Breast Cancer Essay

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_Breast Cancer _

In the United States in 1999 alone, an estimated 43,700 people will die from

breast cancer. It is the number two cancer killer among females ages 15 to

54.

On average if a woman gets this disease, their life expectancy drops

drastically. This cancer is within the top three cancers of all women above

the age of 15, and comprises a great amount of all health care costs in the

U.S. totaling an astounding 37 billion dollars a year in direct medical

costs.

An average woman is said to have a one in nine chance of getting the cancer,

but if that person had family history of the disease, his or her chances have

been measured up to a one in six chance. Sixty-nine percent of

African-American women survive from it, and there are predicted to be nearly

two million new cases reported this year in the U.S. (Breast Cancer Key

Statistics)

Breast cancer is a group of rapidly reproducing,

undifferentiated cells in the area of the breast in men and women. The

earliest changes occur in the epithelial cells of the terminal end buds (TEB)

of the breast milk ductal system. While the progressive steps of breast

cancer

are unknown, the cells in the breast trigger a reaction of cell reproduction.

These new cancer cells form tumors. If cancer cells are active or are

considered malign, the tumor grows at tremendous speeds, and may end up in

metastasis. Metastasis is a complex process in which cells break away from

their primary tumors, and via the blood supply or through the lymph system

relocate into other organs, thus spreading cancer throughout the body.

Generally, if a lump is smaller than one centimeter, it is considered benign,

although every woman should consult her doctor about any unusual bumps or

feeling in the chest. One sign of breast cancer results from ductal cancer in

the breast. A once hollow open tube could be completely clogged up with

cancerous cells leaving an awkward feeling in the chest area. Other

complications that result from this cancer and others are the clogging and

cramming of the system (American Cancer Society, 1999: 10)

Recently genes

have been named as a great cause of cancer. It now is thought in the medical

community that while there are definite environmental contributors to cancer,

even those people who are exposed to few carcinogens may suffer from disease

that runs in their families. Among the genes that are being heavily

researched

is the gene BRCA1 (Case Studies). In one of the preliminary studies of this

particular gene, over 250 Jewish women were discovered to have mutations in

this germ-line allele, which is a version of the trait that is passed to the

offspring through the germ line cell (or gamete). This accounts for

approximately 13% of all breast cancer patients observed. Jewish women in

specific were used, as early on there was a definite pattern of breast cancer

through the Jewish community especially that which lived in the United

States.

The specific mutation, 185delAG, was, “strongly associated with the

onset of

breast cancer in Jewish women before the age of 30.” Scientists advanced

upon

this new information of genealogical interplay, so the “New England

Journal of

Medicine” (NEJM) set out determined to study the overall effects of

these

genes. In an article printed on January 18, 1996, germ-line alterations in

BRCA1 were discovered in six of the 80 women surveyed who had breast cancer

but had no apparent familial history of it. Thus the scientists concluded

that

mutation was not limited to women with a history of cancer. Genes are thought

to cause five to twenty percent of all breast cancers. A gene known as p53

supposedly stalls reproduction of cells, and can even cause a cell to

“commit

suicide”. Other genes that seem to accelerate growth to overtake and

stick to

proteins include HER2, neu, and erB2 (Fitzgerald et al, 1996). The relation

between serum estrogen levels at a single time is linked to breast cancer,

but

no evidence links estrogen levels over an extended time to the risk of breast

cancer. This what was thought until researchers at the “New England

Journal of

Medicine” proposed a study. Bone mass is a cumulative effect of estrogen

on

bones scientists say, and so the study focused on the more easily observed

density and mass of bone tissue in women. Four levels were studied, and the

research was tallied. The risk for getting cancer in the lowest stage of bone

mass was about 2%, and then 2.6, 2.7, and 7.0 in the second, third, and

fourth

levels of higher mass respectively. This research lent itself to the

assumption that cumulative exposure to estrogen might play a part in breast

cancer (Fitzgerald et al, 1996). Other hormonal factors have been viewed as

potential breast-cancer-causing agents. Birth control pills are thought by

some to lead to breast cancer. Early birth control pills used much more

estrogen and progesterone than do today’s pills. Lots of contradictory

results

were found in research on “the pill” because women who had been

taking it for

ten or twenty years had actually been taking several different types with

possibly different levels of cancer causing hormones. But, in general, the

report concluded that “the pill” doubled to up to quadrupled a

woman’s chance

of having breast cancer (Fitzgerald et al, 1996). Diethylstilbestrol (DES)

was

used to increase fertility from 1940 through 1960 and also decrease the

chances of having a miscarriage. Studies showed it to increase the rate of

breast cancer by 1.4. Exposure to estrogen during periods of rapid growth in

the breast tissue during pregnancy may increase risk. In August of 1989,

Swedish doctor Leif Bergkvist studied 23244 women ages 35 and up and found

that an estrogen supplement that they were taking quadrupled chances for

breast cancer (Fitzgerald et al, 1996)

Breast cancer accounts for the

highest number of new cases in women each year, and the war cry for breast

cancer is, “1 in 8!” because according to some statistics a woman’s

chance to

develop breast cancer in her lifetime is one out of eight or 12.5%. In the

“Journal of the National Cancer Institute” in May of 1995 that

women

overestimated their chances for dying from breast cancer by twenty times.

