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I. Introduction
II. Breast cancer define
III. Causes

A. Genetic Factor
B. Environmental factors
C. Risk factors

IV. Symptoms
V. Early Detection
VI. Prevention

A. Breast Self - Examination (BSE)

B. Breast Clock – Examination (BCE)

VII. Conclusion


Breast Cancer constitutes a major public health issue globally with over 1 million new
cases diagnosed annually, resulting in over 400,000 annual deaths and about 4.4 million
women living with the disease. It is the commonest site specific malignancy affecting
women and the most common cause of cancer mortality in women worldwide.(1;2)

There is an international/geographical variation in the incidence of Breast Cancer.

Incidence rates are higher in the developed countries than in the developing countries and
Japan. Incidence rates are also higher in urban areas than in the rural areas.
In Africa, Breast Cancer has overtaken cervical cancer as the commonest malignancy
affecting women and the incidence rates appear to be rising. (3;4) In Nigeria for example,
incidence rate has increased from 13.8–15.3 per 100,000 in the 1980s, to 33.6 per
100,000 in 1992 and 116 per 100,000 in 2001. (5) These increases in incidence are due to
changes in the demography, socio-economic parameters, epidemiologic risk factors,
better reporting and awareness of the disease. While mortality rates are declining in the
developed world (Americas, Australia and Western Europe) as a result of early diagnosis,
screening, and improved cancer treatment programs, the converse is true in the
developing world as well as in eastern and central Europe.(6-8)

Breast cancer and its treatment constitute a great physical, psychosocial and economic
challenge in resource limited societies as found in Africa. The hallmarks of the disease in
Africa are patients presenting at advanced stage, lack of adequate mammography
screening programs, preponderance of younger pre-menopausal patients, and a high
morbidity and mortality. (3;6)

This Review is meant to provide practical guidance for the surgeon working in the
developing world. We have relied on the Chapter on Breast Cancer by Bland et al in
Schwartz’s Principles of Surgery, 8th Edition. (9)

Material which is of interest but not immediately applicable has been placed in smaller
print. In the Recommendations we have followed the principles developed in the Breast
Health Global Initiative. (10-12)

What is Breast Cancer?

Cancer is a general term that refers to cells that grow and multiply out of control and
possibly spread to other parts of the body. There are many different types of breast
cancer. Each may have different characteristics, and each one may require a
different treatment. 1

© 2000 WebMD, Inc. All rights


Cancer can cause harm in different

ways. Cancer cells take nutrition
and space away from normal cells.
A lump of cancer cells, called a
tumor, can invade or destroy
normal tissue. Cancer cells can
also spread to other parts of the
body. This is called metastasis. 1

Breast cancer is a common cancer among women in the United States and second
only to skin cancer, affecting about 178,480 women in the United States in 2007. 2

Most breast cancer begins in the milk ducts. These ducts connect the milk-producing
glands (called lobules) to the nipple. Some breast cancer begins in the lobules
themselves, and the rest begins in other tissues. The diagram shows where these body
parts are within the breast. 3

Risk Factors for Breast Cancer

A risk factor is something that may increase the chance of developing a disease.

The following are risk factors for developing breast cancer 4:

• Female gender
• Increasing age
• Personal history of breast cancer or previous breast biopsies
• Family history
• Genetic factors - cancer causing mutations in BRCA1 (BReast CAncer
gene 1) and BRCA2 (BReast CAncer gene 2) account for 5%-10% of all
breast cancer cases
• Hormonal factors, such as earlier age at first period, later age at birth
of first child, later age at menopause, having no children
Breast Cancer Stages
A cancer's stage refers to how much the cancer has grown and where it has spread.
Staging systems help describe the cancer, so that the doctor can decide what
treatments are appropriate.

Understanding Your Breast Cancer Pathology Report

Knowing the biological makeup of the tumor helps the doctor understand how quickly
any cancer might grow and what treatments may be best.

What cause it?

The exact cause of breast cancer is not known. Female hormones and
increasing age play a part. The chances that you will develop breast cancer
increase as you age. In the United States, about 1 in every 8 women who live
to be 80 will have been diagnosed with breast cancer at some point in her

Family history also plays a role in the development of breast cancer. You are
more likely to have breast cancer if your mother, father, or sister has breast
cancer. Also, women who carry certain genes called BRCA1 and BRCA2 are
more likely to have breast cancer. If you have a strong family history of
breast or ovarian cancer, you may want to be tested for these genes. People
who inherit specific changes, or mutations, in one or both of these genes
have a greater risk of developing breast cancer.

Studies show that menopausal women who take hormone therapy with
estrogen and progestin have an increased risk of breast cancer. Women who
take estrogen alone may have a slightly increased risk.1, 8

Many people believe that only women have breast cancer. But, although rare,
about 1% of all breast cancer occurs in men. Most men who have breast
cancer are older than 65, but it can appear in younger men. For this reason,
any breast lump in an adult man is considered abnormal.7
What are the symptoms?


The first sign of breast cancer is often a painless lump. But early breast
cancer is often found on a mammogram before a lump can be felt.

Other symptoms of breast cancer may not appear until the cancer is more
advanced. These include:

• A thickening in the breast or armpit.

• A change in the size or shape of the breast.

• Changes in the skin of the breast, such as a dimple or skin that looks
like an orange peel.

• A change in the nipple, such as scaling of the skin or a nipple that

turns in.

