Introduction
Cancer of the breast occurs in women of all races and appears to have happened throughout history. It is slowly increasing in frequency all over the western world. Those factors influenced in the development of breast cancer that can be avoided are obesity and ionizing radiation. Of the remaining risk factors, age is inevitable. According to the statistical results: “Breast cancer is the second leading cause of cancer deaths in American women today, claiming more than 40,000 lives annually” (Claudo 92).
Pathology
Breast cancer is a term which covers a very wide variety of disease patterns (Olivier 4). Some patients’ cancers remain confined to the breast for years, while others have no lump to feel in the breast, becoming ill with severe metastatic disease elsewhere in the body. The cells lining the breast ducts and forming the secretory groups are normally orderly both in content and arrangement. Incipient cancer is recognizable by characteristic calcification on X-ray of the breast, or by microscopic examination of tissue taken for diagnosis, or as part of an operation to remove a true cancer (BreastCancer.org, 2007). The condition is fully curable by surgery but may affect both breasts. According to Iversen et al (2000) this situation is comparable to the finding of abnormal cells on the surface of the cervix, curable by excision or vaporization of the tissue. Since it has no manifestation, this phase of breast cancer has only been noticed incidentally in the past, but its ability to produce X-ray signs means it is being found more frequently now. This produces new dilemmas for doctors and patients (Parmigiani 445). It is not known how many breast cancers may start in this way or how long this phase of the disease may last. The cells of an active cancer are demonstrably malignant by their ability to travel to unusual sites. Thus they grow outward into the breast tissue, entering the blood and lymphatic vessels where loose cells travel with the stream of fluid to distant sites (BreastCancer.org 2007).
Metastasis
Metastasis is the appearance of a mass of cancer in another part of the body at a distance from the original cancer. Thus the original lump is the primary and all the metastases are secondaries (Iversen et al 445). Loose cells in the lymph vessels of the breast are trapped in the armpit lymph nodes and form secondaries there. As these secondaries enlarge, they either release cells themselves or cause cells from the primary to by-pass them in new lymphatic channels. Hence nodes further from the tumor become involved, such as those in the root of the neck (2007).
Diagnosis and Treatment
The mainstay of investigation is needle aspiration cytology. In some districts it may be necessary to perform a biopsy, that is remove a piece of the lump either by operation or with a special thick-cutting needle (Breast Cancer 2007). Either test is backed up by a mammogram: an X-ray of both breasts to characterize the known lump and discover any other suspicious areas. Most surgeons know that the choice of initial treatment for the affected breast does not influence outcome in terms of survival. They also know that many women hope to keep their breast and be treated by lumpectomy and radiotherapy (Olivier 45). Unfortunately, 30 to 50 per cent of lumps are unsuitable for this treatment by virtue of their size or proximity to the nipple. The surgeons know that putting more people in this treatment group can lead to future trouble. As it is, about 15 per cent of patients having lumpectomy with radiotherapy will have further cancer at the site of the first lump, and undergo mastectomy up to three years later (Locker et al. 1989). Performing more lumpectomies in the fringe group seems certain to increase the risk of local recurrence. The lumpectomy patients in the large American trial had fewer late mastectomies, probably because the microscopist were not happy with the initial excision in some cases, and the surgeon did an immediate mastectomy at the time of the lumpectomy in 10 per cent of cases (Breast Cancer 2007). Surgeons who are happy to discuss the options with their patients also know that about 30 per cent of those suitable for either operation will choose a mastectomy. The number will vary depending on the way in which the information is presented to the patient. Mastectomy, of course, gives a chance of avoiding radiotherapy, which patients find as debilitating as surgery (Breast Cancer 2007).
Psychological Problems
In those women for whom breast loss creates psychological distress breast reconstruction is available. The breast tissue can be substituted by a plastic sac. It is often appropriate to start with an empty sac which can be progressively filled with fluid through an injection port under the nearby skin. Once the correct size is reached, a small operation removes the first sac and substitutes a permanent and more natural one. Problems include migration of the sac to the wrong place, hardening of the scar round the sac, lack of nipple, and difficulty in diagnosing local recurrence of the breast cancer (Breast Cancer 2007). The ingenuity of plastic surgeons has produced an array of choices in re-forming the lost breast tissue and skin. Detailed descriptions are not appropriate here, but the principles are easy to describe.
