About Breast Cancer

WHAT IS BREAST CANCER? 

Breast cancer is a malignant tumour. It occurs when breast cells become abnormal anddivide without control or order. Normal cells divide and produce in an orderly manner. Sometimes this orderly process is disrupted and cells grow and divide out of control producing extra tissue to form a mass or lump called a tumour. A tumour can be benign (non-cancerous) or malignant (cancerous). The breasts are made up mainly of fat cells and gland cells. Milk-producing glands in the breast are made up of individual cells which normally reproduce under the control of hormones. Sometimes this process of reproduction goes out of control and an abnormal glandular structure develops. This is the beginning of cancer. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules

What are the different types of breast cancer?

There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers. Some of the most common types of cancer are as follows:

Ductal carcinoma in situ: The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS). This type of cancer has not spread and therefore usually has a very high cure rate.

Invasive ductal carcinoma: This cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.

Invasive lobular carcinoma: This breast cancer starts in the glands of the breast that produce milk. Approximately 10% of invasive breast cancers are invasive lobular carcinoma.

The remainder of breast cancers are much less common and include the following:

Mucinous carcinoma are formed from mucus-producing cancer cells.

Mixed tumors contain a variety of cell types.

Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.

Inflammatory breast cancer: This cancer makes the skin of the 

breast appear red and feel warm (giving it the appearance of an infection). These changes are due to the blockage of lymph vessels by cancer cells.

Triple-negative breast cancers: This is a subtype of invasive cancer with cells that lack estrogen and progesterone receptors and have no excess of a specific protein (HER2) on their surface. It tends to appear more often in younger women and African-American women.

Paget's disease of the nipple: This cancer starts in the ducts of the breast and spreads to the nipple and the area surrounding the nipple. It usually presents with crusting and redness around the nipple.

Adenoid cystic carcinoma: These cancers have both glandular and cystic features. They tend not to spread aggressively and have a good prognosis.

The following are other uncommon types of breast cancer:

Papillary carcinoma

Phyllodes tumor

Angiosarcoma

Tubular carcinoma

How to diagnosed ? 

There are a number of ways in which breast cancer is detected:

• It is recommended that your doctor or general practitioner should examine both your breasts and your armpits every year. 
• In addition to this, women should perform Breast Self-Examination (BSE) every month. 
• Women over the age of 40 should have a mammogram (breast x-ray) every two years.  
• Breast ultrasound is used in conjunction with a mammogram to determine the nature of abnormal breast tissue seen on a mammogram. 

      Examine the detection of breast cancer  

What causes breast cancer?

There are many risk factors that increase the chance of developing breast cancer. Although we know some of these risk factors, we don't know how these factors cause the development of a cancer cell.

What are breast cancer risk factors?

Some of the breast cancer risk factors can be modified (such as alcohol use) while others cannot be influenced (such as age). It is important to discuss these risks with your health-care provider anytime new therapies are started (for example, postmenopausal hormone therapy).

The following are risk factors for breast cancer:

·         Age: The chances of breast cancer increase as you get older.

·       Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, daughter) doubles a woman's risk.

·         Personal history: Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast.

·         Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.

·         Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.

·         Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.

·         Race: White women have a higher risk of developing breast cancer, but African-American women tend to have more aggressive tumors when they do develop breast cancer.

·         Exposure to previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer.

·         Having no children or the first child after age 30 increases the risk of breast cancer.

·    Breastfeeding for one and a half to two years might slightly lower the risk of breast cancer.

·         Being overweight or obese increases the risk of breast cancer.

·         Use of oral contraceptives in the last 10 years increases the risk of breast cancer.

·     Using combined hormone therapy after menopause increases the risk of breast cancer.

·         Alcohol use increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used.

·         Exercise seems to lower the risk of breast cancer.

What are breast cancer symptoms and signs?

The most common sign of breast cancer is a new lump or mass in the breast. In addition, the following are possible signs of breast cancer:

·      Nipple discharge or redness

.   Retraction or indentation of nipple 

·      Swelling of part of the breast or dimpling

.  Atypical fullness or puckering

You should discuss these or any other findings that concern you with your health-care provider.

Prevent breast cancer in your life.

         1. Maintain a healthy body weight (BMI less than 25) throughout your life. Weight gain in midlife, independent of BMI, has been shown to significantly increase breast cancer risk. Additionally, and elevated BMI has been conclusively shown to increase the risk of post-menopausal breast cancer.

    2. Minimize or avoid alcohol. Alcohol use is the most well established dietary risk factor for breast cancer. The Harvard Nurses' Health study, along with several others, has shown consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.

           3. Consume as many fruits and vegetables as possible. Eat seven ormore servings daily. The superstars for breast cancer protection include all cruciferous vegetables (broccoli, cabbage, brussels sprouts, cauliflower) ; dark leafy greens (collards, kale, spinach) ; carrots and tomatoes. The superstar fruits include citrus, berries and cherries. Note: it is best to eat cruciferous vegetables raw or lightly cooked, as some of the phytochemicals believed to offer protection against breast cancer are destroyed by heat.

