Pink Ribbon International, Breast Cancer Awareness

Breast Cancer Awareness Pink RIbbon Foundation

Pink Ribbon International is a charitable organization working to create awareness for Breast Cancer around the world. Apart from focusing on the ongoing scientific endeavors to prevent, treat and cure breast cancer,  it provides support, care and guidance to all people whose lives have been affected directly or indirectly by Breast Cancer.


Aside from non-melanoma skin cancer, breast cancer is the most common form of cancer in women. Breast cancer is the number one cause of cancer deaths in Hispanic women. It is the second most common cause of cancer deaths in white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.

Pink Ribbon International is celebrating October 2011 as the Breast Cancer Awareness Month 2011. October is the official Breast Cancer Awareness Month, with each year being pinkier than last. Each year dozens of world-famous landmarks are illuminated in pink light and various walks and runs are organized all around the world to support this cause.

What is Cancer?

Cancer is a class of diseases in which a group of cells display the traits of uncontrolled growth, invasion, and sometimes metastasis. Most forms of cancers form a tumor but some, like leukemia, do not.
When cells grow old, they die, and the new cells take their place. Sometimes, this process goes wrong, and new cells form when the body does not need them, or old cells do not die when they should. This is what is referred to as uncontrolled growth.When a tumor has formed due to uncontrolled growth, and cells break away from the tumor and crawl through surrounding tissues, its called invasion. It leads to cancer cells being transported throughout the body and  possible establishment of a secondary tumor. The creation of this second tumor is metastasis. The most common places where breast cancer spreads to are the bones, liver, lungs, and brain

Who is at Risk?
      
All women are at risk when it comes to breast cancer, but no one knows what exactly causes breast cancer. Research has shown that women with the following risk factors are more likely than others to develop breast cancer.
•    Cancer  is hereditary: If your sister, mother, or daughter developed breast cancer, then you have a higher risk of developing it yourself.
•    Your own personal history with cancer;
•    The age at which your menstrual cycle began:  how earlier your cycle began, how higher the risk.
•    The age at which you go through menopause: women who have their menopause after the age of 55 are at higher risk of developing breast cancer.
•    The age at which you give birth to your first child: the risk increases with older age, but if you have first degree relatives with carcinoma of the breast, then risk goes down.
•    Your current age: The risk increases with age. Age is the biggest risk factor. (76% of women who develop breast cancer had no other risk factors).
•    Your race: Caucasian women have a slightly higher risk than Black, Hispanic, or Asian women.
•    Your health: women who are overweight or obese after their menopause have a higher risk of developing breast cancer.
•    Drinking alcohol: studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

How is Breast Cancer detected?

Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst.
  
Currently, mammography is the most effective technology available for breast cancer screening. But, aside from the conventional mammography, there are several techniques that can be used for screening. These techniques are:
•    Ultrasound
•    Digital Mammography
•    Computer-Aided Detection
•    MRI
•    PET scan
•    Electrical Impedance Scanning
•    Ductal Lavage

Ultrasound
The ultrasound, also referred to as sonography, is a technique in which high-frequency sound waves, unhearable for humans, are bounced off tissues and internal organs. The echoes generated produce a picture known as a sonogram. This form of imaging is commonly used to distinguish between solid tumors and cysts. An ultrasound is sometimes also used to examine lumps that are difficult to see on a mammogram. Ultrasounds are not used for routine breast exams, because this technique is not suitable for detecting early signs of cancer.

Digital Mammography
Compared to the conventional mammograms, digital mammograms use computerized images instead of x-ray film. Before printed on film, the images are displayed on a monitor, where they can be modified (enhanced, magnified, etc.).

Computer-Aided Detection
Computer-aided detection (CAD) is the use of computers to bring suspicious areas on a mammogram to the radiologist's attention. It is used after the radiologist has done the initial review of the mammogram, and is performed by scanning the mammogram into the computer.

