Breast cancer

28 March 2017

Breast cancer, a common cancer that is still frightening

Second cause of death among Canadian women with more than 5000 deaths in 2015, breast cancer or carcinoma is a malignant tumor that appears when abnormal cells proliferate in the breast, the cluster of cells creating the tumor. Cancer often takes years to develop.

Being extremely complex, the breast is primarily intended to produce milk that will feed the newborn. Basically, the breast is composed of glands, ducts and adipose tissue. Furthermore, each breast is composed of a mammary gland with multiple compartments; each compartment is composed of lobules whose function is to produce the milk and of channels for transporting the milk to the nipple. It is in these lobules (cancer under the name of lobular carcinomas) and in these channels (cancer under the name of ductal carcinoma) that these cancers develop the most frequently.

Please note that these uncontrolled cellular changes can lead to diseases that are cured much more easily and therefore are less serious.

We can mention:

  • Benign tumors, therefore non-cancerous tumors, the Fibroadenoma is removed by surgery
  • Cysts
  • Hyperplasia
  • Nipple discharge
  • Fibrocystic breast

When the tumor indicates cancer cells, the severity of cancer is represented by its location and its evolution. In fact, adenocarcinomas accounting for the majority of cancers are:

  • either very localized, in situ cancers that do not spread, cancer cells do not leave the channels and the lobules (stage 0 of the disease)
  • or invasive (stage 1-3), infiltrating carcinoma, then cancer affecting the surrounding tissue with a major risk of metastases (stage 4 of the disease), cancer going from the breast to the lymph nodes and to other parts and organs of the body (liver, bone, lungs …)
In very rare cases, breast cancer can also affect men.

The breast cancer risk factors

There are several risk factors that influence the onset of the disease.

These include:

  • The genetic factor. There are susceptibility genes to breast cancer, these are the BRCA1, BRCA2 and PALB2, 3 genes isolated by researchers since the 1990s. A mutation in these genes would increase the risk of cancer.
  • The family factor. The presence of breast cancer in the family (first or second degree)
  • Age is also an aggravating factor, over 80% of cancers are diagnosed after the age of 50
  • A history of breast cancer in the patient encourages the development of a new breast cancer
  • Excessive alcohol consumption and smoking
  • Early menarche (before the age of 12) or late menopause
  • Late pregnancy or no pregnancy
  • Use of oral contraceptives (those containing progesterone and estrogen)
  • Overweight and obesity
  • A hormone replacement therapy in menopause
  • Breast density (high breast density increasing the risk of breast cancer)

Symptoms that should raise concern

A number of clinical signs should alert the patient to immediately see her doctor in order to diagnose and treat cancer at its earliest stage.

The symptoms that occur most often are:

  • The presence of a mass or a lump in the breast; a mass that does not disappear. The absence of pain is also a characteristic sign. The mass in question has an irregular shape.
  • Hard nodes but usually painless in the armpits, sign that the lymph nodes are affected
  • Breast deforms or changes its size for no apparent reason
  • A change in the breast skin which looks like the orange peel
  • Redness, itching in the breast
  • Nipples changing (retraction, inverted nipples)
  • Pain in the breast
  • The presence of a discharge, a crust in the nipple
  • Nausea, pain throughout the body, fatigue, coughing, loss of weight and appetite, headache, visual disturbances … often the sign of a cancer that has already taken hold
The self-examination (palpation) by the patient and monitoring are the best means of detecting cancer early, before any examination and medical diagnosis.

Screening and breast cancer diagnosis

Pink October, a month to get tested

Screening remains the key to cure the breast cancer.
Therefore, the first attitude in the patient is to be attentive to any changes in her breasts and undertake regular self-examination (palpation) to verify the presence of a mass. In addition, the patient over the age of 50 and under the age of 74 will perform a screening mammography every two years. Monitoring is essential.
Feel free to participate in the Quebec program for breast cancer screening (PQDCS) for women aged between 50 to 69 years old. Take advice from your doctor.

Diagnosis

The diagnosis has a dual purpose, firstly finding exactly at what stage the cancer is and secondly finding exactly what type of treatment the medical team should focus on, depending on the characteristics of the cancer.

During the initial assessment, while the breast cancer is not yet diagnosed, the doctor will perform a physical examination of the breasts of the patient, the doctor taking the opportunity to trace all the family and the personal history of the patient without forgetting the questions about the symptoms she has been detected herself.

He will complement the diagnosis with specific tests:

  • Mammography of both breasts
  • X-rays of both breasts
  • MRI
  • Biopsy of the mass, that certainly shows the cancerous or the non- cancerous nature of the incriminating mass
  • Biopsy in the lymph nodes

Once the presence of cancer has been confirmed, he will perform a number of other tests to find out whether the cancer has metastasized or not:

  • A complete blood test specifically targeting tumor markers and the quality of both white and red blood cells, and of platelets
  • Blood biochemical analysis to verify the proper functioning of the kidneys, of the liver function and to see if the cancer has spread in the bones or not
  • Liver ultrasound scan
  • Lungs X-ray
  • Bone scan
  • A biopsy of the tumor in order to perform an analysis of HER2, a protein located on the surface of the cells, a cells-growth promoting protein and a cancer cells-growth promoting protein in the case of breast cancer
  • An analysis of hormone receptor type ER (estrogen receptor) and type PR (progesterone receptor) on the tumor

All these tests allow establishing an appropriate and effective treatment!

Breast Cancer Treatments

Depending on the type of cancer and after a discussion with the patient, the oncologist will:

  • perform a breast surgery, i.e. either a partial mastectomy, the tumor and a small part of the breast is removed or a total mastectomy, both the breast and the nipple being completely removed. The doctor will remove a lymph node (excision of the sentinel node) or multiple nodes (lymph node dissection) as appropriate. Please note that the patient will be offered a reconstructive breast surgery after the treatment.
  • recommend radiotherapy sessions namely X-rays or radiations aimed at destroying the cancer cells, sessions that always complete the surgery.
  • recommend chemotherapy sessions in addition to surgery and / or radiotherapy. This involves addressing the cancer cells with a drug treatment that is injected through a vein. Chemotherapy will then reduce the size of the tumor before surgery and help prevent cancer cells to reappear and multiply after surgery. It will be used especially if the cancer has metastasized.
  • recommend hormone therapy if the breast cancer is hormone receptor positive, this treatment neutralizing the effect of estrogen that boost the growth of the tumor.
  • recommend the use of new treatments such as biological therapies targeting certain types of cancer (those where the HER2 protein is present in large quantities, for example)

Survival and chances of recovery depend on many factors. (Tumor size, location …) It is estimated that the chances of survival for cancer detected at early stage (stage 0) is of 100% and of 20% for breast cancer that has metastasized. (Stage 4)

Monitoring remains essential to prevent recurrence.

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