Breast Cancer: The most important facts

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Sometimes, it can seem as though breast cancer is everywhere: everyone knows someone, everyone’s family is touched by it. The chord struck by breast cancer is evident in the avalanche of pink ribbons that’s everywhere from the Internet to our streets, and the many stories of those who have survived as well as tributes to those who did not. There are many spin-offs from this high level of public awareness, and one of them is ready funding for more research, which is showing great results. But even though the general public may be more aware of “breast cancer” than is true for most other forms of cancer, international research shows that most women who have been treated for breast cancer, do not know what kind of tumour they had. Yet from any doctor’s point of view, this is first-ranking information! Momentum Health’s JUMP magazine recently interviewed some top South African breast cancer specialists to find out what they regard as the most important facts about breast cancer (see Issue 1, 2015). So here’s what you should know: * Don’t panic. The great majority of lumps that appear in breast tissue are not cancer. But don’t ignore a lump either – expert advice is needed to determine whether or not you need further treatment. * Like any other cell, a cancer cell has its own specific programming which tells it how to behave: its genetic material or DNA. This includes the likelihood of spreading to other organs, the speed at which it grows and divides to form new cancer cells, and even how it will respond to various forms of treatment. That’s another reason to get immediate expert help, because no matter how small it may be, an aggressive tumour will soon become a much worse problem. * Patients should know about the four main types of breast cancer and the treatment you can expect for each one – if you are able to catch it at an early stage. 1. Luminal A: The most common type affecting around 70% of patients and especially older women. Treatment is by cutting off the supply of oestrogen (female hormone) that feeds it; you’ll be on anti-oestrogen medication for up to five years but you won’t need chemotherapy or any other treatment. 2. Luminal B: This less common type also needs oestrogen to thrive but can continue to grow without oestrogen, so in addition to anti-oestrogen medication you will be offered a course of chemotherapy to achieve a better result. 3. HER2: This is a form of breast cancer that usually has a family history. It is treated – with much success – by a combination of chemotherapy and “molecular therapy” targeted specifically...

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Benign changes to the breast

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Unlike many other organs or tissues of the body, a woman’s breasts are shaped and defined by time. Before puberty, there’s nothing there at all. Then – exciting or intimidating as it may be – breasts begin to grow, taking a few years to reach their final shape and in the process becoming an important part of our body image. In human beings breasts are sexual organs, and it doesn’t take girls (or boys for that matter) long to discover that! Their exquisite sensitivity gives pleasure and their rounded shape helps define our womanly style – small and sporty, large and motherly, firm or soft. During pregnancy and after birth, breasts have a new lease on life as we discover their miraculous capacity to feed our babies as much and for as long as we need to. Though not all women are able to breastfeed, with the right help and support most can enjoy this simple, natural way to bond with and nurture our young. As breasts age, other changes take place which are completely normal – or at least common. Some are medically insignificant, such as the gradual change around the time of menopause from firm, dense glandular tissue to softer fatty tissue. Others tend to draw attention and cause anxiety because until investigated we cannot be sure that they are harmless. These are the benign conditions of the breast or “aberrations of normal development”. Lumps within breast tissue Lumps are common, occurring not only in aging breasts but also sometimes in younger breasts. A lump is a small piece of tissue or area under the skin that feels firmer than the surrounding tissue and can be felt from the outside. It doesn’t usually develop overnight and won’t be noticed until it reaches a certain size – at which point finding it can cause alarm and concern. Lumps that are medically concerning are those which stay there regardless of the menstrual cycle. Some women have naturally lumpy or uneven breasts and when the tissues swell under hormonal influence these “lumps” are more easily felt. For your own peace of mind, don’t hesitate to ask your doctor or nurse to check anything that worries you, but it’s the distinct lump which will require further investigation. Worrying as they are, many such lumps turn out to be “benign”. This means that although it is not normal breast tissue and may be growing larger, it does not spread or invade other tissues, either locally or by travelling through the lymph system (as cancer cells do). If you visit your doctor with a breast lump that worries you, he or he will ask you how long it has been there, whether you’ve...

