Breast Cancer

In the United States in 1999 alone, an estimated 43,700 people will die from breast cancer. It is the number two cancer killer among females ages 15 to 54. On average if a woman gets this disease, their life expectancy drops drastically. This cancer is within the top three cancers of all women above the age of 15, and comprises a great amount of all health care costs in the U.S. totaling an astounding 37 billion dollars a year in direct medical costs. An average woman is said to have a one in nine chance of getting the cancer, but if that person had family history of the disease, his or her chances have been measured up to a one in six chance. Sixty-nine percent of African-American women survive from it, and there are predicted to be nearly two million new cases reported this year in the U.S. (Breast Cancer Key Statistics). Breast cancer is a group of rapidly reproducing, undifferentiated cells in the area of the breast in men and women.

The earliest changes occur in the epithelial cells of the terminal end buds (TEB) of the breast milk ductal system. While the progressive steps of breast cancer are unknown, the cells in the breast trigger a reaction of cell reproduction. These new cancer cells form tumors. If cancer cells are active or are considered malign, the tumor grows at tremendous speeds, and may end up in metastasis. Metastasis is a complex process in which cells break away from their primary tumors, and via the blood supply or through the lymph system relocate into other organs, thus spreading cancer throughout the body. Generally, if a lump is smaller than one centimeter, it is considered benign, although every woman should consult her doctor about any unusual bumps or feeling in the chest. One sign of breast cancer results from ductal cancer in the breast.

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A once hollow open tube could be completely clogged up with cancerous cells leaving an awkward feeling in the chest area. Other complications that result from this cancer and others are the clogging and cramming of the system (American Cancer Society, 1999: 10). Recently genes have been named as a great cause of cancer. It now is thought in the medical community that while there are definite environmental contributors to cancer, even those people who are exposed to few carcinogens may suffer from disease that runs in their families. Among the genes that are being heavily researched is the gene BRCA1 (Case Studies). In one of the preliminary studies of this particular gene, over 250 Jewish women were discovered to have mutations in this germ-line allele, which is a version of the trait that is passed to the offspring through the germ line cell (or gamete).

This accounts for approximately 13% of all breast cancer patients observed. Jewish women in specific were used, as early on there was a definite pattern of breast cancer through the Jewish community especially that which lived in the United States. The specific mutation, 185delAG, was, strongly associated with the onset of breast cancer in Jewish women before the age of 30. Scientists advanced upon this new information of genealogical interplay, so the New England Journal of Medicine (NEJM) set out determined to study the overall effects of these genes. In an article printed on January 18, 1996, germ-line alterations in BRCA1 were discovered in six of the 80 women surveyed who had breast cancer but had no apparent familial history of it. Thus the scientists concluded that mutation was not limited to women with a history of cancer. Genes are thought to cause five to twenty percent of all breast cancers.

A gene known as p53 supposedly stalls reproduction of cells, and can even cause a cell to commit suicide. Other genes that seem to accelerate growth to overtake and stick to proteins include HER2, neu, and erB2 (Fitzgerald et al, 1996). The relation between serum estrogen levels at a single time is linked to breast cancer, but no evidence links estrogen levels over an extended time to the risk of breast cancer. This what was thought until researchers at the New England Journal of Medicine proposed a study. Bone mass is a cumulative effect of estrogen on bones scientists say, and so the study focused on the more easily observed density and mass of bone tissue in women. Four levels were studied, and the research was tallied. The risk for getting cancer in the lowest stage of bone mass was about 2%, and then 2.6, 2.7, and 7.0 in the second, third, and fourth levels of higher mass respectively.

This research lent itself to the assumption that cumulative exposure to estrogen might play a part in breast cancer (Fitzgerald et al, 1996). Other hormonal factors have been viewed as potential breast-cancer-causing agents. Birth control pills are thought by some to lead to breast cancer. Early birth control pills used much more estrogen and progesterone than do today’s pills. Lots of contradictory results were found in research on the pill because women who had been taking it for ten or twenty years had actually been taking several different types with possibly different levels of cancer causing hormones. But, in general, the report concluded that the pill doubled to up to quadrupled a woman’s chance of having breast cancer (Fitzgerald et al, 1996). Diethylstilbestrol (DES) was used to increase fertility from 1940 through 1960 and also decrease the chances of having a miscarriage.

Studies showed it to increase the rate of breast cancer by 1.4. Exposure to estrogen during periods of rapid growth in the breast tissue during pregnancy may increase risk. In August of 1989, Swedish doctor Leif Bergkvist studied 23244 women ages 35 and up and found that an estrogen supplement that they were taking quadrupled chances for breast cancer (Fitzgerald et al, 1996). Breast cancer accounts for the highest number of new cases in women each year, and the war cry for breast cancer is, 1 in 8! because according to some statistics a woman’s chance to develop breast cancer in her lifetime is one out of eight or 12.5%. In the Journal of the National Cancer Institute in May of 1995 that women overestimated their chances for dying from breast cancer by twenty times. While that journal reported in 1995 that the chances of getting breast cancer were only 1 in 17 before the age of 65, but it also said that the number of breast cancer cases has increased 30% in the past twenty-five years.

