What are breast cancer prevention treatments?
Selective estrogen receptor modulator (SERM) and its effect of estrogen on breast cell growth
A selective estrogen receptor modulator (SERM) is a chemical that is designed to act like estrogen in certain tissue such as the bones and not like estrogen in other tissue such as the breast. The use of SERMs takes advantage of the benefits of estrogen while trying to avoid the risks associated with estrogen. Two SERMs, tamoxifen (Nolvadex) and raloxifene (Evista), have been used as preventive treatment. The advantages and disadvantages of each are discussed in more detail below.
Tamoxifen is the first SERM to receive approval by the United States Food and Drug Administration (FDA) in the treatment of breast cancer. Some breast cancer cells are "estrogen sensitive," meaning they possess so-called estrogen receptors and need estrogen to grow and divide. But estrogen has to bind to the receptors of these cancer cells in order to stimulate them. Binding of estrogen to the receptors is analogous to fitting a key into a lock. Tamoxifen blocks the action of estrogen on the cancer cells by occupying the receptors (the locks), thus preventing estrogen (the keys) from fitting into the receptors. Blocking estrogen from the estrogen-sensitive cancer cells stops the growth and multiplication of these cells. Tamoxifen (in higher than usual doses) may also possess other properties that cause the death of breast cancer cells that are not estrogen sensitive.
Tamoxifen has been used to treat both advanced and early stage breast cancers. This drug has also proven valuable to women who have had cancer in one breast in reducing the chances of developing cancer in the second breast.
Even though tamoxifen behaves like an anti-estrogen agent in breast tissue, it acts like a weak estrogen in the bones. Thus, tamoxifen may have some benefit in preventing osteoporosis fractures in postmenopausal women.
Tamoxifen also decreases cysts and lumps in the breasts, especially among younger women. Fewer cysts and lumps make early detection by breast examinations and mammograms easier. This use of the drug would only be in extreme situations and is not an approved use.
Primary prevention of breast cancer with tamoxifen
The term "primary prevention" means trying to reduce the risks of developing breast cancer in women without a prior history of breast cancer. Tamoxifen not only blocks the action of estrogen on estrogen-sensitive cancer cells, but it also blocks estrogen from acting on cells that are not cancerous. Therefore, by reducing the growth and division of normal breast cells, tamoxifen decreases the population of cells that can develop cancer-causing DNA damage.
In the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1, more than 13,000 women considered at high risk for developing breast cancer were given either tamoxifen or a placebo for 5 years. The women receiving tamoxifen developed 49% fewer breast cancers than women receiving the placebo. A further study, the International Breast Cancer Intervention Study (IBIS-I) in Europe, also confirmed a reduction in the rate of breast cancer development in high-risk women.
The United States FDA has approved the use of tamoxifen for primary prevention in women at high risk for developing breast cancer. There is no evidence to suggest that tamoxifen can reduce breast cancer incidence in women considered to have a normal risk for the development of breast cancer.
Risks and side effects of tamoxifen
The risk of tamoxifen is the development of uterine cancer. Although the overall risk of developing uterine cancer is small (probably less than 1%), in the NSABP-P1 trial, more women on tamoxifen developed uterine cancer than women taking the placebo.
Additionally, women over 50 years of age on tamoxifen have a slightly heightened chance of developing blood clots in the veins of the lower extremities. These blood clots can occasionally break off and travel to cause blockage of blood vessels in the lungs (a process called pulmonary embolism). Symptoms of pulmonary embolism include shortness of breath, chest pain, and sometimes shock. Some studies have also reported an increased risk of stroke in patients taking tamoxifen.
The other side effects of tamoxifen include weight gain, hot flashes, irregular periods, vaginal dryness or discharge, and a slightly enhanced risk of cataracts.
Many of these side effects also depend on the age group being studied.
