Breast Cancer Essay

Introduction

Over the years, the incidence of malignancies has been growing gradually worldwide. In May 2013, one of the most prominent figures internationally, Angelina Jolie, introduced to the world that she had undergone a double mastectomy. This was owing to the excessive risk of developing breast most cancers which she had, as a result of genetic BRCA gene mutations. In this paper, I shall seek to outline breast cancer, its types, various risk elements predisposing to it, its presentations as well as management.

Types of Breast Carcinoma

Carcinoma of the breast is a malignancy involving the human breast. It is the most common malignancy in women, contributing to as much as 18% of all female malignancies. There are two types of breast carcinoma; familial and sporadic. Familial breast cancer is also known as genetic or hereditary breast cancer. This is so, as it is caused by mutations in BRCA-1 (17q21) and BRCA-2 (13q12.3) genes, which occur in around 0.1% of the population (Antoniou et al. 500). BRCA-1 and BRCA-2 genes are actively involved in tumor suppression, transcription regulation, as well as gene repair (Antoniou et al. 500). Sporadic breast cancer, on the other hand, is non-genetic, caused by intrinsic and extrinsic hormonal exposure. Various classes of breast cancer exist. These are in situ, invasive and metastatic carcinoma of the breast.

Risk Factors for Breast Carcinoma

Various factors predispose one to developing breast carcinoma. Age of the patient, age at menarche, menopause and first term pregnancy all play a role in determination of ones risk to developing breast carcinoma (Sayed et al. 308). Women past 50 years have a 77% risk of developing carcinoma of the breast. Women with history of early menarche, as well as those with late menopause have a high risk of developing breast carcinoma too. Those with early menarche start experiencing estrogen at an early age, whereas prolonged nulliparity exposes one to excessive estrogen exposure, as gestation interrupts estrogen exposure, by elevating progesterone levels (Sayed et al. 308). Late menopause, on the other hand, delays stoppage of estrogen exposure, as estrogen production declines at menopause.

Other Factors Affecting Breast Cancer Incidence

Race is another important factor determining development of breast cancer, as African Americans have a lower incidence (DeSantis et al. 35). Having a first degree relative with breast carcinoma also exposes one to 87% risk (DeSantis et al. 270). Biological factors such as obesity and co-morbidity such as with endometrial carcinoma, also contribute to the development of breast cancer. Diet also plays a key factor, as alcohol and fat are risk factors. Tobacco smoking and radiation exposure may also predispose one to developing breast cancer (Sayed et al. 308). Breastfeeding, on the other hand, has been shown to confer protection against breast cancer.

Clinical Presentations of Breast Carcinoma

Breast carcinoma has many clinical presentations. The classical first identifiable pathology in most cases is a firm, painless mass in the breast (Sayed et al. 309). Skin retraction over the breast occurs in most patients. Lymphatic blockage by malignant cells leads to edema in the breast, giving rise to the classical 'peau d'orange' (Sayed et al. 309). This is the pitted orange peel appearance of the breast that occurs as a result of bulging out of surfaces of the breast where the suspensory ligaments of Cooper are not attached to. Inflammation of the breast tissue also occurs, with nipple inversion, discharge and crusting also occurring. Chronic inflammation occurs, leading to fixation of the painless mass to its adnexia. The end result is a hard breast surface that is woody hard, classically referred to as 'cancer en cuirasse' (Sayed et al. 309).

Diagnosis of Breast Cancer

Diagnosis of breast cancer begins at physical examination (Sayed et al. 309). A breast exam is done, checking for lumps in the breast, asymmetry, lymphatic obstruction as well as tenderness. Other non-invasive methods by which breast cancer is diagnosed include imaging techniques such as mammograms, breast ultrasound, as well as magnetic resonance imaging of the breast (Senkus et al. 18). However, young women below 25 years are not suitable candidates for mammography as their breasts contain high connective tissue content. This could be picked up by the mammogram and confused for malignancy. Cytology of the breast tissue is the definitive modality of diagnosis of breast carcinoma (Senkus et al. 18). Breast tissue is obtained from the region containing pathology, through fine needle aspiration. The specimen is then visualized and pathologic features observed microscopically (Senkus et al. 18). Malignant cells are generally pleomorphic, with prominent nucleoli and enlarged nuclei. Irregular nuclear membranes as well as dark, irregular chromatin, are also observed.

Staging and Grading of Breast Cancer

The staging and grading of breast cancer is done via the TNM and Nottingham systems, respectively. TNM is an acronym for Tumor, involvement of regional lymph Nodes and Metastasis to distant sites. It was developed by the American Joint Committee on Cancer, to describe the extent of spread of breast carcinoma. Nottingham system, on the other hand, is a three modality system incorporating tubule formation, mitotic count and nuclear pleomorphism. It is qualitative, as it checks for differentiation of the affected cells, whereas the TNM system is quantitative, checking the degree of spread. Each parameter in the Nottingham system carries one to three scores, hence the lowest score for the grade would be 3, with the highest being 9. The grade and stage of the cancer are useful in prognostic determination.

Management of Breast Cancer

Management of breast cancer falls into four categories. Preventive management includes avoidance of risk factors, for instance, early parity. Supportive management of breast cancer includes administration of analgesics, as well as psychological counselling of the patients. Mastectomy is the definitive treatment for breast carcinoma, involving removal of the entire breast along with adnexal lymph nodes (DeSantis et al. 37). Medical definitive treatment involves administration of tamoxifen, an estrogen agonist antagonist. Tamoxifen should be administered with caution, as it has an estrogen agonist effect in the endometrium, hence may cause endometrial carcinoma (Senkus et al. 22). Finally, breast reconstruction is the rehabilitative management.

Conclusion

In conclusion, breast carcinoma can be treated in its entirety if detected early. Regular checkups as well as self-breast examination should be encouraged in all post-pubertal females.

Works Cited

Antoniou, Antonis C., et al. "Breast-cancer risk in families with mutations in PALB2." New England Journal of Medicine 371.6 (2014): 497-506. Print.

DeSantis, Carol E., et al. "Breast cancer statistics, 2015: Convergence of incidence rates between black and white women." CA: a cancer journal for clinicians 66.1 (2016): 31-42. Print.

DeSantis, Carol E., et al. "Cancer treatment and survivorship statistics, 2014." CA: a cancer journal for clinicians 64.4 (2014): 252-271. Print.

Sayed, Shahin, et al. "Breast cancer diagnosis in a resource poor environment through a collaborative multidisciplinary approach: the Kenyan experience." Journal of clinical pathology 66.4 (2013): 307-311. Print.

Senkus, E., et al. "Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up." Annals of oncology 26.suppl_5 (2015): v8-v30. Print.