A Breast's Worst Enemy

Cancer is when our cells proliferate out of control forming large masses or lumps called tumors. If cancerous cells reach the blood stream or lymphatic tissue they can migrate to other parts of the body [7]. Tumors can be either benign, where they remain in one place and do not threaten the person's health, or malignant where they move to other places in the body and invade surrounding cells [7].
In women, cancer of the breast is the most common malignancy [8]. Statistically approximately 1 in 10 women will develop a form of breast cancer [1], which can be a scary thought when sitting in a class surrounded by 20 or more women. Alot of breast tumors arise from the epithelium of lactiferous ducts ( Ductal Carcinoma) and are treated by surgical procedures that cut out that portion of the breast to stop the cancerous cells from spreading into circulation [1]. Other types of cancer are caused by mutations in various proteins. One particular protein that suppresses the formation of tumors is BRCA1/BRCA2. When mutations occur in these proteins the chance of developing cancer is heightened. About 5-10% of all types of breast cancer originate from mutations in these important proteins [1].
HER2 is another important protein that regulations cell proliferation. Mutation in this protein also increases the risk of cells dividing out of control. 30% of cancers are associated with mutation in this protein [1].

Factors increasing likelihood of breast cancer [7]

• If you have a family history of breast or ovarian cancer or if you have had cancer before.
• If you have never had children or gave birth for the first time after 30
• Began menstruation early or reached menopause late
• If you had hormone replacement therapy (exposure to increased amounts of estrogen)
  
• If you have denser breast tissue
• If you are obese, drink alcohol, or are on the 'pill'

What are the signs of breast cancer? [7]

• lump in the armpit
• changes in your breasts including shape and size
• swelling, redness and a warm feeling in your breast(s)
• puckering of the skin, inverted nipple (This is only dangerous if it is a new condition [3])
• scaling on the nipple

Diagnosis of breast cancer [8]
Keep in mind that if you have symptoms you may not have breast cancer, these symptoms are not uncommon in a normal woman. Usually further analysis is needed for a certain diagnosis. One method used is a 'triple assessment'. This includes three main assessments before reaching a decision: a clinical assessment, imaging (ie. a mammogram, ultrasound) and closer look at the cytology of the cells through a fine needle aspiration, a needle core biopsy or a breast core biopsy. However, methods are not always 100% certain. Tests may need to be completed more than once so your doctor can be sure of the condition of your breasts.
Treatment of breast cancer

Once diagnosed treatment generally follows similar trend to treatment of other cancers and can include [7]:

• surgery
• chemotherapy
• hormone therapy
• biological therapy
• radiation therapy

Some other notable treatments have been developed. One is the use of an antiestrogen compound called "tamoxifen". This acts by binding to estrogen receptors and changing its shape so certain steroid co-activator proteins cannot bind, and DNA transcription cannot occur. Hence cells cannot proliferate [1]. Antibodies to the HER2 protein mentioned above have been developed and found successful in preventing mutations in this protein.

So how can you protect yourself?
Follow the seven steps to Health, outlined by the Cancer Society [7]:

1) Don't smoke and avoid second hand smoke

2) Eat right

3) Get active!

4) Protect yourself from the sun

5) Follow cancer screening guidelines

6) Visit your doctor regularly

7) Follow hazardous and safety instructions

Breast Self-Examination

Following these simple steps can keep you up to date on your health. If done on a regular basis you can easily recognize any changes in the shape or size of your breast. More information can be found at the Forrest General Hospital Cancer Services

7 P's of a Good BSE
1. Positions
Standing:

* First, stand in front of a mirror with your arms relaxed at your side.
* Then place your hands on your hips.
* Raise arms above your head.
* Bend slightly forward, allowing your arms to hang freely toward the floor.

In each position, look for changes in contour and shape of the breast, color and texture of the skin and nipple, and evidence of discharge from the nipples.
Palpation: Side-lying and flat:

* Use your left hand to palpate the right breast, while holding your right arm at a right angle to the rib cage, with the elbow bent.
* Repeat the procedure on the other side.
* The side-lying position allows a woman, especially one with large breasts, to most effectively examine the outer half of the breast. Do this by lying on the opposite side of the breast to be examined. Rotate the shoulder (on the same side as the breast to be examined) back to the flat surface.
* A woman with small breasts may only need the flat position. Lie flat on your back with a pillow or folded towel under the shoulder of the breast to be examined.

2. Perimeter

Visualize the perimeter of the breast as an imaginary line which extends down from the middle of the armpit to just beneath the breast. The imaginary line continues across along the underside of the breast to the middle of the breast bone, then moves up to and along the collar bone and back to the middle of the armpit. Most breast cancers occur in the upper outer section of this area (towards the shoulder and armpit).
3. Palpation

With Pads of the Fingers: Use the pads of three or four fingers to examine every inch of your breast tissue. Move your fingers in circles about the size of a dime. Do not lift your fingers from your breast between palpations. You can use powder or lotion to help your fingers glide from one spot to the next.
4. Pressure

Use varying levels of pressure for each palpation, from light to deep, to examine the full thickness of your breast tissue. Using pressure will not injure the breast.
5. Pattern of Search

Use one of the following search patterns to examine all of your breast tissue. Palpate carefully beneath the nipple. Any incision should also be carefully examined from end to end. Women who have had any breast surgery should still examine the entire area of the incision:

* Vertical Strip: Start in the armpit, proceed downward to the lower boundary. Move a finger's width toward the middle and continue palpating upward until you reach the collarbone. Repeat this until you have covered all breast tissue. Make at least six strips (passes with your fingers) before the nipple and four strips after the nipple. You may need between 10 and 16 strips.
* Wedge: Imagine your breast divided like the spokes of a wheel. Examine each separate segment, moving from the outside boundary toward the nipple. Slide fingers back to the boundary, move over a finger's width and repeat this procedure until you have covered all breast tissue. You may need between 10 and 16 segments.
* Circle: Imagine your breast as the face of a clock. Start at 12 o'clock and palpate along the boundary of each circle until you return to your starting point. Then move down a finger's width and continue palpating in ever smaller circles until you reach the nipple. Depending on the size of your breast, you may need eight to 10 circles.

6. Practice With Feedback

It is important that you perform a BSE while your instructor watches to be sure you are doing it correctly. Practice your skills under supervision until you feel comfortable and confident.
7. Plan of Action

Every woman should have a personal breast health plan of action:

* Discuss the American Cancer Society breast cancer detection guidelines with your health care professional.
* Schedule your clinical breast examination and mammogram as appropriate.
* Perform a BSE monthly. Ask your health professional for feedback on your BSE skills.
* Report any changes in your breast to your health care professional.