Breast cancer occurs when there is a malignant tumor inside the breast. Each
year more than 185,000 women are diagnosed with breast cancer, and the incidence
of this disease is rising in developed countries. There are approximately 43,500
deaths from breast cancer annually, making this disease second to lung cancer as
the leading cause of death by cancer among women. Ninety percent of breast
cancers are detected by women themselves, often through breast self-examination
(BSE).
Signs and Symptoms
According to the National Cancer Institute, breast cancer is often
accompanied by the following signs and symptoms.
A lump or thickening in or near the breast or in the underarm
area
A change in the size or shape of the breast
Nipple discharge or tenderness, or the nipple pulled back (inverted)
into the breast
Ridges or pitting of the breast (the skin looks like the skin of an
orange)
A change in the way the skin of the breast, areola, or nipple looks or
feels (for example, warm, swollen, red, or
scaly)
What Causes It?
While the cause of breast cancer is not known, it is clear that the disease
is hormone-dependent. Women whose ovaries do not function and who never receive
hormone replacement therapy do not develop breast cancer.
Who's Most At Risk?
People with the following conditions or characteristics are at a
higher-than-average risk for developing breast cancer.
Women (comprise over 99 percent of cases; men comprise under one
percent)
Increasing age
History of cancer in one breast
History of benign breast disease
Never giving birth or first pregnancy after 30
Family history (first-degree relative) of breast cancer (significant
for premenopausal women)
Early onset of menstruation and late menopause
Possibly, long-term oral contraceptive use (although this is
controversial)
High doses of ionizing radiation before age 35
History of cancer of the colon, thyroid, endometrium, or
ovary
Diet high in animal fat, excessive alcohol consumption, and, possibly,
obesity
Alterations in certain genes
Breast implants
Despite the relevance of risk factors, 70 to 80 percent of women with breast
cancer have none of the known risk factors.
What to Expect at Your Provider's Office
If you are experiencing symptoms associated with breast cancer, see your
health care provider immediately. He or she can help make a diagnosis and guide
you in determining which treatment or combination of therapies will work best
for you.
Your provider will do a breast exam and run some laboratory tests, including
a study of breast tissue and genetic studies. Imaging techniques may include
mammography, ultrasound, magnetic resonance imaging (MRI), and other methods
that help distinguish a cyst from a solid mass or make a distinction between
cancerous and noncancerous disease.
Treatment Options
Prevention
Early detection is important. Monthly breast self-examination and annual
gynecologic examinations play a large role in early detection. Nutrition may
play a role in prevention.
Treatment Plan
Treatment options depend on the size and location of the tumor, results of
lab tests, and the stage, or extent, of the disease, along with the patient's
age and menopausal status, general health, and breast size.
Drug Therapies
Your provider may prescribe one or more of the following
therapies.
Radiation therapy— the use of high energy
rays to kill cancer cells and prevent them from growing
Chemotherapy—the use of drugs to kill cancer
cells
Hormonal therapy, which keeps cancer cells from getting the hormones
they need to grow
Antitumor antibiotics
Antiestrogens, such as tamoxifen, which block the action of estrogen
on breast tissue
Monoclonal antibodies to block the protein receptor that is produced
in large numbers in women with breast cancer
High-dose progestogens (steroid
hormones)
Surgical and Other Procedures
Surgery is the most common treatment for breast cancer. The choice of
surgeries includes the following.
Mastectomy—removal of the breast or as much
of the breast tissue as possible; can be followed by breast
reconstruction
Lumpectomy—removal of the tumor and a small
amount of tissue around it, usually followed by radiation therapy
Segmental, or partial, mastectomy—removal of
the tumor and a small amount of tissue around it, as well as the lining of the
chest muscles below the tumor and some of the lymph nodes under the arm. It is
usually followed by radiation therapy.
Complementary and Alternative Therapies
A comprehensive treatment plan for breast cancer may include a range of
complementary and alternative therapies. Psychotherapy and support groups may
help improve quality of life and survival.