MRI
MRI (Magnetic Resonance Imaging) is the creation of detailed pictures of areas inside the body through the use of a magnet, this form of imaging does not use radiation. The entire session may take about an hour.

PET scan
A PET (Positron Emission Tomography) scan is a computerized image of chemical changes taking place in human tissue. Patients are given an injection of a combination of sugar and a small amount of radioactive material. This radioactive sugar helps in locating a tumor, because cancer cells absorb sugar faster than other tissues in the body. PET scans are more accurate in detecting larger and/or aggressive tumors than they are in locating small and/or less aggressive ones.

Electrical Impedance Scanning
Human tissue has different electrical impedance levels (the speed of electricity through material). Breast tissue that is cancerous has a much lower electrical impedance (conducts electricity better) than normal breast tissue. The EIS is done by placing an electrode patch on the patient's arm, and passing a very small current into the body. The current travels through the breasts, where it is measured by the scanning probe . Tumors show up as bright white spots in the computerized image on the screen.

Ductal Lavage
Ductal lavage is an investigational technique for collecting samples of cells from breast ducts for analysis. The doctor then extracts fluids from the duct, which are then checked for indications of cancer.

How many Stages are there?       

The different stages of breast cancer are based on the size of the tumor, and whether the cancer has spread. Staging is done through x-rays, examination of the lymph nodes, and other clinical tests. These tests can show whether the cancer has spread and, if so, to what parts of the body. The pathologic form of staging is more accurate than the clinical form, because it gives doctors the ability to exam the cancer more extensively.

According to the TNM system there are 5 stages of cancer, stages 0 to IV. Stage 0 being the non-invasive cancer, stage I the least advanced, and stage IV the most advanced.

Stage 0
It is referred to as ductal carcinoma in situ (DCIS); it is the earliest form of breast cancer. When a woman is diagnosed with stage 0, the cancer cells have not yet invaded into the surrounding fatty breast tissue. In this stage, abnormal cells grow within the lobules, but do not penetrate the lobules' wall.

Stage I
With stage I the tumor is smaller than 2 cm (3/4 in.) in diameter, and has not spread to the lymph nodes or other, distant, tissue.

Stage IIA
There are many classifications for Stage IIA breast cancer, any of the following applies:
•    The tumor is less than 2cm in diameter, or not found, and has spread to 1-3 axillary lymph nodes.
•    The tumor is less than 2 cm in diameter, or not found, and tiny amounts of cancer can be found in internal mammary lymph nodes on sentinel lymph node biopsy
•    The tumor is less than 2 cm in diameter, and has spread to 1-3 axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
•    The tumor is larger than 2 cm but smaller than 5cm in diameter, but has not spread to the lymph nodes.

Stage IIB
Similar to stage IIA, stage IIB cancer can have any of the following characteristics:
•    The tumor is larger than 2 cm, but less than 5 in diameter. It has also spread to 1-3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
•    The tumor is larger than 5 cm in diameter but does not grow into the chest wall or surrounding tissue, and has not spread to the lymph nodes.

Stage IIIA
•    The tumor is not more than 5cm in diameter, or cannot be found. It has furthermore spread to 4 to 9 axillary lymph nodes, or it has enlarged the internal mammary lymph nodes.
•    The tumor is larger than 5 cm in diameter, but has not grown into the surrounding tissue. It has spread to 1-9 of the axillary nodes, or to internal mammary nodes.

Stage IIIB
With stage IIIB cancer, the tumor has grown into the chest wall or skin, and one of the following applies:
•    It has not spread to the lymph nodes.
•    It has spread to 1-3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
•    It has spread to 4-9 axillary lymph nodes, or it has enlarged the internal mammary lymph nodes.
Inflammatory breast cancer is also classified as stage IIIB unless it has spread to distant lymph nodes or organs, in which case it would be stage IV.

