A dip in the sea, hot coffee on cold days, the smile of the one you love, a tight hug…
With distancing due to the pandemic, simple moments in our daily lives have become even more precious. Appreciating life every day also involves taking care of your health. As hard as it may sound, it involves facing illnesses as well.
Especially in the case of breast cancer, the chances of cure increase considerably when discovered in its earliest stage. Therefore, keeping the exams up to date is the key to cherish, enjoy, and continue living these moments in full health.
WHAT IS BREAST CANCER?
Because we avoid even saying the name, many people also do not know how and why this disease arises – and especially in the breasts.
Breast cancer is formed by the abnormal proliferation of cells in the breast tissue in a rapid and disordered manner as a result of genetic changes. However, this does not mean that breast cancer is always hereditary.
In the normal functioning of our body, old cells are replaced by new cells. Genetic mutations can alter the cell’s ability to keep its splitting under control,
forming tumors. Benign tumors are not cancerous and are close to normal in appearance, do not invade neighboring tissues, and do not spread to other parts of the body. Malignant tumors, on the other hand, are cancerous, and if their cells are not controlled, they can grow and invade other parts of the body.
Breast cancer is a malignant tumor that develops from cells in the breast,
usually beginning in the cells lining the mammary duct. More seldom, it can
start in other breast tissues, such as adipose and fibrous tissues.
WHAT CAUSES BREAST CANCER?
Breast cancer has no single cause, and several factors are related to the increased risk of developing the disease:
GENETIC / HEREDITARY FACTORS
Changes in genes can be acquired or inherited, and although about 90% of breast cancer cases do not have a hereditary origin, these have been
linked to the presence of mutations in certain genes, the most
common genes being BRCA1 and BRCA2.
Women who have several cases of breast cancer and/or at least one case of ovarian cancer in consanguineous relatives, especially at a young age, in addition to a case of breast cancer in men (also in a consanguineous relative), may have a hereditary predisposition to developing the disease and are considered to be at high risk.
Older women, especially after the age of 50, have a higher risk of developing breast cancer. With aging, the accumulation of exposures and biological changes increase this risk in general.
They are mainly related to stimulation by the hormone estrogen, with the risk increasing with greater exposure. The factors are: early menarche (first menstruation), late menopause, first menstruation after the age of 30, nulliparity (women who have never had children), and hormone replacement therapy after menopause.
BEHAVIORAL / ENVIRONMENTAL FACTORS
They include alcohol intake, overweight and obesity, sedentary lifestyle, and exposure to ionizing radiation, and are proportional to dose and frequency. Regarding smoking, there is suggestive evidence of increased risk of developing breast cancer especially in premenopausal women.
Breastfeeding provides some protection from breast cancer, and the use of oral contraceptives has not been associated with the development of breast cancer according to recent studies.
HOW TO CONTINUE THE CARE?
Now that you know what may or may not contribute to the appearance of tumors and have understood the importance of keeping good habits in your daily life, the second step is to keep your doctor’s appointments up to date. How long has it been since you have seen a gynecologist or mastologist?
Thanks to the periodic examinations recommended by doctors, it is possible to detect tumors at an early stage and thereby achieve up to 95% chances of cure. It is worth scheduling an appointment every year, isn’t it?
Along with routine procedures requested by gynecologists, such as ultrasounds and Pap smears, doctors order specific tests to detect breast cancer.
The National Commission of Mammography, composed of the Brazilian Society of Mastology (SBM), the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO), and the Brazilian College of Radiology and Diagnostic Imaging (CBR), recommend annual screening mammography starting at age 40 for women at usual risk, and starting at age 25-30 for high-risk women.
However, to clarify diagnoses with tangible changes, mammography should be performed at any age whenever necessary.
It consists of an X-ray examination of the breasts that searches for changes that could be signs of breast cancer. Screening mammography is done to look for signs of breast cancer in women without symptoms, by taking 2 images of each breast from 2 different angles.
If there are any symptoms or any changes in the screening mammogram, diagnostic mammography is performed, and may include extra images of the breast that are not part of the screening mammogram.
As for its safety, because it uses small doses of radiation, the benefits outweigh the risks of X-ray exposure. If you suspect pregnancy, inform your doctor and the X-ray technician.
Ultrasonography is useful to analyze some breast changes not seen on mammography or in women with very dense breasts. It is a complementary exam to mammography, capable of differentiating nodules from fluid-filled cysts, as well as identifying solid masses and serving as a guide for biopsy exams.
MAGNETIC RESONANCE IMAGING
MRI is not recommended alone as a screening test, since there are still some types of breast cancers that can only be diagnosed by mammography. It is mainly used in women who have already been diagnosed with breast cancer to more accurately determine the size of the tumor and the existence of coexisting lesions in the breast. It is also recommended along with mammography in patients at high risk for breast cancer.
CLINICAL EXAMINATION AND BREAST SELF-EXAMINATION
There is little evidence that the physical examination of the breasts alone helps in the early diagnosis of breast cancer. However, it is important that all women know the characteristics of their breasts and, in the case of the appearance of any alteration, immediately notify their doctor.
It is the removal of a small sample of tissue to evaluate the presence or absence of cancer. There are several types of biopsies, such as fine needle aspiration (FNAB), core biopsy, and surgical biopsy, each with its pros and cons.
