Straight Talk About Breast Cancer: From Diagnosis to Recovery
180
Straight Talk About Breast Cancer: From Diagnosis to Recovery
180eBook
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Overview
Product Details
| ISBN-13: | 9781950091171 |
|---|---|
| Publisher: | Addicus Books |
| Publication date: | 10/01/2019 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 180 |
| File size: | 2 MB |
About the Author
Read an Excerpt
CHAPTER 1
Breast Cancer: An Overview
A diagnosis of breast cancer is never good news. However, research continues at a brisk pace in breast cancer prevention, diagnosis, and treatment, and the research has produced positive results. Since 1989, the death rate from this disease has declined by approximately 40 percent, even though the number of cases has gradually risen. Approximately 270,000 women are diagnosed with breast cancer each year in the United States. The majority of women whose breast cancer is discovered early are cured.
Partly because of a surge in breast cancer awareness, more and more women are learning about this illness and about their own level of risk. The more they know, the more faithfully they practice self-examination, schedule mammograms, and take care of their health. In turn, more cases of breast cancer are detected early and the survival rate continues to rise.
You can see why every woman, regardless of her age, needs information about breast cancer — especially in the United States, where the breast cancer rate is among the highest in the world. If you have breast cancer, knowledge is the most potent antidote to fear and the best preparation for treatment. If you do not have breast cancer, knowledge is your strongest protection.
The best way to start learning about breast cancer is with an understanding of the healthy breast.
Breast Structure and Function
The human female breast is so glamorized and commercialized in our culture, it's easy to forget that the breast has a serious job — producing milk for babies. Even a quick look at breast structure reminds us of this important function.
The breast is made up of fatty tissue that contains blood vessels and lymph vessels, plus fifteen to twenty rounded divisions called lobes, themselves formed of dozens of smaller lobules that end in tiny bulbs. The lobular system produces milk in response to hormonal changes after childbirth or after an abortion or a late miscarriage. Milk flows from the lobes and bulbs through narrow tubes, or ducts, leading to the nipple, which protrudes from the center of the areola — the circle of darker skin at the tip of the breast.
Lymph vessels in the breast carry lymph, a pale fluid containing white blood cells, to lymph nodes — small, rounded masses of tissue that act as filters for this fluid. Lymph serves to transport infection-fighting cells to all parts of the body. There are lymph vessels and nodes throughout the body, but the lymph nodes nearest to the breast are usually the first ones affected when breast cancer begins to spread.
How Cancer Develops
Every part of your body, and of every other living thing, is made up of cells. In human beings, some cells divide to create new cells every twelve to twenty-four hours. In the normal, orderly cell-renewal process, cells reproduce just fast enough to replace the ones that die off, keeping your blood and organs healthy.
Cancer forms when cells become abnormal and start to divide uncontrollably. Eventually, an abnormal growth, or tumor, may form. Tumor cells not only act differently from normal cells, but they also look different under a microscope.
Some tumors are benign — not cancerous. Benign tumors do not spread, so surgically removing them usually solves the problem. By contrast, a malignant (cancerous) tumor — if not detected and treated early — may spread from its original site to other parts of the body in a process called metastasis. Malignant tumors may be removed by surgery and treated with one or more additional types of therapy, depending on how large they are and whether they have metastasized.
Most breast cancers develop in the lobes or ducts of the breast. Scientists are still learning exactly how this occurs; they have identified certain risk factors — some proven, others more questionable. It is helpful to be aware of all risk factors.
Risk Factors for Breast Cancer
Age
A woman's risk of developing this disease increases as she gets older — 80 percent of breast cancers in women are diagnosed after the age of fifty. Even though aging is a risk factor, you can be proactive by getting regular mammograms and staying healthy to minimize risk factors.
Environmental Risks
Every day, we are exposed to toxins in the form of pesticides, herbicides, cleaning solvents, chemical waste, food additives, certain plastics, and many other substances. Some are known carcinogens (cancer-causing agents). Others have been linked to higher rates of cancer among people exposed to them, but the cause has not been scientifically proven.
Hormonal Risks
Compared to the general population, a woman is at greater risk for breast cancer if she has been exposed to higher levels of estrogen over her lifetime. This exposure can be entirely natural, due to the following factors:
• early onset of menstrual periods (before age 12)
• late menopause (after age 55)
• late first pregnancy (after age 30)
• no pregnancies
Also contributing to lifetime estrogen exposure are medicines that contain estrogen, such as birth control pills and drugs taken to ease menopausal symptoms. Most researchers doubt that the synthetic hormones in birth control pills pose much of a breast cancer risk. Some studies suggest a slightly higher risk among long-term users of oral contraception and among women who started using them as teenagers.