While that journal reported in 1995 that the chances of getting breast cancer

were only 1 in 17 before the age of 65, but it also said that the number of

breast cancer cases has increased 30% in the past twenty-five years. Although

breast cancer is the most common cancer in American women, over 80% of cancer

occurs in postmenopausal women. While epidemiologists know that breast cancer

is often the associated with age and genes, now speculation is arising that

the earlier a woman has her first menstrual period the more at risk she is.

The Institute’s environmental studies division says that a large part of the

problem is that one half of women have environmental risk factors. The

disease

is also often perceived as a white woman’s disease. Such white culture icons

as Nancy Reagan, Shirley Temple Black, Linda Ellerbee, Ann Jillian and Betty

Ford have had breast cancer. However, cancer statistics show that the disease

is especially prevalent in uneducated blacks who don’t bother with or don’t

know about regular breast exams. Japanese women have 17% mortality rate when

compared to American women. But, when Japanese women move to the United

States, their breast cancer rates gradually move up as their bodies respond

to

the new environment. Even so, the myth of it being a white-only disease still

lives on (Perceptions of Breast Cancer Risk and Screening Effectiveness in

Women Younger Than 50 Years of Age)

A number of doctors simply take the

common sense approach to preventing breast cancer, which is exercising and

getting your proper nutrients. Dr. Leslie Bernstein, a professor of

preventative medicine at the University of Southern California, proposes one

leading hypothesis on how exercise fights cancer. Dr. Bernstein says that

exercising reduces a woman’s exposure to estrogen, reducing that possible

oncogen (Exercise Reduces Breast Cancer)

Several “miracle foods” have been

tried and marketed as cancer fighting agents. One such food is the green tea

leaf. Dr. Rajendra G. Mehta at the University of Illinois made a synthetic

form of vitamin D-5 that killed cancer cells in a lab culture (Newly

Synthesized Compound Can Inhibit Development of Precancerous Cells). People

who regularly consume hard liquor, beer or wine experience 1.3 times the

relative risk of breast cancer. Those who have more than nine drinks a week

have an increase of two and a half times the rate of breast cancer for a

non-drinking person. In 1987, the National Cancer Institute published a

report

comparing 1524 women with breast cancer against a control group of 1896

without the disease. Again, alcohol appeared to promote breast cancer (Risk

Factors for Breast Cancer)

Several medical procedures or side effects of

them have been thought to promote breast cancer. It was hypothesized that

self-induced abortions could greatly increase the chances of getting cancer,

as during pregnancy the cells in the breast quickly divide and reproduce. By

having an abortion and thus suddenly halting cell division, a number of cells

would become greatly unprotected by there not being any differentiation, and

thus would be vulnerable to cancer (Risk Factors for Breast Cancer).

Radiation has also been thought of, and for all thorough purposes has been

proven to be a cause of breast cancer. There have been three major studies

that have been done concerning radiation. The first was performed around the

bombings of Hiroshima and Nagasaki. It was quickly ascertained that within a

ten mile radius of the bombing there was a definite cancer zone. More

importantly, younger people got much more cancer, especially with regards to

breast cancer, than did older ones. This forces more weight on the theory

that

the changing years of the breasts in women are their most vulnerable and

possibly cancer causing ones (Risk Factors for Breast Cancer)

Prevention is

one point of the attempt to cure breast cancer, but it is extremely important

to get breast examinations often to make sure of no lumps or early tumors.

The

simplest forms of breast exam are a self-exam, one with a doctor, or a

mammography. A mammogram is simply an X-ray of the breast. Mammography can

pick up small lesions of under one half a centimeter, whereas one can not

feel

a lump until it is a full centimeter in diameter. But, if breasts are small

or

dense, a mammogram might not be able to detect a cancerous lump. Another

procedure could be a wire localization. A thin wire is used to show where the

lesion is after the wire is inserted, and local anesthetic is administered.

Thermography is based on the idea that cancer gives off more heat than

regular

cells. Transillumination is founded in the concept that light shines through

breast tissue, but is blocked by lumps. An ultrasound is the use of high

frequency sound waves, which are sent off in a radar fashion, and reflect off

objects that they hit. A CAT scan is the process of visually cutting the body

into cross-sections (Guidelines for the Early Detection of Breast Cancer,

1999)

