Like all cancers, breast cancer is an insidious disease, and here is
much we don't know about it. For instance, why does it seem to strike city dwellers more
than rural dwellers? The exact causes of breast cancer, too, confound us at this time,
through genetics, hormonal activity and dietary factors each probably share a role. We do
know, however, that old wives' tales blaming the disease on blows or bruises to the
breast, childbirth, nursing and sexual activity are simple untrue. And because refined
screening techniques can detect breast cancer early, the outlook for large numbers of
women has improved significantly.
A woman's breasts are make up almost entirely of an admixture of
glandular tissue and fat that is sectioned into approximately 20 lobes and smaller
subdivisions called lobules. A cluster of bulb-shaped glands produces milk, while a
branch-like system of ducts stores milk as well as channels it to the nipple, which is
encircled by darker-pigmented skin known as the areola. The breasts, in addition to
serving as important symbols of femininity, function as secondary sex organs as well as
sources of nourishment in the months or years after childbirth.
Keep in mind that the breasts continually change throughout life.
Sexual development, hormones, pregnancy, menopause, aging - even the monthly menstrual
cycle - affect their size, shape and feel. So a patch of thickened tissue indicating a
possible carcinoma in one person may be perfectly normal in another. Most breast lumps are
not malignant and eventually disappear. That is why it is imperative for every woman to
familiarize herself with her breasts and learn what is normal and abnormal for her.
Breast cancer's warning signs are rarely associated with pain
most cancers, can usually be seen or felt externally. Watch for any of the
Ø A persistent lump or thickening in the breast or armpit
Ø A change in the breast's size or contour
Ø A change in colour of the breast or areola
Ø Dimpling, puckering, scaling or a similar change in skin texture
Ø An abnormal nipple discharge
Ø Nipple retraction or scaliness
Ø Noncyclical pain
Depending on the size and location of the cancer, doctors have
a number of
treatments to consider. The most common surgical procedures to treat breast
Ø In a lumpectomy, the least invasive, the localized breast cancer is removed. In
addition, the axillary lymph nodes in the armpit are usually removed as well, and the
procedure is followed by radiation and/or chemotherapy.
Ø In a partial mastectomy, the tumour is removed, as is a small rim of noninvolved
healthy tissue referred to as negative margins. Most patients then receive radiation
Ø In a total or simple mastectomy, the breast is removed, and sometimes several lymph
nodes as well.
Ø In a modified radiated mastectomy, the most common procedure for breast cancer
patients, the breasts, axillary lymph nodes and the lining over the chest muscles are
removed. The large chest wall muscle, the pectoralis major, is spared.
Ø The more extensive radial mastectomy, previously the standard for all breast cancer
patients, is relatively rare today. In this procedure the surgeon removes the breast,
chest muscles, all axillary lymph nodes, and additional fat and skin.
The effects of breast surgery vary considerably from woman to
woman. Some breeze through a mastectomy and follow-up treatment with few adverse effects,
but most experience at least temporary consequences. For example, cutaneous nerves that
must be sacrificed during the operation may produce numbness or tingling in the chest,
underarm, shoulder and upper arm. Though usually temporary, some patients experience
permanent numbness.It is not uncommon for women who lose a breast to feel weak and stiff
in the arm and shoulder, from shrunken, or atrophied, muscles. But this is usually
fleeting and can be amerliorated though exercise, unless it is allowed to progress to
what's called a frozen shoulder, which would require long-term physical therapy. What's
more, the absence of lymph nodes and their connecting vessels may bring about lymphedema,
in which lymph fluid builds up and causes the arm and hand to swell. Though this happens
to only a small percentage of patients, the effects can be profound - and permanent.The
psychosocial/psychosexual adjustments from breast surgery can be more trying than the
physical effects. Fortunately, today's mastectomy patients have the choice of undergoing
reconstuctive plastic surgery. This may either be done at the time of mastectomy or be
delayed until after treatment has been completed. The breast can be molded from fatty
tissue taken from the abdomen or other areas of the body, or a soft prosthesis can be
How to do breast self-examination
All women should perform this simple self-examination each month;
younger women in the week following a menstrual periods when breast are least apt to be
swollen and tender, and older, postmenopausal women on the first of the month or another
Step 1: Stand in front of a mirror and inspect both breast. Make
sure the contour of the skin is normal, that there is no dimpling or puckering, and that
both nipples point in the same direction. Change the tension of the breast tissue by
placing your arms over your head, once again noting if this elicits any change in the
contour, symmetry or the nipples.
Step 2: With hands on hips, bow slightly toward the mirror while arching
your shoulders and elbows and look for the same signs.
Step 3: Now examine your breasts while showering or bathing. Et the
breast and apply soap or a bath gel; your fingers glide more easily over wet, soapy skin,
making it easier for you to feel any small lumps or changes. With your right hand, rotate
your three middle fingers clockwise around the left breast. Start around the nipple at 12
o'clock, then move around the clock face in ever-increasing concentric circles outward.
Alternatively, move from top to bottom, and side to side, carefully feeling every part of
the breast. Then repeat this step on the opposite breast.
Step 4: Lie flat on your back, a pillow placed under your left shoulder
and your left arm raised over your head. This flattens the breast and permits easier
examination. Repeat step 4 on your left breast, then change position and do the same on
your right breast.