·     4. Exercise regularly the rest of your life. Many studies have shown that regular exercise provides powerful protection against breast cancer. Aim for 30 minutes or more of moderate aerobic activity (brisk walking) five or more days a week. Consistency and duration, not intensity, are key!

·      5. Do your fats right! The type of fat in your diet can affect your breast cancer risk. Minimize consumption of omega-6 fats (sunflower, safflower, corn and cottonseed oils), saturated fats and trans fats. Maximize your intake of omega-3 fats, especially from oily fish (salmon, tuna, mackerel, sardines, lake trout and herring). Consume monounsaturated oils (canola, olive oil, nuts/seeds, avocados) as your primary fat source, as these foods have potential anticancer properties. Specifically, canola oil is a good source of omega-3 fats; extra virgin olive oil is a potent source of antioxidant polyphenols, including squalene; and nuts and seeds provide you with the cancer protective mineral, selenium.

·      6. Do your carbs right! Minimize consumption of the high glycemic index, "Great White Hazards" - white flour, white rice, white potatoes, sugar and products containing them. These foods trigger hormonal changes that promote cellular growth in breast tissue. Replace these "wrong" carbs with whole grains and beans/legumes. Beans/legumes because of their high fiber and lignan content are especially special.

·     7. Consume whole food soy products regularly, such as tofu, tempeh, edamame, roasted soy nuts, soy milk and miso. Only consume organic, non-GMO (genetically modified) soy. Epidemiologic studies have shown a positive association between soy consumption and reduced breast cancer risk.

·         8. Minimize exposure to pharmacologic estrogens and xeno-estrogens. Do not take prescription estrogens unless medically indicated. Lifetime exposure to estrogen plays a fundamental role in the development of breast cancer. Also avoid estrogen-like compounds found in environmental pollutants, such as pesticides and industrial chemicals. Buy organic produce if you can afford it; otherwise, thoroughly wash all non-organic produce. Minimize exposure to residual hormones found in non-organic dairy products, meat and poultry.

·         9. Take your supplements daily. A multivitamin, 500-1,000 mg of vitamin C in divided doses, 200-400 IUs of vitamin E as mixed tocopherols, and pharmaceutical grade fish oil. Also take 200 mcg of the mineral selenium or eat one to two Brazil nuts as an alternative. If you have a chronic medical condition or take prescription drugs, consult your physician first.

·      10. Maintain a positive mental outlook. Engage in self-nurturing behaviors regularly. Develop rich, warm and mutually beneficial relationships with family and friends. Get adequate sleep (7-8 hours per night). The mind-body associations with breast cancer are significant.

Treatment

Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. Treatments include surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. People with breast cancer often get more than one kind of treatment. Breast cancer is usually treated with surgery and then possibly with chemotherapy or radiation, or both. A multidisciplinary approach is preferable.  Hormone positive cancers are treated with long term hormone blocking therapy. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence.

·         Surgery. An operation where doctors cut out and remove cancer tissue.

·      Chemotherapy. Using special medicines, or drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.

·       Hormonal therapy. Some cancers need certain hormones to grow. Hormonal treatment is used to block cancer cells from getting the hormones they need to grow.

·         Biological therapy. This treatment works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.

·      Radiation. The use of high-energy rays (similar to X-rays) to kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

It is common for doctors from different specialties to work together in treating breast cancer.

Surgeons are doctors that perform operations. Medical oncologists are doctors that treat cancers 

with medicines. Radiation oncologists are doctors that treat cancers with radiation.

§  Stage 1 cancers (and DCIS) have an excellent prognosis and are generally treated with lumpectomy and sometimes radiation. HER2+ cancers should be treated with the trastuzumab (Herceptin) regime.^[Chemotherapy is uncommon for other types of stage 1 cancers.

§  Stage 2 and 3 cancers with a progressively poorer prognosis and greater risk of recurrence are generally treated with surgery (lumpectomy or mastectomy with or without lymph node removal), chemotherapy (plus trastuzumab for HER2+ cancers) and sometimes radiation (particularly following large cancers, multiple positive nodes or lumpectomy).

§  Stage 4, metastatic cancer, (i.e. spread to distant sites) has poor prognosis and is managed by various combination of all treatments from surgery, radiation, chemotherapy and targeted therapies. 10 year survival rate is 5% without treatment and 10% with optimal treatment.

How bras are linked to breast cancer?

    Many people say that bras causing breast cancer is just a myth.It is true that bras do not cause breast per se, but ill-fitting, too tight bras can help cancer growth since they can prevent your body from excreting dangerous cancer-causing chemicals. And, as bra industry and even Oprah have noted, 80%+ of women wear the wrong-size bra.