Stage IIIC
Stage IIIC tumors are of any size, or cannot be found, and one of the following applies:
•    The cancer has spread to 10 or more axillary lymph nodes.
•    The cancer has spread to the lymph nodes under the collarbone.
•    The cancer has spread to the lymph nodes above the collarbone.
•    The cancer involves axillary lymph nodes and has enlarged the internal mammary lymph nodes.
•    Cancer involves 4 or more axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.

Stage IV
The cancer can be any size and may or may not have spread to nearby lymph nodes. It has spread to lymph nodes far from the breast, and distant organs; the most common sites being: the bone, liver, brain, and lung.

What are the Treatment Methods available?        

Women diagnosed with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. Many women may receive more than one type of treatment, depending on the stage of breast cancer, the size of the tumor in relation to the breast, and whether the patient has gone through menopause.

There are two main types of treatments:
•    Local therapy: The two forms of local therapy are surgery and radiation therapy. These forms of therapy remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
•    Systemic therapy: The forms of systemic therapy are: chemotherapy, hormone therapy, and biological therapy. This form of therapy uses the bloodstream to destroy, or control, cancer throughout the entire body. Systemic therapy is also used to shrink the tumor before surgery or radiation. But systemic therapy can also be used after surgery and radiation, to help prevent the cancer from returning. Systemic therapy is furthermore used for cancer that has metastasized (spread to other organs).

Because cancer treatments often damage healthy cells and tissues, side effects are common. The side effects depend mainly on the type and extent of the treatment. Not every woman may encounter the same side effects.

Surgery   
The most common treatment for breast cancer is surgery. There are several different types of surgery:

Conservative surgery (breast-sparing surgery): This type of surgery aims to take away the cancer, while leaving behind as much healthy breast tissue as possible. To try to make sure that all the cancer has been removed the surgeon removes a border of healthy tissue around the tumor. This tissue is then sent to the pathologist, who inspects the healthy layer for signs of cancer cells. The surgeon often removes the underarm lymph nodes as well to find if cancer cells have entered the lymphatic system. This procedure is called an axillary lymph node dissection.
Conservative surgery is sometimes also called Lumpectomy, or Wide local excision. Another form of conservative surgery is Segmentectomy/Quadrantectomy .After the surgery, patients usually undergo radiotherapy to make sure that there are no breast cancer cells left behind in the remaining breast tissue.

Mastectomy: For some women mastectomy is the more suitable treatment; the complete removal of the breast. Mastectomy is most suitable when:
•    There is a large lump, particularly in a small breast.
•    The lump is located in the middle of the breast.
•    There is cancer in multiple areas of the breast.
•    There are areas of DCIS in the rest of the breast.

There are different types of mastectomy as follows:
•    Simple Mastectomy: also known as Total Mastectomy, this form only removes the breast tissue
•    Radical Mastectomy: removes the breast tissue and chest wall muscles.
•    Modified Radical Mastectomy: removes the breast and lymph nodes under the arm, leaves the major chest wall muscles intact.
   
Once a patient has undergone a mastectomy, they may feel off balance or discomfort in neck and back, as muscles will tense to cope with the imbalance. This usually goes away with time. The doctor, nurse, therapist, often suggests exercises to regain the movement and strength in the muscles.

Radiation Therapy  

Radiation therapy is a treatment that uses high-energy rays to destroy cancer cells. It is much like getting an x-ray, but the radiation administered is much more intense (yet painless). Most women receive radiation therapy after undergoing a form of breast cancer surgery to ensure that any remaining cancer cells are destroyed. Women sometimes also receive this form of therapy prior to the surgery, in order to destroy cancer cells, and shrink the tumor. It is used when the tumor is large or may be hard to remove.

