BREAST CANCER

How are the breasts:

The breasts are glands and their main function is to produce milk. They are composed of lobes that are divided into smaller portions – lobules and ducts – which carry the milk produced outside the nipple. Like all other organs of the human body, breasts are also made of blood vessels that supply blood to the breast, and the lymph vessels, through which circulates the lymph.Lymph is a clear fluid which has a similar function to the blood, that of carrying nutrients to various parts of the body as well as to collect unwanted substances. The lymphatic vessels are grouped into what is called lymph nodes, or lumps. Breast lymphatic vessels drain into lymph nodes in the armpits, the neck area and chest.

Types of breast cancer:
Breast cancer occurs when the cells of this organ begin to divide and reproduce very fast and in a disorderly fashion. Most breast cancers affects the cells of the ducts of the breast. Therefore, the most common breast cancer is called ductal carcinoma. It is either in situ, when it is confined to the first layers of cells, or invasive, when it invades the surrounding tissues. Cancers that begin in the breast lobules are called lobular carcinoma and are less common than the former. This type of cancer most often affects both breasts.Inflammatory breast cancer is an uncommon type and is usually most aggressive, affecting the entire breast and making it red, swollen, and warm.

Risk factors for breast cancer:
Breast cancer, like many cancers, has known risk factors. Some of these factors are modifiable, that is, the exposure of a person to a given factor can be changed, decreasing her chance of developing this cancer.

There are also protective factors. These are factors that if the person is exposed, her chance of developing this cancer is lower.
The known risk and protective factors of breast cancer are:

Age:

Breast cancer is more common in women over 50 years old. The older the person gets the greater her chance of having this cancer. Mulheres com menos de 20 anos raramente têm este tipo de câncer. Women under 20 rarely have this type of cancer.

Excessive exposure to hormones:

Hormone replacement therapy (hormones used in treating menopause symptoms), containing the female hormones estrogen and progesterone, increase the risk of breast cancer. Not taking or stop taking these hormones is a decision that the woman should take together with her doctor, weighing the risks and benefits of this medication.

Oral contraceptive (pill) taken for many years may also increase this risk.
Surgically removing the ovaries reduces the risk of developing breast cancer because it decreases the production of estrogen (surgical menopause).
Some medications "block" the action of estrogen and are used in some women who have a much increased risk of developing this type of cancer. Using these medications (such as Tamoxifen) is a decision taken with the physician, evaluating the risks and benefits of these medications.

Radiation:

It is part of the treatment of some diseases to irradiate the chest region. Many benign diseases were formely treated with irradiation. Today, this procedure is virtually restricted to the treatment of tumors. people who needed to irradiate the area of the chest or breast have a higher risk of developing breast cancer.

Diet:

Excessive alcohol consumption is associated with a slight increase in breast cancer. The association with drinking alcohol is proportional to the intake, that is, the more you drink the greater the risk for this cancer. Taking less than one drink of alcohol a day helps prevent this type of cancer (one glass of wine, a small bottle of beer or a shot of whiskey are examples of a dosis of alcohol). Therefore, when drinking people are advised to take less than one dosis per day.

Obese women are more likely to develop breast cancer, especially when this weight gain occurs after menopause or after 60 years old. Keeping the ideal weight, especially after menopause reduces the risk of this cancer.

Taking a healthy diet, rich in plant-based foods, including fruits and vegetables and low in animal fat may reduce the risk of having this type of cancer. Although the studies are not conclusive about this protective factor, adopting a healthy lifestyle, which includes this kind of food, reduces the risk of many cancers, including breast cancer.

Exercise:

Exercise usually lowers the amount of circulating female hormones. As this type of tumor is associated with this hormone, getting regular exercise decreases the risk of having breast cancer, especially in women who are or have been exercising regularly when young.

Gynecological History:

Not having children or getting pregnant for the first time after 35 years old is a risk factor for breast cancer.

Early-onset menstruation (11 or younger) or stop menstruating too late exposes women much longer to female hormones and therefore to increased cance risk.

Breast-feeding, especially for a long time, a year or more, plus all periods of breast feeding may decrease the risk of breast cancer.

Family history:

	Women who have first degree relatives – mothers, sisters or daughters- with breast cancer, especially if they have this cancer before the menopause, are part of the risk group for developing this cancer.
	Although rarer, men can also get breast cancer, and having a first-degree relative, as a father, with this diagnosis also increases the risk for familial breast cancer.
	People in this risk group should consult with their doctor to determine the need to have blood tests to identify genes that may be present in these families.If a higher genetic risk is detected, the doctor may suggest some measures to reduce these risks. Some measures may prove quite radical, or have significant side effects.
	Removing the breasts and taking Tamoxifen are examples of these measures. The indication for these procedures and discussion of the pros and cons is individual and should be taken with a very experienced doctor in these cases.