The doctor’s choice of method depends on some specific factors, such as location, number of tumors and other clinical problems, as well as the patient’s personal preference. If any changes in the breast are detected during the imaging exams, the doctor sends the material to be identified.
So always wait for the results and the doctor’s advice.
Technological advances of different diagnostic tests offer new opportunities to improve clinical care for both high-risk patients and patients already diagnosed with breast cancer.
The search for mutations in the BRCA1 and BRCA2 genes is being encouraged in the case of patients who meet specific criteria, with hereditary susceptibility mainly for cases of breast and ovarian cancer.
In the case of patients already diagnosed with breast cancer, gene expression profiling can assess tumor behavior in response to chemotherapy or radiotherapy and map the risk of tumor recurrence.
EVEN IF YOU DO ALL THE TESTS, BE SURE TO LOOK OUT FOR SIGNS THAT COULD BE AN INDICATION OF CANCER:
- A stationary and usually painless nodule
- Reddened, retracted, or orange peel-like skin
- Nipple alterations
- Nodules in the neck or armpit
- Liquid leaking from the nipples
If you notice any of these, see your doctor immediately!
AND IF IT'S BREAST CANCER?
Every year, technology and medicine advance towards more and more effective and less invasive treatments. In other words, there are many possibilities in the search for a cure.
Since not all cancers are the same, treatments also vary according to the type and stage of the disease:
It is based on the use of ionizing radiation to destroy or inhibit the growth of the abnormal cells that form the tumor, but not all women diagnosed with breast cancer are indicated for radiation therapy. The main short-term side effects are fatigue, feeling of heaviness and swelling in the breast, and skin changes at the irradiated site.
It is treatment with drugs used to destroy the cells that form the cancer and can be administered orally or intravenously (injection into the vein). Chemotherapy is administered into the bloodstream so that it can target diseased cells throughout the body.
Depending on the type and dose of the drugs, they can cause side effects such as hair loss, nail changes, sores on mucous membranes (such as the mouth), changes in appetite, nausea and vomiting, diarrhea, infections due to decreased immunity, bruising, fatigue, and changes such as tingling, sensitivity to cold or heat, and irritability in the feet and hands (hand-foot syndrome).
These effects usually go away after the treatment is over, and there are ways to prevent and lessen them. It is important to talk to your doctor to find out about the best way to manage the side effects of the medication you are taking.
In the case of young women, menstrual and/or fertility changes are common effects. Therefore, if a woman is thinking of becoming pregnant after treatment for breast cancer, it is essential that she talks to her doctor before starting treatment.
Some drugs can cause heart problems called cardiomyopathy, and heart function is usually monitored by the doctor during treatment.
One of the ways to inhibit the growth of malignant cells in breast cancer is to eliminate the production of female hormone, mainly estrogen. In breast cancer, hormone therapy is indicated for tumors that are positive for hormone receptors.
In an attempt to reduce the action of estrogens on tumor cells, the medications act by reducing the concentration of hormones in the circulation or by blocking hormone action in the cells.
Possible side effects are associated with the lack of estrogen in the female body, such as symptoms similar to those found in menopause, vaginal bleeding, thromboembolic phenomena, bone pain, and loss of bone mass.
Despite the described side effects, it is a type of therapy that is well tolerated by patients and has a very good level of effectiveness with respect to tumor growth and is one of the most widely used lines of treatment in breast cancer.
It is a type of treatment that uses medications that specifically identify and attack the cancer cells, causing little damage to normal cells. As in chemotherapy, the drug enters the bloodstream and reaches almost all areas of the body, being useful in the treatment of more advanced disease stages and can even enhance other types of treatment.
The side effects are generally milder, but some can be very serious, such as heart disease, liver problems, lung symptoms, and a drop in immunity.
It is a type of therapy that uses drugs to stimulate the immune system to effectively destroy cancer cells. The possible side effects are fatigue, coughing, nausea, loss of appetite, and intestinal changes.
Other more serious side effects can occur, however with less frequency, due to the immune system attacking other parts of the body, and can cause changes in the lungs, liver, kidneys, hormone-producing glands, and intestines. For this reason, it is important to see your doctor if you notice any new side effects.
In recent years, there have been important advances in the surgical treatment of breast cancer. And, today, there are options for less mutilating surgeries, as well as treatment individualization. The indication of the technique varies according to the stage of the disease, the biological characteristics of the tumor, and the patient’s conditions (age, menopausal status, preference, and the presence of comorbidities).
In general, we had an increase in the number of conservative surgeries, with a consequent reduction in postoperative complications and a positive impact on the patients’ quality of life.
In the past, every woman who had to have her breast removed due to a breast cancer diagnosis was forced to live without one or both breasts, and few patients were able to have a breast reconstruction or an implant.
This scenario has changed and, by law, mastectomized women have the right to have their breasts reconstructed in the same surgical procedure. The Brazilian Society of Mastology understands that breast reconstruction is part of the treatment because it affects not only the aesthetics and sexuality of women, but mainly their self-esteem.
HOW TO GET ON WITH LIFE?
Experiencing breast cancer treatment, or supporting a loved one at that moment, is not an easy task. But with proper monitoring at all stages, it is possible.
So, share quality information, maintain good habits on a daily basis, and see your doctor every year to enjoy – in good health – the moments that make life worth living.
And life always comes first.
Technical Manager: Dr. Sérgio Hércules – CRM (Regional Medical Council) 61.605