Who is at risk for breast cancer (BC)? Urban and socio-economic factors. Ways to Prevent Breast Cancer

Breast cancer (BC) - global problem oncological science and modern society. Breast cancer occupies a leading position in the incidence of malignant neoplasms in women. In many ways, the increase in breast cancer cases is a consequence of the increase in cancer diseases in general.

On the other hand, the increase in the detection of breast cancer is a consequence of the development and introduction into everyday practice of new effective diagnostic techniques, their greater availability, informing the population about risk factors for cancer breast, implementation of state cancer screening programs.

Breast cancer is common in Russia, European countries and America, and occurs throughout the world, differing somewhat depending on the region of residence of the woman.

The incidence of cancer, including breast cancer, has become an epidemic. Millions of women are forced to undergo physically and psychologically traumatic treatment when diagnosed with cancer. They and their families experience prolonged stress from the moment they learn of the disease.

In this regard, the question becomes relevant: what can be done to prevent the occurrence of a tumor (cancer) in the mammary gland, or to detect it at an early, preclinical stage? Scientists around the world are trying to find an answer to the question: who is more susceptible to cancer? Who has the maximum? Unambiguous answers have been received to many of these questions, and the causes and risk factors of this serious disease have been reliably determined.

Symptoms of breast cancer

Breast cancer is a disease characterized by varying rates of tumor growth. The rate of cell division depends on the type of cellular structures that form the cancerous tumor. The course of cancer can be relatively benign, when the tumor grows slowly, over the years, and later gives metastatic complications.

Also, a breast tumor may be characterized by a more malignant course (this type of cancer is less common). In the case of highly aggressive cancer, the disease progresses rapidly, quickly metastasizing.

Breast cancer (tumor) at an early stage of the disease does not have symptoms or pain.

The clinically expressed stage of cancer has the following manifestations. A palpable formation appears, that is, a compaction that can be detected by palpation. Often with breast cancer it is lumpy.

On late stages it is fused to the surrounding tissues and does not move easily. Sometimes it is possible to simultaneously detect enlarged (determined visually and by palpation) lymph nodes on the affected side, in the supraclavicular and subclavian areas. With breast cancer, pathological discharge (from the nipple) may appear.

The skin over the tumor may undergo orange peel-like changes, and the nipple may become retracted and deformed. Compared to the intact mammary gland, the gland affected by the tumor process is asymmetrical. The listed signs refer to advanced stages of cancer of this organ.

Character pain syndrome for breast cancer is different, depending on the form and stage of the oncological process. In the initial period there may be no pain. As the tumor progresses and grows and metastasizes, pain and signs associated with the regional spread of metastases appear. That is, symptoms appear outside the mammary glands.

Breast cancer, like cancers of other locations, rarely occurs before the age of 20. summer age. After a woman reaches the age of 30, this disease gradually increases, reaching its peak at 55-60 years. In general, there is a direct dependence of breast cancer on the woman’s age.

However, in addition to age characteristics, it is possible to identify special groups women with risk factors that are more susceptible to breast cancer. These include factors determined by the characteristics of the woman’s reproductive system, the nature of menstrual and reproductive function, the nature, duration and history of lactation, exposure to carcinogenic factors, and heredity.

Let's look at the risks and factors of breast cancer:

