Cancer of the Breast
Cancer of the breast usually arises from cells in the ductal system (90 per cent) rather than the lobular structures (10 per cent). While there may be localised forms of each (called in-situ cancer or carcinoma) the majority spread first locally, and later to the lymphatic system which drains to lymph nodes in the armpit. Microscopically there are different forms of both ductal and lobular breast cancer, which behave differently and therefore require different treatment. While many breast cancers are detected by women who examine their breasts and find a lump, increasingly screening using mammography (low penetration X-rays of the breast tissue) is detecting cancers too small to be felt, when they are said to be impalpable. These can be biopsied under ultrasound control, which enables a diagnosis to be made at an earlier stage of the disease and more prompt treatment, which is improving prognosis. Treatment involves surgery; either removal of the affected area with sampling of the lymph nodes in the armpit to establish the extent of the disease, or mastectomy (removal of the breast) possibly followed by breast reconstruction. Depending on the precise nature of the cancer further treatment involving radiotherapy or chemotherapy is available, and the outlook for many patients is complete cure.
Both genetic and environmental factors play a part in the development of cancer of the breast: some families carry genes that make them much more likely to develop it (the gene is called BRCA1) or cancer of the breast and ovary (the gene is BRCA2). In such families there will be women (mothers, grandmothers, sisters or aunts) who developed breast cancer at an early age; if the family pedigree indicates the possibility that an unaffected woman might carry this gene then genetic counselling might be beneficial. Environmental factors include exposure to high levels of oestrogen, which is why the use of hormone replacement therapy can increase the incidence of cancer of the breast.
As with all cancers the earlier the treatment the better the outcome: women should be aware of their breasts and how to examine them, their family history, and the availability of screening.
|