Long-term estrogen-replacement therapy, during and after menopause, is a risk factor that diminishes when use of the hormone is stopped. Certain hormone combinations, however, are more carcinogenic than treatment with estrogen alone. One of these combinations is estrogen and progesterone, which is sold under several brand names. If you're taking a prescription drug for menopause symptoms, ask your doctor if it contains one of these combinations and, if so, whether you should switch to another drug.
Radiation Exposure
Women who have had radiation to the chest — perhaps as treatment for cancers such as Hodgkin's disease or for conditions such as tuberculosis or breast inflammation (mastitis) — are at greater risk for breast cancer.
If you have been treated with radiation to the chest, you should begin regular breast self-examination and annual mammograms no later than ten years after the radiation treatment began. These precautions are all the more important if you were exposed during puberty, since developing breasts are especially vulnerable. You should also consider yearly MRI of your breasts.
The small amount of radiation delivered in chest X-rays and mammograms is not a cause for concern — except possibly for women who have inherited mutated BRCA1 or BRCA2 genes.
These genes are intended to repair cell tissues; however, if they become damaged, their malfunction may result in the formation of breast cancer.
Diet and Drinking Alcohol
If you are overweight, especially if you put on those excess pounds during adulthood, your risk is higher than other women's. The same is true if you drink alcohol. The more you drink and the younger you start, the higher the risk. As little as three alcoholic drinks a week increases the risk for women.
Nationality and Ethnicity
North America has one of the highest incidences of breast cancer in the world, followed by Western Europe, Australia/New Zealand, and Northern Europe. The incidence is lowest in China and Central Africa. Genetic factors play a part, but environment and lifestyle may be equally important, since second- and third-generation immigrants to the United States are more likely to get breast cancer than their nonimmigrant relatives.
In the United States, white women are at slightly greater risk for breast cancer than African American women, but the death rate is higher among African Americans. The risk is lower among Native American, Hispanic, and Asian women.
Breast Cancer in Men
Although it is rare, breast cancer does occur in men. According to the American Cancer Society, approximately 2,700 men between ages sixty and seventy are diagnosed annually. The odds of a man getting breast cancer in his lifetime is 1 in 1,000. The average age at diagnosis is 72. Symptoms include: a lump in the breast, nipple pain, inverted nipple, nipple discharge, sores on the nipple, and enlarged lymph nodes under the arm. Treatment for men is similar to that for women.
Family History
Women in Western industrial countries have a higher risk of breast cancer even if they do not have a family history of breast cancer. In fact, about 85 percent of breast cancer cases occur in women who do not have a family history of the disease. In the other 15 percent of cases, at least one relative — more often an aunt or a grandmother than a mother or a sister — has had breast cancer. When this family history exists, the disease may be referred to as polygenic breast cancer. Even with a family history of polygenic breast cancer, many family members do not develop the disease.
In about 8 percent of all breast cancers, the disease is clearly passed from generation to generation. The most-commonly mutated genes are BRCA1 (pronounced BRACK-uh one) and BRCA2. BRCA is an abbreviation for "breast cancer." Every man and woman has two of each of these genes. The job of these two genes is to repair DNA damage, which can prevent disease such as cancer; however, sometimes these genes undergo structural changes, called mutations, which limit the cell's ability to repair DNA damage. As a result, the risk of breast cancer is increased. These gene mutations are responsible for hereditary breast cancer.
A father or mother with one mutated gene, whether or not he or she develops cancer, has a 50 percent chance of passing the mutation to the next generation. Accordingly, a woman can have hereditary breast cancer even though her mother and sisters stay cancer-free.
Approximately 55 to 65 percent of women who inherit a BRCA1 mutation will develop breast cancer by age seventy. About 39 percent of women with this mutation will develop ovarian cancer by age seventy. At the same time, 45 percent of women who inherit a BRCA2 mutation will develop breast cancer by age seventy, and 11 to 17 percent will develop ovarian cancer by age seventy.
Cancer research also shows that another gene, called PALB2, raises the risk of breast cancer in women nearly as much as the mutations in the BRCA1 and BRCA2 genes. Like the BRCA1 and BRCA2 genes, everyone has two pairs of the PALB2. It, too, is supposed to repair cell damage; however, this gene can also become mutated. Scientists found that women with the mutation and a strong family history of breast cancer had a 58 percent risk of developing the disease by age seventy. Those who had no family history of breast cancer, but who had a mutation of the PALB2 gene, had a 33 percent chance of developing a malignancy by age seventy.
