cancer symptoms | Breast Cancer

Breast Cancer



All women are affected by breast cancer. Breast cancer is the most common cancer in women. One in eight women is currently affected by breast cancer and this figure could rise to one in seven within twenty years. Breast cancer develops in three-quarters of cases among women over 50 years of age. It is the leading cause of mortality among women between 35 and 65 years. Mortality decreases by 1.3% on average per year.

Definition
Breast cancer is the most common cancer diagnosis among women in the world. Its presence increases with age, but it can also affect young women since a quarter of the cases are diagnosed before the age of 50 years. Breast cancer develops from the cells of the mammary gland: we are talking about adenocarcinoma. It is influenced by female hormones and is more likely to occur in women who have had early puberty or late menopause, women who have not had a child or are taking hormone replacement therapy. A genetic part is also involved, which explains the increased risks when breast cancer has already affected a family member. The development of organized breast cancer screening helps to diagnose cancers earlier, and to allow for rapid management with improved survival. Note that breast cancer can also affect humans.

Statistics
Two out of three breast cancers are reported after menopause. Breast cancer is increasingly young: 7% of affected women are less than 40 years of age, while this figure was 5.6% in 2002 (French Society of Senology and Mammary pathology, October 2010). A woman dies of breast cancer about every 53 minutes. Early onset breast cancer is easier to treat and has less risk of sequelae. It reduces mortality by 25%.

Half of the cancers are detected even though they are less than 2 cm long. Every year around the world, about one million breast cancers are diagnosed and 400000 women die. The increase in the number of cases mainly affects postmenopausal women, but also and increasingly, younger women, i.e. aged 40 to 45 years. Breast cancer remains at the forefront of cancers in terms of frequency (33.5% of all new cancer cases) and 75% of breast cancers are reported after 50 years.
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Risk Factors
There are a number of factors that pose a risk to women in developing breast cancer. However, a large majority of breast cancers occur in women with little or no risk factors.
There is a family predisposition for women who have a number of people with breast cancer in their immediate families. In this case, more appropriate monitoring, including for example an MRI for detecting a tumor earlier is advisable. The presence of certain genes provides predispositions to the onset of breast cancer. Women with mutations in the BRCA1 and BRCA 2 genes are at risk of developing breast cancer (up to 80%), while only 10% in the population. They can also develop breast cancer earlier, around 40-45 years.


A first late pregnancy occurring after 35 years is a major risk factor for breast cancer. The absence of pregnancy is a risk factor. The first early rules are also before the age of 12.

The risk increases with age, especially from 50 years.

A late menopause occurring after 55 years is also a risk factor.

Regular alcohol consumption, i.e. drinking two or three glasses of wine a week, doubles the risk of breast cancer after menopause. Some studies seem to show that smoking increases the risk of breast cancer, especially if smoking started early and before the first pregnancy. Obesity increases the risk of breast cancer, especially after menopause. The absence of regular physical activity, about 30 minutes every day, yet recommended by all experts, is a risk factor. 

Symptoms

The first symptom of breast cancer is the presence of a lump at the breast level, corresponding to the tumor. It can also be accompanied by hard ganglia at the armpit (axillary lymph nodes) corresponding to a spread of cancer, as well as skin changes at the breast and nipple (padded skin and a nipple that enters Place to go out). The breast can gradually deform and ulcerate, which sometimes translates into a flow of the nipple, only one side. If the cancer is diagnosed late, the tumor may spread and trigger other symptoms such as nausea, vomiting, weight loss, jaundice, bone pain or headache, shortness of breath or cough. 

Healing

In 2008, breast cancer resulted in 11,300 deaths while 17,000 women died of breast cancer 10 years earlier. The vast majority of women are cured of breast cancer. The 10-year survival rate is now 75%. 

