Breast Cancer

Breast cancer occurs when there is a malignant tumor inside the breast. Each year more than 185,000 women are diagnosed with breast cancer, and the incidence of this disease is rising in developed countries. There are approximately 43,500 deaths from breast cancer annually, making this disease second to lung cancer as the leading cause of death by cancer among women. Ninety percent of breast cancers are detected by women themselves, often through breast self-examination (BSE).


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Also Listed As
Cancer, Breast

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Signs and Symptoms

According to the National Cancer Institute, breast cancer is often accompanied by the following signs and symptoms.

• A lump or thickening in or near the breast or in the underarm area
• A change in the size or shape of the breast
• Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
• Ridges or pitting of the breast (the skin looks like the skin of an orange)
• A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)


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What Causes It?

While the cause of breast cancer is not known, it is clear that the disease is hormone-dependent. Women whose ovaries do not function and who never receive hormone replacement therapy do not develop breast cancer.

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Who's Most At Risk?

People with the following conditions or characteristics are at a higher-than-average risk for developing breast cancer.

• Women (comprise over 99 percent of cases; men comprise under one percent)
• Increasing age
• History of cancer in one breast
• History of benign breast disease
• Never giving birth or first pregnancy after 30
• Family history (first-degree relative) of breast cancer (significant for premenopausal women)
• Early onset of menstruation and late menopause
• Possibly, long-term oral contraceptive use (although this is controversial)
• High doses of ionizing radiation before age 35
• History of cancer of the colon, thyroid, endometrium, or ovary
• Diet high in animal fat, excessive alcohol consumption, and, possibly, obesity
• Alterations in certain genes
• Breast implants

Despite the relevance of risk factors, 70 to 80 percent of women with breast cancer have none of the known risk factors.

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What to Expect at Your Provider's Office

If you are experiencing symptoms associated with breast cancer, see your health care provider immediately. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

Your provider will do a breast exam and run some laboratory tests, including a study of breast tissue and genetic studies. Imaging techniques may include mammography, ultrasound, magnetic resonance imaging (MRI), and other methods that help distinguish a cyst from a solid mass or make a distinction between cancerous and noncancerous disease.

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Treatment Options


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Prevention

Early detection is important. Monthly breast self-examination and annual gynecologic examinations play a large role in early detection. Nutrition may play a role in prevention.


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Treatment Plan

Treatment options depend on the size and location of the tumor, results of lab tests, and the stage, or extent, of the disease, along with the patient's age and menopausal status, general health, and breast size.


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Drug Therapies

Your provider may prescribe one or more of the following therapies.
• Radiation therapy— the use of high energy rays to kill cancer cells and prevent them from growing
• Chemotherapy—the use of drugs to kill cancer cells
• Hormonal therapy, which keeps cancer cells from getting the hormones they need to grow
• Antitumor antibiotics
• Antiestrogens, such as tamoxifen, which block the action of estrogen on breast tissue
• Monoclonal antibodies to block the protein receptor that is produced in large numbers in women with breast cancer
• High-dose progestogens (steroid hormones)


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Surgical and Other Procedures

Surgery is the most common treatment for breast cancer. The choice of surgeries includes the following.
• Mastectomy—removal of the breast or as much of the breast tissue as possible; can be followed by breast reconstruction
• Lumpectomy—removal of the tumor and a small amount of tissue around it, usually followed by radiation therapy
• Segmental, or partial, mastectomy—removal of the tumor and a small amount of tissue around it, as well as the lining of the chest muscles below the tumor and some of the lymph nodes under the arm. It is usually followed by radiation therapy.


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Complementary and Alternative Therapies

A comprehensive treatment plan for breast cancer may include a range of complementary and alternative therapies. Psychotherapy and support groups may help improve quality of life and survival.

Nutrition
Nutritional tips include the following.
• Eliminate non-organic poultry, dairy, red meat, sugar, white flour and refined foods, coffee, tea, chocolate, and colas.
• Eat cruciferous vegetables (broccoli, cabbage, cauliflower).
• Eat only organically raised foods.
• Include liver foods such as beets, carrots, yams, garlic, dark leafy greens, lemons, and apples.
• Follow a high-fiber diet.
• Use soy.

