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 Breast cancer occurs when abnormal cells
grow out of control in one or both breasts.
They can invade nearby tissues and form a
mass, called a malignant tumor. The cancer
cells can spread (metastasize) to the lymph
nodes and other parts of the body.
 Worldwide, breast cancer comprises 10.4%
of all cancer incidences among women,
making it the second most common type of
non-skin cancer (after lung cancer) and the
fifth most common cause of cancer death. In
2004, breast cancer caused 519,000 deaths
worldwide (7% of cancer deaths; almost 1%
of all deaths). Breast cancer is about 100
times more common in women than in
men, but survival rates are equal in both
sexes.
 26 females out of 100 females and 1 male for
every 105 males may be diagnosed with breast
cancer in the Philippines. Since the 1980s,
breast cancer ranks 1st among the top leading
cancers afflicting women in the Philippines
and ranks 2nd to lung cancer if both sexes are
considered. Its incidence starts to peak at the
age of 30 in women. (Source: Philippine Cancer
Facts & Estimates, PCSI, 2005.) However, it was
reported in 2004 that breast cancer cases in the
Philippines exceeded lung cancer by 685 cases
for both sexes. (source, UP-DOH report,
manila bulletin 2004)
 Recently, more women are presenting with
bilateral disease at an early age (30’s-40’s).
Generally, the disease is still being
diagnosed late in its course hence the
survival rate of breast cancer in the
Philippines is below 50%. Making the
situation more difficult, an estimated
seventy percent (70%) of breast cancer
patients in the Philippines are indigents.
 Alarmingly,
the Philippines has the highest
prevalence of breast cancer in Asia. (Source:
International Agency for Research on Cancer,
2004). In addition to the successful reduction in
fertility and westernization of the Filipino lifestyle,
the limited access to breast health contributes
significantly to its recorded highest prevalence in
Asia. Among the reasons for the limited access to
breast health in the Philippines include: location of
health facilities, limited income, high prices of
diagnostic tests and hospital care, low levels of
education, and the lack of breast cancer awareness.
 The breast self-exam is a way that you can
check your breasts for changes (such as
lumps or thickenings). It includes looking at
and feeling your breast. Any unusual
changes should be reported to your doctor.
When breast cancer is detected in its early
stages, your chances for surviving the
disease are greatly improved.
 A breast exam by a health professional (such
as your doctor, nurse, nurse practitioner, or
physician assistant) is an important part of
routine physical checkups.
 You should have a clinical breast exam at
least every three years starting at age 20 and
every year starting at age 40. A clinical
breast exam may be recommended more
frequently if you have a strong family history
of breast cancer.
 Mammography uses special X-ray images to detect
abnormal growths or changes in the breast tissue.
Mammograms performed on healthy, normal breasts
provide a baseline reference for later comparison.
 Using a machine and X-ray film made especially for
breast tissue, a technician compresses the breast and
takes pictures from at least two different angles,
creating a set of images for each of your breasts. This
set of images is called a mammogram. Breast tissue
appears white and opaque and fatty tissue appears
darker and translucent.
 In a screening mammogram, the breast is X-
rayed from top to bottom and from side to
side. A diagnostic mammogram focuses in
on a particular lump or area of abnormal
tissue.
 Breast ultrasound is a procedure that may be
used to determine whether a lump is a cyst
(sac containing fluid) or a solid mass which
could be cancer. If it is found to be a cyst,
fluid is typically withdrawn from it using a
needle and syringe (a process called
aspiration). If clear fluid is removed and the
mass completely disappears, no further
treatment or evaluation is needed.
 Ultrasound can also be used to precisely locate the
position of a known tumor in order to guide the
doctor during a biopsy or aspiration procedure.
Ultrasound helps confirm correct needle
placement.
 Ultrasound testing works by transmits high-
frequency sound waves, inaudible to the human
ear, through the breast. The sound waves bounce
off surfaces in the breast (tissue, air, fluid) and
these "echoes" are recorded and transformed into
video or photographic images
 Breast MRI (magnetic resonance imaging) is a
test that may be used to distinguish between
benign
(noncancerous)
and
malignant
(cancerous) areas. Performing this test may
reduce the number of breast biopsies done to
evaluate a suspicious breast mass. Although
MRI can detect tumors in dense breast tissue, it
cannot detect tiny specks of calcium (known as
microcalcifications), which account for half of
the cancers detected by mammography.
