Is Breast Cancer a New Ailment to Face Human Kind? Essay Example

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The "Edwin Smith Surgical Papyrus" from 3000-2500 B.C. provides evidence of the enduring impact of Breast Cancer throughout history. It contains case studies, including one that specifically examines "Lumps of the breast." The text differentiates between movable and non-movable masses, indicating that non-movable masses carry a more negative outlook.

Breast cancer remains a formidable opponent despite advancements in surgical and pharmaceutical techniques, as observed by Nelson et al. (2009, p. 727) and Hippocrates' argument in 400 B.C. for not risking patients' lives during surgical procedures to remove cancerous growths (Fayed, 2012). This literature review addresses several specific questions regarding breast cancer, including the significance of categorizing cancer for prognosis and treatment options, the equal distribution of breast cancer across different races, fair treatment of all studies, and the importance of early detection through screening.

The human breast is superficially located to the pectoralis major muscles on the anterior chest wall and extends from the second to sixth rib (Tortora & Grabowski, 2001, p. 560). It primarily consists of adipose tissue (fascia), glandular tissue (mammary glands), and vascular tissue (p. 560). The glandular tissue is arranged into fifteen to twenty lobes resembling petals of a daisy.

The breasts consist of lobes with milk-producing bulbs that are connected by ducts. Before puberty, the breast tissue is mainly composed of adipose or vascular tissue. However, hormonal changes during puberty stimulate the growth and expansion of both glandular and adipose tissue. This differential response leads to an overall increase in all types of tissue and a higher ratio of glandular to adipose tissue. Glandular tissue shows a more active response to hormones, which may explain why glandular-origin

breast cancer occurs more frequently despite having fewer glandular cells overall. In addition, there is an increase in vascular tissue due to the increased demand for oxygen and hormone signaling. Vascular tissue serves as the primary pathway for the spread of breast cancer.

Breast cancer can spread through both the arterial/veins system (hematologic spread) and lymphatics (lymphatic spread), but clinicians generally consider the lymphatic spread more important for prognostic purposes. The cancer can also spread through direct contact tissue invasion. Cancer is the result of unregulated or misregulated cell growth in the affected organ (Beahrs ; Henson, 1992, p. 2869). Normally, cells responding to growth hormones stop growing at a certain point and enter a G0 phase where they remain static.

Cells can sometimes activate themselves or fail to respond to a signal to exit the growth phase, leading to the development of cancer lineages (p. 2869). Cancer of neuronal cells is rare because they have long lifespans, while cancer of lymphatic cells, which constantly divide, is more common as lymphomas and leukemia (Siddhartha, 2010, para. 3). In relation to breast cancer, glandular tissue undergoes frequent cell division and replacement (Wysowski et al., n. d.). Breast cancer is the most prevalent primary cancer in women in the United States and ranks third among all cancer deaths (Kelsey1993;15, Revised Standard Version et al., n. d.; and Chan, 2012). A secondary cancer refers to a cancer that originates elsewhere.

Secondary cancers often occur in tissues that filter larger volumes of blood, lymph, or other bodily fluids. The liver and lungs are major sites for secondary metastasis (p. 2869). Although hemotologic spread can cause secondary

breast cancer (Paulus and Libshitz, 1982, p. 561), the majority of breast cancer starts as a primary cancer (Hayat, Howlader, Reichman, and Edwards, 2007, p. 20). There are various pathways to cancer development. Any factor disrupting the body's ability to control cell growth has the potential to lead to cancer.

There are three types of genes related to cancer on a genetic level: oncogenes, proto-oncogenes, and tumor-suppression genes (Wilbur, 2009). Oncogenes have the ability to cause cancer while proto-oncogenes can enhance an oncogene or produce an oncoprotein that enhances cancer. Tumor-suppression genes play a role in preventing cancer by maintaining balance and regulating cell division, life, and death under normal conditions. However, when this balance is disrupted, it can lead to diseases like leukemia which is characterized by an abnormal increase in immature white blood cells called "blasts" and affects the blood or bone marrow. There are various diseases falling within the broad category of leukemia.

Cancer often occurs due to the overexpression or alteration of specific genes, known as oncogenes or proto-oncogenes. HRAS and other oncogenes have been identified as the cause of a higher number of breast cancer cases in families with no other known exposure (Hall et al., 1989, p. 577). Unlike random mutations, this type of cause typically follows patterns of inheritance or infectious routes (p. 578). Additionally, a decrease or loss of function in tumor-suppression genes can also contribute to the development of a cancer phenotype.

