Breast cancer is a malignant transformation of cells constituting the mammary gland. As these cells are varied, cancers or neoplasms, which are also derived. There is not one but DES breast cancer.
The breasts are glands responsible for producing milk. They are divided into 15 to 20 lobes, divided themselves into many lobules that end in tiny bulbs secreting milk. The lobes, lobules, and bulbs are linked by ducts. These lead to the nipple in the center of a pigmented area, the areola.
Breast tissue is mainly composed of luminal cells producing milk and myoepithelial basal cells which expels during breastfeeding. The classification of breast cancer has been refined through analysis of cellular DNA (genomic analyzes). We now distinguish luminal cancer, cancer basal-like and HER2 + cancer.
Risks and origin of breast cancer
Cancer in women and the second most common cancer in the general population after the prostate, breast cancer is a major public health problem. In 2011, 53,000 new cases of breast cancer were diagnosed. It is estimated that one in 9 women will develop breast cancer in her lifetime. If the disease primarily affects women, it also affects men: 0.5% of breast cancers are male.
Between 1980 and 2005, the 138% increase in the number of cancers is partly explained by the lengthening of life and the effects of widespread screening. Some studies also evoke behavioral or environmental risks, such as age at first child and some hormonal treatment of menopause.
As in other developed countries, the advance has stabilized since 2004, the incidence appears to even decrease (data from the National Health Insurance). Although changes in habits vis-à-vis hormonal treatments are often mentioned, a step back is needed to confirm and understand this actually decrease.
What are the different types of breast cancer?
These cancers arise from luminal epithelial cells in said channels or breast lobules. These are the most common forms, divided into two groups depending on whether they are high or low cell receptors for estrogen (ER called ER or English).
Luminal A cancer represents 25 to 40% of breast cancer expresses many receptors, it is RE + + +. Cancer luminal B represents 20 to 25% of breast cancers and expresses little surface receptors, it is RE +.
Breast cancer HER2 +
Approximately 15% of breast cancers overexpress the HER2 receptor on their surface. They fall into the category known as HER2 + tumors. Activated, the receiver causes cell proliferation. Its overexpression presupposes a more aggressive tumor, which is not true because today has targeted therapies against him. Industrially synthesized antibody blocks this receptor. First proposed to the patient is trastuzumab, better known by its brand name Herceptin ®.
Breast cancer basal-like represent 10 to 15% of breast cancers. They are characterized by the absence of estrogen receptor and progesterone, and the fact that they do not overexpress HER2. They are called triple negative. A worse prognosis than other treatments against them because there are fewer and less effective, they resemble breast tumors due to mutations in the BRCA1 gene (approximately 5% of women with breast cancer).
However, triple negative tumors do not belong to the basal-like category. This illustrates the morphological heterogeneity and prognosis of breast cancer.
Causes and risk of breast cancer
Scientific studies have shown that certain factors increase the risk of developing the disease:
Two-thirds of breast cancers occur after age 50.
The risk of having breast cancer is increased in women whose mother or sister has been reached. If the cancer has occurred in the mother before menopause, the risk in girls are even higher.
Breast cancer affects mainly women.
Obesity, excessive consumption of alcohol or excessive consumption of animal fats increase the risk of breast cancer.
Smoking is also a risk factor and it is preventable.
Signs and symptoms of breast cancer
Breast cancer can occur in a number of symptoms, which are not exhaustive. Indeed, if tiny cancers are undetectable outside a mammogram, tumors metastasized or have already expanded variety of events, and in the distance.
Be wary of:
- A lump or persistent induration or in the armpit,
- Changing the size or the shape of a breast,
- A discharge from the nipple
- A change in pigmentation or texture of the skin of the breast or areola.
The pain is usually not a sign of breast cancer. However, any changes in the breast should be reported immediately to a doctor. Symptoms may be caused by cancer or by a number of other conditions.
Diagnosis and screening of breast cancer
In the framework of generalized screening of breast cancer in women 50 to 74 years are invited every two years to go to a certified radiologist of their choice. After clinical examination (palpation), one practice a mammogram (breast x-ray). This test detects abnormalities not detectable by palpation.
The photo is automatically read by two practitioners. If an abnormal is detected, the radiologist practice exams complementary expansion of clichés, ultrasound, and if deemed necessary, a sample (biopsy) under local anesthesia for analysis of cells under a microscope.
Early detection of cancer allows better management, which increases the chances of recovery.
Treatment of breast cancer available
Treating breast cancer depends on the nature and location of the tumor, and stage of the disease. The choice of treatment strategy depends on the staging (TNM) disease: T = tumor size, lymph node N = M = presence or absence of metastases.
Today there are several therapeutic strategies: surgery, radiotherapy, chemotherapy, hormone therapy and targeted therapies (monoclonal antibodies ...).
The surgeon removes the tumor, which will be analyzed by the pathologist, to specify particular size, aggressiveness, presence or absence of hormone receptors. The type of surgery (total removal of the gland, or lumpectomy) depends mainly on the size of the tumor. In the same operation, it generates axillary dissection on the same side as the tumor, to detect possible cancerous foci in the lymph nodes examined.
It uses high-energy radiation to kill cancer cells and prevent their development. It can be administered in different ways: either from an external radiation source or from radioactive materials implanted directly into the breast (brachytherapy).
It is a treatment which involves the whole broadcast organization (treatment called "systemic" treatments versus "local"). It may be administered before or after surgery.
Hormone treatments means that control tumor growth by regulating hormones. This therapy is indicated when the tumor is hormone dependent breast, that is to say, it has cellular receptors to hormones (estrogen and progesterone).
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