Raloxifene (Evista) is the second SERM to be approved by the FDA. It has been approved for treating and preventing osteoporosis in postmenopausal women. Data suggest that raloxifene, like tamoxifen, can reduce the chance of developing breast cancer in high-risk postmenopausal women. Unlike tamoxifen, raloxifene does not stimulate cells of the uterus and is not believed to increase the risk of uterine cancer.
Studies that examined the effects of both tamoxifen and raloxifene (including the STAR trial, which studied over 19,000 postmenopausal women at high risk for developing breast cancer) showed that both drugs lowered the incidence of breast cancer in a similar manner. While both tamoxifen and raloxifene increased a woman's risk of blood clots, the observed increase was smaller with raloxifene. Raloxifene was also associated with a lower risk of uterine cancer and hysterectomy for noncancerous reasons than tamoxifen. However, data suggest that raloxifene is as effective in preventing the development of early, noninvasive cancers as tamoxifen.
Data are not available on the effects of raloxifene in premenopausal women, and it is a potential teratogen, meaning that it may cause harm to the developing fetus. Therefore, raloxifene is limited to use by postmenopausal women and not used in women of childbearing age.
Other medications, known collectively as aromatase inhibitors, are also used to block the effects of estrogen. Examples of aromatase inhibitors include anastrozole (Arimidex), and exemestane (Aromasin). Their main activity is to inhibit (block) the action of a particular enzyme (aromatase) that creates estrogen from other normally circulating hormones. Tamoxifen and aromatase inhibitors, therefore, act differently and have different side effects. Aromatase inhibitor medications are an option for postmenopausal women at high risk of developing breast cancer.
Surgical measures to prevent breast cancer
Preventive or prophylactic mastectomy is the surgical removal of one or both breasts in women who have moderate to high risk of developing breast cancer. Studies have shown that this technique reduces a woman's chance of developing breast cancer by up to 90%. Since small amounts of breast tissue can remain on the chest wall, in the underarm, or even in the abdomen following a mastectomy, it is impossible to completely prevent development of breast cancer by prophylactic mastectomy. Women often choose to have surgical reconstruction of the breasts at the time of surgery.
It is very important for a woman considering preventive mastectomy to have a frank discussion with her physician concerning her cancer risk, other available treatments, and the potential complications and implications of the surgery before making a decision.
Prophylactic or preventive oophorectomy, or removal of the ovaries, has also been performed in women receiving preventive mastectomies in order to reduce estrogen levels.
Sometimes students are puzzled by the fact that teachers give them assignments on complicated and adverse topics, such as abuse, serious illnesses and other occurrences in human life that can make one feel distressed, especially if these assignments contain a morally debated issue. A breast cancer essay is not an assignment students take without second thought. On the contrary, most students keep asking why they even need to write essays on such adverse topics.
Well, the reason is evident – while you are working on a breast cancer essay, you increase your own awareness, as well as the awareness of all the people who are in the group, if this is a group assignment, or even in your entire class. Even if you don’t get a chance to present your research in front of the class, you still must acquire valuable information while doing the research to write the paper.
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Should Women Who Struggled with Cancer Have Babies?
A tumor or cancer is by definition a neoplastic process where abnormal cellular growth takes place and in which all the newly formed tumor cells are descendants of a single cell that gained the ability to replicate continuously and autonomously (Alison pt. 3; ch. 39).
Accordingly to World Health Organization (WHO), cancer, which accounted for 8.8 million deaths in 2015 (being the second cause of death globally) is expected to increase by about 70% in the next twenty years putting this question right before our eyes (who.int).
There are several types of cancer and thus we cannot generalize but some previous studies on breast cancer and pregnancy concluded that “is possible for women treated for breast cancer and does not seem to be associated with a worse prognosis for their breast cancer although this evidence was not conclusive as some factors, namely the non representation of the entire population and the ‘healthy mother effect’ could influentiate the conclusions“ (Surbone et al.). A similar conclusion was drawn from women treated for Hodgkin Lymphoma, as “no significant associations between pregnancy outcomes and therapeutic approaches were found“ (De Sanctis et al.).
