Introduction
Breast cancer is the leading cancer commonly diagnosed in women in the entire world, and a major cause of cancer mortality in this population (Jemal et al. 2010). This cancer affects more than 1.3 million women, and more than 400,000 women die. The survival rates from breast cancer vary; low-income countries have a survival rate of 40%, while middle and high-income nations have a 60% and 85% survival rate, respectively. Research studies show controversial results with regard to statistics and interventions; hence, more studies are required to draw conclusive evidence. Despite efforts to reduce the morbidity pattern of breast cancer, it remains the most common cancer worldwide. Therefore, there are relentless efforts to come up with strategies to reduce its occurrence and associated effects. This is enough to keep research and study of breast cancer an ongoing venture.
Pathophysiology
Breast cancer can either be invasive or non-invasive. Non-invasive breast cancer does not spread outside the breast, and the commonly known is ductal carcinoma in situ. Invasive breast cancer has the ability to spread and accounts for 80% of breast cancer cases. The common type is invasive ductal breast cancer.
Breast cancer does not cause symptoms at the onset; hence, the reason why one should have regular screening. As the cancer grows, one can feel a hard, rugged and painless breast lump in the armpit. The breast or breast nipple may change in size, feel or shape. A bloody and pus-like fluid may exude from the nipple. Advanced breast cancer is associated with bone pain, skin ulcers, breast pain or discomfort, weight loss and swelling of the breast, especially near to the cancer.
Diagnosis
Consistent mammography screening is deemed important in reducing the mortality rate attributed to breast cancer (U.S. Preventive Services Task Force, 2009). As noted earlier, the survival rates from breast cancer vary depending on the country. According to Jemal et al. (2010), this variation is partly due to nationwide screening programmes, whose availability varies in different countries. Screening programmes are effective in early detection of breast cancer to prevent progression to advanced stages. Breast cancers detected at screening are often smaller, and have not yet spread beyond the breast. In a review study by the U.S. Preventive Services Task Force (2009), breast cancer can be detected by a clinician (CBE), the patient (BSE) or mammography. In the recent years, however, there have been improvements in the quality of mammography.
Clinical breast examination (CBE) is used to detect breast cancer in certain areas of the world, where the use of mammography is not practical, like in India. Film mammography and digital mammography identify particular cases of breast cancer; “some cases detected by film mammography cannot be detected by digital mammography” and the same prevails for digital mammography (U.S. Preventive Services Task Force, 2009). However, the U.S. Preventive Services Task Force suggests that higher detection is observable with digital mammography.
Impact of Disease
Breast cancer takes a huge toll on the general well being of the victims. Women, the main victims, suffer greatly from psychological trauma in addition to the economic and social burden. The disease requires financial support and if the woman doesn’t work, or has stopped working, this may turn out to be a great economic challenge for the entire family. Young women develop a negative perception about their body image due to the side effects of treatment. Young women experience early menopause that may affect how they perceive themselves as women. The relationship between sick women and other people is greatly affected because their distress does not allow them to open up. In addition, sexual interest is lost, and an unsupportive spouse may make things worse (NHS, 2012).
Psychological Impact
When a woman is diagnosed with breast cancer, she feels devastated, depressed and does not know where to turn for assistance. Being diagnosed with cancer is perceived as a threat to life. Even as the treatment process begins, women find themselves in more psychological turmoil due to stressing personal relationships, worry and discrimination. Depression hinders women from seeking treatment, and they lose the zeal to fight. Psychological effects of breast cancer diagnosis are persistent, even after therapy, because the patients are scared of recurrences. A review by Ewertz & Jensen (2011) indicates that most women live in fear of cancer recurrence for the rest of their lives. As a result of this fear, the patients may lead restricted lives.
During disease management, the effects of treatment tend to vary for different individuals. However, there is a feeling of lethargy that affects productivity of an individual. It also causes early menopause in younger women, affecting their fertility. Drugs used during treatment also have a negative effect on fertility. The effects of the disease and treatment on an individual extend up to the societal level. The normal family setup may be disrupted as relationships and responsibilities change. In cases where the breadwinner is affected, for example, in single-headed households, children may be exposed to undue pressure and strain. While some people may resume work, others feel they are treated unfairly with regard to promotions and criticisms (Memorial Sloan Kettering Cancer Center, 2014). It is surprising to realize that there is little scientific evidence on the effects of breast cancer since it is the main cause of morbidity and mortality, in comparison to other cancers.