The risk of developing breast cancer is increased by the presence of BRCA1 and BRCA2 mutations in the breast (Ford, et al., 1998, p. 676). The prognosis and available treatment options

for breast cancer depend on whether tumors are classified as malignant or benign. Malignant tumors have the ability to spread to other parts of the body (Siddhartha, 2010, para. 3), while benign tumors do not have this capability (Siddhartha, 2010, para. 44). However, differentiating between these categories is primarily based on previous epidemiological evidence (Nelson, et al., 2009, p. 730).
Cancer classification and staging also play a crucial role in determining prognosis and treatment. In the past, any detection of breast cancer would result in a recommendation for radical mastectomy - removal of all breast tissue and supporting lymph tissue (Siddhartha, 2010, para. 60).

Staging is increasingly important due to the availability of a wide range of treatment options. It is graded from 0 to 4, with some stages having subgroups. A stage 0 tumor, like carcinoma in situ, indicates containment and localization (Greene, 2002, Vol. 1). Conversely, stage 1 suggests no spread and a smaller size (<2 cm) (Greene, 2002, Vol. 1). The key distinction between stage 0 and stage 1 is that a stage 1 tumor can alter the shape of affected tissue compared to normal tissue and displace nearby normal tissue.

Stage 2 is divided into two parts: Stage 2A and Stage 2B. In Stage 2A, tumors are between 2cm and 5cm in size without lymph node involvement or smaller than 2cm with local lymph node involvement. In Stage 2B, tumors are larger than 5cm without lymph node involvement or smaller than 5cm but larger than 2cm with local lymph node involvement.

Stage three, also known as locally advanced breast cancer, has three sub-stages: Stage3A, Stage B3, and Stage C3. In Stage3A, the tumor

is larger than5 cm and has spread to the local lymph nodes. In Stage B3, the tumor can be any size but has spread to other areas like internal mammary lymph nodes, chest wall or skin. Finally, stage C3 indicates extensive spreading of the tumor involving multiple lymph nodes regardless of its size.

Stage four indicates that the cancer has spread to a distant site. For more information on different stages of breast cancer please click [http://www.m.everydayhealth.com/breast-cancer/breast-cancer-stages].

During an interview with Jenna Clapham CNMT she mentioned that after removing all malignant masses there remains a lesion.

A procedure called Lymphoscintigraphy is performed to detect if the cancer has affected the surrounding lymph nodes. This procedure takes place in a Nuclear Medicine Department. The doctor injects a radioactive isotope called sulfur colloid mixed with methylene blue dye subcutaneously in four places around the lesion. The injected isotope follows the lymph tract and travels to any affected lymph nodes. If any nodes light up during the scan, the surgeon plans surgery to remove them.

The surgeon can accurately locate and remove the affected node with the help of blue dye used in surgery. In 2007, there were 202,964 women diagnosed with invasive breast cancer resulting in 40,598 deaths, according to the Center for Disease Control and Prevention. Additionally, during that time period, there were 50,944 cases of in situ breast cancer.

According to a study by the Cancer Statistics Working Group and others (1999-2007), in 2007, the estimated population of the United States was 301,139,947 after adjusting for growth rates, immigration rates, and the 2010 US Census population of 308,745,538. Among this population, there were an estimated 152,707,884

females and 148,432,063 males. On January 1st of that year alone, there were a total of 2,591,885 cases of breast cancer in women and 13,326 cases in men (Howlader et al., 2011). This gives us a prevalence rate of 1697 per 100000 for women and8.8 per100 ,000for men. When considering those who already have cancer,the incidence rate for invasive breast cancer among at-risk females in the United States during that same year was calculated to be135 per100 ,000 while it was34per100 ,000forin situ breast cancer (Howlader et al.,2011). Another diagnostic model from2003-2008estimatedthe incidence rate for women to be124 .0 per100 ,000(Howladeret al.,2011). It is worth noting that this SEER model does not account for women who have already been diagnosed with some form of breast cancer or systemic cancer that would exclude them from being considered as an incidence case of breast cancer(Hayatetal.,2007,p.24andHowladeretal.,2011).According to the CDC, breast cancer incidence rates in women in the United States are estimated to be 120.4 per 100,000 (95% CI: 119.8-120.9) (U.S.CancerStatisticsWorkingGroup, et al., 1999-2007). However, these rates vary across different states. Rhode Island has the highest incidence rate at 139.2 per 100,000 women (95% CI: 130.1-148.8), followed by Connecticut with a rate of 133.0 per 100,000 women (95% CI:129-139). On the other hand, Utah and Arizona have the lowest rates at103.5per100,000women(95%CI:97-110)and99.per100,000women(95%CI:97-103), respectively.The regions with the highest incidence rates are New England,Midwest,and NorthwestwhiletheSouthwestandPlainsregionshavethelowestrates(U.S.CancerStatisticsWorkingGroupetal.,1999-2007).