Potentially beneficial nutrient supplements include the following.
• Coenzyme Q10 (120 mg three times a day)
• Calcium d-glucarate (500 to 1,000 mg three times a day)
• Vitamin A (25,000 IU a day), vitamin E (800 IU a day), and vitamin C (250 to 500 mg twice per day) to decrease side effects of chemotherapy and radiation
• Selenium (200 to 400 mcg a day) to decrease side effects of chemotherapy and radiation
• Bromelain (500 mg two times a day between meals)
• Melatonin (10 to 50 mg a day)

Herbs
The use of certain herbal remedies may offer relief from symptoms. Try the following: a combination of black cohosh (Cimicifuga racemosa), red clover (Trifolium pratense), and alfalfa (Medicago sativa) as a base (1 to 3 g); add two to three of the following in equal parts, 30 to 60 drops two to three times daily:
• With anxiety: passionflower (Passiflora incarnata), kava kava (Piper methysticum)
• With lymph node involvement: poke root (Phytolacca americana), red root (Ceanothus americanus); maximum dose of poke root is 0.4 ml a day.
• With nausea: ginger root (Zingiber officinale), fennel seed (Foeniculum vulgare)
• With exhaustion: oatstraw (Avena sativa), skullcap (Scutellaria lateriflora)

Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20 minutes).

Homeopathy
An experienced homeopath considers both your symptoms and constitutional type in order to create an individualized treatment regimen. Some of the most common homeopathic remedies that may helpful in treating symptoms associated with breast cancer are listed below.
• Arsenicum for anxiety and nausea, with restlessness and burning pains
• Ipecac for nausea unrelieved by vomiting
• Nux vomica for sharp abdominal pains with anger and collapse

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Acupuncture
While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for symptoms associated with cancer and the side effects of chemotherapy. In a study of 104 women with breast cancer and nausea from chemotherapy (all of whom were taking anti-nausea medication), women treated with acupuncture experienced fewer attacks of nausea than women who received the medication alone. There have also been studies indicating that acupuncture may help eliminate pain and hot flashes caused by tamoxifen (a breast cancer medication). One study found that acupuncture markedly improved breathlessness in women with late stages of breast cancer. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness; this is a technique that individuals can learn and then use to treat themselves.

Some acupuncturists prefer to work with breast cancer patients only after they have completed conventional medical cancer therapy. Others will provide acupuncture and/or herbal therapy during active chemotherapy or radiation. Acupuncturists treat breast cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.


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Prognosis/Possible Complications

Most complications result from surgery, radiation, chemotherapy, or use of the drug tamoxifen, which is effective in preventing recurrence but increases a woman's risk of endometrial cancer and thrombo-embolic disease. These include:

• Restricted shoulder movement
• Increase in size of operative scar
• Inflammation of connective tissue in the affected arm
• Malignant tumor of the lymphatic vessels in the affected arm
• Accumulation of fluid in the breast; swelling of tissue in the arm
• Discoloration of the skin from radiation, or a red spot
• Inflammation of the lung from radiation
• Death of the fat cells underlying the breast tissue
• Recurrence of the disease

The prognosis for breast cancer patients depends primarily on the stage, or extent, of the disease at the time of the initial diagnosis.

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Following Up

Breast cancer patients should be followed every three months for eighteen months to four years, then every six months.

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Supporting Research

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Birdsall TC. Effects and clinical uses of the pineal hormone melatonin. Altern Med Rev. 1996;1(2):94-102.

Bland KI, Copeland EM III. The Breast: Comprehensive Management of Benign and Malignant Diseases. Philadelphia, Pa: W.B. Saunders; 1991:731-747, 877-894.

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:462,464, 466.

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Cummings SR, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women. JAMA. 1999;281:2189-2197, 1999.

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Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1998;10:145-150.

He JP, Friedrich M, Ertan AK, Muller K, Schmidt W. Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obst Gynecol. 1999;26(2):81-84.

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NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm on September 24, 2001.

Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.

Pawlowicz Z, Zachara BA, Trafikowska U, et al. Blood selenium concentrations and glutathione peroxidase activities in patients with breast cancer and with advanced gastrointestinal cancer. J Trace Elem Electrolytes Health Dis. 1991;4:275-277.

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