests to assess the risk of cancer

In most of the 10% of all cancers can also speak of “hereditary”, linked to cancer, that is, the transmission from the parents of a mutated gene. Some genetic tests have been developed, complex methods able to estimate the risk of contracting a tumor based on the genetic make-up. 

Genetic tests in detail

One of the cancers for which there is the possibility of undergoing a test is just that of the breast . It has in fact been shown that those who have a mother or sister with this disease, especially if contracted at a young age, run a greater risk of developing it during their lifetime than those who have never had cases of breast cancer in the family. The BRCA1 and BRCA2 genes predispose to this type of cancer (and also to that of the ovary): this means that, analyzing them carefully, in the case of a tumor one will probably find mutations not present in healthy cells. And this mutation, if the tumor is hereditary, will be the same in the various members of the family.

Once the need to undergo the test is established, through a conversation with a medical geneticist and an oncologist, a simple blood sample is taken from which the DNA to be checked will be extracted . The result may be positive or negative, ie it will be possible to know whether the mutation was actually inherited or not.

The burden of inheritance

Having inherited the mutation does not mean being certain of contracting the disease sooner or later, rather it means having a higher risk than those who do not have the mutation . The genetic test is therefore not a preventive tool in the classic sense of the term, but is limited to providing information on the risk of getting cancer during life and should only be done in case of real need, after consulting with the medical geneticist .

Based on the result of the test, the medical geneticist and the oncologist will be able to create an individual prevention plan based on more frequent and careful checks that will allow to better manage the risk and to identify any tumor in its earliest stages.

Prevent cancer at the table

We know that no food is miraculous, but a balanced diet, inspired by the Mediterranean diet, and a healthy lifestyle can help prevent cancer.

Here are some nutrient-rich foods that are particularly beneficial in a prevention diet.

Broccoli, cabbage and cavofiori. These vegetables contain indole-3- carbinol , a phytochemical substance that has an antioxidant and anticarcinogenic action. Broccoli also contains sulforan , useful in the prevention of colorectal cancer.

Vegetables and orange fruit. Carrots, citrus fruits, peppers, mangoes, squash are all foods rich in carotenoids and beta – carotene , essential antioxidants to prevent cellular degeneration.

Tomato . Very rich in lycopene , a very beneficial substance belonging to the group of carotenoids. Unlike other foods the amount of lycopene does not disperse, but rather increases with cooking.

Figs . These fruits contain a derivative of  benzaldehyde  which, according to studies by the Institute of Physical and Chemical Research in Tokyo, has important effects in cancer prevention.

Raspberries . These fruits are rich in quercetin , a flavonoid with a strong antioxidant effect.

Garlic . It contains  allin  which, after breaking the cloves, comes into contact with an enzyme that converts it into  allicin. This in turn gives rise to numerous substances capable of inducing apoptosis, or programmed cell death.

In addition to following a diet rich in fruit, vegetables, food sources of fiber (whole grains, legumes), it is important to limit the consumption of foods that are very high in calories or rich in sugar , red or processed meats and salt .

Also the lifestyle plays its part in protecting us from tumors: playing sports (even just a moderate physical activity for 30 minutes a day ) helps us to maintain a healthy weight and to contrast overweight and obesity, which represent a risk factor for our health.

Breast cancer: how to treat it

After a diagnosis of breast cancer, there are several options, to be used alone or combined , depending on the stage of the disease and the age of the woman: the main ones are surgery, radiotherapy, chemotherapy, hormone therapy and biological therapies.

Surgery

Surgery is the main therapeutic option when the tumor has not yet spread to other parts of the body (but it can also be used in case of already spread cancer). It can be used alone or in combination with radiotherapy or chemotherapy.

The surgical approach is increasingly in the direction of “conservative” interventions , which aim at eliminating only the tumor mass , preserving as much as possible muscle tissue.

Thanks to the progress made in this field, it is also possible to reconstruct the breast already during the mastectomy procedure: this avoids the need for a new operation and ensures a better recovery.

Radiotherapy

Radiation therapy, or radiation therapy, is often used in combination with surgery and chemotherapy to reduce the risk of relapse after surgery. It can also be performed, in combination with chemotherapy, before surgery to reduce the size of the tumor , thereby improving the effectiveness of the surgery. In patients with advanced cancer, radiation therapy may help to alleviate symptoms .

Chemotherapy

Like radiotherapy , chemotherapy can also be used before surgery, to reduce the size of the tumor, or after, against relapses. When the cancer has already spread to other parts of the body, it can be useful for reducing symptoms and increasing life expectancy.

hormone therapy

The hormone therapy, or hormonal therapy, consists in administering drugs that block the activity of the estrogen hormones , which play a role in the appearance of mammary tumors. This therapy can be adopted both before the operation, to reduce the size of the tumor , and in the following 5 years to fight relapses , and is indicated only in cases where a histological examination has confirmed the presence of estrogen and / or progestin receptors on cancer cells

Biological therapies

Biological therapies are aimed at the pathways that control tumor growth and development, modulating specific molecular and cellular processes that participate in the development and spread of the disease . They can include monoclonal antibodies, vaccines and genetic therapies.

External link: Breast Cancer

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