There are two main types of radiation therapy; in certain cases women can receive both forms:
External Radiation: External radiation is the more common of the two types. This therapy focuses the radiation on the area affected by cancer. The radiation is admitted by a machine that is outside the body. The extent of the radiation depends on the surgery the patient received (lumpectomy or mastectomy).
Potential side effects of radiation therapy are:
•    Swelling and heaviness in the breast.
•    Sunburn-like skin changes in the treated areas.
•    Fatigue.
•    Breasts become smaller and firmer.
•    Weaken ribs (very rare)

Internal Radiation: Also known as Brachytherapy, Internal Radiation is the second method for delivering radiation therapy.The doctor places (small) radioactive implants in the breast tissue, next to the tumor site. A woman who has received the implants must stay in the hospital until they are removed, this may take several days. Who can receive internal radiation depends on the tumor size and location.
There are two types of internal radiation:
•    Intracavitary branchytherapy: this form of internal radiation uses a small balloon attached to a thin tube. The balloon is inserted (deflated) into the space left by the lumpectomy and is filled with a salt water solution. The doctor then places a source of radioactivity in the middle of the balloon, and removes it twice a day. This form of therapy is administered for a 5 day period, after which the balloon is deflated and removed.
•    Interstitial branchytherapy: several small, hollow tubes (catheters) are inserted into the breast around the area of the lumpectomy. Radioactive pellets are then  inserted into the catheters for short periods each day and then removed.

Chemotherapy
   
Chemotherapy is a chemical treatment, which is not only used for breast cancer, but also other forms of cancer. The drugs used during chemo have a high level of toxicity, which is supposed to kill of the cancer cells, but also kills off healthy cells. The chemotherapy drugs are administered intravenously or as tablets. Administering the drugs through an IV usually takes a few hours. Following the treatment, patients receive a rest period of a few weeks; this allows the body to recover from the side effects. Chemotherapy usually takes between 4 and 6 months.

Chemotherapy drugs can cause side effects, but these can usually be controlled through other medicines. Some of the side effects are:
•    Lowered resistance to infection: chemotherapy reduces the production of white blood cells by the bone marrow, making patients more vulnerable to infections
•    Bruising or bleeding: chemotherapy can also reduce the production of platelets, these help against blood clots. This can cause unexplained bruising or bleeding, such as nosebleeds, bloodspots or rashes on your skin, or even bleeding gums.
•    Low red blood cell count (anemia): chemotherapy may make you anemic, meaning that you may feel tired and breathless.
•    Nausea and vomiting: certain drugs can make you feel sick, or even be sick. This can be helped by taking anti-emetics (anti-sick drugs).
•    Sore mouth: some drugs can make your mouth sore and may cause small ulcers.
•    Poor appetite: the treatment may cause you to lose your appetite. It is important to stay nutritious during the chemo, and you could replace meals with nutritious drinks or a soft diet.
•    Hair loss: certain drugs may cause hair loss during chemo, which can be very upsetting. But it is only temporary, and should start to grow back within 3-6 months after the end of treatment.

Hormone Therapy        

Certain breast tumors require hormones to grow. Through hormone therapy doctors try to keep cancer cells from obtaining those hormones. There are many different types of hormonal therapy, each working in a slightly different way. Doctors often subscribe hormone therapy after surgery and radiotherapy, or chemotherapy, to reduce the chance of the cancer from returning. This form of therapy is only effective on women whose cancer cells have receptors for estrogen and/or progesterone. This is classified as being estrogen-receptor positive (ER+) or progesterone-receptor positive (PR+).
There are many issues to take into account when choosing which type of hormone therapy a patient should use, including:
•    the stage and grade of the cancer
•    which other treatments are being used
•    whether the cancer cells are HER2-positive
Unlike chemotherapy, hormone therapy is a long-term therapy, sometimes lasting for more than 5 years.

