Breast Cancer—What to Hope, How to Cope

YETUNDE had none of the classic risk factors. She was 40 years old, healthy, and had no family history of breast cancer. Her regular mammogram had shown nothing abnormal. But one day while examining her breasts in the shower, she felt a lump. It turned out to be cancer. Yetunde and her husband sat numbly while the doctor explained her options

The battle against breast cancer has been an ongoing struggle between the need to treat a killer aggressively and the desire to avoid needless disfigurement and painful side effects. Today’s breast cancer patients may have a range of treatment options. And a steady stream of medical studies and media reports hold out hope that breakthrough treatments, predictive tests, and protective diets will finally conquer the disease.

Despite medical advances, however, breast cancer remains a leading cause of female cancer death. The industrialized countries of North America and Western Europe have high incidences of cancer, but numbers are rising in Asia and Africa, which have historically had lower incidences. Moreover, death rates among those diagnosed in Asia and Africa are higher. Why? “Early detection is negligible,” said a doctor in Africa. “Most patients come to us when they are already in an advanced state.”

Risk increases with age. Some 80 percent of cases are in women over 50. But the good news is that breast cancer is one of the most treatable cancers. Indeed, 97 percent of women whose early-stage breast cancer is localized are still alive five years after diagnosis. Yetunde recently passed the five-year mark.

Breast Cancer Basics

As in Yetunde’s case, breast cancer is often detected as a strange lump. Fortunately, though, about 80 percent of such lumps are benign, or self-contained, many simply being fluid-filled sacks called cysts.

Breast cancer begins with a renegade cell that divides uncontrollably, gradually forming a tumor. A tumor turns malignant, or cancerous, when its cells invade other tissues. Some tumors grow quickly; others may take up to ten years before they are detected.

To test Yetunde for cancer, her doctor used a thin needle to take a tissue sample from the lump. It contained cancer cells. So she had surgery to remove the tumor and the surrounding breast tissue and to determine the tumor’s stage (size, type, and spread) and grade (speed of growth).

After surgery, many patients have additional treatments aimed at preventing the recurrence or spread of the cancer. Cancer cells can break away from a tumor, travel through the bloodstream or the lymphatic system, and start growing again. The spread, or metastasis, of cancer to vital organs and tissues—the brain, the liver, the bone marrow, or the lungs—is what turns the disease deadly.

Yetunde underwent both radiation and chemotherapy to destroy stray cancer cells around the original site and throughout her body. Since her form of cancer fed on estrogen, she also underwent antihormonal therapy to hinder the growth of new cancers.

Advances in breast cancer treatment offer other options to patients according to their age, health, cancer history, and the individual cancer.

For instance, in the case of a woman named Arlette, tests revealed her cancer before it spread beyond the milk duct. So she had a lumpectomy, which saved her breast. Alice had chemotherapy before surgery to shrink her tumor. Janice’s surgeon removed the tumor and only the sentinel lymph node, the first node into which the fluid from the tumor drains. Since it held no cancer cells, additional nodes were left intact. This reduced Janice’s risk of lymphedema, an uncomfortable swelling of the arm that can occur when many lymph nodes are removed.

Much is known about the growth of breast cancer, but a basic question continues, Why and how does breast cancer start?

The Causes?

The causes of breast cancer remain a puzzle. Critics say that more research is done on treatment and screening—which reap big profits—than on causes and prevention. Still, scientists have unearthed important clues. Some believe that breast cancer results from a complex, multistep process, beginning with a faulty gene that causes cells to misbehave—to divide furiously, to invade other tissue, to evade capture by immune cells, and to launch stealthy attacks on vital organs.

Where do errant genes come from? In between 5 and 10 percent of cases, women are born with genes that predispose them to breast cancer. But it seems that in many cases, healthy genes are damaged by outside agents—radiation and chemicals being among the prime suspects. Future studies may confirm these links.

Another link includes the hormone estrogen, which appears to stimulate certain breast cancers. Hence, a woman’s risk may be raised if she began menstruating very early in life or went into menopause later than normal, if she had a late first pregnancy or no pregnancy at all, or if she had hormone replacement therapy. Because fat cells produce estrogen, obesity may increase risk in postmenopausal women, whose ovaries have stopped producing hormones. Other risk factors include high levels of the hormone insulin and low levels of the sleep hormone melatonin, a condition often affecting night workers.

Are more-effective, less-traumatic treatments for breast cancer on the horizon? Researchers are developing therapies that involve using the body’s own immune system and drugs that target the molecular pathways that support cancer growth. Meanwhile, improved imaging technologies should help clinicians deliver radiation more precisely and effectively.

Scientists are also fighting on other fronts, including unlocking the mystery of metastasis, outwitting chemoresistant cancer cells, disrupting cellular-growth signals, and tailoring treatment to individual tumors.