Another controversy runs deep in the issue of using CAT scans to find

cancer tissue. The radiation required to examine a five milliliter lump is

often considered simply too high for safety, and has a possibility of just

simply spreading the cancer to other body parts. A MRI takes advantage of the

electromagnetic qualities of the hydrogen nucleus to produce an electric

chart

or visual. While the most common form of breast exam is mammography, there

are

many critics of that procedure. Cancer patients have said that the mammogram

is often uncomfortable and takes too much time. Younger women are at

increased

risk for biologically more aggressive carcinoma, meaning that the future

battle for curing cancer is not getting any easier. Cancer growths are

dependant upon the growth of blood vessels to nurture the cancer cells. New

drugs are being developed to stop the growth of cancer cells by preventing

nourishment of the cancers by new blood vessels. By cutting off the blood

supply to the cells, they die, and thus are eliminated from the system

(Guidelines for the Early Detection of Breast Cancer, 1999). Chemotherapy

involving tamoxifen has proved useful in delaying breast cancer recurrence,

but the majority of patients treated with Tamoxifen eventually go into

relapse. Traditionally, there are three types of cancer treatments:

radiation,

mastectomy, and cytotoxic chemotherapy. The type of surgery really has its

basis on the size of the tumor. A lumpectomy removes the tumor and

surrounding

tissues. A simple mastectomy removes the breast, nearby lymph nodes, and

portions of the chest and arms (Treatment). Doctors can also perform

preventative mastectomies. Some surgeons feel that if the breast is fairly

lumpy, and the patient appears to be at very high risk of breast cancer, the

surgery may be beneficial. The whole surgery is highly controversial. Both

doctors and patients generally prefer a total bilateral mastectomy and

reconstruction. This removal takes out the entire breast including the nipple

and duct system so that there can be little chance of relapse (Treatment).

There are various treatments aimed at killing the cancerous cells- from

surgically removing that area of the body to killing them off by use of

chemicals. A very common procedure is chemotherapy. Chemotherapy is an

antibiotic designed to kill rapidly dividing cells. Monoclonal antibodies are

antibodies that can be engineered to carry drugs or radiation directly to the

tumor, and is an efficient way of delivering chemotherapy to the body.

Another

adaptation that has been added to chemotherapy is the use of genes that are

chemo-resistant. One treatment involves stem cell transplantation. Stem cells

are often referred to as master cells, and they seem to carry antibodies that

rapidly reproduce which fight malignancies, and may be able to fight cancer.

One solution to cancer may be hormone therapy (Treatment). The hormone,

usually tamoxifen, slows growth of cancer cells by blocking some growth

enhancing properties of estrogen. The controversy over Tamoxifen is that it

might cause other types of cancer. In 1989, the National Cancer Institute ran

a test in which women took a placebo or Tamoxifen. Women with the drug were

less likely to develop cancer of the breast, but they were more likely to

develop blood clots, ovarian cancer, or breast cancer (Tamoxifen)

One

complication that can result in cancer is Ductal Carcinoma Insitu. The ductal

area houses the lobules and ducts and is the area in which milk is produced.

Similar to rust clogging up pipes, often extra cells or cancerous cells will

clog up the tubes providing for some discomfort and other risks. Studies show

that 20-25% of women with untreated DCIS will get invasive cancer within 10

years (American Cancer Society, 1999: 7)

As the twentieth century comes to

an end, breast cancer continues to be a devastating killer in the new

millennium. Breast cancer takes the lives of our mothers, our sisters, our

daughters, and our friends. Although progress is being made through research,

early detection is all we can do to possibly prevent breast cancer. Women

should learn to do a self-examination at a young age, and should continue

throughout their lives. If a lump is found a professional should be

contacted.

If people work together, maybe sometime soon a cure will be found (Breast

Cancer, 1991).

_Bibliography _

“Breast Cancer.” The World Book Encyclopedia. Volume 2; 601. 1991.

“Breast

Cancer Key Statistics.”

http://www3.cancer.org/cancerinfo/main_cont.asp?st=wi=5#stats. September 20,

1999. “Case Studies.” http://www.cancergenetics.org/bc.htm. April

12, 1999.

“Detection.” http://www3.cancer.org/cancerinfo/main_cont.asp?st=ds=5#early.

September 20, 1999. “Exercise Reduces Breast Cancer.”

http://www.oncolink.com/cancer_news/1994/exercise_bc.html. August 26, 1999.

Fitzgerald et al. The New England Journal of Medicine. Vol. 334, No. 3.

January 18, 1996. “Guidelines for the Early Detection of Breast

Cancer.” The

American Breast Cancer Guide (1999): 6. “Newly Synthesized Compound Can

Inhibit Development of Precancerous Cells.”

http://www.ag.uiuc.edu/~ffh/vitamind.htm. “Perceptions of Breast Cancer

Risk

and Screening Effectiveness in Women Younger Than 50 Years of Age.”

http://cancernet.nci.nih.gov/jnci/issue10/87-720.html. “Risk Factors for

Breast Cancer.” http://www3.cancer.org/cancerinfo/main_cont.asp?st=pr=5#risk.

September 20, 1999. “Tamoxifen.”

http://www.infomed.org/100drugs/tamofram.html. 1996. “Treatment.

http://www3.cancer.org/cancerinfo/main_cont.asp?st=tr=5. September 20, 1999.

“Types of Breast Cancer”, ” Breast Cancer Stages.” Breast

Cancer Treatment

Guidelines for Patients, Version II (June 1999): 7, 10.

Category: Miscellaneous

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