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. Bibliography Bloom, H.J.G., Richardson, W.W., & Harries, E.J. (1962). Natural history of untreated breast cancer. British Medical Journal, 2(5299), 213-221. Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., & Meyerowitz, B.E. (2000). Breast cancer survivors: occurence,correlates and impact on quality of life. 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