Running Head: Breast Cancer

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Breast Cancer Ashley Ignacio HSCI 451 Dr. Leila Khatib Spring Quarter 2013

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First and foremost, cancer consists of different diseases that have cells in the body that change and grow rapidly out of control. Most cancers form lumps or tumors in certain parts of the body. With breast cancer, the lumps originate within the breast. The lump is commonly found in the inner lining of ducts that connect to the nipple called ductal carcinoma or the glands of mild production (lobules), which is called lobular carcinoma (A.D.A.M. Medical Encyclopedia, 2012). These two types are the main types of breast cancer. Breast cancer can also be invasive or noninvasive. Invasive breast cancer means that the tumor has moved from the milk duct or lobules to different tissues of the breast. Noninvasive breast cancer means that the tumor has not gone to the other parts of breast tissue. Breast cancer could be caused by sensitivity to the estrogen hormone, which an increase of sensitivity can cause the tumor in the breast to grow and spread. It is said that a lump on your breast that appears to be a size of a pea with uneven edges is likely to be cancerous. It could also be hard and painless, but if it hurts and is moveable, it is most likely a cyst, which is most commonly found around the breasts. Breast cancer may not show symptoms in early stages when the tumor is small. In fact, if it is caught early, it can be treatable. However, there are some signs that someone could have breast cancer. If an individual experiences pain in the breasts and heaviness, changes in the breast, such as swelling, thickening, or redness of the breasts skin; and nipple deformities such as random discharge, erosion, inversion, or tenderness (American Cancer Society, 2011-2012). If one notices these symptoms, one should consult a doctor as soon as possible.

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Some agents that increase chances of breast cancer are carcinogens, such as active and passive smoking, lack of physical activity, excess weight and weight gain, socioeconomic status or level of education, diet and nutrition, family history, use of birth control, and alcohol consumption. Although most of these risk factors are controversial, there is no reason to ignore them. There may not numbers in studies supporting these risk factors, however, these agents have been proven by many studies to increase the probability of breast cancer. Active and passive cigarette smoking in women have been studied for more than 30 years and although there are no definite signs of evidence that specifically causes breast cancer, it still contributes to it. A lack of physical activity has had definite evidence of an increase in breast cancer risk. According to the Womens Health Initiative (WHI) observational study, women who brisk walked for 10 or more hours per week had a reduced chance of breast cancer, especially in postmenopausal women (Tirona, M.T., 2010). Other studies have shown a link between obesity and breast cancer risk especially in women who are overweight after menopause. There have been epidemiological studies showing that there is an increase in breast cancer in women with a higher socioeconomic status or higher level of education. These studies may be surprising to many women who expect it to be seen in women with low economic status and a lack of education. Women who have a poor diet and poor nutrition could also have a higher risk of breast cancer. When one consumes fat, there is a higher incidence rate of disease. A low-fat diet and increasing consumption of fruits and vegetables could help reduce the risk but also may not prevent breast cancer from appearing.

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Approximately 20-30% of women with breast cancer have a family history of the disease. They are most likely to get the gene especially those with a first-degree relative such as a mother, sister, or daughter. There is an increase risk for them to develop breast cancer. Women that have more than one relative that have or has had breast, ovarian, uterine, or colon cancer should get a screening since the risk is much higher within their family especially if the cancer occurred before menopause (Tirona, M.T., 2010). The most common gene deficiencies are found in the BRCA1 and BRCA2 genes. The BRCA gene mutations are responsible for about 5 percent of breast cancers (U.S. Preventive Services Task Force, 2005). There is a high prevalence of these mutations in women who inherit the gene mutations. If the mother passes a deficient gene to their children, they are likely to have an increased risk of breast cancer. If women have one of these deficiencies then they have an 80 percent chance of developing breast cancer within their lifetime. Data from more than 50 studies found that women who were taking birth control pills had a 10 to 30 percent higher risk of breast cancer than those who did not take the pill. Other birth control methods such as Depo Provera and the patch contain hormones to stop pregnancy from occurring. Although there is no direct link to the use of these products and the risk of breast cancer, it is said that there is a possible increase in risk that was found in a study with current, longer-term users compared to those that never used those methods (Susan G. Komen, 2013). Many studies have shown that an increase in alcohol consumption increases breast cancer risk. In the National Institutes of HealthAARP Diet and Health Study between 1995-2003, alcohol was highly

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associated with breast cancer. Even women who consumed a moderate amount of alcohol have an increase chance (Tirona, M.T., 2010). Breast cancer is one of the most common cancers in women and men, but it is seen more in women than men. It is the second leading cause of cancer deaths in women in North America. In, 2008, there were 182,460 new cases of invasive breast cancer and about 40,480 deaths from it in the United States. Breast cancer incidence and death rates increase the older a woman gets. The incidence of breast cancer doubles about every 10 years for women until they reach menopause (McPherson, K., 2000). There is a rising incidence in women between the ages 45 to 75 (Tirona, M.T., 2010). People would probably suspect that women with a lower socioeconomic status would have a higher risk of breast cancer because of their lack of education. However, according to a cohort screening trial, cases of women that had education beyond high school exceeded those who either completed high school or dropped out. According to the Prostate, Lung, Colorectal, Ovarian (PLCO) Cancer Screening Trial Cohort Study, 37,215 women out of 70,575 women they studied who had education beyond high school, were more likely to get breast cancer (Lacey Jr., J. V., 2009). Women with a higher socioeconomic status (SES) are known to drink more alcohol, use more birth control pills, use menopausal hormone therapy, have fewer children, and have their first child at a later age. These are risk factors that can increase break cancer for those who have a higher SES (Susan G. Komen, 2013). Although breast cancer occurs worldwide, the focus will be strictly on the United States due to it having the highest cases of breast cancer.

