Breast Cancer In Australia: Risk Factors And Treatment

What is Cancer?

Cancer is an abnormal growth of cells in the human body that tend to grow uncontrollably and metastasise (spread to other parts of the body via metastasis, the process of growth of a secondary malignant kind away from the primary site of cancer) rapidly (in most cases). These cancers can involve any piece of tissue in the human body and are generally named as such (William C. Shiel Jr., 2018).

Many people mistake tumours for a type of cancer, however, in many cases, tumours are not cancerous at all however they run the risk of becoming cancerous if untreated. A tumour is defined a swelling in the human body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant (Lexico (Oxford), date unknown). Benign meaning a disease (in this case a tumour) that is not harmful in effect (Lexico (Oxford), date unknown). Malignant, which is the opposite of benign, thus tends to invade normal tissue and can recur after removal or be cancerous (Lexico (Oxford), date unknown).

The main differences are that cancer is a disease in which cells, almost anywhere in the body, begin to divide uncontrollably and a tumour is when this uncontrolled growth occurs in solid tissue such as an organ, muscle, or bone and leads to swelling, they may not also be harmful to the body if removed. A cancer can also be in liquid form and spread via the blood, a tumour can only be in solid form.

Cancers and tumours are incredibly harmful to the body as they do not die at the natural end point of the cellular life cycle, instead they continue to grow and reproduce rapidly, this rapid growth then leads the body to use energy (adenosine triphosphate/ATP) as well as other valuable nutrients that a regular (necessary) cell needs to grow and to function correctly, instead of using it on the other, more necessary cells, this can lead to many outcomes such as organ failure, immune system vulnerabilities and even death. Cancers and tumours, because they grow quickly and die a lot slower inhibit many of the body’s natural processes. Please see below of the hypothetical series of mutations leading to cancer.

Breast Cancer

Location in the body

Breast cancer most often begins to occur in the milk production ducts of the breasts, it may also occur in the lobules of the breasts (glandular tissues). These common forms of Breast cancer are called Invasive Ductal Carcinoma and Invasive Lobular Carcinoma, respectively. Breast cancer, however, can occur in any part of the breast as cancer can occur in any part of the human body. A person diagnosed with early stage breast cancer has a 99% chance of survival for at least 5 years.

Number of cases annually

In Australia in 2018 approximately 18,087 women were diagnosed with invasive breast cancer, with approximately 49 women being diagnosed with it each day.

Risk factors:

The main risk factors of Breast Cancer include:

• Being a female, men can get breast cancer, but this only occurs about 1% of the time.
• If you have a strong family history of getting breast cancer you are more likely to get it.
• Previous Diagnosis of Breast Cancer.
• Inheriting a faulty gene from your mother or father you are also much more susceptible.
• Exposure to chest radiation during childhood.

Less common Risk Factors that slightly increase the risk include:

• Starting menstruation before 12 years of age.
• Starting menopause after the age of 55 years.
• Not breastfeeding – The longer you breastfeed, the more you lower your risk.
• Not having children.
• Having a child after 30 years of age
• Drinking more than 2 standard drinks of alcohol per day.
• Gaining a lot of weight during adulthood, especially after menopause.
• Smoking of any kind before the menstrual cycle begins (before 12-14 years of age).
• The consumption of processed meats regularly.

Warning signs/symptoms:

Some of the early warning signs of Breast Cancer can include:

• Lumps in the breast or around the underarm area.
• Changes in breast size and/or breast shape.
• Pain in a specific area of the Breast that does not eb.
• More obvious veins that can be along the surface of the breast.
• Sudden discharge from the nipples.
• A scab or a rash on the nipple.
• Swelling, redness, or darkening of or around the breast.
• Inversion of the nipple
• Inversion of other parts of the breast.

Some symptoms of inflammatory breast cancer:

• Swelling.
• Redness.
• A pink, reddish purple or bruised appearance of the Breast.
• A burning sensation.
• Swollen lymph nodes in the collarbone or underarm areas.
• Inversion of the nipple.
• Ridged skin.
• Pitted skin.
• Rapid increase of breast size.

Diagnosis/screening/testing:

If a doctor wants to test that you have Breast cancer, they will carry out a Clinical Breast Exam (CBE). During this exam the individual suspected of having Breast cancer will have to remove all clothing from the top half of his or her body. There are two methods for this exam:

Visual Examination: They will ask the individual to raise and then lower both of their arms. This can show differences in the size and/or shape of the breasts. They will also check for any rashes, dimpling, or nipple discharge.

Manual Examination: The doctor will use the pads of their fingers to check the entire breast/s of the individual as well as their underarm and collarbone for any abnormalities and /or suspicious lumps. They will also check any enlarged lymph nodes.

If further testing is required there are also other forms to ensure a correct diagnosis:

Mammogram: An X-Ray of the breast and chest area, this will show any dark spots (growths) within the breast.

Magnetic Resonance Imagery (MRI): A scanning procedure of scanning to provide doctors with a detailed picture of the breast and chest area.

Biopsy: The doctor uses a needle or other extraction device to take a sample of tissue or fluid for further testing.

If a doctor recommends these tests, it does not necessarily mean that they have breast cancer, in most cases it will show that they do not have cancer at all.

