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					The Past, Present and Future of Breast Cancer

            Mary Claire Leonard




        Georgia College and State University

         Women’s Health and Social Issues

                 December 3, 2009
       Although breast cancer is one of the most common diseases among women today,

it is not new to the medical community. The first breast cancer patient documented in

medical records dates back to 1805 at Middlesex Hospital, when virtually nothing was

known about the disease and patients couldn’t do anything but lay in their hospital beds.

The first breakthrough wasn’t until 1916, when radiotherapy was found to be effective for

killing cancerous cells (Bloom, 214). For about 83% of the cases that came in to

hospitals, a lump on the breast was the first sign of breast cancer. The problem was that

by the time patients walked into a hospital, the lump had grown to a size that indicated

the patient was well past the early stages of cancer. In 68% of the admitted hospital

patients the cancer had progressed to the point of ulceration. Less than 10% of patients

sought care within the first six months of detection; meaning that for the majority of

them, early forms of treatment would not be enough to ensure their recovery (Bloom,

215). Although male patients were much less frequent, there are early documented cases

of both male and female breast cancer. Admitted patients ranged from age 26 to 88 and

the number of cases increased with age. Anyone admitted in the later stages of cancer

was left untreated and the majority survived no more than three years from the proposed

onset of the cancer. A rare few patients survived ten or more years after lump detection.

However, there is no documentation that shows how this was possible with little to no

treatment. The only information that we have today is the confirmation that cancer was

present in these long-term patients post-mortem (Bloom, 215-216).

       Doctors began trying surgical removal of breast tumors in 1936 for patients at all

stages of cancer progression. Although stage three and four cancer patients might not

have been approved for this surgical procedure today, it did give them a much better
chance at living longer than stage three and four patients left entirely untreated. Patients

that had tumors of low malignancy removed responded very well to surgery and were

expected to live 10 to 15 years longer than the stage one tumors left untreated. Just like

today, doctors emphasized the importance of early detection because of the increased

success seen with early treatment (Bloom, 220). However, in many ways, women were

seen as secondary in a medical community where the average doctor studied only the

male anatomy in medical school. Mammograms were not available to alert women if they

had any potential breast health problems and all of the breast cancer treatments were

invasive and rough.

       Today, breast cancer is the most common of all cancers in American women. It

causes more deaths in Hispanic women than any other cancer and killed a total of 41,491

women in the United States in 2005. These numbers won’t go down with around 80,000

new cases of breast cancer diagnosed every year (Li, 2009). The devastation that breast

cancer has caused women in the United States alone gives cause for the extensive

research taking place at organizations like the Center for Disease Control and the

American Association for Cancer Research. Institutions like these work to asses the risk

factors for breast cancer as well as find methods of prevention and treatments for those

already diagnosed with breast cancer.

       There are many different factors that can put a woman at risk for breast cancer.

Although women can’t control all of these factors (i.e. family history), there are several

preventative measures that can be taken to reduce one’s risk. Making the choice to

abstain from smoking at all times can greatly reduce a woman’s risk of getting breast
cancer. Women who are exposed to the carcinogens in cigarettes between the ages of

pre-puberty and their first full-term pregnancy have a higher risk of getting breast cancer.

There is also a high risk for women who begin smoking later in life (for the first time).

Even women that are exposed to passive smoke inhalation (otherwise known as

secondhand smoke) are at a much greater risk of getting breast cancer than those that are

never exposed to passive smoke inhalation (Nursing Standard).

         Another risk factor that can be avoided by making healthy lifestyle choices is the

production of excesses estrogen in the body. Avoiding obesity by eating healthy foods

and getting regular exercise is very important since obesity liked to aromatase expression

in the body can increase estrogen production in the breast (Simpson, 2009). It has also

been proven that vigorous exercise can have a protective effect for women with a normal

body weight while it has little to no protective effect for obese women (Robertshawe,

2009).