The incidence of breast cancer varies among different races, with white women having the highest risk. The highest incidence rate for white women occurs in their 70s at around 430 per 100,000 women (Howlader, et al., 2011). On the other hand, Alaskan Natives and American Indians have the

lowest risk, with a peak incidence rate of approximately 230 per 100,000 at the age of 75 to 79 (Howlader, et al., 2011). There are no statistically significant differences in risk among Asian Pacific Islanders, Alaskan Natives, and American Indians (Howlader, et al., 2011).

Even though breast cancer risk increases with age, there were still 9,663 new cases diagnosed in women under the age of 40 in 2007 (U. S. Cancer Statistics Working Group et al.,1999-2007). This accounts for about4.76% of all breast cancer cases diagnosed in women that year. The National Cancer Institute considers the age of 40 as a cut-off point for regular screening mammograms. They recommend getting screened every1 to2 years startingatage40(NationalCancerInstitute,20I0;and Saarenmaaemail.et.al.1999,p.I118).Some argue for starting screening at age 30 but conducting it less frequently to minimize the chance of missing early diagnoses, reducing the rate from 4.6% to 0.10%(Howlader et.al.,2011;National Cancer Institute,2010; and Saarenmaa et.al.,1999,p.I118). The financial impracticality of screening a large population to catch a few cases is recognized. According to the National Cancer Institute (2010), self-examinations are recommended for women under 40, while mammograms are recommended afterwards. The U.S. Cancer Statistics Working Group et al.(1999-2007) found that women who live beyond neonatal age have a lifetime risk of developing breast cancer at around 12%.

The table below presents the estimated risk percentages for developing breast cancer over various time spans and ages, including data for 10, 20, and 30 years at the ages of 30, 40, 50, and 60 (per 100).

Table 1: Ten, Twenty and Thirty Year Risk of Developing Breast Cancer
|Age |10 Year Risk (%) |20 Year Risk

(%) |30 Year Risk (%) |
|30 |0.43 |1.86 |4.13 |
|40 |1.43 |3.75 |6.87 |
|50 |2.38 |5.60 |8.5 |
|60 |3.45 |6.71 |8.66 |

Mortality rates (MR) associated with breast cancer differ from incidence rates and are not evenly distributed among races due to variations in diagnosis timing.

One interesting observation is that despite white women having a higher incidence rate, their mortality rate is lower compared to other races (U.S.Cancer Statistics Working Group et al.,1999-2007). In contrast, black women consistently experience higher mortality rates than white women across all age groups but particularly between the ages of 50 and 60.

The cancer incidence rate for black and white women in the age range of 1999-2007 is not statistically different (S. Cancer Statistics Working Group, et al., 1999-2007), but the mortality rates for all other races at all ages were significantly lower than the incidence rates (U. S. Cancer Statistics Working Group, et al., 1999-2007). It should be noted that the distribution of mortality rates across the United States differed from that of the incidence rates.

According to the U.S. Cancer Statistics Working Group, et al., 1999-2007, the states East of Texas had higher rates. Among women, the District of Columbia reported the highest rate at 31.5 per 100,000 (95% CI: 25.8 to 39.3), while New Jersey had a rate of 26.1 per 100,000 (95% CI: 24.7 to 27.5). Conversely, Hawaii and Colorado had the lowest rates for women with rates of 16.9 per 100,000 (95% CI:14.1 to20 .1) and18 .6per100 ,00(95 %CI :16 .9to20 .4 ) respectively.

The survival rates for breast cancer can differ depending on various factors such as age at diagnosis, type

of cancer, stage of the disease, time since diagnosis, and treatments given. These rates are usually presented as five and ten year rates, which show the percentage of people who survive after being diagnosed with a specific form of breast cancer. Between 2004 and 2006, the overall five-year survival rates were 88% in women and 79% in men for all invasive types (U. S. Cancer Statistics Working Group et al., 1999-2007; Howlader et al., 2011). Unfortunately, there is currently no available data on the ten-year survival rates during this period. It's worth noting that older ten-year survival rates may not accurately represent current expectations due to advancements in treatment, diagnostics, and preventive measures over the past twenty years. Considering how these studies influence policy decisions and resource allocation, it is crucial to examine potential factors that contribute to variations between similar studies conducted on the same or related populations.

