BREAST CANCER: CAUSES AND CARE

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13 Oct 2019, Pune : SCENARIO OF BREAST CANCER:

Breast cancer is one of the most common types of cancer in women representing nearly a quarter (23%) of all cancers in women globally. Global breast cancer incidence increased from 6,41,000 (95% confidence intervals 6,10,000- 7,50,000) cases in 1980 to >16,43,000 (14,21,000-17,82,000) cases from 2010 to till date. An annual rate of increase of 3.1% for women aged 14-60 years. The more than 80% of women in India which cause breast cancer are younger than 60 years of age.

Women often do not present for medical care early enough due to various reasons such as illiteracy such as Lack of awareness, financial constraints.
1. A Lack of organized breast cancer screening program.
2. A paucity of the diagnostic aids and general indifference toward the health of females in the predominantly patriarchal society.

The breast cancer programs are more concentrated in the cities and have not reached rural areas of the country. It is a difficult task to diagnose breast cancer in the early stages due to a lack of awareness among women. Over 1,00,000 new breast cancer patients are diagnosed annually in India. The 1,00,000 patients that are treated breast cancer per year in India.

BREAST CANCER:

Breast cancer is a disease in which certain cells in the breast become abnormal and multiply uncontrollably to form a tumor.

Although breast cancer is found to be common in Indian women. In women, the most common form of breast cancer begins in cells. The lining of milk duct (ductal cancer) and cancer can develop in glands that produce milk (lobular cancer).

CAUSES OF BREAST CANCER:
1. Age: The risk of breast cancer increases with age. Mucinous carcinoma is most common in women over 60.
2. Breast density: Females with dense breasts are more likely to develop breast cancer than those of a similar age with less dense breasts.
3. Genetic mutation: The BRCA1 and BRCA2 genes make proteins involved in the repair of DNA in specific tissues,
such as the breasts. Changes or mutations to these genes can significantly increase the risk of breast cancer.
4. Family history of breast cancer: Having a family history of breast cancer increases the risk of developing breast cancer.
5. Menstrual and reproductive history: Starting menstrual periods at a younger age or going through menopause at a later age raises the estrogen and progesterone female hormones in a person’s body, which can increase a person’s risk of breast cancer.
6. Excess alcohol consumption: Esterification of alcohol due to extra levels of alcohol in the body may be responsible for breast cancer. That may happen because of the daily consumption of alcohol.
7. Radiation treatment/ exposure: Exposure to radiation around the chest can increase breast cancer risk.
8. Breastfeeding: Breastfeeding especially less than 1 year appears to increase the chance of developing breast cancer.
When breastfeeding reduces exposure of estrogen increases.
9. Body weight : Three major links known between weight and breast cancer are present that are
a. putting on body weight in adult hood increases the risk of breast cancer development may be in post
menopause
b. . Being overweight or obese before the menopause slightly reduces your risk of developing breast cancer in premenopausal
c. . Aftermenopause loss of control on weight increases your risk of breast cancer. 10. Hormonal replacement therapy: In some cases, it slightly increases the risk of breast cancer during symptoms of
using HRT to treat menopause. The greater risk causing because of using longer HRT, but once we stop taking HRT, this risk will begin to fall. Within a year or two, it will be about the same as if you had never taken it.
11. Occupational hazards: The ionizing and nonionizing exposure, night shift works, pesticides polycyclic aromatic hydrocarbons and metals are called occupational hazards that cause breast cancer.
12. Cosmetic implant: Cosmetic breast implant is trending. Women with cosmetic breast implant had a 26% increased risk of being diagnosed at a later stage of breast cancer than women without the implant.
13. Changes in sex life: People aren’t mature to discuss their sex life and change that take place in your life socially or in front of a doctor. Many females are avoided to do sex due to uncertainty in menstrual and thereby causing illness in the body which may due to preliminary breast cancer and get uninterested in starting and finishing sexual intercourse.

STAGEWISE APPEARANCE OF BREAST CANCER:
Stage1- Lump or thickening of the breast and changes in the skin or nipple or on the inside of an armpit, Redness of skin of the breast, Rash around on one of the nipples.
Stage2- Sunken nipple, swelling of the breast.
Stage3- Change in size and shape of a breast, Discharge from a nipple possibly containing blood.
Stage4- Peeling, flaking, and dimpling of the skin on the breast or nipple, ulceration.

RECENT DIAGNOSTIC TECHNIQUES OF BREAST CANCER:
Breast exam: In breast cancer screening, a woman who has no more signs or symptoms of breast cancer undergoes a breast examination such as a clinical breast exam.
Mammogram: Mammography is a low dose X-ray exam that produces images of the breast.
Breast ultrasound: The primary use of breast ultrasound is to help diagnose breast abnormalities detected by a physician during a physical exam and to characterize potential abnormalities seen on mammography.
Biopsy: A breast biopsy is a test that removes tissue or sometimes fluids from the suspicious area. The removed cell is examined under a microscope and further tested to check for the presence of breast cancer.
Breast magnetic resonance imaging: Magnetic resonance imaging of the breast uses a powerful magnetic field, radio waves and a computer to produce a detailed picture of structure within the breast.
Ultrasound elastography: Ultrasound elastography is the latest ultrasonic imaging technology that gives an elastogram. Elastrogram is a type of medical imaging test that maps stiffness and elasticity of soft tissues.

TREATMENT:

Surgery:
a) Lumpectomy: Lumpectomy is a surgery to remove cancer from the breast. It removes only the tumor and a small rim of normal tissue around it. It is also called breast-conserving surgery, or partial mastectomy.
b) Mastectomy: In conventional mastectomy, you remove the breast tissue and the nipple with an incision and this may be performed in conjunction with a plastic surgeon to conduct an immediate reconstruction.
c) Sentinel node biopsy: The sentinel node biopsy is a surgical procedure used to determine whether cancer has spread beyond a primary tumor into your lymphatic system. The sentinel node is the lymph node into which tumor drains.
d) Axillary lymph node dissection: An axillary lymph node dissection is surgery to remove the lymph node from the axilla (armpit).
e) Reconstruction: During reconstruction, a plastic surgeon creates a breast shape using an artificial implant, a flap of tissue from another place on your body.

Radiation therapy: Radiation therapy uses high energy rays to kill cancer cells. It affects cells only in the part of the body that is treated with the radiation. Breast cancer radiation therapy may be used to destroy any remaining mutated cells that remain in the breast or armpit area after surgery.
Chemotherapy: Chemotherapy is used to treat advanced-stage breast cancer by destroying or damaging the cancer cells as much as possible. Because chemotherapy medicine affects the entire body.
Hormone blocking therapy: Hormone blocking therapy for breast cancer is only used to treat hormone-sensitive cancer (hormone receptor-positive breast cancer). Aromatase inhibitor is used to treat early stage of breast cancer.

Biological treatment: Targeted therapies (also called biological therapies) are new drugs that work differently from
chemotherapy. The main targeted therapy used in breast cancer treatment is trastuzumab (also called as Herceptin). It reduces the risk of breast cancer coming back in women with HER2 positive breast cancer.

Prepared By:
B. Pharm Final Year Students
Ms. Pratiksha Nikam (pratikshanikam89@gmail.com)
Ms. Sarode Priyanka (sarodeps98@gmail.com)
Ms. Tejal Date (tejaldate1998@gmail.com)
Ms. Priyanka Nighot (priyankanighot34@gmail.com)
Email :kasturibpharm@gmail.com

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