Severity of Breast Cancer Essay

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The problem

Breast cancer is the most common cancer among women. Just after lung cancer, it is the second common cause of cancer death in women nowadays in US. Breast cancer is formed in breast tissue where cells grow abnormally. According to the American Cancer Society, about 1.3 million women will be diagnosed with breast cancer annually worldwide and about 465,000 will die from the disease.[1] In US, 1 in 8 women (13%) will be diagnosed with breast cancer with a 1 in 35 (3%) chance of death. The onset of this cancer is significantly influenced by age and gender as well as genetic predisposition. A woman's chance of getting this cancer doubles with every 10 years of life. Only about 5% to 10% of women are due to heredity and the others are owing to genetic abnormalities that happen as a result of the aging process and life in general.[3] Breast cancer is curable in early stage.

"Breast cancer is very curable when found early," said Dr. Ermilo Barrera Jr., chief of surgery at Glenbrook Hospital, American Cancer Society board member and past president of the Illinois division of the ACS.

(http://en.wikipedia.org/wiki/File:Most_common_cancers_-_female,_by_occurence.png), downloaded 22 April 2010.

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A Possible solution - Surgical removal

Surgery is the effective way to cure the breast cancer. They aim to remove the cancerous tumour or lump from the breasts. Breast cancer can be classified into different stages, depending on the size and the location of the tumour after diagnosis. Survival rate varies with the cancer stages.

Stage

5-Year Relative Survival Rate

0

100%

I

98%

IIA

88%

IIB

76%

IIIA

56%

IIIB

49%

IV

16%

(http://www.locateadoc.com/articles/breast-cancer-basics-222.html), downloaded 22 April 2010

Most patients, commonly, will have a combination of treatment such as radiotherapy or drug treatment after surgery, aiming to destroy any undetected cancer cells that may spread to the other parts of the body.

Basically, surgical removal can be divided into two types: breast-conserving surgery and breast-removal surgery. Patients have the right to decide which surgery to be carried out but have to depend on the size of the tumour. Doctor's suggestion and treatment options according to stages are needed once the patients are in dilemma making the decision.

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Breast-conserving surgery, such as lumpectomy and quadrantectomy, aim to excise the lump together with as less breast tissue surrounding as possible. The main advantage of this surgery is to keep the breast even though lump and breast tissue have to be removed.

*dotted line shows the parts removed

Lumpectomy

(http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page5#Keypoint19), downloaded 8 May 2010.

*shaded region shows area removed

Quadrantectomy

(http://www.health.co.th/HealthEducationArticle3/CaBreastTreatment.html), downloaded 8 May 2010.

Compared to each other, more removal of breast tissue is involved in quadrantectomy. There is no size limit for this breast-conserving surgery. However, wide excision of lesion will produce poor cosmetic result in most of the women. This surgery, therefore, is suggested

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for those patients having tumour 4cm in diameter or below. There is no age limit for this breast-conservation surgery.

Breast-removal surgery is the surgery removing the whole breast, including the breast tissue and some overlying skin, the tumour and the nipple as well. The breast is removed from the chest wall, however, can be restored through breast reconstruction. Mastectomy is the example of this surgery. It can be further divided 3 types.

Types of mastectomy

Parts removed

Simple mastectomy

Breast tissue only

Radical mastectomy

Breast tissue, all of the lymph node under the armpits, muscles behind breast tissue

Modified radical mastectomy

Breast tissue, some lymph node under the armpits

[4]

Types of mastectomy used will have to depend on the sizes of tumour, location of tumour and whether it has spread.

Simple mastectomy Modified radical mastectomy

*dotted line shows the region removed

(http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page5#Keypoint19), downloaded 29 May 2010

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Effectiveness

(http://pubget.com/paper/pgtmp_87a74c17d74abbdc76caca37a5e152d1#), downloaded 16 September 2010

The graph above shows the cumulative survival rate after a range of years. We find that the survival rate of women treated with surgery is higher than those refusing it, in overall. From the graph, the most obvious is that the 10-year survival rates of women treated with surgery and those do not are 75% and 36% respectively (Refer to 10 years on x-axis). The mortality rate is doubled without surgery. This evidence, thus, strongly proves that surgery is an effective solution to cure breast cancer. It removes as much cancerous tissues as possible. Devastating the cancer cells that remained in our body, adjuvant therapies are needed.

"It clearly demonstrates that women who refuse surgery have a doubled risk to die of breast cancer, regardless of personal factors, tumour characteristics, stage, and nonsurgical treatment."

(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357734/), downloaded 16 September 2010

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Alternatives

Radiotherapy

It is also called radiation therapy. This therapy uses targeted and high-energy x-rays or gamma ray to destroy the remaining cancer cells within the wound. It can cure breast cancer without surgery in very early and non-metastasis stage by eliminating the tumour but not in the metastatic state. It can be used as: [6]

Neoadjuvant radiotherapy

-Treatment before primary treatment (surgery)

-To shrink the tumour

-Easier to remove the tumour

-Breast-conserving surgery can be used instead of mastectomy.

Adjuvant radiotherapy

-Treatment after primary treatment (surgery)

-To kill the remaining cancer cells within the breast

-Prevent the recurrence rate

-Prevent the spreading

This therapy will be individually planned by radiation oncologist carefully. The total amount of radiation used is typically around 45 - 60 Gy. This dosage will be further divided into about 1.8 - 2 Gy per fraction, received by patients daily for 5 days in a row with a two-day rest per week. The course may last for 3-6 weeks and each daily treatment takes 10 to 15 minutes. Normal cells are affected but not destroyed as they can self-repair. Giving time for cell repair, that is why the course is long.[7]

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(http://annonc.oxfordjournals.org/content/17/3/401.full), downloaded 17 September 2010

By carrying out adjuvant radiotherapy after surgery, it can reduce the cancer recurrence rate by 70% approximately.

