Breast and breast cancer, need awareness.…….
Breast, also called mammary gland, is a specialized accessory gland of skin that is present in both sexes but well developed in adult females.It secrets milk that is source of nourishment for the new born baby.
Breast constitutes of 15-20 lobes composed of tubulo-acinar glands. Each lobe is drained by a duct that opens on the surface of breast nipple. Each duct is divided into terminal ducts leading to a lobule with multiple acini. This is known as terminal-duct lobular unit. Being the most important and physiologically active part it is site of origin for most breast pathologies. Breast cancer is most common cancer among women and is alarmingly increasing in the asian population.within Asia the highest rate of cancer is seen in Pakistan.
cancer is actually uncontrolled growth of abnormal cells that can arise from any part of breast and involve the surrounding structures. The breast cancers are divided into benign and malignant cancers. The benign ones do not metastasize ,are cured by simple excision and simply not the dangerous ones. The malignant tumors are those which can involve lymph nodes as well as other organs and are those which can be fatal.benign tumors are treated successfully with simple excision but the malignant tumors need extensive surgery alongwith hormonal treatment and chemotherapy depending on the subtype of tumor.
RISK FACTORS: The risk of breast cancer is increased by around 25% with use of oral contraceptive pills. Early menarche and hormone replacement therapy is also risk factor. Genetic mutations including BRCA1, BRCA2, PTEN, ATM and p53 are frequently associated with familial breast cancers making it important to have genetic testing in the cases where family members are involved and that too at young age. High socio-economic status and changing life style are also included among the risk factors.However breast feeding, child bearing and exercise lessen the risk of breast cancer. In contrast to frequent assumption that all the breast lesions are cancerous or pre- cancerous the reality is different.
The breast lesions are divided into proliferative and non-proliferative types. The proliferative breast lesions such as hyperplasia have the tendency to progress into cancer. The non proliferative lesions including infections do not progress to malignancy.
CLINICAL FEATURES: most of the lesions of breast regardless benign or malignant present as lump. Thus any lump or symptom should not be ignored as it could be the early manifestation of malignancy. Usually in advanced cases the presentation could be puckered skin, retracted nipple or bloody nipple discharge. Combination of Clinical examination, mammography and fine needle aspiration cytology FNAC known as triple test is required for definitive diagnosis.
TYPES OF BREAST CANCER: on the basis of extent of tumor involving the breast it is divided into two types. In situ carcinoma: in this type the cancer cells are limited to the duct and do not cross basement membrane. Invasive carcinoma: in this type the tumor crosses the basement membrane of ducts and invades into surrounding structures on the basis of histological feauters there is a long list into which breast cancers are classified. Few of them are ductal carcinoma, lobular carcinoma, mucinous carcinoma, papillary and micropapillary carcinoma. The cancers of breast not only arise from the ductal system rather the fat. Vascular system and the overlying skin tumors are also included. Examples of such malignant tumors include angiosarcoma, lymphangiosarcoma and liposarcoma alongwith many others.
Biopsy of breast cancer followed by examination of histopathologist is done which establishes the histopathological diagnosis. In case of malignancy further subtyping is important for deciding therapeutic modalities, prognosis and 5 yr survival rate.This subtyping may require additional immunohistochemical stains.In addition to the subtyping, hormone receptor studies are also conducted with the help of immunohistochemical stains including ER,PR and Her2 neu.If the tumor is positive for ER, PR then those patients are subjected to hormonal therapy. If tumor is Her2 neu positive then targeted therapy is given to those patients.
This makes all these tests to be essentially included in the diagnostic work-up and the need is to make the patients aware of cost-effectiveness of these tests which lead to the therapies that improve 5-yr survival rates. .
Breast cancer is a curable tumor if diagnosed at initial stages. The subtypes even with better prognosis if diagnosed at very late stages can not have good prognosis. Ignoring initial symptoms and delaying in diagnosis can be fatal. Thus, know about breast cancer and spread the awareness to avoid mortalities related to a breast cancer which can be treated.
Dr saadia hafeez