Risk Factors

The risk factors include the absence of pregnancy or a first pregnancy after 35 years, early menstruation before the age of 12, a late menopause occurring after 55 years. The risk increases with age. Drinking two to three glasses of wine doubles the risk of breast cancer after menopause. The presence of certain genes predisposes to the onset of breast cancer. Women with mutations in the BRCA 1 and BRCA 2 genes have a risk of developing breast cancer that can reach more than 80%, while it is only 10% in the population. On the other hand, they can develop breast cancer more early, around the age of 40 to 45 years. A Onco-genetic consultation helps to detect a familial predisposition among women who have several people with breast cancer in their immediate family. In this case, more appropriate surveillance including an MRI, for example, to detect a tumor earlier is recommended. Breast cancer is usually manifested by the presence of a lump in the breast. In some patients, it can be reported by a flow of the nipple, a presence of red plaques on the breast, crevices, abnormal folds or peeling skin. A significant proportion of patients have no signs, but only visible anomalies on a mammogram. When an anomaly is detected, mammography, ultrasound and/or cytoponction may be performed to determine the need to monitor the lesion, or to decide on a tumor removal. 

Diagnosis

The clinical diagnosis is done by palpation of the breast, the aim being to detect an abnormal mass, but also by the search for lymph nodes. The doctor will then carry out a two-sided mammogram, X-ray of both breasts, to see the appearance of the Mass. An ultrasound can be an alternative, especially among young women, whose breasts are denser. Most of the time, a mass puncture is necessary. The sample will then be analyzed. After confirmation of the cancerous nature of the lesion, an extension assessment is carried out, i.e. a set of tests whose purpose is to investigate the possible extension of the cancer to other organs. 

Mammography

Mammography is a painless and quick exam for about 15 minutes. It can detect an anomaly and make a precise diagnosis. It is systematically carried out in women over 50 years of age as part of a follow-up to detect a small, invisible and non-palpable early tumor, in order to quickly set up a treatment to optimize the chances of healing. The radiologist delivers the first interpretations in the day and the results are sent to the attending physician. If an anomaly is detected, other radiological examinations may be immediately performed by the radiologist, such as an ultrasound, for example. 

Report to the radiologist, if you are wearing breast prostheses, if you are taking hormonal medications or if you have undergone surgical procedures.

Ultrasound

Ultrasound is not a first-line breast cancer screening test. It may be advisable after a mammogram to analyze a detected lesion or when a mass has been discovered during palpation and has not been located on the mammography. 

Biopsy

It consists of collecting a fragment of the suspicious tissue to examine it under a microscope. The biopsy can be carried out under local anesthesia, for example using a fine needle during a cytoponction or in the operating room under general anesthesia during surgery on the tumor. If this option is selected, it can be performed during a biopsy, or it may be a lumpectomy. The diagnosis is made via a microscopic examination of the lump of tumor taken. 

Extension balance

This assessment allows to determine the extent of cancer and to check the absence of metastasis. The balance sheet will depend on the protests and the results of the tumor collection. It will generally include at least a chest X-ray, an abdominal ultrasound, a blood sample and a bone scan. 

Screening

Early detection of breast cancer is easier to treat and has less risk of sequelae. When detected at an early stage, it is better treated and reduces mortality by 25%. Half of the cancers are detected at a height of less than 2 cm. When the tumour size is less than 1 cm and no ganglionic invasiveness has been observed, the odds of survival at 5 years are at least 90%. In France, breast cancer is the first cancer in women. To address this public health problem, since 2004 a free mammography screening is organised throughout the French territory. The rate of participation in the breast cancer screening program has increased dramatically in recent years. In 2003, it was 33%, in 2005 of 45% and 2006 of 49%. The government wants to generalize breast cancer screening to 70% of women aged 50 to 74 years, a figure that would reduce mortality by almost one third. 

The arguments of the National Cancer Institute for Breast cancer screening are as follows: Nearly 3 000 women could be saved each year if 70% women from 50 to 74 years old carried out a mammogram in the Org screening framework every 2 years. Aniseed. Choosing this organized screening allows you to benefit from a device in which a second radiologist examines mammography. 7% of the cancers not detected during a first reading are identified by a second reading of another practitioner. It takes about 5 years for a breast tumor to reach a size of 1 mm, two years longer to reach a size of 5 mm and still one or two years to measure 2 cm, sufficient size to be able to be detected at palpation. The management of mammography is 100% in the context of organized screening. 