The differences observed in these studies may be attributed to random variation, with some varying by 4 or more standard deviations. Moreover, disparities in the rates of breast cancer occurrence could be influenced by human error during diagnosis and individuals' willingness to seek help. Another potential source of inaccuracies is the failure to precisely calculate the population at risk. For instance, based on the SEER report, it is estimated that the incidence rate for breast cancer among women is 124.0 per 100,000 women (U.S. Cancer Statistics Working Group, et al., 1999-2007).

The rate of breast cancer among women is estimated to be 120.4 per 100,000 according to the CDC. However, our calculations show a slightly higher rate of 135 per 100,000 (Howlader et al., 2011). The

SEER used a rolling diagnostic model, while the CDC employed a sampling model and this paper utilized a one-year total count with an adjusted at-risk population. It's important to note that the CDC's model assumes all women with breast tissue can develop breast cancer without considering underdiagnosis in individuals with other types of cancer (U.).

The reported rate of 135 per 100,000 for cancer cases may not be accurate according to the S. Cancer Statistics Working Group (1999-2007). This is because it does not take into account that some cases are diagnosed as incidence cases and the undercounting in the census. These factors can artificially decrease or increase the true incidence rate. Therefore, it is expected that the actual rate falls between the CDC's rate of 120.4 per 100,000 women and the adjusted rate of 135 per 100,000 women. Additionally, there is a possibility of errors within the studies themselves.

Neglecting to follow up can raise the likelihood of death or disease progression, particularly for age-related illnesses. Research using sampling methods may introduce bias due to lag time, as individuals who exit or pass away from the study may actually be at a higher risk at their departure compared to when they initially joined. Even with adjustments made to ensure similarity between those who leave and those who remain in the study, incomplete representation of person-years at risk across all age groups can still affect the findings.

According to studies conducted by the U.S. Cancer Statistics Working Group (1999-2007), Howlader et al. (2011), and McCarthy (1998, p. 729), the main reason for the decline in breast cancer rates among women over 80

years old is believed to be the rapid decrease in breast cancer cases. Another potential factor that could contribute to error is lead time bias, which occurs when there is a gap between the development and diagnosis of breast cancer, especially in studies analyzing risk within a specific timeframe. In these cases, some women may develop breast cancer towards the end of the risk period and only receive a diagnosis after the study period.

In a stable condition, the correlation between age and the probability of developing breast cancer would remain the same. Nonetheless, improvements in diagnostic tests and procedures could make it seem like there is a higher perceived risk of developing breast cancer at a younger age, even if the actual risk stays unchanged. It is crucial to recognize that not all studies carry the same weight. Because breast cancer and its treatment have significant financial implications, groups with vested interests often present studies that support their preferred treatments.

When presenting during grand rounds, the radiation treatment facility at a hospital is likely to give priority to studies that show the positive outcomes of combining surgery with radiation treatment. These studies are more influential in convincing physicians to recommend evidence-based treatments within their area of expertise. It should be noted that not all studies may be accessible to the public due to their source. Additionally, since breast cancer primarily affects superficial tissues, symptoms may not be noticeable until the disease has progressed.

It is crucial to be aware of the signs and symptoms of breast cancer, including feeling breast lumps or thickenings that differ from surrounding tissues, experiencing a

bloody discharge, noticing rapid changes in the size or shape of the breast (especially if it is unilateral), observing dimpling or other skin changes over the breast, having an inverted nipple, and experiencing peeling, scaling, or flaking of the nipple or breast skin (Mayo Clinic Staff, 2011). Additionally, it is important to understand that genetic factors can increase one's risk of developing this condition.

Breast cancer risk factors include a higher spike in hormones, particularly estrogen, which can increase the risk of breast cancer (Wysowski, et al., n.d., 791). Other risk factors include the age when the first menstrual period starts, the age at menopause, and the age at which a woman has her first child; younger ages for each of these factors indicate a higher risk (Helmrich, et al., 1983 p.36). The use of oral contraceptives has also been shown to increase the risk of breast cancer (Vessey, Baron, Doll, McPherson, and Yeates, 1983, p.455). Obesity, physical inactivity,and diets high in fat are also considered as risk factors (Helmrich et al., 1983 p.36). Furthermore alcohol consumption has been associated with an increased risk of breast cancer. Additionally,it is observed that white women have a higher risk compared to other races due to possible access to care and diagnosis issues(Howladeret al.,2011).

