Breast cancer is a malignant tumor that affects the mammary gland. The malignant cells multiply in an uncoordinated manner to create a tumor that attacks the surrounding healthy tissue. If it is not diagnosed and treated, cancer cells spread throughout the body, giving metastases.

• Breast cancer is the most common cancer in women: 1 in 8 is affected by breast cancer, and this figure could climb to over 1 in 7 in twenty years.
• Breast cancer develops in three-quarters of cases among women over 50.
• Two breast cancers in 3 occur after menopause.
• The increase in the number of cases mainly affects postmenopausal women, but increasingly, also younger women, i.e. aged 40 to 45 years.
• Breast cancer detected at an early stage is easier to handle and presents less risk of sequelae; it can reduce mortality by 25%.
• Half of the cancers are detected when they are less than 2 cm wide.
• Altough the mortality rate decreases by 1.3% on average per year (INVS sources, published in February 2008 on the evolution of incidence and mortality of cancer between 1980 and 2005), it is the leading cause of death among women between 35 and 65.
• Each year worldwide, a million breast cancers are discovered and 400 000 women die.
• A woman dies of breast cancer every 53 minutes.
• But thanks to better health habits, its incidence starts to decline: between 2004 and 2005, the number of new cases fell by 2.1% and by 3.3% between 2005 and 2006 (Académie de Médecine (Academy of Medicine), France, February 2008)

• Early first menstrual periods (before age 12).
• The absence of pregnancy or first pregnancy after age 35.
• A late menopause occurring after age 55. The risk increases with age.
• The regular consumption of alcohol: two to three glasses of wine per day increase by 50% the risk of breast cancer after menopause.
• Genetic factors: the presence of certain genes predispose to the appearance of breast cancer. Women with a mutation of the BRCA 1 and BRCA 2 genes have a risk of developing breast cancer which can reach more than 80% in that group, while only 10% in the population. They can develop breast cancer earlier, around the age of 40 to 45 years old.
• An oncogenetic consultation can detect a family-induced genetic predisposition among women who have several cases of breast cancer in their family. In this case, a closer surveillance, such as a MRI to detect cancer early is recommended.

Self-Examination: One Method, 3 ways

Breast cancer in general manifests itself by the presence of a lump. In some patients, it may manifest itself as nipple discharge, a red spot on the breast, crevices, abnormal creases or skin peeling ...

But note that a significant proportion of patients shows no signs, but only abnormalities visible on a mammogram.

1. In front of the mirror

First, with hands on your hips. Second, with arms above your head. Look for any dimpling, puckering or change in the size, shape or contour of the breast. Check for a change in skin texture, discharge from, or a change in the nipple.

2. Lying down

Place a towel under your right shoulder and right hand behind your head. Examine the right breast with the fingers of the left hand. Start at the outermost edge of the breast, pressing in small circles towards the nipple. Check every part of both breasts. Look for any change from last month. Using the tips of the fingers with arm at your side, check the underarm area. Start high under the arm and slide your fingers along your ribs. (Reverse process for other breast.)

3. In the shower

Place your right arm behind your head. With the middle three fingers of your left hand, roll and touch every part of the right breast, gently feeling for a lump or thickening.(Reverse process for the left breast.)

A significant proportion of patients has abnormalities only visible on a mammogram.

When an anomaly is discovered, an ultrasound may be performed to determine the need to monitor the injury, or decide on a sampling (cytoponction / biopsy) of the tumor.

A breast cancer detected early is easier to handle and presents less risk of sequelae: detected at an early stage, breast cancer is treated much better and can reduce mortality by 25%.

Half of the cancers are detected when they are less than 2 cm wide. When the tumor size is less than 1 cm and no node is found, the chances of survival 5 years after are of at least 90%.

It is a quick and painless test, which last 15 minutes; a mammography can detect an anomaly and establish an accurate diagnosis.

It is done in a systematic way among women over 50 as part of a monitoring to detect small, invisible and non palpable tumors to quickly develop a treatment to maximize the chances of healing.

The radiologist issues later that day the first interpretation and the results are sent to the doctor.

If an abnormality is detected, other radiological examinations can be immediately applied by the radiologist, such as an ultrasound for example.

