Breast Cancer

Breast cancer is a disease that plagues many of the world’s women. Normally cells reproduce by diving in a regular orderly fashion so that growth and repair body tissues takes place. Disease can disrupt this normal fashion in various ways. Sometimes there is an uncontrolled growth of cells causing a tumour (Baum and Schipper, 1999. ) However some rumours are not cancer because they cannot spread or threatens some ones life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors.

Despite advances in scientific knowledge Breast cancer still makes up for a quarter of all cancers Incidence and Mortality Breast cancer is the most common cancer in women; a woman’s lifetime risk is 1 in 12. It is a cancer mainly of older women with about half of cases appearing in women who are over 65. It also affects about 220 men a year. Incidence and mortality vary considerably between countries. If we take a look outside the US, of age-standardized rates, cases per 100,000 women, incidence and mortality are in Australia, 59. 6 and 21. 41; in England and Wales, 56. 1 and 30. 27. A

study carried out in Miyagi, Japan, produced comparatively low figures of 27. 8 and 6. 11. As with most cancers, the earlier breast cancer is diagnosed, the greater the chance of a cure. Stage 1 is a cancer in a very early stage; stage 4 is one which has already spread to many organs. Early Detection Early detection is all-important. Research in Britain and Sweden has shown that small breast cancer those less than 15 mm (1 in) in diameter—are less likely to have spread and are less aggressive. In 1994-1995, the National Breast Screening Program identified 6,500 cancers, and 2,660 were smaller than 15 mm.

Nearly 20 per cent of the cancers found had not become invasive, that is, they had not spread beyond the breast ducts. In the United Kingdom with the US also have a similar program all women between 50 and 65 are invited to have a mammogram (breast X-ray) every three years through the National Breast Screening Program; women over 65 are entitled to be screened on request. The program aims to cut breast cancer deaths by 25 per cent in the screened population and it has a 77 per cent take-up rate. Women are advised to practise self-examination between screenings or if they are under 50. Self-examination involves a

monthly check for unusual lumps or other breast changes, such as nipple discharge or bleeding. At present, however, there is no clear evidence of the effectiveness of breast self-examination in reducing deaths from breast cancer. Nevertheless, the majority of breast cancers are found by the women themselves rather than through mammography screening. Many doctors believe that women should be made aware of breast cancer symptoms and encouraged to examine their breasts, or at least be aware of how they usually feel, so that any changes can be reported to their family doctor quickly. Causes Hormones

The female hormone oestrogen plays an important part in breast cancer development. The following factors may increase risk: starting menstruation (periods) early in life; late menopause; obesity after the menopause, as very overweight women produce more oestrogen; and having no children, or having a first child after 40 years old. Incidence in later life increases with a woman’s age at the time of her first pregnancy. It is around three times greater when the first birth is after 35 than when it occurs before 18. Taking the contraceptive pill or hormone replacement therapy (HRT) may also have an impact.

In 1996, the largest overview on the Pill and breast cancer reported a small increased risk while taking the Pill. However, the risk decreased when women stopped taking it, and after ten years their risk was the same as for women not on the Pill. There is no conclusive link between HRT use and breast cancer. So far, it seems that taking HRT drugs for up to five years is safe, but prolonged use may incur a small increased risk. Any risks associated with HRT have to be weighed against the benefits, which are decreased risk of serious disease, such as heart disease; osteoporosis (thinning of the bones); and possibly

bowel cancer. A number of large studies are under way in Britain and the United States that may further clarify possible breast cancer risks of HRT. Family History About 5 per cent of breast cancers are linked to family history. The risk for a woman whose mother or sister had breast cancer is at least double that of someone with no family history. If her relatives were under 40 when diagnosed, her risk is even higher. Two genes, BRCA1 and BRCA2, have been found to be involved in familial breast cancer, particularly in young women. A woman who has a fault in one of these genes has a high risk of developing breast cancer.

It is possible that tests for mutations in these genes will be widely available in the near future. An international study is under way to see if giving the hormone-blocking drug tamoxifen to high-risk women, mainly those with a family history of the disease, will prevent them from developing breast cancer. Diet Diet may play a part in breast cancer. Studies indicate that girls who eat too much and take little or no exercise grow faster and reach puberty earlier, which is thought to increase breast cancer risk because of the production of oestrogen for longer period in life.

