DR FAITH B YISRAEL
It’s time to rise is the theme for this year’s Breast Cancer Awareness Month. This annual campaign is commemorated in October, and this year the aim is one of fundraising and education. Fundraising, to ensure that the women with breast cancer who need services get access to them.
What is breast cancer?
Let us start with the definition of the word “cancer.” According to the National Cancer Institute, a “Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and multiply (through a process called cell division) to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.
“Sometimes this orderly process breaks down, and abnormal or damaged cells grow and multiply when they shouldn’t. These cells may form tumours, which are lumps of tissue. Tumours can be cancerous or not cancerous (benign).
“Cancerous tumours spread into, or invade, nearby tissues and can travel to distant places in the body to form new tumours (a process called metastasis). Cancerous tumours may also be called malignant tumours. Many cancers form solid tumours, but cancers of the blood, such as leukaemia, generally do not.
Benign tumours do not spread into, or invade, nearby tissues. When removed, benign tumours usually don’t grow back, whereas cancerous tumours sometimes do. Benign tumours can sometimes be quite large, however. Some can cause serious symptoms or be life threatening, such as benign tumours in the brain.”
Breast cancer is therefore a cancer that has formed in breast tissue.
Breast cancer stages and its influence on treatment
According to the American Cancer Society, “the stage (extent) of your breast cancer is an important factor in making decisions about your treatment options. In general, the more the breast cancer has spread, the more treatment you will likely need. But other factors can also be important, such as:
• If the cancer cells contain hormone receptors (that is, if the cancer is ER-positive or PR-positive)
• If the cancer cells have large amounts of the HER2 protein (that is, if the cancer is HER2-positive)
• Your overall health and personal preferences
• If you have gone through menopause or not
• How fast the cancer is growing (measured by grade or other measures)”
Stage zero means that the cancer is limited to the inside of the milk duct and is non-invasive. Treatment for this non-invasive breast tumour is often different from the treatment of invasive breast cancer.
• Ductal carcinoma in situ (DCIS) is a stage zero breast tumour.
• Lobular carcinoma in situ (LCIS) used to be categorised as stage zero, but this has been changed because it is not cancer. Still, it does indicate a higher risk of breast cancer.
A woman with DCIS can choose between breast-conserving surgery (BCS – the surgeon removes the tumour and a small amount of normal breast tissue around it) and simple mastectomy (removal of the entire breast). If the DCIS is hormone receptor-positive (oestrogen or progesterone), treatment with tamoxifen (for any woman) or an aromatase inhibitor (for women past menopause) for five years after surgery can lower the risk of another DCIS or invasive cancer developing in either breast. If you have hormone receptor-positive DCIS, discuss the reasons for and against hormone therapy with your doctors.
Stages one to three
Treatment for stages one to three breast cancer usually includes surgery and radiation therapy, often with chemo or other drug therapies either before (neoadjuvant) or after (adjuvant) surgery.
• Stage one: These breast cancers are still relatively small and either have not spread to the lymph nodes or have only a tiny area of cancer spread in the sentinel lymph node (the first lymph node to which cancer is likely to spread).
• Stage two: These breast cancers are larger than stage one cancers and/or have spread to a few nearby lymph nodes.
• Stage three: These tumours are larger or are growing into nearby tissues (the skin over the breast or the muscle underneath), or they have spread to many nearby lymph nodes.
Most women with breast cancer in stages one to three will get some kind of drug therapy as part of their treatment. This may include chemotherapy; hormone therapy (tamoxifen, an aromatase inhibitor, or one followed by the other); HER2 targeted drugs, such as trastuzumab (Herceptin) and pertuzumab (Perjeta); or some combination of these. The types of drugs that might work best depend on the tumour’s hormone receptor status, HER2 status, and other factors.
A BCS or a mastectomy may also be used. In some cases, breast reconstruction can be done at the same time as the surgery to remove the cancer. But if you will need radiation therapy after surgery, it is better to wait to get reconstruction until after the radiation is complete.
Stage four (metastatic breast cancer)
Stage four cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. Treatment for this stage is usually a systemic (drug) therapy. These may include hormone therapy, chemotherapy, targeted drugs, immunotherapy, or some combination of these. Surgery and/or radiation therapy may be useful in certain situations. Treatment can often shrink tumours (or slow their growth), improve symptoms, and help women live longer. These cancers are considered incurable.
Recurrent breast cancer
Cancer is called recurrent when it comes back after primary treatment. Recurrence can be local (in the same breast or in the surgery scar), regional (in nearby lymph nodes), or in a distant area. Treatment for recurrent breast cancer depends on where the cancer recurs and what treatments you’ve had before.
Reducing your risk of breast cancer
The Mayo Clinic gives a host of recommendations for reducing your chances of getting breast cancer. These include the following:
• Ask your doctor about breast cancer screening. Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.
• Talk to your doctor about the benefits and risks of screening. Together, you can decide what breast cancer screening strategies are right for you.
• Become familiar with your breasts through breast self-exam for breast awareness. Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness. If there is a new change, lumps, or other unusual signs in your breasts, talk to your doctor promptly.
• Breast awareness can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.
• Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day if you choose to drink.
• Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your doctor whether it's okay and start slowly.
• Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.
• Some women experience bothersome signs and symptoms during menopause, and for these women the increased risk of breast cancer may be acceptable to relieve menopause signs and symptoms.
• To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.
• Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise.
• Choose a healthy diet. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer.
The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter, and fish instead of red meat.
Even though we’ve been inundated with information about covid19 since 2020, it’s important to note that there are other diseases of concern. Let us use this month to ensure that everyone knows a little more about breast health and works to prevent breast cancer. It is time to rise.
Dr Faith B Yisrael is a health educator, social scientist, public health specialist and politician.
Email address: Imani.Consulting.Tobago@gmail.com
Phone number: 494-8827
Facebook Page: @ImaniConsultingAndFoundationTobago