A small proportion of women have abnormalities detected at mammography. This does not necessarily mean it is cancer. In this case, other tests, such as an ultrasound will be carried out immediately by the radiologist.

Report to the radiologist if you wear breast implants, if you are taking hormonal medication or if you have undergone surgery.

An ultrasound is not an exam used on the first stage of a breast cancer screening. It may be advisable after a mammogram in order to analyze a lesion detected or when a mass is discovered during palpation that has not been localized on the mammogram.

A reliable sampling done with a small needle, that enables physicians to differentiate between cancer and benign tumors. No hospitalization is required for a cytopunction.

It involves taking a piece of suspect tissue for examination under a microscope. The biopsy can be performed under local anesthesia, or in an operating room, under general anesthesia during the removal of the tumor. The diagnosis is made by the examination of the piece of tumor removed .

This assessment determines the extent of the cancer and verifies the absence of metastasis, and depends on the results of the sampling of the tumor. It will at least consist of a chest radiography, an abdominal ultrasound, a blood draw and bones scintigraphy (A diagnostic test in which a two-dimensional picture is obtained through the use of radioisotopes).

The characteristics of the tumor determine the choice of treatment.

It depends on the type of tumor. Surgery is now more effective and less mutilating.

The lumpectomy, a conservative surgery, removes a tumor of a size usually less than 3 cm and conserve the breast.

A Mastectomy removes the breast in cases where the tumor is larger or if there are multiple tumors in the breast.

Rehabilitation and exercise are important steps. They can help restore flexibility to the arm and shoulder located on the side of the intervention and also to reduce post operative pain.

• Do not carry heavy loads.
• Wear loose clothing and avoid irritants.
• Avoid sun exposure.
• Avoid tobacco and do not drink too much alcohol.

Breast radiotherapy can consolidate the effect of surgery.

This treatment applies to the breast in question, if it has not been removed, and is used to destroy remaining cancer cells with radiation.

It is generally done over a period of 5 to 6 weeks and does not require hospitalization.

Chemotherapy is often performed in conjonction with other breast cancer treatments. It involves the diffusion of drugs to destroy tumor cells.

This treatment is to deliver molecules that block the effects of estrogen on the growth of cancer cells. These products are offered to women with hormone-dependant breast cancer.

The surveillance is aimed at early detection of possible relapse, but also to detect a new cancer. Mammograms will be performed regularly.

The plastic and reconstructive surgery, more and more often recommended after the removal of a tumor, allows patients to recover a breast similar to what they had before surgery. More oncology departments integrate in their team a plastic surgeon to advise patients with breast reconstruction. The oncologist and plastic surgeon work together on this important step in improving psychological well-being.

Breast reconstruction consist in the reconstruction of the shape of the breast with a saline or silicone gel prosthetic implant. A little intervention on the other breast is often performed for reasons of symmetry.

The surgeon will advise the patient depending on the type of intervention, treatment after surgery, the condition of the skin and muscles ...

Do not hesitate to ask him to show you pictures of the breast reconstructions he has already done.

Breast reconstruction is sometimes done at the same time as the removal of the breast or is at other times practiced after the end of chemotherapy. Breast reconstruction can take place in several stages and require several months, and sometimes even almost a year to be complete and satisfactory.

Breast reconstruction has no effect on cancer and does not compromise the chances of healing and does not hindrance subsequent monitoring. It can also be done after a lumpectomy.

Note that a reconstructed breast has diminished tactile sensations at the nipple.

Scarves and Wigs

Alopecia (hair loss) is a side effect of chemotherapy. It begins about 2 to 4 weeks after the first infusion of chemotherapy.

Hair always regrows after cessation of treatment, sometimes even before, at a rate of about one centimeter (half an inch) per month. During the first growth, color and texture of your hair can be changed. Your hair regains its normal appearance 4 months after stopping treatment.

Scarfs, turbans, hats or even a wig are accessories that can help those who wish to cover or hide hair loss, making this period less unpleasant.

External breast prostheses

External breast prostheses can help retrieve a feminine shape and restore a static balance.

There are prosthetics that fit into the bra and other prostheses are adhesive or adherent to the skin.

Developed in collaboration with health professionals under the direction of Dr. Pierrick HORDE.