A letter is sent every 2 years to women aged 50 to 74 years by the structure responsible for organizing the screening. Then make an appointment with the radiologist you choose from the list of approved firms: the usual radiologist is very often, in more than 85% of cases, in this list of practitioners meeting the quality criteria of organized screening. Radiologists participating in this screening must perform at least 500 mammograms per year and use equipment that meets very stringent quality standards. The completion of a mammography consists of two X-rays per breast. If an anomaly is detected, the radiologist may propose additional tests. If no anomaly has been detected, mammography is routinely verified by another radiologist. Within fifteen days the patient is informed of the result of the second reading. It is necessary to keep the pictures that are rendered after the screening in order to report them at the next appointment. The diagnosis of cancer is carried out in about 6 women out of 1000 who participated in the screening, or 0.6% of them, contact the health insurance Fund or the structure responsible for organizing the screening in your department, if you are more than 50 years and That you have not received any mail. 

A small proportion of women have abnormalities found during mammography. This does not necessarily mean that it is a cancer. In this case, other examinations, such as ultrasound, will be performed immediately by the radiologist. These tests are not supported at 100% for screening purposes, but they are reimbursed by the health insurance Fund under the usual conditions. For more information and to have a list of the centres participating in the screening, visit the Inca site the senology centres bring together all the professionals involved in breast cancer management. These structures, which are present in the cancer centers, allow to carry out in one day the vast majority of the necessary exams and to obtain a precise diagnosis within a few days. These structures allow to perform biopsies and avoid hospitalization, to improve the comfort of the patients and to generate less stress. 

Breast palpation

Palpation is the indispensable and important examination, unfortunately it only allows to detect visible and palpable tumors. Breast cancer can evolve for many years without causing any manifestation, pain or lump. 

The awareness of women to monitor their breasts by practicing self-palpation allows early detection of the disease. The autopalpation is a gesture that is advisable to perform every month after the rules, in order to spot a possible lump of the breast. Stand in front of a mirror, inspect both breasts, and check for a lack of flow from a nipple, crevices, abnormal creases, or peeling skin. Then lift one of the two arms, then with the 3 fingers with the other hand, palpate the breast on the side of the lifted arm: start with the outer part, the fingers flat, making small circles. It is necessary to look for any sensation of ball, dimple on the skin, or size. Also palpate the nipple and the area between the breast and armpit and squeeze the nipple and check that no flow occurs. 

Mri

Several studies presented at the annual Congress of the American Society of Clinical Oncology, held June 1-5, 2007 in Chicago, demonstrate that MRI is the most effective examination for the detection of small tumors that cannot be detected by mammography. Experts recommend the annual implementation of an MRI in women at high risk, those with a family history or a genetic anomaly, or about 4000 women in France.  "Mammography remains the first screening test for Breast cancer If the most effective examination to detect a beginner breast cancer is MRI, it is not possible to recommend its generalization because the procedures of this examination are not yet standardized and are not subject to quality control as it is performed today for mammography.

It is not a question of stopping mammography screening that saves thousands of women each year to the benefit of MRI.

Other indications of MRI:

Look for other lesions in the same breast or another cancer in the other breast

Evaluate and monitor the evolution of cancer during treatment..

Treatment

The vast majority of breast cancers can lead to healing. Of the 52 000 new cases of breast cancer detected each year in France, 84% are alive five years after the diagnosis. The treatment of cancer will depend on the stage of the tumour, determined by the size of the tumor and the results of the extension balance, depending on the number and location of the other affected organs. In general, the preferred solution is the removal of the tumor if the stage is not too advanced. Depending on the size, the surgeon can only ablate the tumor, called lumpectomy, until the total removal of the breast, a mastectomy. It can also be rebuilt surgically remotely to compensate for the aesthetic deficit. The lymph nodes in the vicinity will undergo a cleaning. Radiation therapy or chemotherapy can also be associated. In some cases, a hormone-based treatment will decrease the frequency of recurrences. 

The choices of the techniques depend on the characteristics of the tumor. Surgery is more and more efficient and less mutilative. 

Lumpectomy

Lumpectomy, a conservative surgery, removes a tumor that is usually less than 3 cm in size and conserves the breast.

Mastectomy

Mastectomy removes the breast with the tumor, for larger tumors or if there are several tumors in the breast. 

Removal of a portion of the Ganglionic chain located in the armpit near the affected breast is no longer performed systematically. During the procedure, before the tumor was removed, 1 or 2 ganglia on average were withdrawn by means of a small incision, then analyzed during the procedure, in order to d''évaluer or not the interest of removing the entire ganglionic chain.

If there is no anomaly in the ganglion, no other lymph nodes will be removed.