Recent studies have not upheld an early hypothesis that fat content in the diet is involved in breast cancer. There is some evidence that breast cancer rates could be lowered by including soya products in the diet. Smoking Whether or not smoking plays a part in breast cancer is a subject of much debate. Researchers reported in the United States in 1996 that smoking may be involved. They compared 324 breast cancer patients with 327 controls and discovered that post- menopausal smokers with mutations in a gene that helps the body get rid of carcinogens were four times more likely to get

breast cancer than non-smokers. However, a previous review of 50,000 breast cancers and 100,000 controls found no link between breast cancer and smoking. Some researchers have pointed out that this recent report involved a small number of cases and that the results could well be due to chance. Treatment Early Breast Cancer Breast conservation therapy is suitable for about 80 per cent of cancers and involves removing the lump (lumpectomy) and the lymph glands under the arm (the first site breast cancer spreads to), followed by radiotherapy.

Research has shown that this newer method is as effective as mastectomy (surgical removal of the breast), which still tends to be the main treatment for early breast cancer. Women may also be offered other treatments afterwards. Prescribing the hormone-blocking drug tamoxifen for post- menopausal women, and offering ovarian ablation (stopping the ovaries from producing oestrogen) to younger women would save 1,000 extra lives a year in the US. Ovarian ablation can be done by removing the ovaries, irradiating them, or prescribing certain drugs. Advanced Breast Cancer

Treatment of advanced breast cancer, that is, cancer, which has spread, is usually aimed at giving the patient a manageable quality of life with the disease kept under control, rather than a cure. Conventional treatments include drugs which cut oestrogen levels, and various chemotherapy combinations. Some women have bone metastases that cause pain and fractures. They may be treated with a new drug, APD, which helps to alleviate symptoms. There are many new treatments in the trial stages such as high-dose chemotherapy, targeting therapies, immunotherapies, and

gene therapies. However, it will be several years before their efficacy is known. THE PSYCHOLOGICAL AND SOCIAL IMPACT OF BREAST CANCER Learning that cancer has been diagnose can have devastating effects on the patients and her family. The key to breaking bad news is to try to slow down the effects of transition from a patient’s perception of being well to a realisation that she has a life threatening disease. Evidence shows that breaking the news abruptly will disorganise the patient psychologically and impair adaptation or provoke denial (Maguire & Faulkner, 1988).

The response to diagnosis of cancer has also been associated with persons search for meaning as to why she had cancer (O’connor, et al, 1990). Faith and social support were found to assist individuals in this search and the nurse most familiar with the patient was found to be in the best position to help. It is also recommended that newly diagnosed breast cancer patients should be clearly advised that treatment is not something that is quickly dispensed but something that involves a combination of therapies over a period of time. Therapies that may include the

removal of breast but as Fallowfield, et al, 1990 says an immediate effect of breast cancer is threat to patient’s life and health; a threat to life being greater than loss breast. In a review of literature, Morton presented the findings of Maguire 1985 who noted that patients who received a diagnosis of breast cancer may feel uncertainty, helplessness, loss of meaning, failure, stigma and isolation (Morton 1996). Morton 1996 went on to identify other feelings and reactions, which included denial, anger, blame, despair and depression. It is difficult to predict how patients will respond to cancer diagnosis, each individual will respond in a

different way which will be determine by things like cultural background, religion, support networks and quality of rapport with the health care professional (Franklin & Smith 1994; Morton 1996). In this situation the nurse can emerge as the key player by establish an open intimate relationship with the patient. However, Parathian and Taylor 1993 points out that nurses have not really come to terms with dealing with patients who have received bad news and there is a case for more intensive training in communication skills which has been supported. Psychological support should be available at every stage to help patients and

their families cope with the effects of the disease. Up to one third of women develop severe anxiety or depression illness within a year of diagnosis (Dixon 2000). Patients should be offered clear objective full information about their condition in both verbal and written form. work cited BAUM, M and H SCHIPPER Fast Facts: Breast Cancer. Oxford: Health Press (1999) Maguire, P. , Faulkner, A. (1988). Communicate with cancer patients O’connor, et al, 1990, breast cancer Fallowfield LJ, Hall A, Maguire GP, Baum M. (1990). Parathian, A. , & Taylor, F. (1993).

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