Breast Cancer Health Article

Treatment and management

Breast cancer treatment is determined by the exact size and type of cancer, so it is often unique to an individual. Treatment may include surgeries, such as a lumpectomy (removal of the breast lump) or mastectomy (removal of the entire breast). Breast reconstruction (recreation of the breast) by plastic surgery is an option some individuals may pursue.

Chemotherapy, or using strong chemicals to kill fast-growing cells, is a common treatment. Side effects from chemotherapy may include nausea, vomiting, hair loss, exhaustion, and sores in the mouth. Symptoms associated with menopause (such as "hot flashes" and the absence of menstrual periods) may occur, or menopause may actually begin because of chemotherapy. Radiation therapy is another common form of treatment, in which directed radioactive waves are used to kill fast-growing cells. Some side effects of radiation therapy are dry and itchy skin, rashes, exhaustion, nausea, and vomiting.

Sometimes, medications such as Tamoxifen are used to prevent a breast cancer from coming back. Tamoxifen is often used for five years following a breast cancer diagnosis to actively prevent a recurrence. Tamoxifen is only effective in specific types of breast cancer, which again are unique to each individual. Some side effects of Tamoxifen include beginning menopause, as well as an increased risk for uterine cancer. Other drugs, such as Raloxifene, are currently being studied for breast cancer prevention because it may be able to do the same things as Tamoxifen, without the side effects. Research studies are under way to determine whether Tamoxifen or Raloxifene can reduce the risk of breast cancer in women with BRCA alterations.

An example of a screening program for women at high risk to develop breast cancer includes:

• BSEs monthly starting in early adulthood (about 20–25 years of age)
• CBEs every six months or yearly starting at age 25–35
• mammograms yearly starting at age 25–35

Exact screening guidelines may vary between physicians. For men with a BRCA2 alteration, breast cancer screening is recommended, though no formal program is specifically recommended.

In addition to screening, women with BRCA1 or BRCA2 alterations should know about their preventive surgery options. They may consider having their healthy breasts and/or ovaries removed, in order to reduce their risks of developing breast and/or ovarian cancer. Women may be more agreeable to an oophorectomy because ovarian cancer is difficult to detect. Surgeries may greatly reduce a woman's cancer risk, but they can never eliminate the risk entirely.

For people with cancer or at high risk, there are support and discussion groups available. These may be invaluable to those who feel alone in their situation.

Prognosis

The type and size of breast cancer developed largely determines the overall prognosis for an individual. Those with larger tumors and those with a type of breast tumor that does not usually respond to treatment may have a poorer outcome. Additionally, once cancer has spread to other areas of the body the prognosis worsens because the cancer is more difficult to treat. The cancer may also be more likely to continue spreading to other areas of the body.

Those with BRCA alterations who develop breast cancer have a similar prognosis to those without BRCA alterations that have equivalent cancers. In addition, people with BRCA alterations are treated for their cancers using the same methods as those without alterations.

For cancer-free individuals identified to have BRCA alterations, it is important to remember that they are at an increased risk to develop the associated cancers, but that the risk is not 100%. Though people with BRCA alterations may feel "destined" to develop cancer, it is by no means a certainty. It is also important to emphasize that breast cancer screening techniques and treatments are constantly being evaluated and improved.

BOOKS

Chart, Pamela. Breast Cancer: A Guide for Patients. Toronto: Prospero Books, 2000.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345. <http://www.cancer.org>.

Facing Our Risk of Cancer Empowered (FORCE). 934 North University Drive, PMB #213, Coral Springs, FL 33071. (954) 255-8732. info@facingourrisk.org. <http://www.facingourrisk.org>.

The National Alliance of Breast Cancer Organizations. 9 East 37th Street, 10th Floor, New York, NY 10016. (888) 806-2226 or (212) 889-0606. NABCOinfo@aol.com. <http://www.nabco.org>.

Susan G. Komen Breast Cancer Foundation. Occidental Tower, 5005 LBJ Freeway, Suite 370 LB74, Dallas, TX 75244. (800) 462-9273 (Hotline) or (214) 450-1777. helpline@komen.org. <http://www.breastcancerinfo.com>.

WEBSITES

"The Genetics of Breast and Ovarian Cancer." CancerNet. <http://cancernet.nci.nih.gov/clinpdq/cancer_genetics/Genetics_of_breast_and_ovarian_cancer>.

Deepti Babu, MS