However recent studies have concluded that women treated for cervical cancer had elevated risk of “preterm birth and low birth weight when compared to unexposed women and women with cervical diagnostic procedures” suggesting that “increased risk derives from the treatment itself, not from the characteristics” (Weinmann et al.).
Another study concluded that “women with a breast cancer history were at higher risk of delivering a preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infant, especially if they received chemotherapy or gave birth within 2 years of their breast cancer diagnosis date“ changing the prior paradigm (Black et al.).
Despite some controversy in the facts about cancer and pregnancy, scientists agree that further investigation is needed to address this particular question but maybe we need to address it from different points of view, as scientific knowledge should pave the way but ethical questions should also be asked.
Alison, Malcolm. The Cancer Handbook. 2nd ed. Chichester, West Sussex, England: John Wiley & Sons, 2007. Print.
“Cancer”, World Health Organization, http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed 14 Mar. 2017.
Surbone, A., et al. Cancer And Pregancy. 2008, http://link.springer.com/book/10.1007/978-3-540-71274-9.
De Sanctis, Vitaliana, et al. “Impact of Different Treatment Approaches on Pregnancy Outcomes in 99 Women Treated for Hodgkin Lymphoma.” International Journal of Radiation Oncology*Biology*Physics, vol. 84, no. 3, Nov. 2012, pp. 755–761, doi:10.1016/j.ijrobp.2011.12.066.
Weinmann, Sheila, et al. “Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study.” PLOS ONE, edited by Maria Lina Tornesello, vol. 12, no. 1, Jan. 2017, p. e0165276, doi:10.1371/journal.pone.0165276.
Black, Kristin Zeneé, et al. “Prevalence of Preterm, Low Birthweight, and Small for Gestational Age Delivery after Breast Cancer Diagnosis: A Population-Based Study.” Breast Cancer Research, vol. 19, no. 1, Breast Cancer Research, Dec. 2017, p. 11, doi:10.1186/s13058-017-0803-z.
Essay about Breast Cancer. Variant II
How to Reduce the Risk of Having Breast Cancer?
Today, breast cancer ranks second after skin cancer regarding prevalence among women around the world. Unfortunately, the morbidity rate is growing every year, regardless of the women’s race or ethnicity. The most frightening in this disease is that breast cancer is rather complicated to detect in the first stages. Thereby, when a woman is diagnosed with this type of cancer, the tumor is already progressing. It is very difficult to cure, the treatment is painful and not always successful. For this reason, mortality from breast cancer is also one of the highest among other types of cancer. In view of this, it is essential to take all possible measures to reduce the risk of having breast cancer.
According to this year World Cancer Research Fund International analysis (2017), the main factors that lower the risk of breast cancer were determined. Among them were the balanced diet, reducing alcohol consumption, maintaining the weight norm, physical activity. A significant part of the diet is choosing the right foods. It is necessary to exclude foods that are high in fat and low in fiber, and avoid consuming foods and drinks that are high in sugar. To do this, one should eat less fast food and other energy-dense products, and replace them with relatively unprocessed energy-dense foods rich in beneficial vegetable oils. It will also be useful to reduce the portions. Increasing the diet share of grains and legumes, as well as vegetables and fruits without starch, will also have a positive effect. It is recommended to eat at least five servings of vegetables and fruits a day, and limit the consumption of refined starchy foods. Fruit of different colors, such as red, yellow, white, purple, orange, and the allium vegetables, such as garlic, will be healthy as well. As for the meat products, a woman should consume less red meat and avoid the processed one. It is essential to reduce salt intake and minimize the amount of moldy cereals and grains in food. In addition, any dietary supplements negatively affect the diet and do not contribute to the risk reduction. It should be mentioned that it is better not to drink alcohol for the prevention of cancer. If it can not be eliminated from the diet completely, it would be rational to minimize its consumption. It is still unknown how exactly alcohol affects the development of cancer in women and which women are more affected by it, but the restriction in its consumption is vital for women who have other risk factors such as cases of breast cancer in close relatives.