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Birthday parties – 14 million of them

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Any excuse to celebrate, and millions of birthday parties around the world tell the story – cancer, though still a big public health concern, is not a death sentence. Since reaching a peak in the early 1990’s, cancer death rates have been steadily falling – at around 20% for women and over 25% for men. This is according to Cancer Research UK and the American Cancer Society. Probable reasons for this improvement are: – fewer people smoking – improved screening and early diagnosis for common cancers – more treatment options – targeted drug and/or radiotherapy treatment – new surgical techniques – more effective treatment and prevention of co-occurring conditions such as diabetes, obstructive airways disease, stomach ulcers, chronic infection and so on “We needed to give patients more options and better news about their future. I was impatient for more advances sooner and I still am. But clearly we’re moving in the right direction” – Prof Peter Johnson, Cancer Research UK There are still challenges. Pancreatic cancer appears to be on the rise, and amongst women, lung cancer has increasing by around 8% (whilst falling amongst men). This is thought to be the tragic harvest of 1960’s cigarette marketing, which successfully targeted millions of women by promoting tobacco smoking as an aid to slimming. Whilst older women tend to take better care of their health, younger women sometimes fail to notice or to report symptoms that could serve as early warnings of cancer. These include: – unexplained weight loss – bloating – breast changes: lumps, thickening, persisting rash, discharge, nipple changes – unusual bleeding – skin changes (moles, pigmentation, scaling) – difficulty swallowing – blood in urine or stool – gnawing abdominal pain especially associated with depression (may indicate pancreatic cancer) – indigestion for no apparent reason – white patches or spots in the mouth (especially if you are or were a smoker) – unexplained pain: not likely to be cancer but get it checked out – a swelling under the armpit, in the neck, or anywhere else – unexplained fever (sometimes associated with early blood cancers) – persistent fatigue, even if you think you have reasons to be so tired – persistent coughing There are a few ‘wild cards’ in our future whose effect on rates of cancer diagnosis and death are still unknown. The most worrying of these is the so-called “obesity epidemic”, especially insofar as it affects younger people. Recent research has connected excessive sugar consumption with a variety of conditions including auto-immune and inflammatory conditions which may predispose to some forms of cancer. We really need to start dealing with this!  ...

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Vitamin D – are you getting enough?

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For some time it’s been known that maintaining adequate levels of Vitamin D helps prevent cancer, especially colo-rectal cancer but also of the breast, pancreas and bladder. Now there’s evidence that women who already have breast cancer can benefit from increased Vitamin D. A major review study reported in the journal Anticancer Research has found that women with high levels of Vitamin D in their blood when diagnosed with breast cancer showed improved survival rates (at average 9 years), compared to women with low Vitamin D levels. The study involved 4443 patients with breast cancer and according to the statistics there is almost no probability that this difference occurred by chance – though further research is needed to see whether more severe illness can lower Vitamin D levels. Improved levels of Vitamin D prevent cancer by helping cells to stick together. When cells are loosely packed they start reproducing at a faster rate and may evolve into cancer cells. The presence of Vitamin D can keep a developing cancer in check by limiting its ability to develop its own blood supply, and/or to invade nearby structures like blood vessels. Dr Cedric Garland of the University of California, San Diego, told Medscape Medical News that up until a fairly late stage of development, cancer cells have intact Vitamin D receptors. He recommends that women undergoing treatment for breast cancer should check their blood levels of Vitamin D, to keep it in the optimal range. And most women could use more Vitamin D. The average American would be in the “low” group whereas the “high” group had nearly twice as much Vitamin D. Moreover, current recommendations for daily consumption are conservative: you would have to take a large amount of Vitamin D on a daily basis before signs of toxicity (such as thirst, nausea, stomach upset or muscle weakness) occur. This would be unlikely unless supplements are added to natural sources. Vitamin D deficiencies by contrast are fairly common, especially in climates where winters are long and cold. Some of the study data came from Canada, but studies in Southern Australia have also found Vitamin D deficiency, so South Africans shouldn’t be complacent about our sunny skies. Here are some ways to keep Vitamin D in good supply: – Sunlight. Make the most of the sun, especially in winter – it’s 100% free! You don’t need to risk getting burned – 20 minutes will do. After that, avoid the hottest part of the day or use sunblock, keeping the sun off your face if you want to protect your youthful good looks. – Oily fish, which comes with a bonus of cholesterol-free protein and heart-healthy fatty acids. A generous serving of...

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One for the men….

