Last year, 80,000+ new breast cancers were diagnosed in the USA. It is estimated that 1 in 8 women will develop breast cancer throughout their lives.
Male breast cancer accounts for less than 1 per cent of all cases of breast cancer, although no explanation is yet a certain increase.
The vast majority of cases are unknown the causes of cell abnormalities that lead to the development of cancer, but it is known that 5-10 % of them are found in people with a hereditary predisposition to breast cancer. They are usually young – under 40 – with one or more first-degree relatives – including men – with breast cancer, bilateral breast cancer, ovarian cancer, or combinations of them. Being a carrier of a genetic-type mutation does not mean a greater chance of having it throughout life, although it requires specialized preventive follow-up.
Risk factors
Some of the factors that increase the risk of breast, female, or male cancer, include:
1. The old age. It is in approximately 90% of cases, which results in the risk of breast cancer increasing with age. In men, for example, they are diagnosed more often after age 60. In women, half of the breast cancers diagnosed are diagnosed between the ages of 35 and 54. Since the risk increases with age, most early detection campaigns are aimed at the sector between 50 and 69 years of age.
2. If medications related to the strtrógen, such as those used in hormone therapy for prostate cancer are taken for men, some ovulation stimulators in in vitro fertilization or treatments for symptoms of menopause that contain high rates of estrogens, are at increased risk of breast cancer.
3. A family history of breast cancer, as we have already mentioned, is also a risk factor. If there is a close family member with breast cancer, they are more likely to develop the disease.
Origin
For breast cancer to develop, basically three circumstances converge:
1. Uncontrolled growth of breast cells.
2. The loss of normal differentiation of cells (they no longer have their normal traits and regulated behavior).
3. An inability of our immune system to recognize and eliminate such mutant, cancerous, or precancerous cells.
The sum of these changes allows the local invasion of tissues close to the tumor or even metastases by lymphatic (expansion to axillary nodes, for example). Also through the blood, it can spread to other organs (metastasis to bones, lungs, liver, or even the brain).
First Symptoms
Symptoms of breast cancer, both in men and women, may:
1. A lump or thickening without pain in the breast tissue.
2. Changes in the skin that cover the breast, such as dimples, wrinkles, redness, or peeling.
3. Changes in the nipple, such as redness or peeling.
4. A nipple that starts to sink
5. Secretion of a nipple
6. Lymph nodes in the armpit that increase in size
7. Bone pains or liver in case of late presentation (as may occur in older women and with cognitive loss, or in cases of very aggressive cancer) with metastasis.
8. Significant weight loss and not explainable.
However, there are sometimes lesions either felt or detected but can be diagnosed by screening mammograms (for early prevention and detection).
Although in high-risk cases, both because they are carriers/are of predisposition mutations of genes known as yet unknown genes, there are already ongoing studies on preventive treatments (e.g. through antigenic oral medications administered under medical supervision for a while), the best prevention remains early detection.
Treatment of each type of cancer
According to the resulting markers, we can talk about:
1. Infiltrating ductal breast cancer type “Luminal A”. It is usually the least aggressive and responds best to hormone therapy in pill form after surgery and radiotherapy.
2. The HER-2 positive cancer. It responds to the blocking treatment of the HER-2 oncogene.
3. Cancer known as “Triple Negative” is the worst breast cancer because it does not express hormone receptors for estrogen or progestogens, nor does it have amplification of HER-2 oncogene. This limits successive therapeutic options, beyond cytotoxic chemotherapy (and post-surgery radiation therapy) or, in some promising cases, immunotherapy combined with chemotherapy.
How can we prevent breast cancer or detect it early?
1. Through population screening for breast cancer, which is usually done through successive mammograms, especially after 45 or 50 years of age.
2. It is advisable to breastfeed the children for several months (it is said to “clean the ducts” or milk ducts).
3. Take a healthy life with regular moderate physical exercise and a balanced Mediterranean diet rich in fruits and vegetables, fish, and little red meat, fats, and sugar.
4. It is also important to avoid obesity because it carries an increased risk of breast cancer.
Treatment
The current treatment is varied and complex and depends on the type of breast cancer, the biological and molecular characteristics of the tumor, its degree of spread or stage of the disease (from I to IV), and the clinical characteristics of each patient. Different treatment modalities are used, combined in a personalized way, and based on protocols with high scientific evidence.
1. Conventional chemotherapy. It can be offered even before surgery to reduce the tumor and avoid metastasis. Currently, in the case of women with early breast cancers, there are different molecular analyses of the aggressiveness of each cancer once removed or biopsied, which recommend or discourage chemotherapy. This is managing to avoid unnecessary chemotherapy.
2. Surgery. Fewer mastectomies are becoming increasingly common, and when necessary, breast plastic reconstruction (immediate or deferred) is carried out by significantly reducing the stress or depression by the mutilation of such a sensitive and significant organ for a woman. Most of the interventions are already tumorectomys, in which only the tumor is removed and not all the breast, and even avoid extracting all the axillary lymph nodes by studying the sentinel node. This is usually the first affected by metastasis or micrometastasis and is located with image techniques in the armpit on the same side of the tumor. The earlier the diagnosis and the smaller the breast tumor, the lower the risk of axillary nodes affected by cancer. Currently, even at the microscopic level, the appearance of affected nodes in more than 20 or 30% of cases is not often frequent.
3. Post-surgery, dietary, and aesthetic physiotherapy. In our working group, at the 360th Center for Cancer Excellence in Genesis Carey Corachan Clinical, we incorporate physiotherapy, as well as the appropriate dietetics to avoid gaining or losing weight with treatments, and also the supervision of specialists in aesthetic medicine due to possible problems associated with chemotherapy, such as hair loss or alopecia, damaged nails or dry skin.
4. Oncological infirmary. Watch the administration of chemotherapy drugs at the Day Hospital, and give further explanations and resolve doubts.
5. Psychooncology. A specialist with specific training in clinical psychology applied to the problem of cancer in the patient and his family environment.
6. Radiation therapy. Necessary as a complementary crazy-regional treatment, especially if a mastectomy is not performed and tumorectomy is only done. Radiation therapy is also effective as a soothing method in metastases and even directed in oligometastatic disease, i.e., with fewer metastases. With modern techniques such as those used in our center, it has been possible to reduce the overall time of radiation therapy treatment from between 4 and 6 weeks (every day) to 1 to 3 weeks maximum, with the same efficacy and safety results.
7. Hormonotherapy. It is given in pills or sometimes in injections in patients with hormone-sensitive tumors for 5 to 10 years after healing surgery, or chronically until the progression of the tumor disease is detected in patients with metastasis.
8. Customized treatment or directed to specific molecular targets of the tumor. The paradigmatic example is that of oncogen HER-2, which can be inhibited by specific monoclonal antibodies.