According to the research, such problems as obesity, overweight and weight gain increase the risk of developing 11 cancer types, and breast cancer is one of them. The maintaining of healthy weight will help to reduce the danger of having the disease. This is specifically immediate for the women after menopause since it is associated with the estrogen production in fat tissues. Regular exercising and a balanced diet should contribute to keeping a woman’s weight low within the healthy range. Generally, women need to avoid increases in the waist and weight gain during adulthood, however, excessive weight gained in childhood can encumber to do it.
The next advice is to maintain physical activity. A woman should dedicate to the moderate physical exercise at least 30 minutes a day. Fast walking or jogging can be good equivalents, but also exercises can be part of transport, occupational, leisure, and household activity. The small physical drills several times a day will be more effective than one long training session. Yet it is worth keeping in mind not only to exercise but also to rest after it, so as not to overwork the body and accumulate the energy spent. However, it is even better if one has an opportunity to exercise longer and more intensely. Also, a woman should not forget about the limitation of sedentary habits, especially with regard to sitting work, watching TV and cooking. It does not matter how much exercise you get, as sitting increases the chance of cancer development, especially for women. This will speed up the metabolism and spend the accumulated energy.
Breastfeeding mothers compound a separate risk group. According to the results of the study, to a large extent, the risk is not related to the number of children breastfed, although it was observed that prolonged breastfeeding led to a lower risk of breast cancer (Brinton et al., 1995). If a mother is able to, she is recommended to breastfeed her baby for about six months. This implies the rejection of any additional food except for mother’s milk. Thus, breastfeeding contributes to the health of both mother and child.
Another important factor to pay attention to is the avoidance of hormone therapy. In the past, Hormone replacement therapy (HRT) was commonly used as a remedy against cold sweats, flashes of heat during the menopause. “But researchers now know that postmenopausal women who take a combination of estrogen and progestin may be more likely to develop breast cancer” (Simon, 2016). Only five years after the end of the course of hormone intake, the risk of breast cancer is reduced to the standard level.
In addition, it is necessary to remember about the importance of regular health checks. Studies and screenings do not help protect against cancer, but they signal the appearance of threatening signs like polyps in the intestines or suspicious moles. Specialists recommend starting testing from the age of 20. Women need to do mammography every year after they turn 45. It is always better to recognize the disease beforehand and take the necessary measures than to miss the moment and cure with expensive and painful methods.
Considering all the above, it is crucial for women to be aware of the risk of having breast cancer and of the basic measures to prevent it. Of course, there are many other risk factors to be taken into account, but compliance with these methods alone will lead to a significant improvement of the situation. As the fight against this disease remains one of the greatest problems of our time and requires constant active strivings of the world community. Following the methods described here, women will be able to significantly protect their health. All these measures are simple to practice and should not take a lot of effort and time. Nowadays, a person can easily afford to monitor personal weight and diet, find time for daily exercise and training, give up on bad habits. It is not such a big payment for staying healthy and not to have such a terrible disease as breast cancer.
Wcrf.org. (2017). Breast cancer | World Cancer Research Fund International. [online] Available at: http://wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/breast-cancer [Accessed 7 Sep. 2017].
Brinton, L., Potischman, N., Swanson, C., Schoenberg, J., Coates, R., Gammon, M., Malone, K., Stanford, J. and Daling, J. (1995). Breastfeeding and breast cancer risk. Cancer Causes & Control, 6(3), pp.199-208.
Simon, S. (2016). Five Ways to Reduce Your Breast Cancer Risk. [online] Cancer.org. Available at: https://www.cancer.org/latest-news/five-ways-to-reduce-your-breast-cancer-risk.html [Accessed 7 Sep. 2017].