1. The nature of lactation function (breastfeeding a child) makes a significant contribution to the risks of developing breast cancer. Women who do not have a history of childbirth, and therefore do not breastfeed, are at risk of developing breast cancer (have a greater risk). How longer period(periods) of lactation, the more favorable their effect on breast tissue is in terms of preventing the subsequent development of breast cancer.
2. Pregnancy and childbirth before the age of 18-20 significantly reduce the risk and likelihood of subsequently being diagnosed with breast cancer in a woman.
3. Menstrual function influences the risk of cancer. Moreover, both the time of the first menstruation and the duration of the period matter regular cycle. It is significant that when menstruation begins before the age of 13 ( early menstruation), the risk of cancer is doubled. If menopause is delayed and menstruation occurs after age 55, the risk of breast cancer is increased by 2.5 times.
4. A woman's age at the time of her first pregnancy influences her subsequent risk of cancer. In women whose first pregnancy occurred after 30-35 years of age, the risk of acquiring breast cancer is several times higher than in women who gave birth at the age of 20-25 years.
5. Termination of pregnancy (abortion), especially the first one, has an adverse effect on hormonal levels, breast tissue, and is a risk factor for cancer localized in the mammary gland. Women with a history of multiple pregnancy losses at any age have a greater risk of breast cancer. A history of several pregnancies and lactations reduces the risk of breast cancer.
6. Gynecological pathologies of the female reproductive system, especially those that last for a long time, can increase the risk of malignant neoplasms of both the female genital area and breast cancer. These diseases include inflammatory processes in the uterus and ovaries.
7. Hyperplasia of uterine and ovarian tissue has been proven to increase the likelihood of cancer (ovarian and breast cancer).
8. The role of metabolic factors and concomitant endocrine disorders in the development of breast cancer has been proven by numerous epidemiological studies. These include of various nature obesity and overweight, non-insulin-dependent diabetes mellitus, diseases thyroid gland, neuroendocrine tumors. Obesity increases the risk of developing breast cancer several times compared to women who are not overweight.
9. Benign diffuse processes in the breast tissue of a dyshormonal nature are not precancer, but against their background, its early diagnosis may be difficult.
10. It has been proven that the nature and diet significantly determine the risk of cancer of any location, including breast cancer. Increasing saturated animal fats in the diet increases this risk. Saturated fats disrupt the endocrine balance and cause an increase in the synthesis of pro-inflammatory substances, peroxide metabolic products, and free radicals. These are functional active substances can contribute to the development and growth of breast cancer, disrupt the structure of cell membranes. Thus, fatty foods of animal origin, consumed regularly and in large quantities, while simultaneously reducing fiber and fiber in the diet, along with other risk factors, contribute to neoplastic changes leading to the development of breast cancer. While a low-fat, plant-based diet protects the body from breast cancer.
11. Excessive regular use alcohol may pose a risk of cancer localized in the mammary gland.
12. It has been proven that long-term use of hormonal drugs (estrogen-containing) can be important in the occurrence of of this disease, especially if the intake of these hormones takes place in at a young age.
13. Risk factors associated with the presence of a genetic hereditary predisposition for breast cancer have a convincing evidence base. There are so-called “familial” cases of breast cancer, which occur in blood relatives. Family breast cancer has its own characteristics, it debuts earlier (has its first manifestations). Often, genetically determined breast cancer is detected 10-15 years earlier than in the general population of women. In addition, often a malignant tumor can be detected in both glands. There is a group of malignant diseases that simultaneously combine ovarian and mammary gland cancer, or breast cancer and cancer of other localizations. The hereditary nature of cancer can be determined by studying the BRCA -1,2 genes. At the same time, the absence of this gene in women does not mean that they cannot develop breast cancer.
14. Harmful exogenous factors, such as exposure to tobacco smoke(the carcinogenic effect of smoking is well known), ionizing radiation. Long-term exposure and exposure to chemical carcinogens, hazardous industries, and environmental problems are proven risk factors for breast cancer.
15. Some studies have shown that high growth women slightly increases the risk of breast cancer (compared to short representatives of the fairer sex).

Early diagnosis of breast cancer and breast cancer screening

Despite the studied and proven risk factors for breast cancer, it is not always possible to correct them. Therefore, at present, prevention of this frequent cancer carried out by early diagnosis preclinical forms of cancer and breast cancer screening.

Preclinical forms of breast cancer are forms of the disease that do not manifest themselves in any way and do not cause complaints in women. These are forms of cancer that can only be detected through preventive diagnostics and screening.

Cancer screening includes visualization of the tumor using X-rays - a mammographic method of examining all women after 39 years of age (for hereditary forms of cancer, preventive breast diagnostics carried out at an earlier age).

With mammographic screening, it is possible to visualize small foci (from 1-2 mm), foci of calcification, accumulation of calcifications against the background of locally dense breast tissue, cysts, fibrous changes.

The method is very informative and can be combined with ultrasound and tumor marker studies, which further increases its diagnostic value.

Ultrasound of the mammary glands is a non-invasive diagnostic tool available to women of any age, including pregnant women, and can be performed several times.

Self-examination (using palpation) by women of the mammary glands is an important stage in the diagnosis of tumor formations of the mammary glands.

Importance preventive measures is that breast cancer detected at an early preclinical stage can be completely cured in most cases. IN in this case V cancer centers Organ-preserving treatment methods can be successfully used.

Particular attention should be paid to women with existing risk factors for breast cancer and in cases with a family history of breast cancer.

So, breast cancer is one of the diseases that is associated with certain factors and risks, knowing which steps can be taken to reduce the likelihood of this disease occurring.

Every year, a million new breast cancers (BC) are detected worldwide, projecting their growth to 1.35 million by 2010. It ranks first among malignant tumors women, amounting to 20% in 2008. In men, the disease is 150 times less common.

The annual increase in incidence among the female population over the past 10 years has been 2.25%. The disease appears more often between 40 and 70 years of age. Among all cases, women under 45 years of age account for 12.5%.

The mortality rate of the female population from breast cancer increases in proportion to the increase in incidence. In 2008, it was 29.9%, ranking first among all malignant tumors. The mortality rate of patients during the first year was 9.7%.

In stages I-II the disease was detected in 62.7% of cases, in stage III - in 26%, in stage IV - in 10.3%. There is an accumulation of registered patients.

Thus, cancer is very important for women's health. In Ukraine, the problems of treating malignant tumors are dealt with by “LISOD”, and specifically by the Center for Modern Mammology. You can read more about malignant breast tumors on their website.

Risk factors

Factors that increase the risk of breast cancer are identified in 25-30% of patients. They can be divided into three groups: significantly, moderately and slightly increasing the likelihood of a tumor.

TO first group factors include:

identified mutations in the BRCA 1, BRCA 2 genes;

syndromes of true and false hermaphroditism;

familial cancers of the 1st type (carcinomas of the ovary, endometrium, colon);

familial cancers of the 2nd type (soft tissue sarcomas, embryonal tumors);

benign breast diseases with glandular hyperplasia and cell atypia (increases the risk by 4 times);

exposure to ionizing radiation;

Previously cured breast cancer (increases the risk by 3-5 times). Mutations of BRCA 1 and BRCA 2, which are involved in DNA repair, account for up to 10% of hereditary causes. In this case, the risk of developing the disease is 33-50% before the age of 50 and 56-87% before the age of 70 with a high frequency of bilateral lesions. The presence of the disease in direct female relatives in patients before increases the risk by 2-5 times, moreover, the risk of damage to the second breast (in cases of early bilateral cancers in relatives) is 50%.