If cancer cells are present, the surgeon performs the removal of a portion of the Ganglionic chain located in the armpit on the side of the breast reached.

Re-education and physical exercise are crucial steps. They can help to give flexibility to the arm as well as to the shoulder on the side of the intervention and also to alleviate post-operative pain. 

These exercises participate in the management of the patient and offer opportunities for dialogue and evacuation of her anxieties. Avoid heavy loads to wear or work that lasts for several weeks. 

Wear loose clothing and avoid using irritating products. Avoid solar and of course tobacco exposure. Do not drink too much alcohol. 

Radiotherapy

Radiotherapy of breast to achieve a consolidation of the effect of the surgery. This treatment will apply on the affected breast, if it has not been removed and can destroy cancer cells through the issued irradiations. It is generally over a period of 5 to 6 weeks and requires no hospitalization. 

Chemotherapy

Chemotherapy is often performed as part of the breast. Objectives depend on the extension of the tumor. Chemotherapy that allows the dissemination of drugs intended to destroy the tumor cells, is most often performed before surgery. This treatment is not available when for example the tumor measures less of a centimeter and lymph sentinels, located close to the tumor are not met. 

Hormone therapy

This treatment, which is to deliver the molecules that block the effects of estrogen on the growth of cancer cells. These products are offered in women with cancer hormone breast that has receptors for estrogen. 

Monitoring

Monitoring is intended to detect early possible relapses, but also to find new cancer. Mammograms will be carried out regularly.

Breast reconstruction

Plastic surgery and Reconstructive, more often recommended after the removal of a tumor, allows to offer patients considerable assistance in finding a close chest than they had before the procedure. More and more cancer services include in their team a plastic surgeon to advise a breast reconstruction patients in the best conditions. The oncologist and the plastic surgeon work sets at this important juncture for women. 

Find the forms of her body remains an important step for the sick and participates in its psychological improvement. Breast reconstruction is to rebuild the contour of the breast by implanting a prosthesis in saline or silicone gel. A small intervention on the other breast is often done for reasons of symmetry. The surgeon will advise the patient based on the type of work carried out, the post-operative treatment, the condition of the skin and muscles... Don't hesitate to ask him to show you photos of breast reconstructions it has already made. 

Breast reconstruction is sometimes performed at the same time as the breast removal or practiced after the end of chemotherapy. A delay is sometimes essential after the removal of the breast. Breast reconstruction can take place in several stages and take several months, and sometimes even almost a year to be complete and satisfactory. Breast reconstruction has no effect on cancer and does not compromise the chances of cure and don't mind the subsequent monitoring. This procedure can also be performed after a Lumpectomy. 

A reconstructed breast decreases the tactile sensations at the level of the nipple. 

Prostheses, scarves, wigs

Several accessories can help for people wishing to cover or hide hair loss: headscarf, turban, hat or well still wig. 

Wigs: the national Institute of cancer, the Inca Trail, established in consultation with professionals, a Charter of rights of the client and the duties of the seller of wigs. Stores that have subscribed are committed to a quality approach both at the level of hospitality, product and service presentation. You will find on the site led ' INCA, the list of vendors who had joined the Charter, Department by Department. 

External breast prostheses allow to find a feminine silhouette and a static balance. They are sold at surgeons, pharmacists-surgeons and some lingerie corsets. There are dentures that slip in the bra and others, solidarity prostheses, are sticky or adherent to the skin. The prostheses are supported by the health insurance fund to the tune of a certain amount on prescription issued by the treating physician. Check with your health insurance fund. A mutual can also support the addition, in part or completely. People affiliated with CMU, of State medical aid (AME) universal health coverage may benefit from the paying agent. It is advised them to take advice from their health insurance fund. 

It is important to learn before going to a store, as all do not benefit from social security or the paying agent support.

Nurses and social workers of the service where you are supported are familiar with the various possibilities of aid or loans. Hospital services have also sometimes wigs and accessories donated by former patients. Some associations also offer financial aid or redistribute wigs. 

Chances of survival

Breast cancer is the most common cancer in women: it touches a woman on 8. The 5-year survival chances are 75%. However, this figure varies depending on the age of the patient, as in young women (a third of patients), the risk of recurrence is higher. In addition, cancer is usually more aggressive. As with all cancers, early detection increases the chances of survival. Breast cancer remains the leading cause of mortality among women from 35 to 65.