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Breast Cancer : Breakthroughs

Dr Vivian Oputa

October is officially tagged “Breast Cancer Awareness Month”. Of recent, there have been a lot of medical breakthroughs in the detection and treatment of Breast Cancer. Scientists have identified more accurate tools for screening younger women who are more likely to get the most dangerous forms and new strategies have also been developed for the treatment of newly diagnosed pregnant women.  Advanced research has led to the development of better, less toxic drugs to guard against recurrences.

In the Western world, breast cancer deaths have plummeted and survival rates are soaring. Research has made more headway in the fight against breast cancer than any other form of cancer. These milestone achievements are as a result of the constant campaigns, awareness creation and fundraising activities directed toward the cause. Early detection and a study which showed that hormone replacement therapy in postmenopausal women strongly contributed to the development of breast cancer are greatly responsible for the lower incidence rates.

In breast cancer, some cells in the breast for reasons poorly understood start growing abnormally, dividing more rapidly than normal cells and may spread (metastatize) to adjascent tissue, lymph nodes or other parts of the body.The most common type begins in the milk producing ducts while otherforms occur in other breast tissue. It is known that 5 to 10% of breast cancer cases areinherited. There is usually a defect in one of two genes namely BRCA1 and BRCA2 (Breast Cancer Genes 1 and 2).

Most genetic mutations related to breast cancer are not inherited and develop during one’s lifetime such as exposure to polycyclic aromatic hydrocarbons found in tobacco and charred meats and radiation exposure.
Newer drugs such as Herceptin and Tamoxifen that are specifically targeted for the treatment of pathologically different cancer types has greatly reduced deaths as a result of breast cancer. In the past, one drug was used to treat all forms of breast cancer with less than satisfactory results.

Types of Breast Cancer:

The majority of tumours (about 60%) are hormone sensitive and are stimulated by the female sex hormones oestrogen and progesterone. About 25% of cases are the deadlier form associated with an excessive amount of the protein known as HER2.

Some cancers are both hormone sensitive and HER2 positive. There is a form of breast cancer more likely to occur in younger women known as Triple Negative Breast Cancer because it is neither oestrogen sensitive, progesterone sensitive nor HER2 positive. Fortunately, there have been developments in treatments to help all three forms.
Hormone Responsive Cancer is usually treated with Tamoxifen which is given after surgery to suppress hormones that stimulate tumour growth. Tamoxifen has serious side effects such as vaginal bleeding, hot flashes, an increased risk of uterine cancer and the development of blood clots. There are newer oestrogen-blocking aromatase inhibitors namely Femara, Arimidex and Aromasin which have been found to offer the same or even better results.

HER2 Cancer due the HER2 protein triggering the growth of cancer cells is an aggressive form of cancer.
The drug Herceptin is used to stop the action of this protein and is combined with chemotherapy. Tykerb, also a protein suppressor, will be on the market in 2007 and has shown excellent results when combined  with the chemotherapeutic agent, Xeloda.

Triple Negative Cancer is tackled with the use of a colon cancer drug known as Avastin and is combined with chemotherapy with promising results.

In the past, a pregnant woman found to have breast cancer had to make the difficult decision of having to save her own life or the life of the unborn child. New treatment guidelines allow women to have a mastectomy or a breast conserving lumpectomy and commence chemotherapy as early as the second trimester. Some studies have shown that there have been little or no adverse effects on the foetus while others have shown that the development of the foetus may be affected by chemotherapy. Radiation and oestrogen therapy may  harm the foetus and should be delayed until after the birth of the child.

More than 75% of cases of breast cancer occur in women aged over 50 years. Other risk factors include having a first degree relative (mother, daughter, sister) who has had breast cancer, having had breast cancer previously, an abnormal biopsy result, a mutation in the breast cancer genes, postmenopausal obesity, hormone replacement therapy and prolonged exposure to oestrogen such as reaching puberty before the age of 12 years, starting menopause after age 55 years and having children after the age of 30 or not having children at all.

Women are advised to have routine mammograms once they reach age 40. MRI’s are useful for locating difficult to identify tumours.The risk of developing breast cancer may be reduced by checking breasts monthly for lumps, getting regular exercise which boosts immune function and cuts the risk in half, watching your weight as obesity encourages further storage of oestrogen in fatty tissue. Women who are about 30kg overweight are up to 3 times more likely to develop advanced metastatic cancers than women who are not overweight. Exposure to oestrogen should be minimized thus hormone replacement therapy should be dicouraged.

It should be noted that men may also develop breast cancer. As a matter of fact, a male case was the first I was presented with as a medical student. In men, like women, the most common sign of breast cancer is a lump (often painless) or thickening of breast tissue. Other signs include change in the size or contour of the breast, clear or bloody nipple discharge, retraction or indentation of the nipple, flattening or retraction of the skin overlying the breast and redness or pitting of the skin overlying the breast.


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