Screening plays an important role in detecting breast cancer early. For example,a screening mammogram can reduce mortality rates by 20% to 35%in women aged50to69(Elmoreet al.,2005,p1245).

Breast cancer screening methods consist of self-examination, clinical examination, and mammograms. According to the National Cancer Institute (2010), it is advised for women to regularly perform breast self-exams in both standing and lying positions. If any

abnormalities are discovered, a clinical exam should be conducted. Regular check-ups involving a clinical exam are also recommended. If any irregularities are detected during the clinical exam, a diagnostic mammogram is carried out to visualize possible tumors. This particular type of mammogram is utilized for diagnosing suspected tumors.

The National Cancer Institute (2010) recommends regular screening mammograms from age 40. These differ from diagnostic mammograms, which require more time and x-rays to capture various angles of the suspected tumor. Previously, cancer treatment often involved risky surgery or allowing natural progression. However, Siddhartha (2010) notes that there are now numerous patient-specific treatment options based on factors such as cancer type, tissue origin, stage, and grade.

The main treatment options for breast cancer include surgery, radiation therapy, chemotherapy, hormonal therapy, and targeted therapies (Siddhartha, 2010). Surgery is the oldest and initial form of treatment for breast cancer. The concept behind surgery is that if the cancer is detected early enough and completely removed from the body, further potentially harmful treatments may not be necessary (Fisher et al., 1989, p. 822). Types of surgery can range from a partial mastectomy to a full or radical mastectomy where part or all of the breast is removed.

The complete removal of the breast, chest muscle (including pectoralis major and pectoralis minor), and axillary lymph nodes is known as a full or total mastectomy. On the other hand, a lumpectomy involves surgically removing a single lump.

Radiation therapy can be used in addition to surgery or as an alternative. There are various methods for administering radiation, including external radiation therapy, internal radiation therapy, and intraoperative radiation therapy.

External radiation therapy involves using

an external machine to emit beams of radiation onto the targeted area.

The insertion of radioactive material internally in the body aims to target cancer cells and reduce their likelihood of recurrence by 70%, although it also raises the risk of developing other cancers like leukemia (Curtis, 1992, p. 1748). Chemotherapy has been a widely employed method for treating cancer since the 1940s. It utilizes toxic chemicals that selectively attack cancer cells more than normal cells. These chemicals exploit the fast growth rate of cancer by targeting rapidly dividing cells (Siddhartha, 2010).

In the context of breast cancer, there are three primary objectives to consider. The first objective is adjuvant therapy, which aims to prevent or delay the recurrence of cancer after initial surgery, radiation, or other treatment (Slamon, et al., 2001, p. 783). The second approach is neo-adjuvant therapy, which involves shrinking the tumor before surgery. This method can assist with the surgery by highlighting cancer cells or reducing the amount of tissue that needs to be removed (Coudert, et al., 2006, p. 409).

Jenna Clapham CNMT explains the bone scan procedure that is performed after surgery. The purpose of this procedure, according to Clapham, is to check for any spread of cancer to other areas. It is common for cancer to metastasize and reach the bones in such cases. The process involves injecting a radioactive isotope into the arm, which takes three hours for results to show. Following this, a scan of the entire body is conducted to look for any signs of metastasis (Clapham, 2012). Furthermore, Siddhartha (2010) states that chemotherapy is frequently used as a treatment for breast

cancer once it has spread.

The selection of drugs for treatment is determined by the stage of cancer and the desired treatment outcome. After surgery, chemotherapy is administered to eradicate cancer cells and lower the chances of recurrence in early-stage cancer. In advanced cases, chemotherapy aims to weaken and eliminate cancer cells as effectively as feasible. Adverse effects vary depending on the potency of the chemical agent employed, which has led to an increase in the use of targeted therapies that are continually being developed.

HER2-overexpressing tumor is an example of a directly targetable tumor, which allows for better direction of chemical agents towards the tumor (Coudert, et al. , 2006, p. 411). This approach helps decrease drug concentration and minimize side effects (Coudert, et al. , 2006, p. 415). Other targeted therapies include herceptin, tykerb, and avastin. Herceptin inhibits growth-promoting chemical signals, tykerb blocks growth-enhancing proteins, and avastin hinders blood vessel development.

In certain cases where chemotherapy and radiation treatment may be too severe, patients may choose palliative care. In such situations, the primary goal is not to directly combat cancer but to improve the patient's quality of life for as long as possible.