Early diagnosis greatly improves the odds of survival. When detected early, breast cancer has a very high five-year survival rate, and patients who reach this stage often go on to live long, healthy lives. Survival rates are lower for cancers that have spread locally, and they are very low for cancers that have metastasized, or spread, to distant parts of the body.
Breast cancer may be discovered by the patient during a regular breast self-examination. When a self-exam is performed on a monthly basis, a woman becomes familiar with her breasts and can readily detect an abnormal change, such as a lump, a swelling, dimpling, or a change in contour, warranting immediate clinical examination. However, a change that is noticed through self-examination may not always be indicative of cancer. Alternatively, if the change found is cancer, the growth may already be fairly advanced.
Before they are palpable, growths in the breast may be detected through a procedure known as mammography, which entails the use of X-rays to detect lesions in breast tissue. Mammography is often used for initial diagnosis, but, in order to confirm the presence of cancer, a tissue sample (biopsy) usually must be taken. If cancer is suspected to have spread (metastasized) to nearby lymph nodes, they must also be sampled. Metastasis generally begins in a so-called sentinel lymph node (the first lymph node invaded by cancer cells) and, in the case of breast cancer, spreads to axillary lymph nodes, which are located in and around the armpits.
Once cancer has been diagnosed, the tumour’s type and degree of invasiveness is assessed. Several imaging methods may be used to determine the degree of metastasis, including X-rays, computerized axial tomography (CAT) scans, or magnetic resonance imaging (MRI). The presence of receptors for the hormones estrogen and progesterone is also determined because these receptors play an important role in the cancer’s development and in decisions regarding the appropriate treatment.
Any lump found in the breast should be examined by a physician for the possibility of cancer. If it is found to be malignant, treatment may entail surgery, radiation, or chemotherapy. Biological treatment is also an option. Surgery is often the first method of treatment, and a range of procedures are used depending on the type and progression of the cancer. A lumpectomy removes only the cancerous mass and a small amount of surrounding tissue; a simple mastectomy removes the entire breast; and a modified radical mastectomy removes the breast along with adjacent lymph nodes. Radical mastectomies involving removal of the breast, underlying muscle, and other tissue are rarely performed. Surgery is associated with a wide range of side effects, including changes in arm or shoulder mobility, swelling, infection, numbness, and, when lymph nodes are removed, fluid buildup in the region they were taken from. Partial or complete breast removal is often followed by cosmetic or reconstructive surgery. Over the course of the late 20th and early 21st centuries, the treatment of breast cancer progressed steadily toward less-invasive approaches, primarily in order to prevent women from undergoing unnecessary operations and particular procedures such as radical mastectomy. The rationale for moving away from aggressive surgery was reinforced by a study of women with early-stage breast cancer whose tumours were relatively small and had not metastasized. Researchers determined that the removal of axillary lymph nodes (axillary lymph node dissection), which was once standard procedure and believed to prevent recurrence of disease, had no impact on five-year survival rates and in fact had left some patients susceptible to a host of complications, including infection. Less-invasive treatments for breast cancer include radiation therapy, chemotherapy, and biological therapy. Radiation is usually employed—either to shrink tumours before surgery or to destroy small amounts of cancerous tissue remaining after surgery. Side effects of radiation include swelling or thickening of the breast, vomiting, fatigue, diarrhea, or skin irritations resembling sunburn. Chemotherapy, the use of chemicals to destroy cancerous cells, is commonly employed. Chemotherapeutic agents also attack normal cells to some degree, causing side effects that include hair loss, immune suppression, mouth sores, fatigue, and nausea. Breast cancer can also be treated through biological therapy, in which chemical inhibitors are used to block the hormones that stimulate growth of cancer cells. Tamoxifen, for instance, is a common drug that blocks the ability of estrogen to stimulate tumour growth, and Megace (megestrol) blocks the action of progesterone by partially mimicking the hormone. Herceptin is a manufactured antibody that binds to growth factor receptors on the surface of cancer cells and thereby blocks cell proliferation. Letrozole is used to inhibit the synthesis of estrogen in postmenopausal women who have hormone-dependent breast cancers.
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Source: Encyclopedia Britannica
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