Testing for Genetic Factors
If you have a family history of breast cancer, talk to your doctor about genetic testing to assess your risk of developing breast cancer or other cancers. Most insurance plans, including Medicare, usually pay for genetic testing. It takes about three weeks to receive test results for gene testing, but this information is helpful to both you and your physician in making decisions about breast surgery. The test can be expedited if necessary.
Genetic testing analyzes small samples of blood or saliva to determine whether you carry genes for inherited diseases. The results can help with cancer prevention; or, if you have cancer, the testing can help determine the best treatment.
CHAPTER 2Getting a Diagnosis
You may tell yourself, "It's probably nothing"— that lump or thickness you think you feel in your breast. Perhaps you're thinking you should wait a while before going to see your doctor. Maybe you're thinking it really isn't a lump and that it will go away. But now is not the time to listen to this inner voice.
It is important to investigate any suspicious change in your breast and schedule that mammogram and annual physical. Breast cancer tumors that can be felt are usually discovered by you or by your doctor during a routine physical. Most lumps that can't be felt show up in mammograms.
If you find a lump, the next step is to get a diagnosis — to find out whether it is caused by cancer or something else. Odds are, it's something else. Only about one out of five breast lumps is cancerous.
Methods of Examining the Breasts
Breast Self-Examination
Many women discover their own cancers during a breast self-examination (BSE). That's why every woman should examine her breasts every month. BSE should become routine as soon as the breasts develop, or by age twenty at the latest.
Possible Warning Signs of Breast Cancer
During self-exams, watch for the following:
• a lump or thickening in the breast, surrounding area, or armpit
• swelling, redness, or rash
• puckering or dimpling of the skin
• skin texture like that of an orange (a condition called peau d'orange)
• itchiness, soreness, or scaling of the nipple
• drawing-in (retraction) of the nipple or another part of the breast
• unusual warmth that feels feverish in or near the breast
• any change in breast size, shape, or symmetry
• unusual pain in a part of the breast, armpit, or surrounding area
• bloody discharge from the nipple
Because the breasts tend to swell during the menstrual period, premenopausal women should perform BSE three to five days after their period ends. Postmenopausal women should examine their breasts on the same day every month, so that the date itself is a reminder.
Some women, especially those in high-risk categories, avoid BSE because they are afraid of what they might find. This avoidance is understandable. It's also unhealthy, emotionally and physically. Frequent, habitual self-examination is by far the best way to discover a cancer while it is small and highly treatable, and finding a small tumor is much better than finding a large one.
One excuse some women use for not doing BSE is that their breasts are always lumpy — the result of benign masses called cysts or fibrocystic changes. This condition is noncancerous.
If you have benign masses in your breasts, you might assume that you wouldn't notice a new lump or one that is unusual. But if you examine your breasts regularly, you'll learn the "terrain." After you're familiar with the texture and the pattern of cysts in your breasts, you will be able to detect changes, even small ones.
Women are encouraged to perform self-breast exams monthly.
Every month, use both BSE techniques described below: one lying down and one standing before a mirror.
Self-Examination Lying Down
To examine your breasts while lying down:
1. Place a small pillow under your right shoulder; then raise your right arm, and rest the back of your hand on your forehead. This position flattens the breast and makes it easier to examine.
2. Using the pads of the three middle fingers of your left hand, make small circular motions to examine your right breast with light, medium, and then firm pressure. Don't lift your fingers but keep them flat as you do this.
3. Use an up-and-down pattern, as if following narrow vertical stripes, to cover the entire breast and surrounding area — from collarbone to lower bra line to breastbone, and including the armpit.
4. Repeat steps 1 through 3 using the right hand to examine the left breast.
5. You can examine your breasts this way in the shower or bathtub, although if you're not lying down you lose the advantage of your breasts being flattened, which makes abnormalities easier to find. On the other hand, slick, soapy skin makes small changes more noticeable. You can get the soapy-skin effect while lying down by applying a smooth lotion or placing a piece of slippery fabric (such as satin) over your breast while you examine it.
(Continues…)
Excerpted from "Straight Talk About Breast Cancer"
by .
Copyright © 2019 Suzanne W. Braddock, M.D..
Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface vii
Acknowledgments ix
Introduction xi
1 Breast Cancer: An Overview 1
2 Getting a Diagnosis 10
3 Coping Emotionally 35
4 Surgery for Breast Cancer 55
5 Breast Reconstruction 72
6 Radiation Therapy 98
7 Chemotherapy, Hormone Therapy, and Targeted Therapy 108
8 Local Recurrence of Breast Cancer 122
9 Metastatic Breast Cancer 131
Resources 145
Glossary 149
Index 165
About the Authors 179