After the initial cancer operation, the microscopist’s report is reviewed and decisions on future care made according to the unit’s policy. Most lumpectomy patients and some mastectomy patients will be recommended to have radiotherapy, normally on an outpatient basis. Sessions are painless, happening every weekday for three to six weeks. Extra treatment is given to the lumpectomy area itself, either by more external beam therapy, or occasionally with implants. Under anaesthetic the surgeon or radiotherapist places plastic tubes in the breast tissue, and subsequently radioactive material is placed in the tubes for a suitable time, usually a few hours (BreastCancer.org.2007). Afterwards the tubes are withdrawn and the remainder of the treatment given by external beam, using gamma-rays from a cobalt source, or X-rays from a generator.
The primary aim in counseling patients with breast cancer is to help women find their own means of coping with the emotional stresses of having a life-threatening illness. The outcome of good coping in this sense means successfully adapting to the difficult and changing physical and emotional demands placed on a woman with breast cancer. At different times women may be beset and bemused by feelings of anger, guilt, fear, uncertainty, depression, and confusion about what to do and what the future holds (BreastCancer.org 2007). Effective counseling and psychotherapy should permit appropriate expression and ventilation of these negative emotions and then help the woman develop some more positive means of dealing with them by, for example, restructuring, channeling, or changing the way in which they perceive their current situation and perceive their future.
Preventive Measures
Regular attendance and examination are required of, or requested by, most cancer patients. “Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered” (Breast Cancer 2007). Hopefully, this will lower the number of deaths caused by cancer. The interviews and examinations are conducted by surgeons or radiotherapists at intervals ranging from twelve weeks at first to a year later. The traditional visit and examination have been shown to be oddly ineffective, as only one in three recurrences are found by examination or enquiry at that time (Olivier 45). Patients often find their own recurrences, perhaps through knowing where to look. In addition, much of the depression and anxiety catalogued later in this book is not recognized by surgeons or seen as their problem (Breast Cancer 2007). In general, ways to prevent cancer include: “Changing lifestyle or eating habits, avoiding things known to cause cancer, taking medicines to treat a precancerous condition or to keep cancer from starting” (Breast Cancer 2007). The visit seems to provide reassurance for both patient and doctor, but this may only be as a consequence of the anxiety generated in the lead-up to it. Perhaps the most significant part of follow-up is regular mammography of the other breast to discover any small new cancer there. In future it may be possible to do this through the general breast screening program. Following Iversen et al (2000) “Incorporating family history as a predictor in statistical models is often done by selecting suitable summaries of a pedigree and using them as right-side variables” (445). For some patients, then, confidence in survival grows as the shock of mutilation and threat of death recede. Visits are less frequent, more of a reunion and a secret celebration of success. Others demonstrate their anxiety by repeated attendances to discuss various bodily symptoms which need reassurance and sometimes investigation.
Works Cited
BreastCancer.org .2007.
Breast Cancer. Medical Center Institute. 2007. Web.
Claudio, L. Breast Cancer Takes Center Stage. Environmental Health Perspectives 112, (2004): 92.
Iversen Jr., E.S. Parmigiani, G., Berry, D.A., Schildkraut, J.M. Genetic Susceptibility and Survival: Application to Breast Cancer. Journal of the American Statistical Association 95, (2000): 445.
Olivier, S. The Breast Cancer Prevention and Recovery Diet. nguin Books Ltd; New Ed edition. 2000.
Bibliography Cards.
BreastCancer.org . Online Internet. 2007. Web.
Breast Cancer. Medical Center Institute. Online Internet. 2007. Web.
Claudio, L. Breast Cancer Takes Center Stage. Environmental Health Perspectives 112, (2004): 92.
Iversen Jr., E.S. Parmigiani, G., Berry, D.A., Schildkraut, J.M. Genetic Susceptibility and Survival: Application to Breast Cancer. Journal of the American Statistical Association 95, (2000): 445.
Olivier, S. The Breast Cancer Prevention and Recovery Diet. nguin Books Ltd; New Ed edition. 2000.
Personal Collection.