Breasts Changes:

Having had a previous breast cancer is a major risk factor for this type of cancer. Keeping the ideal weight, working out, properly following the recommendations of your doctor and taking regular tests are important measures to decrease the risk of tumor return or have a second breast tumor.

Undergoing biopsies even for benign conditions is associated with an increased risk of breast cancer.

Dense breasts on mammogram is associated with an increased risk for this tumor. It is very important that the mammogram is done at a qualified service and that the examination should be compared with previous tests.

Breast Cancer Symptoms

Breast cancer usually does not hurt. The woman may feel a lump not previously felt.That should make her see her doctor. The doctor will feel her breasts, armpits , neck and collarbone areas, and if he feels a lump in the breast he will order for a mammogram.

The woman may also notice a deformity in her breasts, or breasts may be uneven.She can still notice a retracting of the skin or a bloody fluid coming out the nipple. In most advanced cases there may appear a "wound" (ulceration) in the skin with very unpleasant odor.
In the case of inflammatory carcinoma, the breasts can rapidly increase in volume, and get warm and red.

Na maioria dos casos, a mulher é a responsável pela primeira suspeita de um câncer. In most cases, the woman is responsible for suspecting cancer in the first place. It is critical that she knows her breasts, so as to know when something unusual is happening. Breasts undergo change throughout the menstrual cycle as well as throughout life. However, if finding acute changes and symptoms such as the ones listed above, women should promptly seek their doctor's advice. Only he can tell if these changes may or may not be cancer.

How to make the diagnosis of breast cancer:

Mammogram is an x-ray of the breasts. It can also detect breast cancer in the earliest stages, as the woman is screened without showing any symptoms. If the breast is very dense, the doctor will also order an ultrasound examination of the breasts.
If the mammogram shows a suspicious lesion, the physician indicates that a biopsy should be done either with a thin or thick needle. Generally, this biopsy is done with the help of an ultrasound examination to precisely locate the nodule, from which the material should be collected, if the lump cannot not be easily palpable. After collection, the material is examined by a pathologist (an anatomical-pathology examination) that will determine whether or not the lesion is a cancer.

Treatment for breast cancer:

There are several types of treatment for breast cancer. Several factors define what is most appropriate in each case. Before taking a decision on what type of treatment is most appropriate, the physician will analyzes the results of the anatomical-pathology examination of the biopsy or surgery, if this has already been made. Moreover, the doctor ordes laboratory tests and imaging to define which is the extent of the tumor, and if it has spread from the breast to another body parts.

If the tumor is small, the first procedure is a surgery to have the tumor removed.Depending on the size of the breast, tumor location and possible aesthetic results of the surgery, the surgeon removes either only the lump, or a part of the breast (usually one fourth of the breast), or removes the breast completely (mastectomy) and axillary lymph nodes.

The characteristics of the tumor removed and the extent of the surgery will determine whether or not a woman will need additional treatment .Generally, if the entire breast is not removed, it is referred for radiotherapy.

Depending on the cancer staging, or how much the disease has spread (size, amount of axillary lymph nodes affected, as well as the involvement of other body areas), either chemotherapy or hormone therapy will also be indicated. Radiotherapy is the treatment which is done by applying beams to eliminate any cells that may possibily be left on the site of the surgery, which because due to its small size has not been found neither by the surgeon nor the pathologist. This treatment is done by means of a machine and the duration and intensity depends on the characteristics of the tumor and the patient herself.

Chemotherapy is the use of drugs, usually intravenous, which kill circulating malignant cells.The type of chemotherapy used depends on whether the woman has already reached menopause and the extent of her disease. Hormone therapy is the use of drugs that block the action of hormones which increase the risk of developing this type of cancer. This treatment is given to those patients whom the tumor has shown to have these positive receptors (estrogen receptor and progesterone receptor).

Early detection of breast cancer:

The screening conducted by the physician and mammogram are the exams for the early detection of cancer.

How does the physician make this test?

Breast palpation is the easiest examination to be performed in order to detect any changes in the breasts. In this examination the doctor feels the entire breast, axillary region and upper trunk in search of any lump or change in the skin, such as skin retraction or hardening, or any changes in the nipple.

A mammogram is an x-ray of the breasts and underarm portions closest to the breast. In this examination, the radiologist looks for images that suggest changes in breast tissue and armpit lymph nodes. An ultrasound examination of the breasts can help radiologists to define what kind of changes are these.

These tests, when performed annually or, more frequently, depending on the patient's history (presence of risk factors or history of previous biopsies and tumors) can reduce mortality for this type of tumor, when performed between ages 50 and 69.

However, this type of tumor has different characteristics for different populations. This changes the extent of how a mammogram is effective in reducing mortality for this type of tumor.

Performing these examinations between 40 and 49 years old can reduce mortality for this type of tumor, but the effect of this reduction will only occur when these women will be over 50 years.