Treatment

For an individual diagnosed with early stage breast cancer, multiple treatment options are available. These treatment methods include:

Breast Surgery: Surgery for early breast cancer involves either breast conserving surgery or mastectomy. Breast reconstruction may be possible after a mastectomy. Both types of breast surgery usually also involve surgery to remove of one or more lymph nodes from the underarms.

Mastectomy: Involves the removal of the entire breast (including the nipple) and usually one or more lymph nodes from the underarms.

Breast Conserving Surgery: Involves the removal of the cancer itself as well as a small portion of healthy tissue surrounding the tissue (known as a surgical margin)

Breast Reconstruction surgery: Surgery to rebuild a breasts’ shape after a mastectomy.

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Radiotherapy: For people diagnosed with breast cancer, this method is almost always recommended after breast conserving surgery and only sometimes after a mastectomy.

This method uses X-rays to destroy cancer cells in some parts of the body (in this case, the breasts). This method is a localised treatment, meaning that it only treats the area of the body it is targeted towards.

Chemotherapy: This method is usually recommended for people diagnosed with Breast cancer that is suspected to have metastasized to other areas of the body. It can also lower the risk of breast cancer recurring after treatment as well as it increases the likelihood of survival.

This method uses various drugs to destroy cancer cells. As well as killing cancer cells, this method of treatment also destroys normal cells that are rapidly dividing. However, unlike cancer cells, regular cells have the ability to repair the damage and can recover over time.

Hormonal Therapies: This method is used on women whom have hormone receptors on their breast cancer cells. They can be used alone or alongside other forms of treatment.

Hormone Receptors: If a breast cancer cell has hormone receptors on it, it means that the cancer is caused by female hormones. If a woman’s cancer has hormone receptors, there cancer is known as “Hormone Receptor Positive” There are 2 main types of receptors, progesterone receptors (PR), and oestrogen receptors (ER).

It involves the consumption of drugs over a period of time and has been known to decrease the likelihood of cancer returning after the completion of treatment. They stop hormone receptor positive cancer cells from growing.

Targeted (Biological) Therapies: Involve drugs that halt the growth of certain types of cancer cells. This method is only suitable for some women. They may be used with other breast cancer treatments.

The most common targeted therapy used to treat early stage breast cancer is trastuzumab (Herceptin).

New Technology in Oncology

Ever since the Ancient Egyptian times, which is when the treatment of cancer (although it was not called that) in its earliest forms can be found to date back to (Approximately 3000BC), there has been a great deal of development and improvement when it comes to the field of oncology (the study of the development and treatment of cancer). From the development of chemotherapy in the 1940’s to vaccines being discovered to prevent specific cancers, the advancement of technology in regard to oncology is astronomical.

Vaccines for The Prevention of Cervical Cancer:

In 2006, Gardisil and in 2007, Cervarix®, both vaccines that are used in conjunction as a vaccine to prevent Human Papillomavirus (HPV), which is known to be a main co-efficient in the cause of cervical cancer, were certified by the FDA.

These vaccines were created to protect against the four most common types of HPV; HPV 6, HPV 11, HPV 16, and HPV 18. These strains of the Human Papillomavirus are known to be responsible for approximately 70% of cervical cancers internationally.

This form of vaccination (called in various locations by other names and brands) are administered by a needle three times over a period of six months to both males and females between 12 and 18.

Pap Smears for Early Detection of Cervical Cancer

George Papanicolaou (1883 – 1962) discovered the pap smear in 1928 while studying the cytopathology of the human reproductive system. He (debatably) discovered that there was a discernment between normal cells and malignant (cancerous) cells could be detected via observation through a microscope.

In 1943, he published his book “Diagnosis of Uterine Cancer by the Vaginal Smear”, by which his method soon became the gold standard of methods when it comes to detecting cervical cancer. This book described physiological changes the menstrual cycle as well as the influence of hormones and malignancy in vaginal cytology.

Pap smears have been proven to reduce the risk of developing cervical cancer due to the detection and treatment of cervical changes prior to development into cancer. Statistics show that 80% of cervical cancers occur in women who have never been screened or who have not had timely screening of their cervix.

The method involves the scraping of the cervix by an extraction device and the viewing and analysis of the cell sample under a microscope. This method is quick, efficient and cheap to conduct.

According to the US Preventative Services Task Force and the American Congress of Obstetricians and Gynaecologists, it is recommended that women begin getting pap smears at the age of age 21 and book another one every three years until the age of 65.

Mammograms and DNA Sequencing for Early Detection of Breast Cancer Risk: Mammograms and DNA sequencing, as previously stated (See “Breast Cancer”) are two very common methods used for the detection of Breast Cancer.

Mammograms are a low dose x-ray examination of your breasts that were invented in the 1960’s and developed further during the 1970’s. They can sometimes detect breast cancer before there are any signs or symptoms.

DNA Sequencing (Cancer Genome Sequencing), which first appeared in a study of several breast and colorectal tumours in 2006, is the whole genome sequencing of a sing, homogeneous or heterogeneous group of breast cancer cells, it is done to profile and note the changes (mutations) in the DNA of cancer cells. These changes, depending on their mutations, can lead to a specific form of treatment or therapy being recommended of the breast cancer patient.

This method is also used to determine whether or not specific genes can be found within an individual’s genetics such as the BRCA 1 and BRCA 2 genes, which are what a person has if they are likely to inherit either ovarian or breast cancer. Studies have shown that approximately 20 to 25 percent of women globally who are diagnosed with ovarian cancer have a hereditary tendency to develop the disease