Breast Cancer

Breast Cancer is a neoplastic disease in which normal body cells rare transformed into
malignant ones (Opatt & Chung, 2007). It is the most common cancer in women and the
second leading cause of cancer deaths (lung cancer is first) among American women. Over
200.000 cases of invasive breast cancer are diagnosed in United States each year (ACS,
2007c). Breast cancer can also affect men, but only 1% of all individuals diagnosed with
breast cancer annually are men (ACS, 2007). Because men are not routinely screened for
breast cancer, the diagnosis often delayed.
The most common clinical manifestation of male breast cancer is a painless, firm,
subareolar breast mass. Any suspicious breat mass in a male should undergo diagnostic
biopsy. If a malignancy is diagnosed , typical treatment is mastectomy with assessment of the
axillary nodes.
The cause of breast cancer, while not well understood, is thought to be a complex
interaction between environment, genetic, and hormonal factors. Breast cancer is a
progressive rather than a systemic disease, meaning that most cancer grow from small size
with low metastatic potential to larger size and greater metastatic potential (Opatt & Chung,
2007).

Pathophysiology
Cancer is not just one disease, but rather a group of diseases that result from
unregulated cell growth. Without regulation, cells divide and grow uncontrollably until they
eventually from a tumor. Breast cancer strarts in the apithelial cells that line the mammary
ducts within the breast. The growth rate depends on hormonal influences, mainly estrogen
and progesterone. The two major categories of breast cancer are noninvasive and invasive.
Nonnvasive, or in situ, breast cancers are those that have not extended beyond their duct,
lobule, or point of origin into the surrounding breast tissue. Conversely, invasive, or
infiltrating, breast cancer have extended into the surrounding breast tisuue, with the potential
to metastasize.
Breast cancer is considered to be a highly variable disease. While the process of
metastasis is a complex and poorly understood phenomenon, there is evidence to suggest that
new vascularization of the tumor plays an important role in the biological aggressiveness of
breast cancer (Hackley, Kriebs, & Rousseau 2007). Breast cancer metastasizes widely and to
almost all organs of the body, but primarily to the bone, lungs, lymph nodes, liver, and brain.
The first sites of metastases are usually local or regional, involving the chest wall or axillary
supraclavicular lymph nodes or bone (ACS, 2007f).

Risk Factor
An estimated 80% of women in whom breast cancer develops have no documented
risk factor (Sukumvanich & Borgen, 2007). Breast cancer is thought to develop in response to
a number of related factors: aging, delayed child bearing or never bearing children, high
breast density, family history of cancer, late menopause, and hormonal factors (ACS, 2007e).
Risk factors for breast cancer can be devided into those that cannot be changed
(nonmodifiable risk factors) and those that can be changed (modifiable risk factors).
Nonmodifiable risk factors (ACS, 2007e) are :
 Gender (female)
 Aging (>50 years old)
 Genetic mutations (BRCA-1 and BRCA-2 genes)
 Personel history of ovarian or colon cancer
 Increased breast density
 Family history of breast cancer
 Personel history of breast cancer (three- to fourfold increased in risk for recurrence)
 Previous abnormal breast biopsy (atypical hyperplasia)
 Exposure to chest radiation
 Early menarche (<12 years old) or late onset of menopause (>55 years old)

Modifiable risk factors related to lifestyle choices (ACS, 2007e) include:

 Not having children at all or not having children until after age 30. This increases the
risk of breast cancer by not reducing the number of menstrual cycle.
 Postmenopausal use of estrogens and progestins
 Failing to breastfeed for up to a year after pregnancy
 Alcohol consumption
 Smoking
 Obesity and consumption of high-fat diet
 Sedentary lifestyle and lack of physical exercise