To risk factors second group relate:

early or late menarche;

childlessness or the birth of the first child over the age of 24-30 years (increases the risk by 30%);

obesity in the postmenopausal period;

parenchymal predominance in the mammary glands on mammography or (increases the risk by 4 times);

previously diagnosed, ovary (increases the risk by 2 times), colon;

soft tissue sarcomas in a son or daughter;

alcohol abuse (increases the risk by 1.5 times);

mutations of the CHK 2 gene, RBI (increases the risk by 1.5 times).

Have low impact:

use of oral contraceptives;

use of estrogen or progesterone in the postmenopausal period;

interrupted first pregnancy;

psychosomatic factors;

fatty diet;

fibroadenomas without proliferation;

irradiation with low-frequency electric fields.

There are factors that reduce the risk of breast cancer:

full-term first pregnancy at the age of 20-24 years;

several pregnancies;

oophorectomy before 45 years of age for gynecological diseases;

regular sex life;

lactation;

physical activity (walking 3-4 hours a week reduces the risk by 54%).

The size of the mammary glands, fibrocystic changes without proliferation phenomena during morphological examination, and smoking do not affect the incidence.

Features of morphology and tumor growth factors

Breast cancer is more or less hormonal dependent. At the same time, in addition to hormones, there are a number of factors involved in carcinogenesis and subsequently influencing the rate of tumor growth, its biological characteristics, in particular, sensitivity to certain therapeutic factors. In general, the appearance and growth of malignant cells is a consequence of disruption of their genome, the expression of growth factors (GFs), and the ways in which these factors are realized.

A number of GFs of malignant cells are produced in the cancer cell itself (epidermal growth factor, transforming growth factor a, transforming growth factor?), another part - in the cells of the tumor stroma (insulin-like growth factors 1 and 2, fibroblastic growth factors) or brought by the bloodstream (hormones , biologically active substances). These factors (with the exception of transforming growth factor? and mammostatin) are potentially mitogenic for cancer cells. Great importance Vascular endothelial growth factor (VEGF) is involved in tumor growth. Overexpression of these and other tumor growth factors results from oncogene amplification.

For the effective implementation of the PR effect, the presence of appropriate receptors is necessary, in particular for peptide factors and hormones - on the cell membrane, for steroids - in the cytosol and nucleus. Breach of control cell division also occurs due to the activation of oncogenes, loss or mutation of fission suppressor genes. The products of oncogenes are both risk factors and their receptors. In breast cancer cells, high expression of oncogenes of the myc and ras family (c-myc, Ha-ras-1), int-2, the epidermal growth factor receptor family (EGFR, erbB), including erbB-2 or HeR-2 neu, is found. HER-3 and HER-4. This mechanism, along with others, leads to uncontrolled cell division. Expression of epidermoid growth factor (EGFR) in tumors sharply reduces the effectiveness of anti-estrogen therapy. However, blockade of these receptors by using biotherapy in the form of monoclonal antibodies to EGFR provides a pronounced antitumor effect. This effect is synergistic with anthracyclines, platinum derivatives and taxanes. Overexpression of another gene, BRCA 2, or its protein is also an unfavorable prognostic factor.

Changes in tumor suppressor genes for breast cancer and some other solid tumors (retinoblastoma gene - RBI, p53 gene, BRCA1, BRCA2) due to mutations or deletions lead to changes or loss of the corresponding proteins and disruption of the regulation of cell passage through the cell cycle. Mutations of the p53 gene are noted in 50% of breast cancer tumors. With the development of gene technologies, it became possible to inactivate genes or their proteins, or introduce normal genes.

Thus, quantitation the content of hormones (pituitary gland, gonads, thyroid gland, insulin), steroid hormone receptors, growth factors in the tumor, proteins associated with individual genes, is a necessary addition for constructing the prognosis and treatment regimens for breast cancer.

Pathological diagnosis is established using puncture biopsy or trepanobiopsy. According to modern requirements, it must be obtained before the start of all types of treatment. The material is subjected to cytological and immunohistochemical examination. In this case, the nature of the tumor lesion is established, including the type, degree of differentiation, degree of tumor malignancy, content of receptors for steroid hormones, overexpression of receptors for tumor growth factors.

The article was prepared and edited by: surgeon

In most cases, the causes of breast cancer remain unclear.

However, as a result of numerous studies, the main causes of the development of breast diseases (including breast cancer) have been established.

Risk factors for breast cancer

1. Individual

Floor And age are the main risk factors: the likelihood of breast disease in women increases sharply after 40 years of age and reaches its maximum by 64 years of age. There is a direct relationship between age and an increased risk of breast cancer. Only 6.5% of all tumor cases are diagnosed before age 39. Thus, the likelihood of developing breast cancer exists at any age.

The continuous increase in incidence confirms the need for regular visits to a mammologist and examination of the mammary glands.

Previous history of breast or ovarian cancer. It has been established that people treated for breast cancer or ovarian cancer, the risk of relapse or development of cancer of the second gland is quite high, and increases by 0.5-1% with each subsequent year of life.