Interventions
Prevent Disease
Early screening
Timely and early detection of breast cancer is associated with prompt treatment that prevents the cancer from spreading.
Medicine
According to Visvanathan et al. (2013) pharmacological interventions that entail selective estrogen receptor modulators and aromatase inhibitors are effective in reducing risk of breast cancer. Tamoxifen and Raloxifene are the most common drugs used for breast cancer prevention. They are presumed to reduce the incidence of breast cancer by 50%.
Prophylactic Mastectomy
This entails the removal of either one or both breasts. Risk of breast cancer is reduced by 90% in women who have had bilateral prophylactic mastectomies. This procedure is taken up by women who have a very high risk of breast cancer due to previous breast biopsies showing atypical ductal or lobular hyperplasia coupled with a strong family history of breast cancer (Chang & Prati, 2014).
Treatment
Effective treatments include:
- Radiation
- Chemotherapy, which encompasses hormonal treatment
- Surgery
Preventing Complications
Medicine
In a study by Stopeck et al. (2010), bone complications were reduced five months longer when using XgevaTM (denosumab) than zoledronic acid. Xgeva contains a special protein that controls the activity of RANK ligan, a body protein that regulates the function of osetoclasts.
Safety and care
Patients who suffer from lymphedema, swelling due to damaged lymph nodes and vessels, causing accumulation of fluid in various parts of the body. There is no cure for lymphedema, but special care to avoid injury and infection should be observed. Patients with lymphedema should avoid exerting even the slightest pressure, such as wearing tight fitting clothes, staying in a fixed position for too long, exercises or hot temperature, on the affected part.
Drug Choice
Cardiovascular complications and preventive interventions are yet to be fully studied. As of now, there is no known intervention that can be pointed out as a preventive strategy for cardiovascular complications. However, studies show that doctors should thoroughly investigate risk factors for cardiovascular complications; hence, avoid them. For example, doctors could avoid the use of drugs known to trigger cardiovascular complications such as anthracyclines, carboplatin and cyclophosphamide.
Education
Family members need to be educated on how to live and handle a patient with breast cancer. To begin with, they should be educated on accepting the condition as it is and avoid being stressed out. This is meant to help the patients cope without external stress from family members. Family members should offer encouragement to the patients because more than anything else, patients are distressed and this affects their ability to cope and fight the disease. Family members should learn ways to seek support from family, friends and social institutions. This will lessen the financial strain that could impede access to health care.
Conclusion
Despite the fact that breast cancer is top on the list of most common cancers, it is worrying that research on this cancer is not as high as expected. There is a lot of theory on what to be done and not to be done, but actual scientific evidence to verify these claims, is missing. Despite the fact that survival rates have risen, mortality due to complications associated with breast cancer and therapy continue to pose as a great threat to life. Research on breast cancer is therefore ongoing to reduce the associated mortality rate and address prevailing gaps.
References
Chang, H., & Prati, R. (2014). Breast Cancer Prevention. UCLA Health. Web.
Ewertz, M., & Jensen, A. B. (2011). Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncologia, 50, 187-193.
Jemal, A., Bray, F., Center, M., Ferlay, J., Ward, E., & Forman, D. (2011). Global Cancer Statistics. CA CANCER J CLIN, 61, 69-90.
Memorial Sloan Kettering Cancer Center. (2014). Web.
NHS. (2012). Breast cancer (female)-living with breast cancer. Web.
Stopeck, A., Martin, M., Ritchie, D., Body, J., Paterson, A., Viniegra, M., … Braun, A. (2010). Effect of denosumab versus zoledronic acid treatment in patients with breast cancer and bone metastases: results from the extended blinded treatment phase. Cancer Research, 70(24), P6-14-01.
U.S. Preventive Services Task Force. (2009). Screening for Breast Cancer: Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 151(10), 716-726.
Visvanathan, K., Hurley, P., Bantug, E., Brown, P., Col, N., Cuzick, J., … Lippman, S. M. (2013). Use of pharmacologic interventions for breast cancer risk reduction: American society of clinical oncology clinical practice guideline. Journal of Clinical Oncology. Web.