02-01-2013, 11:21 AM
Introduction to Breast Cancer and Mammography
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WHAT IS BREAST CANCER
Breast cancer is a “malignant neoplasm of the breast.” A cancer cell has characteristics that
differentiates it from normal tissue cells with respect to: the cell outline, shape, structure of nucleus
and most importantly, its ability to metastasize and infiltrate. When this happens in the breast, it is
commonly termed as ‘Breast Cancer’. Cancer is confirmed after a biopsy (surgically extracting a
tissue sample) and pathological evaluation.
Demographics
Breast Cancer is second to Lung Cancer in the fatality rate due to cancer among women today. In
the developed countries, one out of every nine women gets breast cancer during her lifetime.
Incidence Rate
Country (I) United States 94.2 Switzerland 73.5 Netherlands 72.7 Canada 71.1 Denmark 68.6
France 66.3 Italy 65.4 Sweden 62.5 Australia 61.7 Great Britain 56.1 Norway 54.8 Germany 46.3
Slovak 34.5 India 24.6 Japan 21.9
Risk Factors
Age
The most important risk factor is age. The incidence of breast cancer increases with age. The
majority of women diagnosed with breast cancer are over the age of 50. Women under the age of
25 are least likely to develop breast cancer. However, younger women who do contract breast
cancer, suffer from speedy and aggressive growth of cancer.
Gender
Women are the main victims of breast cancer, but male breast cancer accounts for less than 1% of
the total breast cancer cases.
Family History of Breast Cancer
A family history of breast cancer increases the risk of getting breast cancer during a woman’s
lifetime. Breast cancer can appear in multiple family members and can be carried down to up to
three generations. The maternal side of the family contributes to the high risk category of breast
cancer, meaning, if a woman’s grand-mother, mother, aunt or sister has breast cancer, then she is
more likely to develop breast cancer. The indirect commonalties are: lifestyles, hormonal and
menstrual patterns and dietary habits.
Hormonal Factors
Breast cancer is directly related to the spurts of hormonal changes through a woman’s lifetime.
Starting menstruation at an early age, no childbirth and late age of menopause contribute to the high
risk category of breast cancer. A direct co-relation is found between the age of first pregnancy and
breast cancer. It is believed relative risk of breast cancer increases by 1.4 if the first pregnancy
occurred after the age of 30. On the other hand, women who experienced their first childbirth
before the age of 20, had decreased relative risk of breast cancer (0.8). Some studies have shown
that the use of oral contraceptives and long-term estrogen therapy increase the risk of breast cancer.
Lifestyle
Lifestyle contributes towards the probability factor of breast cancer. High fat content in the diet
increases the risk of breast cancer. Some studies indicate that high meat consumption, high caffeine
intake, smoking, environmental pollution also increases the risk of breast cancer, but these results
are still unconfirmed.
Signs and Symptoms
Clinical Signs
The most common clinical sign of breast cancer is a painless, hard and fixed lump in the breast.
This is one of the reason that makes clinical detection of breast cancer very difficult, as painlessness
gives the woman a false sense of security. If the lump is movable, it is less likely to be cancer, and
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gives the woman a false sense of security. If the lump is movable, it is less likely to be cancer, and
more likely to be benign cysts. Approximately, one-tenth of the patients have breast pain with no
detectable lump.
Other symptoms are categorized under breast distortion. Dimpling of the skin surface, swelling,
skin irritation, skin edema with ‘peau d’orange appearance’ (looks like orange peel), nipple
inversion, tenderness and nipple discharge. At times, a rapidly growing tumor may cause dilated
superficial veins forming a prominent vascular patters, visual on the breast surface.
Economic Justification
In 1994, out of 183,000 new cases of breast cancer diagnosed, 25% were at the late stage (National
Cancer Institute, USA). The Treatment cost for early stage breast cancer is approximately $
11,000, whereas at a late stage diagnosis, the treatment cost is about $ 140,000 per case. Hence,
the difference between early and late stage cancer treatment is between $ 130,000 to $ 230,000 per
case. Recent studies show that a second reading of mammograms increases the number of cancers
detected by 5% to 15%. We know that very early detection of breast cancer through well structured
screening programs, availability of a second reader and patient education, is highly cost-effective.