This circumstance indicates the need for observation and regular examination of such women throughout their entire lives.

Previous (precancerous) diseases of the mammary gland. The term “fibrocystic mastopathy” combines a wide range of benign breast pathologies with characteristic structural changes in the epithelium and stroma. However, in most cases, the risk of developing cancer is small or absent, and only certain morphological variants increase the risk of cancer.

2. Family (hereditary)

Family history- one of the most important risk factors when assessing the likelihood of breast cancer.

In the presence of such a factor as familial breast cancer, the probability of the disease increases according to the number of 1st degree relatives (mother, Native sister, daughter) who had breast cancer before the age of 40.

If a first-degree relative has cancer of both breasts or there is an accumulation of cases of breast cancer in the family (more than one), the risk increases 8-10 times.

3. Hormonal factors

Endogenous hormonal influences.

The primary role of ovarian hormones in the occurrence of breast cancer and the duration of their effect on the epithelium of the mammary glands has been convincingly proven. Estrogens (hormones produced by the ovaries) promote the growth and proliferation (enlargement) of the ducts and may increase the risk of disease by stimulating an increase in the number of newly formed cells.

Early onset of menstruation (menarche) - before age 12 - increases the risk of breast cancer.

Late onset of menopause (after 55 years) increases the risk of breast cancer by 2 times compared to cases of early onset - before 45 years. Early menopause has a protective effect on breast tissue in women.

Absence of childbirth and/or postpartum lactation increases the risk of nulliparous women by 1.5 times. It has been established that giving birth for the first time before age 20 reduces the risk compared to nulliparous women. The risk increases with age at first birth; women who give birth to their first child after age 30 have a 2-5 times higher risk compared to first-time mothers before age 19.

The mechanism of the effect of abortion on the risk of developing breast cancer has not yet been clarified. A number of experts note that termination of pregnancy increases the risk by up to 1.5 times; abortion before 18 or after 30 years is even more dangerous.

Exogenous hormonal influences.

The exogenous influence of hormones is associated mainly with hormone replacement therapy (HRT) during peri- and postmenopausal periods, as well as with the use of oral contraceptives.

Hormone replacement therapy with estrogens or combination drugs used to mitigate complications of age-related loss of estrogenic ovarian function, including prevention cardiovascular diseases, diseases of the musculoskeletal system, genitourinary disorders, etc., in the last decade has spread quite widely in the USA, Western Europe and, to a lesser extent, in Russia. At the same time, the results of studies on their use are contradictory and ambiguous.

Overall, HRT use does not significantly increase the risk of breast cancer. The latter provides grounds for prescribing HRT to women during peri- and postmenopausal periods if they do not have a high risk of developing cancer. At the same time, the prescription of these drugs requires strict justification and consideration of oncological alertness.

People who have undergone treatment for breast cancer are still abstaining from prescribing HRT for fear of provoking tumor recurrence or increasing the risk of developing cancer of the second gland. In addition, there is no data demonstrating the safety of estrogen-containing drugs for this category of patients.

Widely used combined oral contraceptives (COCs) contain synthetic estrogens, progesterone and their derivatives. Experience with their use is insufficient to assess the relationship with an increased risk of developing breast cancer. Nevertheless undesirable consequences their application in population cannot be completely excluded. There is evidence of an increased risk with long-term use of drugs (more than 4 years before the first birth) or with very long-term use (more than 10-15 years).

4. Lifestyle and environmental factors Geographical location and diet.

Incidence and mortality rates from breast cancer (BC) around the world are characterized by wide geographical differences. Mortality from breast cancer is growing in Russia, as well as in other European countries and the United States. At the same time, the highest rates of growth in mortality are in Western Europe and the USA, the maximum rates are in the UK - 27.7 deaths per 100,000 population. The lowest mortality rate is in China and Japan - 4.9 and 6.6 deaths per 100,000 population.

Initially, such differences were associated with a genetic predisposition to the disease. However, as studies of migrants from Japan to the United States have shown, as they adapted to the Western lifestyle, the incidence of this population reached the level of the indigenous population. In addition, the incidence of breast cancer in Japan gradually increased after the 50s, when the country became more civilized. These observations led to the conclusion that the cause of morbidity is not in genetic differences, but in factors environment and lifestyle.

The main difference between Japan and the West is the nature of the diet. Residents of Asia eat a lot of rice and fish, while Western European countries typically eat large amounts of meat and fats.

Dietary patterns may be an indirect marker of the influence of hormonal disorders on an increased risk of breast cancer. High-calorie, high-fat diets typically lead to overweight and obesity.

The possible dependence of the increased risk of disease on an excessively high-calorie diet high in fat is due to the influence of nutrition on endogenous hormonal levels. Also, an increase in the risk of disease is affected by excess cholesterol, a lack of fruits and vegetables in the diet, and low-calorie diets are also harmful.

Ecological deterioration, especially in large cities. Residents of large cities and industrialized regions suffer from breast cancer more often than the rural population. This is due to environmental violations, unhealthy diet - increased consumption of fats, synthetic vitamins, surrogate food. The content of carcinogens in cities is incomparably higher. Carcinogens have a particularly severe impact in early childhood and adolescence.

