Cancer and women’s health. Breast cancer is the leading cause of cancer death in women and is the most frequently diagnosed worldwide cancer. They mainly develop as intra-ductal carcinomas with a well-developed distended duct with an intact basement membrane (Finn et al.,2016). In many of the developing countries, breast cancer is the leading cause of death for the women. However, in the developed nations, the cancer has been surpassed by lung cancer which is the killer cause.
In the United States, it accounts for 30% of the cancer with lung cancer leading. The main challenge with the diagnosis and the management is that it is not easily recognizable. When developing, it is asymptomatic in the initial stages. It is usually detected as an abnormality through a mammogram before even it is able to be felt by the woman. The examination of breast cancer is generally divided into three main approaches; clinical examination, imaging such as scans and ultrasounds, and a needle biopsy. Due to increased awareness, the rate of knowledge among women has increased especially in developing countries. Treatment is categorised by surgical resections and other curative therapies such as pharmacological approaches.
The primary treatment for the condition is surgical and radiation therapy with adjuvant hormonal or chemotherapy. For all patients who have been diagnosed with early stages of the condition, surgery with local radiation is the immediate form of management (DeSantis & Fedewa 2016). The adjuvant types of management have been used to treat the breast cancer cells that metastasize to other parts of the body. Actually, the type of treatment has been attributed to a reduction of more than 30% of the total cases of cancer mortality. Various studies have been conducted to help understand the condition better and thus have led to better treatment and outcomes among the patients.
The common symptom of breast cancer is that it presents as asymptomatic. When the lump grows, there is a change in the breast size, the skin may appear to be dimpled, nipple inversion may happen, and a discharge from one of the ducts. Apart from detection through the mammogram, the lump may be detected from imaging and biopsy. The common physical findings include, changes in breast size and formation, ulcerations, paget disease, irregularity, hardness, and fixation to skin and muscle.
The common screening modalities are ultrasonography, breast self-examinations, mammography, ultrasonography, and magnetic resonance imaging (MRI). In non-fatty breasts, the best screening tests are ultrasonography and MRI as they are more invasive (Coates et al.,2015). Radiation therapy is part of the management of breast cancer. It is usually done in two forms; external beam radiotherapy (EBRT) and partial breast irradiation (PBI). The common chemotherapeutic agents include; trastuzumab, doxorubicin, docetaxel, carboplatin, and methotrexate.
Recommended preventive services
One of the recommendations for the mothers that suffer from breast cancer is early detection and diagnosis. Additionally, the mothers require proper health education on the best approaches for diagnosis and testing. Even though breast cancer screening is not effective in treating the condition, early detection is important in helping to manage the condition better. According to the US Center for Disease Control and prevention (CDC), there are some specific and regular behavioural management approaches that can be applied in prevention of breast cancer.
One of the approaches is managing weight and obesity. An increase of body weight results in an increased risk of developing all types of cancer, breast cancer inclusive. The other approach of management and prevention is physical exercise. Apart from helping with weight management, physical exercises have been useful in helping promote quality health for all patients. Women should be actively involved in daily physical exercises for at least 30miniutes each day. Another approach of prevention is the nutrition and dietetics management. The women should consume abundant fruits and vegetables in every meal. Additionally, they should avoid extreme intake of alcohol as it increases the risk.
Smoking cessation is effective in preventing and reducing risk of breast cancer. Smoking is a leading risk factor in the cause of many cancers worldwide. For the women who smoke, they should try and avoid it completely for optimal health. Breastfeeding for the lactating mothers is effective in preventing breast cancer and swelling. Additionally, all mothers should ensure that they reduce the intake of contraceptives especially the oral ones. Contraceptives increase risk of breast cancer even though they have other benefits for the women as well.
The U.S. Preventive Services Task Force
The United States Preventive Services Task Force (USPSTF) is an independent group of medical experts on the fields of primary care and prevention. It is actively involved in assessment of the evidence based practices in the prevention of health problems and provides the appropriate recommendations on clinical prevention. The panel consists of epidemiologists and primary care physicians who are appointed by the US Department of Health and Human services. The main purpose of the task force is to determine if the methods of assessment, examination, diagnosis, and treatment are appropriate and evidence based according to the guidelines (Prabhu et al.,2015).