Although breast cancer is the most common cancer in American women, over 80% of cancer occurs in postmenopausal women. While epidemiologists know that breast cancer is often the associated with age and genes, now speculation is arising that the earlier a woman has her first menstrual period the more at risk she is. The Institute’s environmental studies division says that a large part of the problem is that one half of women have environmental risk factors. The disease is also often perceived as a white woman’s disease. Such white culture icons as Nancy Reagan, Shirley Temple Black, Linda Ellerbee, Ann Jillian and Betty Ford have had breast cancer. However, cancer statistics show that the disease is especially prevalent in uneducated blacks who don’t bother with or don’t know about regular breast exams. Japanese women have 17% mortality rate when compared to American women. But, when Japanese women move to the United States, their breast cancer rates gradually move up as their bodies respond to the new environment.

Even so, the myth of it being a white-only disease still lives on (Perceptions of Breast Cancer Risk and Screening Effectiveness in Women Younger Than 50 Years of Age). A number of doctors simply take the common sense approach to preventing breast cancer, which is exercising and getting your proper nutrients. Dr. Leslie Bernstein, a professor of preventative medicine at the University of Southern California, proposes one leading hypothesis on how exercise fights cancer. Dr. Bernstein says that exercising reduces a woman’s exposure to estrogen, reducing that possible oncogen (Exercise Reduces Breast Cancer). Several miracle foods have been tried and marketed as cancer fighting agents. One such food is the green tea leaf.

Dr. Rajendra G. Mehta at the University of Illinois made a synthetic form of vitamin D-5 that killed cancer cells in a lab culture (Newly Synthesized Compound Can Inhibit Development of Precancerous Cells). People who regularly consume hard liquor, beer or wine experience 1.3 times the relative risk of breast cancer. Those who have more than nine drinks a week have an increase of two and a half times the rate of breast cancer for a non-drinking person. In 1987, the National Cancer Institute published a report comparing 1524 women with breast cancer against a control group of 1896 without the disease. Again, alcohol appeared to promote breast cancer (Risk Factors for Breast Cancer). Several medical procedures or side effects of them have been thought to promote breast cancer. It was hypothesized that self-induced abortions could greatly increase the chances of getting cancer, as during pregnancy the cells in the breast quickly divide and reproduce.

By having an abortion and thus suddenly halting cell division, a number of cells would become greatly unprotected by there not being any differentiation, and thus would be vulnerable to cancer (Risk Factors for Breast Cancer). Radiation has also been thought of, and for all thorough purposes has been proven to be a cause of breast cancer. There have been three major studies that have been done concerning radiation. The first was performed around the bombings of Hiroshima and Nagasaki. It was quickly ascertained that within a ten mile radius of the bombing there was a definite cancer zone. More importantly, younger people got much more cancer, especially with regards to breast cancer, than did older ones. This forces more weight on the theory that the changing years of the breasts in women are their most vulnerable and possibly cancer causing ones (Risk Factors for Breast Cancer).

Prevention is one point of the attempt to cure breast cancer, but it is extremely important to get breast examinations often to make sure of no lumps or early tumors. The simplest forms of breast exam are a self-exam, one with a doctor, or a mammography. A mammogram is simply an X-ray of the breast. Mammography can pick up small lesions of under one half a centimeter, whereas one can not feel a lump until it is a full centimeter in diameter. But, if breasts are small or dense, a mammogram might not be able to detect a cancerous lump. Another procedure could be a wire localization. A thin wire is used to show where the lesion is after the wire is inserted, and local anesthetic is administered. Thermography is based on the idea that cancer gives off more heat than regular cells. Transillumination is founded in the concept that light shines through breast tissue, but is blocked by lumps. An ultrasound is the use of high frequency sound waves, which are sent off in a radar fashion, and reflect off objects that they hit.

A CAT scan is the process of visually cutting the body into cross-sections (Guidelines for the Early Detection of Breast Cancer, 1999). Another controversy runs deep in the issue of using CAT scans to find cancer tissue. The radiation required to examine a five milliliter lump is often considered simply too high for safety, and has a possibility of just simply spreading the cancer to other body parts. A MRI takes advantage of the electromagnetic qualities of the hydrogen nucleus to produce an electric chart or visual. While the most common form of breast exam is mammography, there are many critics of that procedure. Cancer patients have said that the mammogram is often uncomfortable and takes too much time. Younger women are at increased risk for biologically more aggressive carcinoma, meaning that the future battle for curing cancer is not getting any easier.