Physical activity is associated with a lower risk of developing breast cancer, which may also be due to effects on hormonal metabolism. Physical activity can improve the condition of the musculoskeletal system, control body weight and prevent depressive conditions. According to WHO, physical inactivity causes approximately 10-16% of all cases of breast cancer in all countries of the world.

Alcohol has been consumed by humans for thousands of years, but its numerous negative health effects are significant, as are some positive properties, were discovered quite recently. Alcohol consumption has increased worldwide in recent decades, especially in developing countries.

A direct and statistically significant connection between alcohol consumption and the development of breast cancer has been confirmed by numerous studies.

Smoking. Tobacco smoking has been found to be the leading cause of many forms of malignant tumors and the cause of one-fifth of cancer deaths. Currently, there is a rapid increase in tobacco smoking in the world.

Given the adverse effects of smoking on the cardiovascular system and the increased risk various tumors, women should be advised to give up this bad habit.

Radiation. Ionizing radiation, a known carcinogen, under certain circumstances can increase the risk of developing breast cancer, which has been repeatedly shown by epidemiological studies of various population groups exposed to radiation for therapeutic purposes and frequent fluorographic studies.

The information provided is also very important for correctly informing women about the safety of mammography screening, since the radiation doses for mammography are low, and such research is rarely recommended before the age of 35. After 35 years, the iron is quite resistant to radiation, and the risk of x-ray examination minimal.

5. Women's loneliness

Absence or early cessation of sexual activity.

6. Presence of additional diseases and disease-provoking factors

Gynecological diseases(fibroids, endometriosis, adenomyosis, etc.). The mammary gland, like the uterus, is a target organ for sex steroid hormones. Most often, nodular formations, including breast cancer, in women of reproductive age develop with uterine fibroids, especially in combination with endometriosis. Therefore, the presence of changes in one of the target organs requires mandatory systemic examination.

Inflammatory processes in the mammary glands (mastitis) can occur in women of all age groups as a result of hypothermia, colds, and infection. The most common are postpartum lactation mastitis, as well as diabetes, thyroid diseases, and liver diseases.

Factors contributing to the development of breast cancer:

Stress plays an extremely negative role in the development of breast cancer. Experience shows that against the backdrop of severe emotional experiences, long-term constant psychological overload, pathological processes in the mammary glands sharply worsen, various types of nodular formations are formed, etc. Statistics show that professions related to administrative work (stress cannot be avoided!) are the most dangerous in relation to possible development oncological disease of the mammary glands.

Incorrect selection of underwear. A tight bra with metal underwires often unnecessarily tightens and deforms the breasts.

Breast injuries are often a provoking factor for the development of oncological pathology, especially in cases where they have a complicated course. In recent years, there has been an increase in mammary gland injuries: car injuries, including seat belt injuries, in transport, while playing with small children, and cases of animal bites have become more frequent. Negative consequences often discovered after many years, when the very fact of the injury is forgotten.

The list of risk factors can be supplemented by the abuse of coffee, fried meat dishes, drug use, etc.

It is quite obvious that the proportion of the listed factors in the risk of developing cancer is not only different, but also to a certain extent relative.

Therefore, risk factors can be divided into several groups: confirmed, possible and unlikely.

• To confirmed factors relate hereditary cancer in the female line of kinship, a history of breast cancer, fibrocystic disease with proliferation and atypia, intraductal papillomas, intracystic growths.
• TO possible factors include absence of childbirth, late first birth, early menarche, late menopause, trauma, mastitis, long-term hormone replacement therapy.
• To the unlikely- contraceptives, coffee, nicotine, drugs, alcohol, etc.

Having a risk factor does not mean that a woman will definitely get breast cancer. The likelihood of developing cancer increases in the presence of several risk factors, especially if they are confirmed. On the other hand, breast cancer can also be detected in women who are not obviously related to risk groups.

Breast cancer is one of the most common reasons death in women compared to other malignant tumors. Until the 1980s, there was an increase in morbidity and mortality in both economically developed and developing countries. Later in Western countries Mortality rates have decreased while morbidity rates have continued to rise. In Eastern Europe and Latin America, both morbidity and mortality continue to rise. Every year, 390,000 women die from breast cancer worldwide.

The only real way to successfully cure and reduce mortality from breast cancer at present is to improve early diagnosis .

Information provided by the program "Together against breast cancer"

Treatment of breast cancer in modern medicine has good results, and mortality from this disease is decreasing. However, some patients, after undergoing a mastectomy or other types of surgery, develop a recurrence of breast cancer - the return of signs of the tumor after its treatment.

Types of relapses

There are 3 types of this condition:

• Local

It occurs when tumor cells reappear after some time at the original site of the malignancy. This condition is not considered as a spread of cancer, but as a sign of failure of primary treatment. Even after a mastectomy, pieces of fat and skin tissue remain on the breast, making recurrence in the surgical scar possible, although this is rare.

Women who have undergone breast-conserving surgery, such as lumpectomy, or radiation alone have a higher risk of recurrence.

• Regional

This is a more severe condition indicating the spread of tumor cells through the lymphatic tract through axillary lymph nodes into the pectoral muscles, tissue under the ribs and sternum, into the intrathoracic, cervical and supraclavicular lymph nodes. The last two of the indicated localizations of the newly emerged pathological process, as a rule, indicate a more aggressive form of the malignant process.

