Breast cancer is one of the most common malignant neoplasms, which is the most common cause of death among the female population. However, unlike many other types of tumors, such as lung or pancreatic cancer, which relatively quickly lead to the death of the majority of patients, in breast cancer, cure is possible in two thirds of patients. In the article "Breast Cancer in Young Women" you will find very useful information for yourself.
Risk group
Contrary to popular belief, breast cancer develops mainly in older women, most often after menopause. The probability of occurrence of the disease to 35 years is approximately 1: 2500. By the age of 50 years, this risk rises to 1:50, and by 80 years reaches a frequency of 1:10. Although in most cases it is impossible to determine the exact cause of breast cancer, a number of risk factors for the development of the disease are reliably known:
• age;
• anamnesis of the disease in the family or the patient;
• previous benign breast tumors;
• Excessive effects of the female sex hormone estrogen (early menstruation and later onset of menopause), as well as use of hormone replacement therapy (HRT);
• features of nutrition and alcohol consumption.
A woman, in whose family several members, especially first-line relatives (mothers, sisters and daughters), suffer from cancer, is at extremely high risk of developing the disease. This is due to the inheritance of the breast cancer gene. Scientists identified two genes responsible for cancer, BRCA1 and BRCA2. The risk of developing a malignant breast tumor in carriers of these genes is 87%. For this reason, it is extremely important to identify such families and conduct genetic counseling. The gene for breast cancer from a sick woman is transmitted to the offspring with a probability of 50%. Family members who inherited this gene are at high risk of developing a tumor.
Other factors
Although the presence of breast cancer genes is the most important cause of the development of the disease, it is necessary to understand that among all cases of breast cancer, the proportion of patients in whose family these specific genes are detected is less than 10%. There are several methods of preventing a breast tumor. Their use is usually important in women at risk, and especially in carriers of one of the inherited breast cancer genes.
Tamoxifen
Previously, for the prevention of breast cancer, an anti-tungsten drug tamoxifen was used. Studies conducted in the United States showed that women who took the medicine for 5 years, fell ill with breast cancer less often than those who did not take it. On the other hand, the use of tamoxifen increased the risk of developing endometrial cancer (mucous membrane of the uterus) and thromboembolism (the formation of thrombi in the veins of the lower limbs and their migration to the vessels of the lungs). In addition, it turned out that the use of the drug did not reduce the death rate from breast cancer. Preliminary results of modern studies in a group of women with a family history of breast cancers do not confirm the advisability of tamoxifen. Contradictory results lead to the lack of a unified treatment system. Women considering the possibility of chemoprophylaxis of breast cancer should receive detailed information from the appropriate specialist.
Preventive surgery
- Mastectomy. The most effective method of prevention with optimal results is bilateral mastectomy (or mastectomy in patients already treated for breast cancer). Removing healthy mammary glands is a radical decision that requires careful consideration and weighing of alternative methods. The reduction in the risk of breast cancer is directly related to the volume of the removed glandular tissue. For this reason, subcutaneous mastectomy with the retention of the nipple is usually not recommended, since it leaves about 10% of the breast, compared to 1% after the traditional operation.
- Ovariectomy. Carriers of BRCA genes are at higher risk and ovarian cancer, therefore, should be seriously considered as a means of preventing ovariectomy (removal of the ovaries).
Ovariectomy reduces the risk of developing a breast tumor by reducing the level of estrogen production, including in women who carry BRCA genes. Suspicion of breast cancer can occur in the following cases:
• detection of pathological formation in screening mammography;
• detection of the tumor by the patient.
The most common signs of breast cancer include the presence of education, a change in the shape of the gland, anomalies of the skin and nipple, discharge from the nipple. Diagnosis of the tumor is based on clinical examination, mammography and the conclusion of a puncture biopsy. In some women, especially in young women, mammography is poorly informative because of the density of the glandular tissue, in such cases, one resorts to ultrasound examination or magnetic resonance imaging. In most patients with a suspected malignant tumor, breast cancer is not confirmed. With a positive conclusion, a woman undergoes treatment. It needs an interdisciplinary treatment strategy involving the surgeon, oncologist, physiotherapist and other specialists. An important role is played by the average medical staff, specially trained to care for patients with breast cancer, in order to help them to undergo sometimes severe medical procedures. New methods of treatment of breast cancer allowed to reduce the mortality rate for this disease by 30%. The treatment program may include surgery, radiotherapy, hormonal or chemotherapy.