Cancer growths are dependant upon the growth of blood vessels to nurture the cancer cells. New drugs are being developed to stop the growth of cancer cells by preventing nourishment of the cancers by new blood vessels. By cutting off the blood supply to the cells, they die, and thus are eliminated from the system (Guidelines for the Early Detection of Breast Cancer, 1999). Chemotherapy involving tamoxifen has proved useful in delaying breast cancer recurrence, but the majority of patients treated with Tamoxifen eventually go into relapse. Traditionally, there are three types of cancer treatments: radiation, mastectomy, and cytotoxic chemotherapy. The type of surgery really has its basis on the size of the tumor. A lumpectomy removes the tumor and surrounding tissues. A simple mastectomy removes the breast, nearby lymph nodes, and portions of the chest and arms (Treatment).

Doctors can also perform preventative mastectomies. Some surgeons feel that if the breast is fairly lumpy, and the patient appears to be at very high risk of breast cancer, the surgery may be beneficial. The whole surgery is highly controversial. Both doctors and patients generally prefer a total bilateral mastectomy and reconstruction. This removal takes out the entire breast including the nipple and duct system so that there can be little chance of relapse (Treatment). There are various treatments aimed at killing the cancerous cells- from surgically removing that area of the body to killing them off by use of chemicals. A very common procedure is chemotherapy. Chemotherapy is an antibiotic designed to kill rapidly dividing cells. Monoclonal antibodies are antibodies that can be engineered to carry drugs or radiation directly to the tumor, and is an efficient way of delivering chemotherapy to the body. Another adaptation that has been added to chemotherapy is the use of genes that are chemo-resistant. One treatment involves stem cell transplantation.

Stem cells are often referred to as master cells, and they seem to carry antibodies that rapidly reproduce which fight malignancies, and may be able to fight cancer. One solution to cancer may be hormone therapy (Treatment). The hormone, usually tamoxifen, slows growth of cancer cells by blocking some growth enhancing properties of estrogen. The controversy over Tamoxifen is that it might cause other types of cancer. In 1989, the National Cancer Institute ran a test in which women took a placebo or Tamoxifen. Women with the drug were less likely to develop cancer of the breast, but they were more likely to develop blood clots, ovarian cancer, or breast cancer (Tamoxifen).

One complication that can result in cancer is Ductal Carcinoma Insitu. The ductal area houses the lobules and ducts and is the area in which milk is produced. Similar to rust clogging up pipes, often extra cells or cancerous cells will clog up the tubes providing for some discomfort and other risks. Studies show that 20-25% of women with untreated DCIS will get invasive cancer within 10 years (American Cancer Society, 1999: 7). As the twentieth century comes to an end, breast cancer continues to be a devastating killer in the new millennium. Breast cancer takes the lives of our mothers, our sisters, our daughters, and our friends. Although progress is being made through research, early detection is all we can do to possibly prevent breast cancer. Women should learn to do a self-examination at a young age, and should continue throughout their lives. If a lump is found a professional should be contacted. If people work together, maybe sometime soon a cure will be found (Breast Cancer, 1991).

Bibliography

Breast Cancer. The World Book Encyclopedia. Volume 2; 601. 1991. Breast Cancer Key Statistics. http://www3.cancer.org/cancerinfo/main_cont.asp?st=wi&ct=5#stats. September 20, 1999. Case Studies. http://www.cancergenetics.org/bc.htm. April 12, 1999. Detection. http://www3.cancer.org/cancerinfo/main_cont.asp?st=ds&ct=5#early. September 20, 1999. Exercise Reduces Breast Cancer. http://www.oncolink.com/cancer_news/1994/exercise_bc.html. August 26, 1999. Fitzgerald et al. The New England Journal of Medicine. Vol. 334, No. 3. January 18, 1996. Guidelines for the Early Detection of Breast Cancer. The American Breast Cancer Guide (1999): 6. Newly Synthesized Compound Can Inhibit Development of Precancerous Cells. http://www.ag.uiuc.edu/ffh/vitamind.htm. Perceptions of Breast Cancer Risk and Screening Effectiveness in Women Younger Than 50 Years of Age. http://cancernet.nci.nih.gov/jnci/issue10/87-720.html. Risk Factors for Breast Cancer. http://www3.cancer.org/cancerinfo/main_cont.asp?st=pr&ct=5#risk. September 20, 1999. Tamoxifen. http://www.infomed.org/100drugs/tamofram.html. 1996. Treatment. http://www3.cancer.org/cancerinfo/main_cont.asp?st=tr&ct=5. September 20, 1999. Types of Breast Cancer,  Breast Cancer Stages. Breast Cancer Treatment Guidelines for Patients, Version II (June 1999): 7, 10.

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