 A breast biopsy is the removal of cells or
tissue from a suspicious mass. The tissue or
cells are then examined under a microscope
to check for breast cancer cells. A biopsy
may be performed when an abnormal breast
change is found during a mammogram,
ultrasound, or physical examination. A
biopsy is the only way to determine if a
potential trouble spot is cancerous or
benign.
 There are many types of breast biopsy
procedures. The method recommended by
your doctor will depend on how large the
breast lump or abnormal area is; where in
the breast it is located; how many lumps or
abnormal areas -- such as suspicious
calcifications -- are present; if you have any
other medical problems; and what your
personal preferences are.
 When a breast biopsy is recommended to
test for breast cancer, patients may be able
to choose a minimally invasive alternative to
surgery known as image-guided needle
biopsy. This is a technique that does not
require surgery. Most of the time, the
radiologist performs this type of biopsy.
 For breast cancer detection, ductal lavage is
a procedure for collecting cells from the
milk ducts of the breast for analysis. The
procedure is used to identify precancerous
cells, called atypical cells. Ductal lavage
currently is performed only on women who
have multiple breast cancer risk factors to
try to detect breast cancer before it starts.
 Ductal lavage works on the premise that
most breast cancers (about 95%) develop in
cells that line the milk ducts of the breast.
Cancer usually begins in one duct and may
be contained to that duct if caught early,
making treatment more effective and
increasing survival.
 Breast cancer is usually treated with surgery,
medicine, and radiation therapy. Because of
improved screening methods, diagnosis at
an early stage, and improved treatment
techniques, the number of deaths from
breast cancer has been steadily declining
over the past few years. Decisions about how
to treat breast cancer are based on a
combination of factors that include specific
information about the cancer, your
preferences, and your health.
 Radiation therapy is the use of high-dose X-
rays to destroy cancer cells and shrink
tumors. Radiation may come from a
machine outside the body (external
radiation therapy) or from the placement of
thin plastic tubes containing radiation
(radioisotopes) into the area where the
cancer cells are found (internal radiation
therapy, or brachytherapy).
 Radiation
therapy
is
standard
treatment for many types of cancer. It
may be used in combination with
surgery, chemotherapy, or hormonal
therapy.
 Chemotherapy is the use of medication to
destroy cancer cells. Chemotherapy is called
a systemic treatment because the
medications enter the bloodstream, travel
through the body, and can destroy cancer
cells outside the target area.
 Chemotherapy may be taken by mouth
(orally), or it may be given through a needle
into a vein (intravenously, or IV) or a muscle
(intramuscular, or IM).
 Hormone therapy is used to change the
way hormones stimulate cancer
growth. These medicines either block
the effects hormones have on the
cancer cells or block the production of
the hormones.
 If tests show that the breast cancer cells
have estrogen and progesterone receptors
(ER/PR-positive), hormone therapy may be
used. Tamoxifen and aromatase inhibitors
are the most commonly used hormonal
therapies. Other hormonal therapies
include progestins, such as megestrol
(Megace), and antiestrogen, such as
fulvestrant.
 Neoadjuvant therapy is treatment given
before the primary treatment for a condition
or disease. Examples of neoadjuvant therapy
include chemotherapy, radiation therapy,
and hormone therapy given before surgery
to remove cancer.
 Neoadjuvant therapy is often given to reduce
the size of the surgical area or to provide for
a better cosmetic result. Additional
chemotherapy, radiation therapy, or
hormone therapy is usually needed
following the surgery for the treatment of
cancer.
 A mastectomy is the surgical removal of the
breast. It is used to treat breast cancer.
 Partial or segmental mastectomy is the
removal of the area of the breast that contains
cancer, some of the breast tissue around the
tumor, and the lining over the chest muscles
below the tumor. The lymph nodes under the
arm are also removed and examined under a
microscope (auxiliary lymph node dissection or
sentinel node biopsy).
 Total (or simple) mastectomy is the
removal of the whole breast.
 Modified
radical mastectomy is the
removal of the breast, the lymph nodes
under the arm, the lining over the chest
muscles, and sometimes part of the chest
wall muscles.