         One more recently proposed risk for breast cancer is working a night shift or

rotating night shift for an extended period of time. According to research, light exposure

at night can suppress the nocturnal production of melatonin, which can cause estrogen to

release into the ovaries and increase a woman’s risk of breast cancer. Researchers

observed that melatonin suppresses mammary tumor growth in mice and inhibits human

breast cancer cell growth in in vitro testing. In addition to these changes in body

chemistry, there is also concern that night shift workers are more at risk for negative

lifestyle choices such as increased alcohol intake and high rates of smoking. One study

of primarily female hospital employees reported that women who worked a night shift for

at least six months were at a greater risk for breast cancer. Although this study seems to
have clear results, researchers express that they are eager to do more studies in the future

with controlled variables and workers outside of the medical field (Chung, 15-17).

        Women that are looking to receive fertility treatments should also be aware of the

possible risks associated with the estrogen-progestin therapy. The clomiphene citrate and

gonadotropins that are used in therapy change sex hormone levels and may effect the

breast of the patient. In a study of women taking high doses of clomiphene citrate,

researchers found that the women who had non-ovulatory infertility problems were at an

increased risk for breast problems (Fertility Weekly). Although researchers are still not

sure about the exact relation between breast health and fertility treatment drugs, women

should at least be aware that there are possible health risks involved.

        Since the days of radiotherapy at Middlesex Hospital, the medical community has

much more information about breast cancer and methods for detection and treatment.

When the more modern mammogram compression machine was created in 1986, cancer

could be spotted in its earliest stages and women were learning how to check themselves

for signs of breast cancer between doctor visits. New, safer forms of treatment began to

be offered and patients could discuss with their doctor what type of treatment would be

best for them. The most commonly used treatments today are chemotherapy, radiation

treatment, surgery, hormonal therapy and biological therapy. All of these can have both

positive and negative impacts on the body, but they have also proven to kill cancer in the

body.

        For women who choose to go through chemotherapy treatments, newer chemicals

like tamoxifen and aminoglutethimide are now being used for the powerful results of past

agents with less chance of death (Holland & Perlow, 1983). The main purpose of
chemotherapy is to stop the cancer from spreading to other parts of the body and destroy

the cancer cells already in the patient. It can be administered through an IV, an injection,

swallowed in a pill or liquid or rubbed on the skin as a cream (National Cancer Institute).

Although the side effects can be difficult to cope with, many patients choose the IV

chemotherapy because it is a fast, aggressive method for fighting the cancer. Some

common side effects of chemotherapy are loss of hair, change in appetite, skin and nail

changes, fatigue, pain, anemia and swelling caused by fluid retention. When a patient

begins to see and feel the signs of their treatment, it can take a heavy physical and

emotional toll on them. The support and encouragement of others is vital during this time

for the patient to get through the treatment.

       Biological therapy is somewhat like chemotherapy because it has the same

slowing and destroying effect on cancer cells. The difference is that it has the added

benefit of working with the patient’s immune system to fight the cancer and help manage

the negative side effects. Another benefit is that some people are able to use biological

therapy as their only treatment whereas chemotherapy is often paired with hormonal

therapy or radiation.

       Hormonal therapy is a set of estrogen and progestin pills administered to women

during and after treatment to help ease the side effects associated with post-menopause

and breast cancer treatment. Generally this treatment is limited to older women since

their bodies are no longer producing these hormones after menopause (Espié, 391).

       Radiation therapy allows doctors to direct a ray of energy at cancer cells in order

to damage their genetic makeup and make it impossible for them to grow and divide.

Some types of radiation can penetrate deeper into the body but doctors must be careful
using deep radiation treatments because they are supposed to avoid healthy tissues as

much as possible. “Intracavitary” or “intraluminal” radiation therapy is a ray that destroys

cancerous tumors from the inside out and doctors are hoping that they will be able to use

this new tool on breast cancer patients in the near future (National Cancer Institute).

       There are several different surgical options for breast cancer patients. The main

determining factors for which one a person will have done are how far along the cancer is

(which stage) also a little bit of personal choice. If a woman has early stage cancer a

surgeon can perform “breast sparing surgery” where only the tumor is removed but if a

patient would prefer to stay on the safe side, they might elect to have a single or double

mastectomy in order to eliminate any spread of the disease to other parts of the body.

Unfortunately, women who are in the later stages of breast cancer usually aren’t able to

opt out of a mastectomy if they want to beat the cancer.