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Here at Bay Breast Care we’re all about women’s health, but let’s not neglect the guys.   It’s time to talk about prostate cancer….including family risk and the importance of what we eat. A recent study from Scandinavia estimated that prostate cancer is the most strongly inherited form of cancer, followed by testicular cancer and only after that, breast cancer. This can be proved by studying two types of twins: non-identical twins who have the same genetic relationship as brothers, and identical twins who came from the same egg and share the same genes. The genetic risk levels for these male cancers are higher than previously estimated but are believed to be accurate because the study that generated this data is based on the comprehensive birth-to-death registries kept in the Denmark, Finland, Norway and Sweden (These same registries have also provided valuable information on breast cancer). A study like this will also encourage research, as not much is known about inherited prostate cancers. The picture isn’t likely to be simple, as in ‘find one gene that causes cancer’. Rather, it’s likely to be a number of genes that, put together, add up to an increased risk. Meanwhile, the Physicians’ Committee for Responsible Medicine (PRCM), a non-profit organisation promoting better nutrition in order to prevent disease, has bad news for our red-blooded, carnivorous South African guys: grilling meat (including chicken) over a direct flame until charred is a significant risk for a variety of cancers. For prostate cancer, which like many breast cancers is linked to hormone production, red meat is the worst culprit as a food group – though it’s not the red part that promotes testosterone, but the fat. Dedication to fast-food like boerewors, fried chicken and burgers, is associated not only with rising rates of obesity but also with more colon and rectal cancer in the under-fifty age group. It’s not always the meat itself, but the way we cook it: at high temperatures, producing Polycyclic Aromatic Hydrocarbons, a fancy term for the delicious smell of fat that dripped onto the fire and is being carried back by smoke and flames onto the food. Compared to those eating mainly plant based food, meat eaters develop more of the type of gut bacteria that turns natural bile acids (which help digest fat) into cancer promoting “secondary bile acids”. So what’s the problem with meat? In addition to harmful chemicals formed by charring and by gut bacteria, or promotion of excess hormones by the fat in the meat, meat eaters don’t get the benefit of fibre which effectively removes carcinogens by speeding the passage of food through the colon. A diet high in plant material actually changes the type of...

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Is a sense of purpose good for our health?

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Perhaps it’s just about getting older, but as each year goes by, I feel less inclined to make New Year resolutions – too conscious of the many that have come in with a bang like a firework display only to fade into a whisper of smoke before the first week of January is gone. However, some interesting recent research suggests that living a more resolved and purposeful life can make a measurable difference to our health. Tom Jacobs, of Pacific Standard Magazine, reports that genetic researchers Barbara Fredrickson and Steven Cole studied the relationship between the activity of genes regulating the immune system, and forms of happiness. Though the focus of happiness is as variable as people are, the researchers identified two main forms, which they called “hedonic” and “eudaemonic”. Hedonic comes from a form of moral philosophy which holds that pleasure is the only intrinsic good in life. Eudaemonic, as readers of Plato or Philip Pullman might guess, refers to the guardian spirit or angel that guides us wisely and well; or, according to Socrates, the invisible plane in which mortals encounter the divine. Fredrickson and Cole, being geneticists, are more interested in molecular physiology than moral philosophy. However, it turns out that both are equally complicated. Participants in the research filled out a questionnaire about their feelings and self image in the past week: happy, satisfied, having a sense of direction in life, having something to contribute to society, or “challenged to grow and become a better person”. Questions about health and about depression were also included. Not surprisingly there was a strong overlap between the two types of happiness: both can flow from the same source, such as a rewarding job, a happy relationship, or being creative. Also not surprisingly, people who reported high levels of either form of happiness were less likely to have depressive symptoms. At that point the obvious turned into the unexpected, as researchers compared the genetic results. People who reported more hedonic happiness also showed higher levels of a genetic activity associated with extended stress in the immune system. This activity promotes inflammation and reduces other responses to immune challenge (such as a virus). The people reporting more eudaemonic happiness showed a ‘markedly divergent’ genetic response in comparison to their pleasure seeking comrades. Levels of unwanted genetic activity were lower; therefore their immune systems would function better and they would have less inflammation – seen as a culprit in a variety of chronic health conditions. What could be provoking this genetic stress response in pleasure seekers who lack a sense of direction or purpose? They’re enjoying life and not depressed, so why are they physiologically at odds with themselves? Jacobs speculates that...

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