Breast Cancer Health Article

Chemotherapy

Breast cancer surgery may be followed by chemotherapy, even when it is diagnosed in the earliest stages. Chemotherapy is administered either orally or by intravenous injection. It is usually administered in cycles: anticancer agents are given, followed by a period of time for recovery. Treatment time ranges from four to nine months.

There may be significant side effects with some types of chemotherapy, including nausea and vomiting, temporary hair loss, mouth or vaginal sores, fatigue, weakened immune system, and infertility. Advances in chemotherapy, especially regimens for early breast cancer, use medications that cause fewer side effects.

Hormone therapy

The growth of some breast cancer cells may be slowed by the antiestrogen drug tamoxifen. Administered orally, tamoxifen travels throughout the bloodstream, affecting all cells in the body. Treatment with tamoxifen continues at least two years, and often as long as five years. Research suggests that tamoxifen may lower the risk of breast cancer recurrence by between 25–35%. Side effects of tamoxifen may include a slightly higher risk of endometrial cancer (cancer of the lining of the uterus). The risk increases if the drug is taken for more than five years. Other side effects include menopause-like symptoms such as weight gain, hot flashes, and mood swings.

Other possible hormone treatments include the use of progestins, estrogens, and androgens. In rare cases, the surgeon may suggest oophorectomy (surgical removal of the ovaries) in pre-menopausal women as a way of eliminating the main source of circulating estrogen, which can boost the growth of some breast tumors.

Stem cell treatment

Stem cell treatment may be used to treat advanced breast cancer. Treatment involves removing stem cells from the patient's bone marrow or blood, and administering very high doses of chemotherapy or radiation to kill cancer cells. Since these high doses of chemotherapy also kill healthy white blood cells, patients are left extremely vulnerable to infection. When the stem cells are replaced, they restore the body's ability to combat infection.

Prognosis

The prognosis for breast cancer depends on the type and stage of cancer. Most patients can return to a normal lifestyle within a month or so after surgery. Arm, shoulder, and chest strengthening exercises can help patients regain strength and flexibility, and avoid lymphedema (swelling resulting from fluid retention).

Despite significant advances in early detection, imaging, and treatment, in 1999, more than 43,000 women in the United States died from breast cancer. There is a five-year survival rate of 97% for women with localized breast cancer, but that drops to 77% for women with cancer that has spread to the axillary lymph nodes, and to 22% for those with distant metastases, such as metastases to liver, lungs, bone, or brain.

Because of the emotional upset caused by the diagnosis and treatment of breast cancer, counseling or participation a support group program may benefit some patients. Indeed, many women have found a peer group of breast cancer survivors to be invaluable.

Health care team roles

Patients with breast cancer are usually cared for by a multidisciplinary team of health professionals. The patient's family physician or primary care physician collaborates with specialists such as surgeons and oncologists. Radiologic technicians perform mammograms, x rays, and other imaging studies, and nurses and laboratory technicians may obtain samples of blood, urine, and other laboratory tests.

Before and after any surgical procedures, including biopsies, nurses provide preparatory education to help patients and families. Depending on the tumor stage and treatment plan, patients may also benefit from rehabilitation therapy with physical therapists, nutritional counseling from dieticians, and counseling from social workers or other mental health professionals.

Patient education

It is vitally important for health professionals to instruct and encourage women to perform regular, monthly breast self-examination (BSE). Physicians, nurses, and health educators should use every patient encounter to reinforce the value and importance of BSE.