"Nearly all show that the risk of relapse in the breast is much higher when radiation is not used (20 percent to 40 percent) than when it is (5 percent to 10 percent)."

(http://www.radiologyinfo.org/en/info.cfm?pg=breastcancer#decision), downloaded 17 September 2010

Based on the quote above, I think that radiotherapy is an effective way to specific cases. It skips the surgery if the cases can be cured directly using this therapy. However, it is mostly used as adjuvant therapy in nowadays to reduce the risk of relapse.

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Targeted therapy

It is known as molecularly targeted therapies too. It aims to block the growth of tumour and the spreading of cancer by interfering specific molecules involved in tumour growth and development. Targeted therapy can be divided into 2 types:

Monoclonal antibodies

-Antibodies made in lab from a type of immune system cell

-Identify the substances attached on cancer cells that aiding growth and kills them

-Can be used together with chemotherapy as adjuvant therapy

-Introduce into body by infusion

Tyrosine kinase inhibitors

-Drugs that block the signals for cell growth

-Used with other anticancer drugs as adjuvant therapy

Herceptin (transtuzumab) and Tykerb (lapatinib) are therapies that target HER2-positive tumours. HER2 (Human Epidermal growth factor Receptor 2) also known as ErbB-2, is a protein playing role in cell growth. Studies show that approximately 25% of breast cancer patients have tumours that are HER2-positive [16]; having an abnormally high number of HER2 genes per cell results in rapid growth. This kind is more aggressive than other types of breast cancer. Different types of breast cancer require different drugs.

(http://www.medscape.com/viewarticle/503916_2), downloaded 19 September 2010

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From my point of view, this method is good because its function targets the root of this disease since we know that cancer is caused by uncontrolled growth and division of cells. Some more, the advantage of this therapy is that it is unlikely to harm the normal cells like chemotherapy. This therapy is basically used as adjuvant therapy.

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Social & Economic Implications

Patients require great adherence to treatment or hospitalisation which would cause huge financial burden and economic impact.

"According to a HealthDay News report from 2008, the average cost of breast cancer treatment in the US is $20,964."

(http://www.surgery.com/article/breast-cancer-surgery-insurance-cost), downloaded 18 September 2010

In addition, the mortality rates of breast cancer patients are different from countries. The patients in advanced countries are usually having higher survival rates that those in underdeveloped countries which lack of adequate medical technology to cure this disease.

"The United States spends about US$8.1 billion (RM29.3 billion) to diagnose and treat breast cancer, but in the city of Poona, India, home to 3.5million women, only one medical facility provides comprehensive breast-cancer diagnostic and treatment service"

"In South Africa, only 5%of breast cancers are seen in the early phase of the disease, whereas in the US, that figure is 50%. Late detection of the disease is one of the major challenges faced by doctors worldwide."

(http://www.scribd.com/doc/11694131/TheSun-20090205-Page12-Breast-Cancer-Rising- Fear-Factor), downloaded 15 September 2010

I truly believe that late detection may due to lack of awareness among women. So, education and knowledge of breast cancer should be provided to public and government should basic level of heath care to nations.

Among patients, up to 30% of women with breast cancer tend to be emotionally and psychologically stressed as well as depressive illness within a year of diagnosis. From female patients' perspective, 20-30% of them care about their self-image and woman's sexuality-breast. So, they may also feel embarrassed or have low self-esteem if their breast is infected or removed. This could lead to very serious impact and would also bring great distress and worries to people around them.

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Benefits

From my point of view, surgical removal is beneficial as it improves the survival rate of breast cancer patients. It removes the infected breast tissues and lymph nodes. At early stage, the surgery reduces the risks of recurrence and prevents the spreading of cancer to other parts of body and even cure it. As for late stage, the mortality rate can be reduced by surgery with the aids of adjuvant therapy.

Risks

However, there is always a risk of getting wound infection after surgery. Besides, fluid called seroma may accumulate near to the wound, causing swelling and pain. It normally goes away its own but sometimes has to be withdrawn with needle and syringe. If the nerve nodes are removed, patients may suffer from painfulness since they will repair themselves after cut. In addition, swelling of arm or hand occurs after surgery is normal. It should goes away once exercises are carried out to get back the movement of shoulder and arm. Prolonged swelling is called lymphedema, which need treatment. Therefore, patients should be alert to any changes at the wound and handle it well after surgery. [5]

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Source Evaluation

Source 1

http://www.cancer.gov/ is the web site of NCI (National Cancer Institute). NCI is part of the National Institutes of Health (NIH), which is one of 11 agencies that are part of the US Department of Health and Human Services. It is a non-profit organization aimed to give information about the more effective approaches to cancer prevention, diagnosis, and treatment. The source is factual and valid as NCI is recognised for its scientific excellence. Harold Varmus, Doctor of Medicine, co-recipient of a Nobel Prize for studies of the genetic basis of cancer, is the current director. I retrieved the information about the targeted therapy on page 8. There is another source that comes up with the same information which is http://www.breastcancer.org/treatment/.

Source 2

Another source is http://annonc.oxfordjournals.org. This Oxford Journals is a division of Oxford University Press, which is a department of Oxford University. Older issues of journals are scanned back and published electronically. They have been publishing journals for more than a century, and as part of the world's oldest and largest university press, have more than 500 years of publishing expertise behind them. Graphs and statistics data can be obtained from their researches (page 7). So, the information should be reliable and trustable. There is another web that we can get valid graphs and statistics http://pubget.com/paper/.

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