 Radical
mastectomy (Halsted radical
mastectomy) is the removal of the breast,
chest muscles, and all of the lymph nodes
under the arm. For many years, this was the
most common operation for breast cancer,
but now it is rarely used.
 Breast-conserving surgery (lumpectomy) is
the surgical removal of a breast lump and
some of the tissue around it. The lump (and
sometimes the lymph nodes under the arm)
is removed and sent to the lab for
examination.
 Breast-conserving surgery can be used in
early-stage breast cancer and when the
breast lump is small compared with the size
of the breast. Radiation therapy is used after
breast-conserving surgery for invasive breast
cancer.
 Whether you have a mastectomy or breast-
conserving surgery (lumpectomy) for breast
cancer, your doctors need to know whether
the cancer has spread to the lymph nodes.
Lymph node involvement increases the
likelihood that cancer cells have spread
through the bloodstream to other parts of
the body. Women with some forms of very
early breast cancer, such as ductal or lobular
carcinoma in situ, do not need lymph node
testing.
 Targeted therapy is a type of treatment that
uses drugs or other substances to identify
and attack specific cancer cells without
harming
normal
cells.
Monoclonal
antibodies and tyrosine kinase inhibitors are
two types of targeted therapies being
studied in the treatment of breast cancer.
Preoperative
 Assess patient’s reaction to the
diagnosis and ability to cope with
it.
 Take a complete health and
gynecologic history.
 Ask about coping skills,
supportive systems, knowledge
deficit, and presence of
discomfort.
 Perform a complete physical
assessment, with particular
attention to breasts and related
mass signs and symptoms
Postoperative
 Monitor pulse and blood pressure
for signs of shock and hemorrhage.
 Avoid performing blood pressure
readings, injections, intravenous
lines, and venipuncture on the
operative side to prevent infection
and compromised circulation.
 Inspect dressings for bleeding on a
regular basis.
 Monitor drainage.
 Turn and encourage deep breathing.
 Assess graft areas for unusual
redness, pain, swelling, or drainage.
The truth behind some of the most
common misconceptions about breast
cancer.
Public awareness about breast cancer has
increased dramatically over the past 20 years.
Yet misleading ideas still persist. Here, we
explain the truth behind common
misconceptions.
Myth: The "one in eight chance of breast
cancer" statistic means that if eight women
are randomly selected, one of them must
have or will get breast cancer.
Fact: In reality, the statistic -- which comes
from the National Cancer Institute -- is an
estimate of a woman's chance of developing
breast cancer during her entire lifetime.
Myth: Only women can get breast cancer.
Fact: Men have breast tissue, so it is
possible for them to develop breast cancer.
Like all cells of the body, a man's breast duct
cells can undergo cancerous changes.
Myth: Using deodorant or antiperspirant
causes breast cancer.
Fact: This urban legend has suggested that
chemicals in antiperspirants are absorbed
through the skin, interfere with lymph
circulation and cause toxins to accumulate
in the breast that eventually lead to breast
cancer.
Myth: Any mass that shows up on a
mammogram is most likely cancerous.
Fact: Most abnormalities will turn out not
to be cancer. A mass could be a cyst or
another benign breast condition.
Myth: Breast-feeding increases your risk
for breast cancer.
Fact: A woman who breast-feeds can get
breast cancer, but no studies indicate that
breast-feeding causes breast cancer. In fact,
some studies indicate that breast-feeding
can reduce a woman's risk of developing the
disease.
Myth: Birth-control pills cause breast
cancer.
Fact: Today's birth-control pills contain a
low dose of the hormones estrogen and
progesterone. They have not been
associated with an increased risk of breast
cancer and, in fact, can provide some
protection against ovarian cancer.
Sources: American Cancer Society, National Cancer Institute, National Breast
Cancer Foundation
There are a number of “myths” about the risk factors
and causes of breast cancer that sound plausible
but have little or no scientific theory or data to
support them.
There is no body of evidence that an increased risk
for breast cancer can be attributed to:
 The use of antiperspirants,
 Wearing an underwire or tight fitting bra,
 A bump or knock to the breast,
 Stress,
 Having silicon breast implants,
 Termination of pregnancy (This includes both
induced abortion and spontaneous miscarriage)
Information source: National Breast and Ovarian Cancer Centre