Know About The Breast Cancer
Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast
.Epithelial malignancies of the breast are the most common cause of cancer in women excluding skin cancer, accounting for about one-third of all cancer in women.Breast cancer may exist for a long period as either a noninvasive disease or an invasive but non metastatic disease. These facts have significant clinical ramifications.
Epidemiology
Breast cancer is a hormone-dependent disease. Women without functioning ovaries who never receive estrogen-replacement therapy do not develop breast cancer. The female:male ratio is about 150:1.
ETIOLOGY:
Women who experience menarche at age 16 have only 50-60% of the breast cancer risk of a woman having menarche at age 12; the lower risk persists throughout life.
Similarly, menopause occurring 10 years before the median age of menopause which may be around 52 years, whether natural or surgically induced, reduces lifetime breast cancer risk by about 35%.
Women who have a first full-term pregnancy by age 18 have a 30-40% lower risk of breast cancer compared with nulli parous women.
The role of diet in breast cancer etiology is controversial. While there are associative links between total caloric and fat intake and breast cancer risk, the exact role of fat in the diet is unproven.
Increased caloric intake contributes to breast cancer risk in multiple ways: earlier menarche, later age at menopause, and increased postmenopausal estrogen concentrations reflecting enhanced aromatase activities in fatty tissues.
Moderate alcohol intake also increases the risk by an unknown mechanism.
Folic acid supplementation appears to modify risk in women who use alcohol but is not additionally protective in abstainers.
Evaluation of Breast Masses in Men and Women.
Because the breasts are a common site of potentially fatal malignancy in women and because they frequently provide clues to underlying systemic diseases in both men and women, examination of the breast is an essential part of the physical examination.
Although breast cancer in men is unusual, unilateral lesions should be evaluated in the same manner as in women, with the recognition that gynecomastia in men can sometimes begin unilaterally and is often asymmetric.
Virtually all breast cancer is diagnosed by biopsy of a nodule detected either on a mammogram or by palpation.
The Palpable Breast Mass.
Women should be strongly encouraged to examine their breasts monthly.All regional lymph node groups should be examined, and any lesions should be measured. Physical examination alone cannot exclude malignancy. Lesions with certain features are more likely to be cancerous which are hard, irregular, tethered or fixed, or painless lesions.
A negative mammogram in the presence of a persistent lump in the breast does not exclude malignancy.
Palpable lesions require additional diagnostic procedures including biopsy.
In premenopausal women, lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2-4 weeks, during the follicular phase of the menstrual cycle.
The Abnormal Mammogram
Diagnostic mammography should not be confused with screening mammography, which is performed after a palpable abnormality has been detected.
Diagnostic mammography is aimed at evaluating the rest of the breast before biopsy is performed or occasionally is part of the triple-test strategy to exclude immediate biopsy.
If a nonpalpable mammographic lesion has a low index of suspicion, mammographic follow-up in 3-6 months is reasonable.
Screening
Breast cancer is virtually unique among the epithelial tumors in adults in that screening usually in the form of annual mammography improves survival.
Meta-analysis examining outcomes from every randomized trial of mammography conclusively shows a 25-30% reduction in the chance of dying from breast cancer with annual screening after age 50; the data for women between ages 40 and 50 are almost as positive.
Staging
Correct staging of breast cancer patients is of extraordinary importance. Not only does it permit an accurate prognosis, but in many cases therapeutic decision-making is based largely on the TNM (primary tumor, regional nodes, metastasis) classification.
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