Nutrition
Nutritional tips include the following.
Eliminate non-organic poultry, dairy, red meat, sugar, white flour and
refined foods, coffee, tea, chocolate, and colas.
Include liver foods such as beets, carrots, yams, garlic, dark leafy
greens, lemons, and apples.
Follow a high-fiber diet.
Use soy.
Potentially beneficial nutrient supplements include the
following.
Coenzyme Q10 (120 mg three times a day)
Calcium d-glucarate (500 to 1,000 mg three times a day)
Vitamin A (25,000 IU a day), vitamin E (800 IU a day), and vitamin C
(250 to 500 mg twice per day) to decrease side effects of chemotherapy and
radiation
Selenium (200 to 400 mcg a day) to decrease side effects of
chemotherapy and radiation
Bromelain (500 mg two times a day between meals)
Melatonin (10 to 50 mg a day)
Herbs
The use of certain herbal remedies may offer relief from symptoms. Try the
following: a combination of black cohosh (Cimicifuga racemosa), red
clover (Trifolium pratense), and alfalfa (Medicago sativa) as a
base (1 to 3 g); add two to three of the following in equal parts, 30 to 60
drops two to three times daily:
With anxiety: passionflower (Passiflora incarnata), kava kava
(Piper methysticum)
With lymph node involvement: poke root (Phytolacca americana),
red root (Ceanothus americanus); maximum dose of poke root is 0.4 ml a
day.
With nausea: ginger root (Zingiber officinale), fennel seed
(Foeniculum vulgare)
With exhaustion: oatstraw (Avena sativa), skullcap
(Scutellaria lateriflora)
Herbs are generally available as dried extracts (pills, capsules, or
tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose
for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20
minutes).
Homeopathy
An experienced homeopath considers both your symptoms and constitutional type
in order to create an individualized treatment regimen. Some of the most common
homeopathic remedies that may helpful in treating symptoms associated with
breast cancer are listed below.
Arsenicum for anxiety and nausea, with restlessness and burning
pains
Ipecac for nausea unrelieved by vomiting
Nux vomica for sharp abdominal pains with anger and
collapse
Acute dose is three to five pellets of 12X to 30C every one to four hours
until symptoms are relieved.
Acupuncture
While acupuncture is not used as a treatment for cancer itself, evidence
suggests it can be a valuable therapy for symptoms associated with cancer and
the side effects of chemotherapy. In a study of 104 women with breast cancer and
nausea from chemotherapy (all of whom were taking anti-nausea medication), women
treated with acupuncture experienced fewer attacks of nausea than women who
received the medication alone. There have also been studies indicating that
acupuncture may help eliminate pain and hot flashes caused by tamoxifen (a
breast cancer medication). One study found that acupuncture markedly improved
breathlessness in women with late stages of breast cancer. Acupressure (pressing
on rather than needling acupuncture points) has also proved useful in
controlling breathlessness; this is a technique that individuals can learn and
then use to treat themselves.
Some acupuncturists prefer to work with breast cancer patients only after
they have completed conventional medical cancer therapy. Others will provide
acupuncture and/or herbal therapy during active chemotherapy or radiation.
Acupuncturists treat breast cancer patients based on an individualized
assessment of the excesses and deficiencies of qi located in various meridians.
In many cases of cancer-related symptoms, a qi deficiency is usually detected in
the spleen or kidney meridians.
Prognosis/Possible Complications
Most complications result from surgery, radiation, chemotherapy, or use of
the drug tamoxifen, which is effective in preventing recurrence but increases a
woman's risk of endometrial cancer and thrombo-embolic disease. These
include:
Restricted shoulder movement
Increase in size of operative scar
Inflammation of connective tissue in the affected arm
Malignant tumor of the lymphatic vessels in the affected
arm
Accumulation of fluid in the breast; swelling of tissue in the
arm
Discoloration of the skin from radiation, or a red spot
Inflammation of the lung from radiation
Death of the fat cells underlying the breast tissue
Recurrence of the disease
The prognosis for breast cancer patients depends primarily on the stage, or
extent, of the disease at the time of the initial
diagnosis.