In most patients, the initial method of treating breast cancer is surgery - removal of the primary tumor.
Operation
In patients with a massive tumor, it is most advisable to perform a mastectomy (removal of the whole breast), after which a plastic correction is possible. With a small tumor size, sectoral resection is most often performed, in which part of the gland is eliminated. Such an intervention is more favorable from a cosmetic point of view. During the operation, as a rule, part or all of the lymph nodes of the axillary region is removed. Subsequently, the preparation is examined under a microscope, after which the pathologist gives a conclusion that details the size of the primary tumor, its histological type, the number of affected lymph nodes and the concentration of estrogen receptors. The examination complex of a patient usually includes a chest X-ray to determine the spread of the tumor, a blood test, and, if suspected of running, a bone scan or ultrasound examination of the liver. Based on the totality of these data, a plan for further treatment is drawn up.
Radiotherapy
Postoperative radiotherapy is considered a mandatory component of treatment in patients who underwent sectoral resection; irradiation of the axillary region may be an alternative to surgical removal of the lymph nodes. It is known that postoperative radiotherapy of the area of the scar, underlying tissues and axillary region reduces the risk of recurrence, which, in turn, reduces mortality. Chemotherapy and hormone therapy is prescribed intravenously or orally after surgery. This is necessary for the destruction of micrometastases - small fragments of tumor tissue that have separated from the primary focus and spread through the body. Such foci of tumor screening represent a threat of recurrence of the disease.
Hormonotherapy
Cyclic changes in breast tissue are under the control of estrogens. In 60% of cases, estrogen receptors are found in the breast tumor, therefore tamoxifen, which blocks these receptors on cancer cells, can be used for treatment. This reduces the risk of spread and recurrence of the tumor. Recent studies show that women with an estrogen-sensitive breast tumor who take tamoxifen for five years after surgery have a much more favorable prognosis.
Chemotherapy regimens
In patients under 50 years of age with breast cancer, a positive effect of adjuvant (supplementary) chemotherapy was demonstrated. The most justified application of this method of treatment in patients with a high risk of recurrence. A variety of chemotherapy regimens have been developed that are proven to reduce the risk of tumor recurrence. One widely used regimen is called CMF and is a combination of cyclophosphamide, methotrexate and 5-furouracil. Adding such modern drugs as doxorubicin and paclitaxel, helps improve the results of chemotherapy.
In patients with metastatic breast cancer - the spread of the tumor across the body - cure is impossible. Nevertheless, there are therapeutic methods aimed at alleviating the symptoms, and modern developments tend to increase the chance of survival. Unfortunately, despite the significant advances made in the treatment of breast cancer in recent decades, not every patient has a chance of recovery. Patients with the presence of metastases at the time of diagnosis of cancer or those whose outbreak centers appeared after initial treatment have an unfavorable prognosis. The most frequent places for localization of metastases are bones, liver, lungs, skin and subcutaneous tissues, as well as the brain.
Objectives of therapy
Treatment of such patients is aimed at increasing longevity and alleviating symptoms (palliative therapy). Although some patients with advanced stages of cancer can survive and several years, talk about the cure in such cases is not necessary. Carrying out surgery and radiotherapy in the presence of metastases are less important than chemo and hormone therapy, since drugs can destroy tumor cells throughout the body. The only exception is bone metastases, which are much more sensitive to radiotherapy. To reduce the risk of bones and related complications, including fractures, use a group of drugs known as bisphosphonates. The choice of the method of treatment depends on the location of cancerous foci, the previous treatment, the characteristics of the tumor and the general state of health of the patient.
The quality of life
When drafting a treatment plan, they take an individual approach to each patient, with an emphasis on improving the quality of life. In order to most effectively alleviate the symptoms of the disease, it is advisable to involve physicians and nurses specially trained to provide palliative care. The control of the pain syndrome and other supporting measures at this stage become of primary importance. Scientists and doctors all over the world are tirelessly developing new methods of fighting cancer, and patients are often invited to participate in clinical research. Most often in such cases, a comparative analysis of the effectiveness of an already existing and tested drug. Other studies, not comparing with the already widely used, test a new tool, assessing its activity and toxicity.
Clinical researches
Clinical studies determine the most effective medicine and provide the data needed to invest new drugs in expensive technologies. Observations show the best results of treatment in those patients who take part in the tests. Recent trends are characterized by a departure from traditional chemotherapy towards the use of less toxic drugs that meet the needs of a particular patient.