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Dread disease and breast cancer

Breast cancer is the most common cancer in women worldwide and its incidence is increasing in most countries. Breast cancer is the most common cancer among women in South Africa, with one in 27 South African women diagnosed with breast cancer in her lifetime, according to the National Cancer Registry. Early detection of breast cancer is important, regardless of risk factors, because the earlier a cancer is found, the smaller it is. Small breast cancers are less likely to have already spread to lymph nodes and to other organs such as the lungs, liver, bones and brain.

What are the chances of getting breast cancer?

Globally, research shows that the incidence of cancer is increasing. Cancer statistics are very outdated in South Africa. The last National Registry report was published in 2001, so these statistics are almost 10 years old. According to the latest National Cancer Registry, the reporting of many cancers is suboptimal due to a lack of tissue diagnoses.

The latest 2000-2001 NCR Report shows that males have a lifetime risk of 1 in 6 of getting cancer, as opposed to 1 in 4 in the previous report (1998-1999), with cancers of the prostate (1 in 23), lung (1 in 69), oesophagus (1 in 82), colon/rectum (1 in 97) and bladder (1 in 108) predominating. Prostate cancer therefore remains the most common major cancer in men, with lung, oesophagus and colorectal cancer following closely behind.

In women the lifetime risk of getting cancer is now 1 in 8, as opposed to 1 in 6 in the previous report, with cancer of the breast (1 in 27) and cancer of the uterine cervix (1 in 35) predominating. Uterine, colorectal and oesophageal cancer follow, as was the case in 1998-1999.

CANSA has more recent statistics, which were published in 2009 and these statistics are as follows:

  • About 100 000 new cases per annum in South Africa
  • About 60 000 deaths per annum in South Africa
  • 40% survival

However, according to the Liberty dread disease claims experience for 2008, Cancer is consistently the number one reason for claims and make up 46% of all dread disease claims paid in 2008. 40% of the cancer claims were for breast cancer. From the Liberty claims experience and book we can conclude the following:

  • 1 in 27 women will have a chance of dying of breast cancer
  • 1 in 7 women will suffer with some sort of cancer

What are the risk factors for breast cancer?

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

  • Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60.
  • Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: A woman’s risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother’s or father’s family) may also increase a woman’s risk.
  • Tobacco usage: Smoking is the single biggest cause of cancer in the world. According to CANSA, over 44000 South Africans die from tobacco-related diseases annually.
  • Reproductive and menstrual history:
    • The older a woman is when she has her first child, the greater her chance of breast cancer.
    • Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
    • Women who went through menopause after age 55 are at an increased risk of breast cancer.
    • Women who never had children are at an increased risk of breast cancer.
    • Women who take menopausal hormone therapy with oestrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
  • Race: Breast cancer is diagnosed more often in white women
  • Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
  • Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
  • Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

Men are not immune to breast cancer

Unfortunately men are not immune to cancer and rather surprisingly for most men; they can also contract breast cancer. A little known fact is that all men have breast tissue and can develop breast cancer. Women are about 100 times more likely to get breast cancer, but any man can develop breast cancer. While breast cancer in men is much less common than breast cancer in women (accounting for about 1 per cent of all breast cancer) it can be life-threatening. Male breast cancer is most common in men between the ages of 60 and 70.

Another point to note is that the survival rate for men is no better than for women. The survival rate for men is comparable by stage of disease at the time of diagnosis. However, men are usually diagnosed at a later stage, after the cancer has spread, because they are less likely to report any symptoms.

Signs of breast cancer

The earlier the disease is discovered, the more treatment options and the better the chances are of recovery. Most breast lumps aren’t cancerous. Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often the lump is painless. Other signs of breast cancer include:

  • Abnormal lumps or swelling in either the breast, nipple, or chest muscle
  • Skin dimpling or puckering
  • Nipple retraction (turning inward of the nipple)
  • Redness or scaling of the nipple or breast skin
  • Nipple discharge
  • Lumps under the arm

Treatment of breast cancer

In recent years, there’s been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement for those with the disease. Instead of only one or two options, today there’s an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer.

Four types of standard treatment are used:

Surgery and Reconstructive Surgery

Surgery is usually the first line of attack against breast cancer. Decisions about surgery depend on many factors. Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.

Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

  • Lumpectomy: Surgery to remove a tumour (lump) and a small amount of normal tissue around it.
  • Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.

Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.

Other types of surgery include the following:

  • Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
  • Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
  • Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. The hormone oestrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making oestrogen is called ovarian ablation.

The decision regarding the most suitable form of treatment needs to be taken in conjunction with the patient and his/her surgeon, the oncologist and the plastic surgeon.







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