   The main reason why tight bras are bad for breast health is because they  restrict the lymph flow in your breast. There are numerous lymph pathways and lymph nodes in the armpits, under the breasts, and in between the breasts. 

     Normally the lymph fluid washes out waste materials and other toxins away from the breasts, but bras (and especially push-up bras) inhibit this action, so toxins can start to accumulate in the breast, and that can help cancer to develop.  In other words, bras inhibit the way our bodies normally cleanse themselves and get rid of cancer cells and toxins like PCBs, DDT, dioxin, benzene and other carcinogenic chemicals that cling to the body's fatty tissues like breast.  In fact, if you find a lump in your breast, it may very well be filled with lymph fluid that was not able to move away from the breast tissue.

Bra wearing may also be connected to cancer in other ways.  Wearing bras slightly increases the temperature of the breast tissue, and women who wear bras have higher levels of the hormone prolactin.  Both of these may influence breast cancer formation.

Choosing a Bra

     Bras are designed to contain the breasts and give shape and support. Breasts are a part of the body shape of a woman and, therefore, of her sexuality. Perception of size or change of shape can have profound psychological effects.

      Choosing a bra can thus become quite a complex matter, and can be complicated further by a non-average body shape, weak hands and fingers or other such difficulty. Some women decide not to wear a bra for a number of reasons, but those who perspire a lot or have heavy breasts could have problems with soreness or even ulceration underneath.

       Breasts change shape over time, particularly after childbirth and with age, so it is a good idea to be measured and fitted regularly, or certainly if some change has been noted.

      The information contained in this information sheet is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution ie bra is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance when choosing a bra.

SIZING

      It is always advisable for your comfort and breast health to be measured and fitted by a trained bra fitter. Look in your local phone directory for your nearest specialist shop, or ask the lingerie department of your nearest department store.

Measure chest under bust for bra size.

Measure fullest part of bust for cup size.

If the cup size is:

·         same as bra size you require an AA cup

·         up to 1 inch larger you require an A cup

·         up to 2 inches larger you require a B cup

·         up to 3 inches larger you require a C cup

·         up to 4 inches larger you require a D cup

·         up to 5 inches larger you require a DD cup

·         up to 6 inches larger you require an E cup.

     For instance, if your underarm measurement is 38 inches and the fullest part of the bust 42 inches, you need size 38D. This enables you to know what size to look for when shopping, but not the style.

Only you can find out which is the most comfortable for you.

STYLES AND TYPES OF BRA

Strapless bras support from beneath and may give relief to those with painful shoulders.

Backless bras fasten at the waist, have very narrow straps, and may be useful where the spine is not straight.

T-back or racer-back bra straps do not fall off the shoulders, and may accommodate sloping shoulders. These styles tend to be front-fastening.

Mastectomy bras. Many women who have had mastectomies have found that they do not need special bras. All women who have had breast cancer surgery are entitled to their initial prosthesis and two bras free of charge. Mastectomy bras normally have a pocket to contain the prosthesis. For those who prefer a standard bra choose a style with high underarm contours, wide adjustable shoulder straps and strong elastic side panels with some support for the prosthesis. A criss-cross of ribbon is an alternative to a pocket. For more information on prostheses, bras and beachwear for women who have had breast surgery, contact Action Breast Cancer (see Useful Addresses).

LENGTH

Bras are normally available in three lengths, short, midi and long. Long length bras give the greatest support to a heavy bust but need to fit well around the body for comfort. They sometimes have hooks to fasten onto a corset and so prevent the bra from riding up. Bras are normally fastened with hooks and eyes but some do not have any fastenings. The number of hooks and eyes normally depends upon the length.

FASTENINGS

Back-fastening bras are commonly available but some women find them difficult to manage. In which case other bras may be appropriate.

Front-fastening bras are available up to sizes E and F. Most front fastening bras are made with small hooks and eyes, but one company now makes a front fastening bra with large trouser hook type fasteners with loops to help when gripping the fabric. Contact your nearest clothing advice service for details.

Sleep bras are normally front fastening and give soft support and are useful while dressed in nightwear. They usually have a high back with wide straps.

Crop tops give little support but usually have wide straps and no fastenings. They can be put on over the head or held by the shoulder straps and pulled on over feet and legs, like pants.

Sports bras give different levels of support with full freedom of movement, and are often T-back or racer back. They are often put on over the head or over the feet and legs and pulled upwards, but are also available with front and back-fastening.

STRAPS

Shoulder straps can be narrow, average width, wide or camisole style.

Adjustable straps can be adapted to adjust either with Velcro, buckles or rings.

Stretch straps allow for comfort and easy movement.

Non-stretch straps may be best if the bust is heavy, but may also cut into shoulders.

Cushion pads are often incorporated into the non-stretch straps of larger cup size bras to protect shoulders.

OTHER FEATURES

Underwiring gives support, but may dig in, rub or cause pressure areas to develop.

Backs of bras: some cover the back fully, some have straps which follow the lines of the armhole.