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According to cancer.org, by state, the geographic differences in breast cancer incidence and death rates are defined per 100,000 women from non-Hispanic white, African American, and Hispanic women. Non-Hispanic white women have the highest incidence rates in Arkansas with 110.8 cases per 100,000 women, 140.4 cases per 100,000 women in California and the District Columbia. African American women have high incidence rates in New Mexico with 73.2 cases per 100,000 women and 131 cases per 100,000 women in Delaware. Lastly, Hispanic women have high incidence rates in Mississippi with 34.1 cases per 100,000 women and 133.3 cases per 100,000 women in Delaware (American Cancer Society, 2011-2012). The incidence rates are based on the women who get screened for breast cancer.

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The graph above shows the incidence rates per 100,000 women in 20042008 and the mortality rates per 100,000 women in 2003-2007 by race and ethnicity of female breast cancer in the United States. According to the graph, all of the incidence rates shown exceed the mortality rates given. The graph also shows that Non-Hispanic white women and African American women have the highest incidence rates in the United States with Non-Hispanic white women having the highest incidence rates. With mortality rates, Non-Hispanic white women and African American women have the highest. However, African American women have a higher mortality rate than Non-Hispanic white women. Hispanic/Latina women and American Indian/Alaska Native women are closely tied in incidence rates and mortality rates while Asian American/Pacific Islander women have the lowest incidence rates and mortality rates out of the U.S. population (American Cancer Society, 2011-2012). All women in the United States would be the target population for a breast cancer screening. Screenings should also be done at a national level since all women could have breast cancer. Breast cancer could be detected early when the individual decides to get a mammogram, a clinical breast examination (CBE), or a magnetic resonance imaging (MRI) done. A mammogram is a low energy xray procedure that is used to examine the internal structure of the human breast. It is recommended by the American Cancer Society that women get an annual mammogram done starting at the age of 40. It is better for women to receive a regular mammogram in order to detect breast cancer before the symptoms develop. There have been many randomized trials and population-based

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screening evaluations that have shown that the use of a mammogram reduces the risk of dying from breast cancer (American Cancer Society, 2011-2012). Women in their 20s or 30s should also get a CBE done every three years as part of a regular health examination and women 40 years of age and older should get an annual CBE done after they get a mammogram done since there could be a small possibility that mammograms miss the cancer. A health examiner gently feels for any lumps and gives special attention to where those lumps are located in the breasts. He/she will also examine the area under both arms to see if there are any lumps. It is also important that women give themselves monthly selfbreast examinations to know the shape and feel of their breasts so they know if any changes occur. An MRI could also be used to capture detailed images of breast tissue by injecting a contrast material into a small vein in the arm during the examination (American Cancer Society, 2011-2012). Women with a high risk of breast cancer should get an MRI done with their annual mammogram. Women who have breast cancer could get treated for it through surgery, which often comes with other treatments such as radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy. Breast cancer surgery removes the cancer from the breast and is evaluated to see the stage of the disease. There are different types of surgeries such as a lumpectomy, which removes only the cancerous tissue plus some normal tissue around it, and a mastectomy, which is the removal of the entire breast. Women who get a mastectomy done could have reconstruction done on their breast with salinefilled or silicone-filled implants or tissue from other parts of their body (American

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Cancer Society, 2011-2012). After breast surgery, women could get therapy done. A common one is radiation therapy, which destroys the remaining cancer cells in the breast, chest wall, or underarm area. Chemotherapy drugs attack cells that grow rapidly, including cancer cells. Targeted therapy attacks certain cancer cells and hormone therapy blocks the bodys natural hormones, which can stimulate cancer cells to grow. Going through breast cancer screenings and/or treatments could help lower mortality rates of breast cancer in women in the United States. It is important for women to consider undergoing these procedures in order to sustain a healthy and better life.

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A.D.A.M. Medical Encyclopedia. 2012. PubMed Health. Date Accessed: May 21, 2013. American Cancer Society. 2011-2012. Breast Cancer Facts & Figures 20112012. Date Accessed: May 21, 2013. Lacey Jr., J. V., Kreimer, A. R., Buys, S. S., Marcus, P. M., Shih-Chen, C., Leitzmann, M. F., and Hartge, P. (2009). Breast cancer epidemiology according to recognized breast cancer risk factors in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial Cohort. BMC Cancer, 91-8. doi:10.1186/1471-2407-9-84 McPherson, K., Steel, C. M., and Dixon, J.M. 2000. Breast cancer epidemiology, risk factors, and genetics. BMJ 321(7261): 624-628. Susan G. Komen. 2013. Susan G. Komen. Date Accessed: May 22, 2013. Tirona, M.T, Sehgal, R., and Ballester, O. 2010. Prevention of breast cancer (part 1): epidemiology, risk factors, and risk assessment tools. Cancer Investigation, 28: 743-750. U.S. Preventive Services Task Force. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: recommendation statement. Ann Intern Med. 2005;143:355 361.