The frequency of relapses, manifested by regional spread of tumor cells, is quite high and ranges from 2 to 5% of cases of malignant breast tumors.

• Remote

This term refers to the appearance of metastases in other organs. In this case, the likelihood of cure is significantly reduced.

From the tumor site, cancer cells enter the axillary lymph nodes. In 65-75% of cases of distant recurrence, they spread from the lymph nodes to the bones. In more rare cases, metastases occur in the lungs, liver, brain or other organs.

In some cases later for a long time After the primary lesion is cured, breast cancer reappears, but in a different gland. At the same time, he has something else histological structure and other characteristics. Such patients are considered as newly diagnosed patients.

Frequency of development

In the first 5 years without the use of additional treatment methods, only 60% of women do not develop new signs of the disease. If only surgery is performed, the probability of breast cancer recurrence is maximum in the first 2 years after surgery and is almost 10%.

Researchers studied the medical histories of almost 37,000 patients and found that relapses most often develop in stage 1 cancer, since in this case radical surgery and subsequent treatment with hormonal agents are often not used.

The overall recurrence and mortality rates continue to be high at 10 years, with a significant percentage of cases occurring in the first 5 years after treatment. If the patient did not have axillary lymph node involvement (stage 1) but did not receive hormonal therapy, the likelihood of the disease returning within 10 years after surgery is 32%. If the lymph nodes are affected (stage 2), this risk increases to 50%, provided only surgical treatment is performed.

Unlike other forms of cancer, a malignant tumor of the mammary glands is not considered cured if no new signs of the pathological process appear over the next 5 years. Relapse can occur 10 or 20 years after the initial diagnosis, but this likelihood decreases over time.

Risk factors

A recurrent course of breast tumors occurs if the cells primary tumor persist in this area or other parts of the body. Later they begin to divide again and form a malignant focus.

Chemotherapy, radiation, or hormonal drugs used after primary diagnosis cancer, are used to destroy possibly remaining malignant cells after surgery. However, in some cases such treatment is ineffective.

Sometimes the remaining cancer cells remain dormant for years. They then begin to grow and spread again.

The reasons for the recurrence of breast cancer are unclear, but there is an association between this condition and various characteristics of the tumor. A number of common factors, which can help predict the likelihood of disease recurrence.

Risk indicators:

• Lymph node involvement

Spread of the tumor to the axillary and other lymph nodes at the initial diagnosis, a large number of affected lymph nodes. If the lymph nodes were not involved, this means a favorable outcome for the patient.

• Tumor size

How larger size of the original tumor, the higher the risk of recurrence. Especially often in such cases, a relapse occurs after partial removal of the gland and associated lymph nodes.

• Degree of differentiation

This is an assessment of tumor cells under a microscope. There are 3 main characteristics that determine the malignancy of breast cancer: the rate of cell division, their histological type(ductal tumor is more aggressive than tubular tumor), changes in cell size and shape. If the tumor is classified as class III (poorly differentiated cancer), the recurrence rate is higher than with a differentiated tumor.

• HER2/neu status

This gene controls the production of a protein that promotes the growth of cancer cells. If such a protein is detected, more careful monitoring after surgery is necessary for early detection of precancerous changes in the remaining cells and timely treatment.

For patients with high level HER2/neu requires immunotherapy with the drug trastuzumab (Herceptin), often in combination with additional chemotherapy. Herceptin is also prescribed when chemotherapy or hormonal drugs are ineffective.

• Vascular invasion

The presence of tumor cells in tumor vessels increases the risk of recurrence.

• Hormone receptor status

If the tumor has estrogen receptors (ER+) or progesterone receptors (PgR+), the risk of recurrence is lower with additional therapy.

• Proliferation Index

This is an important prognostic factor. The Ki-67 protein is produced during cell division. Increasing its concentration is associated with a higher relapse rate and reduced life expectancy.

Low risk group

Experts from the International Breast Cancer Study Group have found that with a positive ER or PgR status, the patient can be classified as low risk for recurrence if the following conditions are met:

• the cancer has not spread to the lymph nodes;
• tumor is less than 2 cm in diameter;
• the nuclei of cancer cells are small in size, slightly changed in color and other characteristics compared to normal ones (well-differentiated tumors);
• there is no tumor invasion into blood vessels;
• the Her2/neu gene is missing.

Even for small tumors classified as the lowest risk, in the absence of additional therapy, the 10-year risk of recurrence is 12%.

Risk categories

Experts suggest classifying patients into the following risk categories:

How to avoid breast cancer recurrence?

Completely protect the patient from this modern medicine unable.

However, many studies have shown that relapse prevention can be achieved with additional hormone therapy. It reduces the likelihood of the disease returning by at least 30% and significantly improves long-term survival rates.

For additional (adjuvant) hormone therapy, antiestrogens (Tamoxifen) and aromatase inhibitors (letrozole, anastrozole and exemestane) are used. Preference is given to the last group of drugs. They are prescribed after surgery.

To prevent the recurrence of cancer, modern surgery should also be carried out after surgery.

Clinical signs

Any patient who has undergone surgery for a malignant breast tumor should know how a relapse manifests itself and contact an oncologist in a timely manner. It must be remembered that its symptoms can occur many years later, when the woman has already been removed from the dispensary register.

