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Clinician’s Corner: October is breast cancer awareness month

October is breast cancer awareness month, so here is sound, clinical information concerning breast cancer from your Thompson pharmacist.

After skin cancer, breast cancer is most common cancer in women, causing more deaths than any malignancy other than lung cancer. The lifetime risk of developing breast cancer in women is 1 in 8 .  There was a 7% drop in breast cancer incidence in 2003, probably due to drop in Hormone Replacement Therapy due to publication of the Women’s Health Initiative (WHI) study in 2002.  This study established that HRT increases risk of breast cancer.

Breast cancer warning signs and symptoms

  • Breast lumps. Single painless mass that feels solid. Breast pain is not usually a symptom of malignancy, but it can occur.
  • Skin changes: areas of thickening, swelling, depression, dimpling, redness, irritation or unusual appearance on the breast or underarm.
  • Veins on surface of one breast have become more prominent.
  • Nipple discharge: bloody or watery from one nipple only is cause for most concern
  • Nipple changes– turning inward, rash, changes in nipple skin texture.
  • Breast cancer develops in the breast tissue, usually in the milk ducts (ductal carcinoma) or glands (lobular carcinoma)

Factors that increase risk for breast cancer

Risk factors for a 2-5 fold increase:

  • Age: 78% of women with invasive breast cancer are 50 or older
  • Inherited genetic mutations: Genes BRCA-1, BRCA-2 have a 60-85% chance of developing breast cancer.
  • Personal history: previous breast biopsy result of atypical hyperplasia increases risk 4 to 5 times
  • Women with breast cancer in one breast have a 3-4 times greater risk of developing a new cancer in the other breast, or the same breast.
  • High dose radiation the chest (Hodgkin’s disease treatment)
  • Family history: 1 first degree relative (mom, sister, and daughter) doubles risk.  First degree relatives is 5 times the risk

Risk Factors for a 1.1 to 2 fold increase

  • Race (white women are more susceptible)
  • Use of estrogen

Current or recent use of estrogens- risk returns to normal in 5 years after stopping hormone replacement.

Use of oral contraceptives:  no increase risk if stopped greater than 10 years ago

Prolonged estrogen stimulation increases risk

  • Early menstruation (less than age 12)
  • Late menopause (over age 55)
  • Pregnancy: no children, or first pregnancy after age 30.
  • Lifestyle: alcohol consumption: greater than 3 drinks per day.
  • Obesity

Breast cancer receptors:

  • About 80% of breast cancers are estrogen receptor positive. Cancers grow in response to estrogen. Known as ER positive.
  • Progesterone: About 65% of the estrogen receptor positive receptor positive breast cancers are progesterone receptor positive. Cancer grows in response to progesterone. Known as PR positive.
  • Human epidermal growth factor receptor-2 (HER2) – is a protein which promotes the growth of cancer cells. Is not inherited from a parent.  It accounts for about 20% of all breast cancers and are the most rapid growing and aggressive cancers.

Any of these three cancers are treatable, with specific therapy directed at the receptor to help destroy the rapid growing cells.

Triple-Negative Breast Cancer (TNBC)

Between 10% and 20% of breast cancers are known as “triple negative” because they don’t have hormone receptors and don’t overexpress the HER2 protein. Many breast cancers associated with the gene BRCA1 are triple negative.

  • There are currently no “targeted therapies”, so treatment includes surgery either lumpectomy or mastectomy, followed by chemotherapy or radiation. Chemotherapy is the “backbone” for TNBC therapy.
  • Twice as often diagnosed in women younger than 40 years compared with hormone-positive breast cancer.
  • African American women have a higher incidence
  • Breast feeding might  be protective.
  • Prognosis is poorer than women with other receptor positive cancers.

Your Thompson Pharmacist is a great resource for all of your women’s health issues. Go ahead and ASK… at Thompson Pharmacy it’s all for you.