BAB I

PRELIMINARY

1.1. Background

Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a
group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant
areas of the body. The disease occurs almost entirely in women, but men can get it, too. (American cancer
society, 2014)

According to American cancer society (2014), Breast cancer can be classified into Ductal
carcinoma in situ (DCIS; also known as intraductal carcinoma), Invasive (or infiltrating) ductal carcinoma
(IDC), Invasive lobular carcinoma (ILC),and inflammatory breast cancer (IBC).

Breast cancer typically produces no symptoms when the tumor is small and most treatable.
Therefore, it is important for women to follow recommended screening guidelines to detect breast cancer
at an early stage. Larger tumors may become evident as a breast lump, which is often painless. Less
common symptoms include persistent changes to the breast, such as thickening, swelling, distortion,
tenderness, skin irritation, redness, scaliness, or nipple abnormalities, such as ulceration, retraction, or
spontaneous discharge. Breast pain is more likely to be caused by benign conditions and is not a common
early symptom of breast cancer. . (American cancer society, 2014)

Among American women, breast cancer is the most commonly diagnosed cancer, and is second
only to lung cancer as a cause of cancer deaths in women. (Kushi,2012)

The American Cancer Society provides an overview of female breast cancer statistics in the
United States, including data on incidence, mortality, survival, and screening. Approximately 232,340
new cases of invasive breast cancer and 39,620 breast cancer deaths are expected to occur among US
women in 2013. One in 8 women in the United States will develop breast cancer in her lifetime. Breast
cancer incidence rates increased slightly among African American women; decreased among Hispanic
women; and were stable among whites, Asian Americans/Pacific Islanders, and American Indians/ Alaska
Natives from 2006 to 2010. Historically, white women have had the highest breast cancer incidence rates
among women aged 40 years and older; however, incidence rates are converging among white and
African American women, particularly among women aged 50 years to 59 years. Incidence rates
increased for estrogen receptor-positive breast cancers in the youngest white women, Hispanic women
aged 60 years to 69 years, and all but the oldest African American women. In contrast, estrogen receptor-
negative breast cancers declined among most age and racial/ethnic groups. These divergent trends may
reflect etiologic heterogeneity and the differing effects of some factors, such as obesity and parity, on risk
by tumor subtype. Since 1990, breast cancer death rates have dropped by 34% and this decrease was
evident in all racial/ethnic groups except American Indians/Alaska Natives. Nevertheless, survival
disparities persist by race/ethnicity, with African American women having the poorest breast cancer
survival of any racial/ethnic group. Continued progress in the control of breast cancer will require
sustained and increased efforts to provide high-quality screening, diagnosis, and treatment to all segments
of the population. (DeSantis,2013)

The risk of breast cancer is increased by several reproductive and other factors that are not easily
modified: menarche before age 12 years, nulliparity or first birth at age older than 30 years, late age at
menopause, and a family history of breast cancer. Risk factors may differ for breast cancer that is
diagnosed before or after menopause. These factors also differ for hormone receptor-positive and
hormone receptor-negative breast cancers. An area of growing interest is whether early life exposures,
including in utero and during adolescence, may have an important effect on breast cancer risk later in life.
That breast cancer risk is increased with taller adult height points to earlylife nutritional factors in breast
cancer. There is consistent evidence that increased body weight and weight gain during adulthood are
associated with an increased risk of breast cancer among postmenopausal (but not premenopausal)
women. This increased risk may be due in part to the higher levels of estrogens produced by excess
adipose tissue after menopause. The adverse effect of weight gain is not seen as readily among women
taking postmenopausal hormone therapy, since it may be masked by higher levels of exogenous
estrogens. (Kushi,2012)

Among dietary factors, alcohol intake is widely recognized as one of the behaviors most
consistently associated with increased breast cancer risk. Since associations were initially reported in the
early 1980s, numerous studies have examined this link. Analyses that combine the results of many of
these studies clearly demonstrate an increased risk with increasing intake, with a modest increased risk
suggested at even low levels of alcohol intake. While the precise mechanisms by which alcohol exerts its
carcinogenic effect on breast tissue are not well established, they may involve effects on sex hormone
metabolism.While early interest in the effects of physical activity on breast cancer resulted from the
associations of activity with weight and hormone metabolism, the effects of physical activity as an
independent risk factor in its own right became an area of active research interest within the past 2
decades. Numerous studies have shown consistently that moderate to vigorous physical activity is
associated with a decreased breast cancer risk among both premenopausal and postmenopausal women,
with this risk decreased by approximately 25% among women who are more active versus those who are
less active. (Kushi,2012)

A dietary pattern that is rich in vegetables, fruits, poultry, fish, and low-fat dairy products has
been associated with a reduced risk of breast cancer in observational studies. While studies of fruits,
vegetables, and breast cancer overall have shown little reduction in the risk of all breast cancers, some
recent studies suggest a lower risk of estrogen receptor-negative tumors, which are harder to treat. A
recent study found that higher levels of certain carotenoids in the blood may lower the risk of breast
cancer, supporting a recommendation to consume deeply colored plant foods for breast cancer prevention.
The best nutrition- and physical activity-related advice to reduce the risk of breast cancer is to engage in
regular, intentional physical activity; to minimize lifetime weight gain through the combination of caloric
restriction (in part by consuming a diet rich in vegetables and fruits) and regular physical activity; and to
avoid or limit intake of alcoholic beverages. (Kushi,2012)

Treatment of primary breast cancer are surgery, radiotherapy, adjuvant systemic therapy, adjuvant
endocrine therapy, neoadjuvant systemic therapy and neoadjuvant endocrine therapy. (SIGN,2013)

1.2. Problem

1. What is breast cancer?

2. What are the classification of breast cancer based on type of group breast cancer?

3. How is the management of breast cancer based on classification ?

1.3. The purpose of writing

1. knowing the definition of breast cancer.

2. knowing the classification of breast cancer based on type of the group of breast cancer.

3. knowing the management of breast cancer which need to be treated when the breast cancer
cases happen in citizen.

1.4. Benefits of Writing

1. Benefits for the institution or program

 Results of this study is used as a recommendation for the women on the classification of breast
tumors management.

2. Benefits for researchers

a. Knowing what are the classification of breast tumors based.
b. Management knows what to do when encountering cases of breast tumors in society.

 Kushi, Lawrence H. ScD,2012,” American Cancer Society Guidelines on Nutrition and Physical
Activity for Cancer Prevention : Reducing the Risk of Cancer With Healthy Food Choices and
Physical Activity”. CA CANCER J CLIN 2012;62:30–67,
http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/pdf, 14 Desember 2015.
 DeSantis, Carol. MPH,2013,” Breast Cancer Statistics, 2013”. CA CANCER J CLIN 2014;64:52–62,
http://onlinelibrary.wiley.com/doi/10.3322/caac.21203/pdf, 14 Desember 2015.
 Scottish Intercollegiate Guidelines Network (SIGN), “Treatment of primary breast cancer”.
Edinburgh: SIGN; 2013. (SIGN publication no. 134). [September 2013]. Available from URL:
http://www.sign.ac.uk, 14 Desember 2015.
 American Cancer Society,2014,” Cancer Facts & Figures 2014 “.
http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf,
14 Desember 2015.