Signs of recurrence depend on the type of breast cancer.

Local relapse

The tumor appears in the same area as originally. If performed, malignant cells may spread to the remaining gland tissue. After a mastectomy, a tumor may appear in the scar area.

Symptoms:

• uneven density of the gland or the formation of “bumps” in it;
• changes in the skin on the chest, inflammation, redness;
• nipple discharge;
• the appearance of one or more painless nodules under the skin in the scar area;
• the appearance of an area of ​​thickened skin next to the scar after a mastectomy.

Regional relapse

In this case, cancer cells multiply in the nearest lymph nodes. This manifests itself as the formation of a lump (“bump”) or swelling in the area under the armpit, above the collarbone or on the neck.

Distant metastases

Cancer cells develop in other organs - bones, lungs, liver, brain. The most common symptoms:

• persistent constant pain in the bones and back that cannot be treated;
• persistent cough;
• shortness of breath, difficulty breathing;
• loss of appetite, weight loss;
• Strong headache;
• convulsive seizures and others.

Diagnostics

Your doctor may suspect recurrence based on clinical symptoms, physical examination, or... In this case, the following studies are additionally prescribed:

1. Visualizing, that is, allowing to “see” a tumor or metastases: magnetic resonance, computer, positron emission tomography, radiography, radioisotope scanning.
2. Biopsy followed by histological analysis: this is necessary to determine whether the new tumor is a relapse or another case of disease, as well as to determine sensitivity to hormonal or targeted therapy.

Treatment

Options depend on many factors, including tumor size, hormonal status, previous interventions, general condition of the body, as well as treatment goals and patient preferences.

For local recurrence it is required surgery. Since it usually occurs after breast-conserving surgery, the patient undergoes removal of the entire gland. After a previously performed mastectomy, the tumor and part of the surrounding healthy tissue are removed. The axillary lymph nodes are also excised.

RISK FACTORS FOR BREAST CANCER

V.P. Letyagin, I.V. Vysotskaya, E.A. Kim

GU RONC im. N.N. Blokhin RAMS, MMA im. THEM. Sechenov

RISK FACTORS OF BREATH CANCER

V.P. Letyagin, I.V. Vysotskaya, Ye.A. Kim

N.N. Blokhin Russian Cancer Research Center,

Russian Academy of Medical Sciences, I.M. Sechenov Moscow Medical Academy

The paper gives the current data on the major risk factors that significantly affect the occurrence of breast cancer. Potential criteria for a risk, as well as factors that significantly reduce the risk of its incidence are identified. The impact of hormone replacement and correction therapies on the incidence of breast cancer is considered. Major hereditary syndromes, including breast cancer, are determined.

Breast cancer (BC) is one of the most current problems modern clinical oncology, since this pathology ranks first in the structure of morbidity among the female population in most economically developed countries of Europe and North America.

As for our country, in 2004, 47,805 patients with malignant neoplasms of the mammary glands were identified in Russia, with an annual increase in incidence corresponding to 8.5%. Statistical data also indicate a high mortality rate from cancer of this location (22,0054 patients in 2004) with a share in the mortality structure of 16.5%. Thus, for our country the problem of breast cancer is also very significant.

Its solution seems possible in several fundamental areas: implementation of screening programs in order to maximize detection early forms, as well as identification of risk groups depending on a set of relevant factors, with high probability leading to the development of neoplasia, improving treatment strategies.

According to available data, about 66% of women have no idea about risk factors. Naturally, knowledge on this issue would increase the appeal to specialists - mammologists.

Risk factors can be divided into several groups:

Increasing risk;

Potential;

Reducing the risk of breast cancer incidence. Factors that increase risk

Floor. The ratio of men and women with breast cancer is 1:135.

Age. Breast cancer is a disease of the menopausal and postmenopausal period. No more than 10% of patients develop breast cancer before the age of 30 years. However, from 25 to 65 years, the risk of morbidity increases 6 times. About 17 in 1,000 women aged 60 are likely to develop this type of cancer

localization within 5 years, i.e. greatest risk The age range is 60-65 years.

The state of the reproductive sphere. Back in 1961, it was shown that nulliparous women have a higher risk of developing breast cancer compared to those who have given birth and had a pregnancy before the age of 20. Moreover, women who gave birth for the first time before age 18 are significantly less likely to develop the disease compared to those whose first birth occurred at age 25 or older (40% increased risk).

A history of abortion, especially before the first birth, is also a risk factor.

The incidence increases 2-2.5 times in the group of women who experience menarche early (before 13 years) and, conversely, menopause late (after 55 years).

Impaired ovarian function and inflammatory processes can increase the incidence of mammary gland neoplasia. Disturbances of hormonal homeostasis, ovarian dysfunction, various types of inflammatory conditions in a significant way influence the incidence of breast cancer.

Hormonal factors. In literature recent years The effect of hormone replacement therapy on the incidence of breast cancer is widely discussed. The positive effect of this treatment, especially in menopause, is undoubtedly, but, on the other hand, it is quite possible to assume the negative effects of estrogens on breast tissue.

Most studies consider hormone replacement therapy to be a controversial risk factor, indicating a slight increase in incidence only during its use (2.1%). Canceling therapy reduces the likelihood of neoplasia, and the period of use with minimal risk is estimated at two years. The use of synthetic estrogens during pregnancy is undesirable.