       Besides all of these mainstream medical treatments, there is a whole other

category of treatment called “Complementary and Alternative Medicine”. This includes

a wide range of things like dietary supplements, acupuncture, herbal remedies, massage

therapy, magnet therapy, spiritual healing, and meditation (National Cancer Institute).

Although cancer research institutions do not promote these as a single means for getting

well, they can be very useful when used in conjunction with other medical procedures

(like chemotherapy). The main function of these treatments is to give gentle and soothing

care to patients whose bodies are going through nauseating, painful and stress inducing

treatments. Alternative medicine like massage therapy can also provide patients with

non-threatening human interaction outside of the hospital setting. These types of
treatments may not be for everyone but they are a useful and important part of recovery

for some patients.

       When a woman survives breast cancer, her fight is not always over. Women are

sometimes left frail and weak long after their cancer is gone (Bower, 2000). Some factors

that have been found to make survivors more susceptible to fatigue are lower age, greater

percentage of body fat, poor low-extremity muscle strength and less physical activity.

Strength of recovering patients can be measured using the “chair-stand test” in which you

count how many times someone can rise from a seated position in 30-seconds (Winters-

Stone, 2). Nurses are needed to help motivate breast cancer patients to set obtainable

exercise goals. If nurses are not educated in exercise science, then it is recommended for

them to at least tell patients about the short and long term benefits of exercising on a

regular basis (Winters-Stone, 6). Studies have shown that there are great benefits to

having simple exercise education programs for patients and yet this type of information is

not always part of cancer patient care.

       The American Cancer Society provides several additional creative ideas for

getting patients to work their muscles. Music and art therapy are just a couple ideas that

they recommend especially for those that have had little to no use of their muscles in the

recent past. In addition to giving patients some muscle movement, it has been proven

that music therapy reduces blood pressure, depression and sleeplessness. It is commonly

used for patients undergoing chemotherapy as well as patients who have recently

recovered and are working on getting back into their daily lives. Both art and music

therapy have earned the respect of the medical community by proving their invaluable
contribution to the physical and emotional wellbeing of patients (American Cancer

Society).

       What seems to be in store for the future of breast cancer is a slam on

environmental problems and how they affect breast health. The current global issues are

not only reflected in the news but in medicine as well. Researchers are concerned that

the carcinogens women take in through cigarettes and the toxins in from the air are being

transmitted to children through their mother’s milk (Casamayou, 2002). Another

upcoming trend for those that are worried about their family history of breast cancer is

genetic counseling. By definition, genetic counseling is “the process of helping people

understand and adapt to the medical and familial implications of genetic contributions to

disease (Brown, Muglia, & Grumet, 2007)”. This has caused a big stir among those who

have felt anxiety about their family history of breast cancer. In these counseling sessions,

the client can talk about everyday situations- like seeing stars in the media with breast

cancer- and how it causes them anxiety. These specially trained counselors respond by

helping the client to rationally work through their fears and make logical plans for the

future. The main point of these sessions is that the client leaves feeling at peace with the

risks associated with their family history. In some cases, the counselor will even help the

client to find a laboratory where they can be tested for whatever it is they are concerned

about. Although this does not ensure a perfectly healthy life forever, the client knows

that if they get bad news someone will be there to help them work through it.

       Since women began learning just how many lives breast cancer has claimed and

continues to affect, they have been joining together to create a sort of sisterhood the likes

of which haven’t been seen since the 1970’s. Women are using their voice as a whole to
demand social awareness and support for finding a cure. Organizations like the Susan G.

Komen foundation have brought women together from all walks of life to give of their

time and energy to raise money for breast cancer research. There have already been

many lives lost to this disease but because of the mothers, sisters and daughters that carry

on their fight, we see many women winning the battle against breast cancer today.

Presently and certainly in the future we will not see women worrying quietly about who

else this disease will claim. Women are driven, supported and strengthened by one

another. They march down the streets clad in pink, proud of what they stand for and who

they represent. Breast cancer isn’t just a health issue any more; it has become a social

outcry.

          When The United States Preventative Task Force recently announced the reduced

recommendation for mammograms, there was an outcry among breast cancer survivors

who reiterated that they would not be alive had it not been for the early detection of their

cancer. Over the years, the quality of breast cancer treatment and knowledge about

women’s health in general has increased so vastly that women today won’t stand for

anything less than progress.
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