Following Up
Breast cancer patients should be followed every three months for eighteen
months to four years, then every six months.
Supporting Research
Ariel IM, Cleary JB. Breast Cancer: Diagnosis and Treatment. New York,
NY: McGraw-Hill; 1987:35- 43, 172-180, 475-484.
Austin S, Hitchcock C. Breast Cancer: What You Should Know (But May Not Be
Told) About Prevention, Diagnosis, and Treatment. Rocklin, Calif: Prima
Publishing; 1994:194.
Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed.
Garden City Park, NY: Avery Publishing; 1997:160-164.
Birdsall TC. Effects and clinical uses of the pineal hormone melatonin.
Altern Med Rev. 1996;1(2):94-102.
Bland KI, Copeland EM III. The Breast: Comprehensive Management of Benign
and Malignant Diseases. Philadelphia, Pa: W.B. Saunders; 1991:731-747,
877-894.
Blumenthal M, ed. The Complete German Commission E Monographs. Boston,
Mass: Integrative Medicine Communications; 1998:462,464, 466.
Boik J. Cancer and Natural Medicine. Princeton, Minn: Oregon Medical
Press; 1995:138, 149, 166.
Cummings SR, et al. The effect of raloxifene on risk of breast cancer in
postmenopausal women. JAMA. 1999;281:2189-2197, 1999.
Cunningham FG, et al. Williams Obstetrics. 19th ed. Norwalk, Conn:
Appleton & Lange; 1993:1269-1270.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:562-568.
Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of
cancer-related breathlessness. Palliat Med. 1998;10:145-150.
He JP, Friedrich M, Ertan AK, Muller K, Schmidt W. Pain-relief and movement
improvement by acupuncture after ablation and axillary lymphadenectomy in
patients with mammary cancer. Clin Exp Obst Gynecol.
1999;26(2):81-84.
Holleb AI, et al. American Cancer Society Textbook of Clinical
Oncology. Atlanta, Ga: American Cancer Society; 1991: 177-193.
Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary
rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:40,42,192,274.
NIH Consensus Statement: Acupuncture. National Institutes of Health, Office
of the Director. 1997;15(5):1-34. Accessed at
http://odp.od.nih.gov/consensus/cons/107/107_statement.htm
on September 24, 2001.
Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and
alternative medicine in the management of pain, dyspnea, and nausea and vomiting
near the end of life: a systematic review. J Pain Symptom Manage.
2000;20(5):374-387.
Pawlowicz Z, Zachara BA, Trafikowska U, et al. Blood selenium concentrations
and glutathione peroxidase activities in patients with breast cancer and with
advanced gastrointestinal cancer. J Trace ElemElectrolytes Health
Dis. 1991;4:275-277.
Shen J, Wenger N, Glaspy J et al. Electroacupuncture for control of
myeloablative chemotherapy-induced emesis. JAMA.
2000;284(21):2755-2761.
Thomson JD, Rock JA. Te Linde's Operative Gynecology. Philadelphia,
Pa: J.B. Lippincott's; 1992:979-907.
Towlerton G, Filshie J, O'Brien M, Duncan A. Acupuncture in the control of
vasomotor symptoms caused by tamoxifen. Palliat Med. 1999;13(5):445.
Vickers AJ. Can acupuncture have specific effects on health? A systematic
review of acupuncture antiemesis trials. J R Soc Med.
1996;89:303-311.
Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats
Publishing Inc; 1987:98-106.
Review Date: March 2000
Reviewed By: Participants in the review process include: Anne McClenon, ND, Compass Family
Health Center, Plymouth, MA; Lonnie Lee, MD, Internal Medicine, Silver Springs,
MD; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's
Catholic Medical Center, New York, NY; Ira Zunin, MD, MPH, MBA, (Acupuncture
section October 2001) President and Chairman, Hawaii State Consortium for
Integrative Medicine, Honolulu, HI.
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of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed
herein.