Breast Cancer

What is breast cancer?

Breast cancer is the most frequently diagnosed malignancy globally. It involves the abnormal and uncontrolled growth of cells in the breast that creates a mass of tissue called a tumour. 2.3 million new cases were diagnosed in 2020 among Canadian and American women. Outcomes have generally improved, even in Canada, where the death rate has dropped 49% since 1986. This is largely attributed to new multidisciplinary approaches to care, such as better screening, improved local therapies, and advances in systemic treatment. [1] [2][5] [6]

Fig. 1. Time trend in the gap between age-standardized breast cancer incidence and mortality rates [5]

Risks factors

A risk factor is something that increases the risk of developing cancer. There are numerous risks for breast cancer, including a family history of cancer and dense breasts. However, breast cancer can still develop in women who do not have any of the risk factors. The risk of developing breast cancer increases with age, 83% of breast cancer cases occur in women over 50. [1] [6]

Most breast cancers develop in women at a much higher rate than in men because breast cells are exposed to the female hormones estrogen and progesterone. These hormones, especially estrogen, are linked to breast cancer and encourage the growth of some types of breast cancer. [1][6]

Family history (one or more close blood relatives - mother, sister, daughter -?have or had breast cancer) can also increase your risk of developing breast cancer over your lifetime. However, it is not clear whether a family’s pattern of cancer is due to chance, shared lifestyle factors, genes (BRCA1 or BRCA2 genes mutations), or a combination of these factors. [1] [6]

Personal history of breast cancer may put women at higher risk of developing breast cancer again. The new breast cancer can develop in the same breast as the former one or in the other breast.?Ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) have a higher risk of developing a second breast cancer, but most women who have had these types of cancer do not develop breast cancer again. [1]

Regardless of family history and genetics, there are several risk factors that can be controlled: alcohol consumption, obesity, night shifts, and physical inactivity. It is also essential to avoid long-term hormone therapy (estrogen plus progesterone) and exposure to ionizing radiation (breast and armpit) as much as possible, but not mammography. Modern mammography equipment uses very low doses of radiation, and the benefits far outweigh the risks of radiation exposure.[1] [6]

Other risk factors can be no full-term pregnancy or late full-term pregnancy (after the age of 30), early menarche (beginning of menstruation) and late menopause (after the age of 55). [1]

It is essential to work on things that can help with decreasing these risk factors for cancer:

• be a non-smoker and avoid secondhand smoke;
• be physically active on a regular basis;
• eat a healthy diet and control your weight - 4 food groups are described in Eating Well with Canada's Food Guide;
• avoid or limit your alcohol consumption to 1 to 2 drinks per day;
• avoid exposure to radiation;
• try breastfeeding if it works for you;
• follow cancer screening guidelines. For women, mammograms and Pap tests are suggested;
• Health Canada and Environment Canada have guidelines for handling cancer-causing substances.[1]

Fig. 2. Breast cancer prevention - WHO

Symptoms

Breast cancer usually has no signs or symptoms in its early stages. A breast lump is the most common symptom of breast cancer. If you find a lump, schedule an appointment with your doctor, but don't be too harsh on yourself and panic, because most lumps are not cancerous. Other signs could be: nipples discharge or skin changes. Adherence to screening guidelines is therefore crucial to detecting the disease and improving outcomes for women.[1] [6]

Fig. 3. Breast cancer - symptoms -WHO

Screening

Screening helps identify breast cancer before symptoms appear. The surest way to detect early breast cancer in women is with a mammogram, a low-dose X-ray of the breasts that identify whether cancer is developing in the tissue. Depending on your age, the frequency of mammograms changes. [1][6]

The Canadian Task Force on Preventive Health Care recommends that women between the ages of 50 and 74 be screened with a mammogram every 2 to 3 years. [1]

Fig. 4. Mammography [8]

You can do self-exams at home by checking your breasts for lumps or any changes. Many breast problems are discovered first by women themselves. [6]

Fig. 5. Breast self-examination

Diagnosis

Diagnostic tests are done when symptoms or screening suggest a problem with the breast. [1]

Statistics

The rate of new breast cancer cases in Canadian women increased between 1984 and 1991 and has fluctuated since then, with little overall decline. It is estimated that about 1 in 8 Canadian women will develop breast cancer in their lifetime and 1 in 34 will not survive it. [1]

Fig. 6. Percentage of new breast cancer cases to all other new cancer cases in women, 2022

It is estimated that in 2022:

·?????28,600 Canadian women will be diagnosed with breast cancer - 25% of all new cancer cases;

·?????5,500 Canadian women will die from breast cancer -14% of all cancer deaths in women;

·?????On average, 78 Canadian women will be diagnosed with breast cancer every day;

·?????On average, 15 Canadian women will die from breast cancer every day;

·?????270 Canadian men will be diagnosed with breast cancer and 55 will die from breast cancer.[1]?

Fig. 7. Percentage of breast cancer deaths to all other cancer deaths in women, 2022

Treatments

Treatments for breast cancer include surgery, radiation, chemotherapy, and hormone therapy. After breast cancer surgery, breast reconstruction and breast implants might be options that can help you feel better about yourself and your body based on your preferences. [1]

Supportive care

Supportive care helps people meet breast cancer’s physical, practical, emotional and spiritual challenges. Many programs and services are available to help meet the needs and improve the quality of life of people living with cancer and their loved ones. [1]

Finding out you have cancer can be overwhelming. However, there are things that can be done to better cope with this journey:·

• Talk to your family, friends and to the people involved with your care healthcare team;
• Acknowledge your emotions and don’t be too hard on yourself as you learn how to cope with all of these;
• Accept help from others throughout your journey. Your family and friends may support you, or you may also find it helpful to turn to your healthcare team, other healthcare professionals or other people living with cancer.
• Look after your relationships;
• Additional resources that might help:

?Canadian Partnership Against Cancer

Canadian Cancer Society

Cancer Care Ontario

Canadian Mental Health Association

Fig. 7. Stronger together

Resources:

1.????https://cancer.ca

2.????Gandhi, S., Brackstone, M., Hong, N.J.L.?et al.?A Canadian national guideline on the neoadjuvant treatment of invasive breast cancer, including patient assessment, systemic therapy, and local management principles.?Breast Cancer Res Treat?193, 1–20 (2022). https://doi.org/10.1007/s10549-022-06522-6

3.????Brunet, J., Price, J., & Harris, C.?(2022).?Body image in women diagnosed with breast cancer: A grounded theory study.?Body Image,?41,?417-431.https://doi.org/10.1016/j.bodyim.2022.04.012

4.????Angarita, F. A., Jedrzejko, N., Eisen, D., Muraca, M., Ash, M., & Osman, F.?(2022).?Primary Care Physicians’ Perspectives in Leading Breast Cancer Follow-Up Care.?Clinical Breast Cancer,?22(4),?e497-e505.https://doi.org/10.1016/j.clbc.2021.11.011

5.????Kirkham, A. A., & Jerzak, K. J. (2022). Prevalence of Breast Cancer Survivors Among Canadian Women,?Journal of the National Comprehensive Cancer Network,?20(9), 1005-1011. Retrieved Oct 25, 2022, from?https://jnccn.org/view/journals/jnccn/20/9/article-p1005.xml

6.????https://www.cpp.ca