Based on a research conducted by the USPSTF, there was a recommendation of using mammography for all the women aged 50yrs to 70yrs. According to the study, mammography has been the standard mode of assessment with the rates being at a regular level for all the women in US. The effectiveness of the test has been applied in managing among variants of age, risk factors, imaging modalities, and screening intervals. With effective screening, there was reduction of mortality outcomes among the mothers under the study. 44% of the cases of mortality were reduced among women who undertook the mammography tests.
Genetics and ethnicity
Approximately 10% of the breast cancer cases are caused by heredity thus associated to genetic mutations. The common cause is the mutation of the genes BRCA1 and BRCA2 (Swain et al.,2015). Their role in cells is the repair of the DNA that is damaged. When the genes become mutated they can result to abnormal cell growth which causes cancer. Those children who inherit either of the genes are at increased risk of getting breast cancer. Among the US races, BRCA mutations are common among the Jewish people of Ashkenazi even though others are also at a risk.
Ethnicity is also a contributor to developing breast cancer. Among the US populations, the white Americans are at a higher risk of developing the type of cancer as compared to the African American, the Hispanic, and Asian women. However, according to statistics, the African American women develop it at a more tender age and also their type is more advanced compared to the latter (Jemal et al.,2017). They are also more likely to succumb to breast cancer as compared to the Caucasians because of reduced knowledge and access to screening services.
Drug treatment and short-term and long-term implications
One of the common pharmacotherapeutic agent is trastuzumab which is sold under the trade name Herceptin is monoclonal antibody that is used to treat breast cancer. It treats breast cancer that HER2 receptor positive (Swain et al.,2015). It may be used a single agent of management or synergistically as a chemotherapy combination. Doxorubicin is a chemo therapy known as anthracycline. It acts by slowing or stopping the growth of cancer cells through blockage of the enzyme topo isomerase 2 which is vital for the cancer to grow and divide. It is also combined with other chemotherapy agents. Apart from breast cancer, it also treats bladder cancer, kaposi’s sarcoma, lymphoma, and acute lymphocytic leukemia.
Use of pharmacotherapy in the management of cancer is associated to several long term and short term implications. Some of them are manageable and others are permanent and the patients have to live with them. The agents cause permanent damage of the actively dividing cells in the body. All part are affected mainly the intestines, the mouth, the skin, hair, and bone marrow. The main challenge is because the specific parts have actively dividing cells which are growing each day and thus they end up not dividing.
References
Coates, A. S., Winer, E. P., Goldhirsch, A., Gelber, R. D., Gnant, M., Piccart-Gebhart, M., … & Baselga, J. (2015). Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Annals of oncology, 26(8), 1533-1546.
DeSantis, C. E., Fedewa, S. A., Goding Sauer, A., Kramer, J. L., Smith, R. A., & Jemal, A. (2016). Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA: a cancer journal for clinicians, 66(1), 31-42.
Finn, R. S., Martin, M., Rugo, H. S., Jones, S., Im, S. A., Gelmon, K., … & Gauthier, E. (2016). Palbociclib and letrozole in advanced breast cancer. New England Journal of Medicine, 375(20), 1925-1936.
Jemal, A., Robbins, A. S., Lin, C. C., Flanders, W. D., DeSantis, C. E., Ward, E. M., & Freedman, R. A. (2017). Factors that contributed to black-white disparities in survival among nonelderly women with breast cancer between 2004 and 2013. Journal of Clinical Oncology, 36(1), 14-24.
Prabhu, V., Lee, T., Loeb, S., Holmes, J. H., Gold, H. T., Lepor, H., … & Makarov, D. V. (2015). Twitter response to the United States Preventive Services Task Force recommendations against screening with prostate‐specific antigen. BJU international, 116(1), 65-71.
Swain, S. M., Baselga, J., Kim, S. B., Ro, J., Semiglazov, V., Campone, M., … & Clark, E. (2015). Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. New England Journal of Medicine, 372(8), 724-734.