Oral contraceptives are the most effective way to protect against unwanted pregnancy. These drugs have long and firmly taken their place in gynecological practice. On the other hand, the components they contain

cannot but have a direct effect on mammary gland tissue. How much can this increase the risk of breast pathology? A slight increase in the percentage of women with breast cancer is observed with continuous use of oral contraceptives for more than 10 years. In other clinical situations, no increase in the risk of morbidity was noted. Moreover, similar drugs often used as an effective correction for some types of fibrocystic disease.

Fibrocystic disease (mastopathy, dyshormonal dysplasia). Mastopathy is a widespread diffuse or nodular pathology of the mammary glands, which, according to statistics, affects 53-62% of women. The variety of specific changes reflected in the classic description of mastopathy (WHO) is as follows: it is dishormonal hyperplastic process, characterized by a wide range of proliferative and regressive changes in breast tissue with an abnormal ratio of epithelial and connective tissue components.

From a morphological point of view, there are 3 variants of fibrocystic disease, depending on the degree of proliferative activity of the epithelium:

No proliferation;

With proliferation;

With atypical proliferation.

The risk of increased incidence is minimal with the non-proliferative form of mastopathy, but increases 2-4 times as proliferative activity increases, reaching the highest figures (up to 22 times) with atypical epithelial proliferation, especially in women with a family history.

Genetic factor. The assumption about the hereditary nature of breast cancer was made after studying clinical features occurrence of the process. The so-called familial cancers are characterized by the following:

Younger average age of onset - 44 years (i.e. 10-16 years higher than in the population);

The cumulative risk of developing metachronous cancer reaches 46%;

Often combined with other types of tumors (integral specific hereditary syndrome RMJ).

In 1990, the first gene responsible for the occurrence of hereditary forms of breast cancer was mapped - BRCA I (^ 12-21). Its expression increases the overall risk to 85%, with 33-50% of cases occurring before the age of 50 years and 56-84% after 30 years of age. The overall risk in the age-matched population is 2 and 7%, respectively.

However, subsequent studies demonstrated that BRCA I expression is a more specific marker of ovarian cancer associated with breast cancer (increased risk to 44%, regardless of age).

Soon after the discovery of the BRCA I gene, there was speculation about the existence of a second suppressor gene, more specific for breast cancer, and this gene - the BRCA II gene (13g 12-13) - was discovered. Its expression increases the risk of developing highly differentiated forms of cancer with a low mitotic index by up to 85%.

It is also necessary to mention a number of genetic syndromes in which primary multiple tumors include breast cancer:

Leigh-Fraumeli syndrome;

Ataxia - telangiectasia + breast cancer;

BLOOM disease + breast cancer;

Mohr's tumor + breast cancer;

Breast cancer + sarcoma;

Cowden disease + thyroid cancer + colon cancer + breast cancer.

Ionizing radiation. A large number of studies have proven the direct effect of ionizing radiation on the risk of developing breast cancer. An exposure dose of 100 rad triples the risk. Moreover, the age when the patient was exposed to radiation is extremely important: the period up to 30 years is especially dangerous in this regard (with a peak between 15 and 18 years).

A similar pattern can be seen in patients who received radiation therapy as a component of complex treatment of other oncological pathologies. Thus, radiation used in the treatment of Hodgkin's lymphoma increases the risk of breast cancer, especially in young patients with a tendency to bilateral lesions.

Alcohol. Alcohol becomes a significant risk factor when daily use at least 50 ml, which increases the incidence by 1.4-1.7 times, especially when combined with other negative risk factors (family history, etc.).

The second group consists of the so-called potential risk factors, of which the dietary factor is actively discussed.

Nutritional components play an important role in at least one third of all malignant tumors. According to a number of authors, foods rich in fats actively influence the occurrence and development of certain neoplastic processes, which include breast cancer. Possible mechanisms of this influence are as follows:

Endocrine imbalance;

Modification of cell membrane lipids;

Changes in the metabolism and biological activity of prostaglandins;

Direct effect on cell metabolism;

Formation of peroxide compounds that provoke tumor growth;

Changes in enzymes that metabolize carcinogens;

Changes in the immune system.

In contrast to this, the use plant food, seafood, vegetable oils(olive, etc.) most used

CURRENT TOPIC MAMMOLOGY 4’2006

CURRENT TOPIC MAMMOLOGY 4’2006

Investigators consider it to be very useful, especially with concomitant obesity and hypertension.

And finally, factors that significantly reduce the risk of breast cancer include:

Active negotiability, allowing up to 37% reduction in the risk of neoplasia in regular checkups from a specialist;

Early firsts childbirth;

Lactation (breastfeeding at a young age reduces the risk of developing breast cancer during menopause).

Thus, having considered most of the risk factors, with a certain degree of optimism we can assume that by reducing or completely blocking one or another factor or all together, we will be able to make significant progress in preventing such a terrible disease as breast cancer.

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5. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet

1996;347(9017): 1713-27.

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8. Marchbauks P., McDonald JA, Wilson H.G. et al. Oral contraceptives and the risk of breast cancer. N Eugl J Med. 2002;346(26): 2025-32.

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BRCA2: 1994 and beyond. Natl Rev Cancer 2004;4(9): 665-76.

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