• A green or bloody fluid that comes from the nipple.

• A change in the color or feel of the skin around the nipple (areola).

About 1% of breast cancer occurs in men. Although most men diagnosed with
breast cancer are older than 65, the disease can appear in younger men. For
this reason, any breast lump in an adult male is considered abnormal.7

Inflammatory breast cancer is a specific type of breast cancer that involves

the skin of the breast. It occurs when breast cancer cells form "nests" and
block the lymphatic drainage from the skin of the breast. Symptoms include
redness, tenderness, and warmth. Thickening of the skin of the breast (an
orange-peel appearance), rapid breast enlargement, and ridging of the skin
of the breast may also be present. Some women may also develop a lump in
the breast. For more information, see the topic Inflammatory Breast Cancer.
How can I prevent breast cancer?


You cannot control some things that put you at risk for breast cancer, such as
your age and being female. But you can make personal choices that lower
your risk of breast cancer. If you are at high risk for getting breast cancer,
your doctor may also offer you certain medical treatments that can help
prevent breast cancer.

Female hormones

Hormones change the way cells within the breast grow and divide. The years
when you have a menstrual cycle are your high-estrogen years. Experts think
that the longer you have higher estrogen, the more risk you have for breast
cancer.4 This includes taking hormones after menopause.1, 26

• Avoid long-term, high-dose hormones after menopause. If you use

hormone therapy for menopause symptoms, use a low dose for as short a
time as possible. This includes estrogen-progestin and estrogen-
testosterone.1, 3
Using estrogen by itself may slightly raise breast cancer

• Breast-feed. Breast-feeding may lower your breast cancer risk. The

benefit appears to be greatest in women who breast-fed for longer than 12
months or who breast-fed several children.27

• Strive for a healthy weight. Extra fat cells make extra estrogen, which
raises your breast cancer risk.4 Getting regular exercise and watching what
you eat can help.

Having a full-term pregnancy before age 30 also lowers your breast cancer

Healthy food and exercise

• Eat a healthy diet with plenty of fruits, vegetables, and whole grains. A low-fat
diet with limited red meat may lower your breast cancer risk.28, 29, 30

Methods of detecting Breast Cancer

1. Breast Self-Examination (BSE) once a month. This can be aided by "Can-Scan".

Recommendation for BSE

Once a month for women from age 40 onwards.

When should one do BSE?
It should naturally be done when the breast is smaller in women having menstruation, i.e.
just after the period. In post menopausal women it can be done on a fixed day of each
o Complete steps for conducting BSE are given in CanScan. CanScan also
predicts broadly, risk of Breast cancer.
2. Examination by health worker/doctor.
3. Mammography, usually after 50 years of age, periodically.
o It is an X-ray of the breast Screening mammography is key to early
detection, i.e. looking for cancer in a woman who has no obvious
symptom of disease.
4. Ultrasonography and FNAC (Fine Needle Aspiration Cytology).
o Ultrasonography scanning is now a part of breast examination. It is helpful
to find precisely the site for FNAC and biopsy. It can differentiate
between cyst and solid lesion. It can be done easily, a number of times,
with no radiation.
o FNAC can be done conveniently without even local anaesthesia by a
disposable syringe attached with a fine needle. The aspirates are spread
over slides and examined under microscope for abnormal cells.
5. Biopsy: It means examination of tissue under microscope.
o The tissue from the suspicious area can be achieved by various methods. It
is usually done in clinic under local anaesthesia by a specially designed
instrument. It confirms the diagnosis of breast cancer.


Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes,
which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs
that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.


Management of breast cancer is a major challenge in resource limited

Efforts should be geared towards early diagnosis, prompt and
standardized treatment to reduce the burden of advanced disease in
African women, majority of who are worse hit in the most productive
part of their life time.
Our knowledge about breast cancer is evolving, but is still limited with
respect to its etiology and biology, and with respect to its features in
individual countries and
Further research is needed to understand the role of genetics and
environment in the etiology of breast cancer in Africa.

Average life expectancy will increase by 10 years in 2020 AD. The

global incidence of cancer is soaring due to rapidly ageing population
in most countries. By the year 2020 there will be 20 million new cancer
cases each year. But incidence of cancer may be controlled by certain
precautionary and prophylactic measures. Cancer screening and
prophylactic drug like Tamoxifen (chemoprevention) have been proved
useful in Breast Cancer. Avoidance of smoking will decrease tobacco
related diseases. Some vaccines are helpful in prevention of some

In high-resource countries, evidence-based guidelines outlining optimal approaches to
early detection, diagnosis, and treatment of breast cancer have been defined and
disseminated. These guidelines unfortunately are not applicable in countries with
resource constraints as they are not economically feasible or culturally appropriate.
The following recommendations might be considered appropriate in the resource-poor
countries of Africa. Following the Breast Health Global Initiative we have stratified the
recommendations into Basic, Limited, Enhanced and Maximal. (10-



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As the Chinese proverbs: “ When you drink from the stream, remember
the spring” goes, the Researcher would like to thank the following

First, to my English teacher Mr. Joselito Orbase___ Thank you for being
you – your’e a wonderful person. You were there when I needed you to
confide in and ask advice from. Through you, I began to understand &
even like myself.

Second, to my loving parents____ Thank you for the support that you
spend to me for all my requirements in school. Thank you for taking
care of me & for loving me always.

And most of all__ to our Almighty God for making this research paper a

The Researcher,