Biological Therapy        

Biological Therapy is a form of breast cancer treatment that strengthens the patients' immune system. This form of therapy helps fight cancer, but it also controls side effects from other cancer treatments, such as chemotherapy. Many of the biological treatments are still in the experimental stage.
Despite the fact that this form of therapy is labeled biologic, the medication can have side effects, such as:
•    Allergic reactions
•    Difficulty breathing
•    Swelling
•    Nausea
•    Fever or Chills
•    Dizziness

Can a Male have Breast Cancer?

Breast cancer is not a disease that exclusively affects women, men can develop breast cancer as well.  Although men have less breast tissue than women, they also have breast tissue that can undergo cancerous changes. Statistically, women are 100 times more likely to develop breast cancer than men. Male breast cancer is most common in men ages 60-70.
As with female breast cancer, it is important that male breast cancer is detected at an early stage, which can help save lives. The earlier the disease is discovered, the higher the survival chance.
There is no certain way of saying why one man develops breast cancer, while another doesn't. Doctors do say that between 5 and 10% of breast cancer in men is inherited.

There are certain risk factors that increase the chance of developing breast cancer.
•    Age - average diagnosis age is 67
•    Family History - if a close relative, such as a mother or sister, with breast cancer, the risk increases
•    Radiation exposure
•    Klinefelter syndrome
•    Exposure to estrogen
•    Liver disease
•    Excess weight
•    Excess use of alcohol
The detection and treatment methods are essentially the same in women and men.

Breast Cancer Myths : Is it true?

There are large no. of rumors floating around regarding the development of breast cancer. But how do we know which one are true? We here try to clarify few myths regarding these which could make a difference between life and death of a human being.

Myth 1: Having a risk factor for breast cancer means you'll develop the disease.
No risk factor either alone or in combination with others means you'll definitely get breast cancer. There are various factors that may increase your risk of developing the disease. Some of these appear to increase your risk only slightly. Even an inherited genetic abnormality in your family doesn't necessarily mean you're going to get breast cancer. Abnormalities in the so-called breast cancer genes BRCA1 and BRCA2 are very strong risk indicators. But 20 to 60 percent of women with these inherited abnormalities will not develop breast cancer.
Myth 2: If there is no breast cancer in your family, then you're not at risk for the disease.
Every woman is at risk for breast cancer. So are some men! For any individual woman, an inherited abnormality is the strongest risk factor, but only about 10 percent of all cases of breast cancer are due to inherited abnormalities. About 85 percent of women who develop the disease don't have a family history. That's why it's important for all women to get screened regularly.
Myth 3: Breast cancer is passed only from your mother, not your father.
We now know that breast cancer genes can be inherited from your dad's side of the family. In fact, male breast cancer is most closely associated with a BRCA2 abnormality.
Myth 4: No matter what your risk factors are, you really don't have to worry about breast cancer until you're through menopause.
The odds of getting the disease do increase as you age. But breast cancer can occur at any age. That's why all women need to be vigilant.
Myth 5: Wearing a bra or using antiperspirants and deodorants increases your risk of breast cancer.
It's not true that wearing a bra, especially underwire bras, traps toxins by limiting lymph and blood flow in your breasts, increasing risk. There's also no proof for the claims that antiperspirants and deodorants cause cancer by keeping the body from sweating out the cancer-causing substances that build up in the breasts, or because they contain harmful chemicals that are absorbed through the skin.
Myth 6: If you have small breasts, you're much less likely to get breast cancer.
Size doesn't matter. Anyone with breasts can get it.
Myth 7: Research shows that using hormone therapy (HT) even for a short period of time, causes breast cancer.Many women were understandably concerned when a major study found that HT combining estrogen and progestin increased risks of invasive breast cancer slightly. Another study also showed that a combination of therapy boosts breast cancer risk somewhat, however, it was able to offer some reassurance: This risk appeared to return to normal within a year or so after women stopped using the therapy. This seems to be the case for women who've been on HT for just months and those who've used it for more than 5 years.


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Niagara Falls illuminated Pink supporting Breast Cancer Month. Photo courtesy: Pink Ribbon International