Breast cancer is a major public health issue in low-income and middle-income countries. In the world, incidence and mortality of breast cancer have risen in the past few decades.
Changes in health-care policies in Iran have incorporated programmes for access to early diagnosis and treatment of this disease ,so iran turn to one of the popular destination for treatment cancer in the world .
struggle with a breast cancer is part of this disease.The cost of breast cancer treatment is very important too .The cost of treatment cancer between in 10,000 to 80,000 $ or more than in the world.
But iran is one of the inexpensive country in the world for this treatment . according to a new statistic medical tourism in 2019 the cost of tretment cancer in iran on avreage 60_400 percent less than other country.
This diagram outlines the status of breast cancer in the world, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care.
Breast cancer is the most common type of cancer in women around the world. It is the second cancer with highest worldwide incidence, following the lung cancer. According to statistics, one of every 8 women is caught by breast cancer in a particular time of the life.
Cancer cells usually originate from mammary lobules, where the milk is produced, or milk drainage canals in the breast. Breast cancer is most likely in peri-menopausal women, but it may develop at any age. Breast cancer can be seen in men, albeit very rare. For every 100 women diagnosed with breast cancer, one man is diagnosed.
If one has concerns about symptoms of breast cancer, she/he should take action immediately. More than 90% of early diagnosed breast cancers are successfully treated. You can feel a lump or a solid formation in self-examination of your breast, your physician can palpate a solid formation or a lump in the clinical examination of your breast or an abnormal zone in the breast tissue can be visualized during a mammography test or MRI scan of chest.
Perhaps the most recognized symptom of breast cancer is a lump or mass in the breast tissue. While many women go to the doctor after finding a lump, every woman should also be aware of other changes to the breast or nipple.
With the different types of breast cancer come a variety of related symptoms. For example, invasive ductal carcinoma (IDC), which forms in the milk ducts, may cause a distinct breast lump that you can feel. Invasive lobular carcinoma (ILC), which forms in milk-producing glands, may cause a thickening in the breast.
Symptoms of breast tumors vary from person to person. Some common, early warning signs of breast cancer include:
Symptoms more specific to invasive breast cancer are:
It's important to remember that other, benign conditions may have caused these changes. For example, changes to the skin texture on the breast may be caused by a skin condition like eczema, and swollen lymph nodes may be caused by an infection in the breast or another, unrelated illness. Seeing a doctor for an evaluation will help you determine whether something you notice is cause for concern.
Invasive breast cancer symptoms may include:
Doctors know that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.
Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.
Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.
Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.
A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.
If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family.
Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks and limitations of genetic testing to assist you with shared decision-making.
Several risk factors for breast cancer have been well documented. However, for the majority of women presenting with breast cancer it is not possible to identify specific risk factors
A familial history of breast cancer increases the risk by a factor of two or three. Some mutations, particularly in BRCA1, BRCA2 and p53 result in a very high risk for breast cancer. However, these mutations are rare and account for a small portion of the total breast cancer burden.
Reproductive factors associated with prolonged exposure to endogenous estrogens, such as early menarche, late menopause, late age at first childbirth are among the most important risk factors for breast cancer. Exogenous hormones also exert a higher risk for breast cancer. Oral contraceptive and hormone replacement therapy users are at higher risk than non-users. Breastfeeding has a protective effect .
The contribution of various modifiable risk factors, excluding reproductive factors, to the overall breast cancer burden has been calculated by Danaei et al. (Danaei et al., 2005). They conclude that 21% of all breast cancer deaths worldwide are attributable to alcohol use, overweight and obesity, and physical inactivity. This proportion was higher in high-income countries (27%), and the most important contributor was overweight and obesity. In low- and middle-income countries, the proportion of breast cancers attributable to these risk factors was 18%, and physical inactivity was the most important determinant (10%).
The differences in breast cancer incidence between developed and developing countries can partly be explained by dietary effects combined with later first childbirth, lower parity, and shorter breastfeeding . The increasing adoption of western life-style in low- and middle-income countries is an important determinant in the increase of breast cancer incidence in these countries.
Depending on the condition of the disease, the characteristics of the patient and general health, treatment options may include one or more of the following: surgery, radiation therapy, hormone therapy, chemotherapy or targeted therapy
1- Surgical treatment
2 – Radiotherapy
3- Chemotherapy (Medication therapy)
4- Hormone therapy
It is usually the first frontage in the fight against the cancer. Treatments of most patients start with surgical removal of the cancerous tissue. Sentinel lymph node is biopsied along with axillary lymph node dissection, if required.
Recently, there are several different surgical procedures that are used to treat the breast cancer. These are broadly addressed in two groups; breast-sparing surgery and radical surgery that requires removal of whole breast. Thanks to recent medical novelties, cancerous locus is removed, while the breast is spared and axillary lymph nodes are biopsied, and thus, similar successful outcomes are obtained and patients can be discharged to home in the same day. If it is necessary to remove the whole breast, the breast is reconstructed by plastic surgeons.
Radiotherapy is employed to eliminate likelihood of postoperative tumor residues by delivering X-rays (roentgen beams) to breast tissue and axilla.
External beam radiation is the most common method. It is used for postoperative 4 to 6 weeks. Whole breast and sometimes axilla are externally irradiated with the help of a special linear accelerator. Radiation beams are usually delivered for 5 days of week for 4 to 6 weeks.
Side effects of the radiotherapy: tiredness is the most common complaint specified by women who receive radiotherapy. Swelling or feeling of weight in breast may occur. Suntan discoloration in the skin of the targeted area can be observed. Those side effects spontaneously disappear in approximately one year. Novalis TrueBeam STx, the linear accelerator used in our center, reduces the damage in healthy tissues, resulting with minimization of those side effects.
In this method, medications are used to kill cancer cells. After medications are administered by oral or intravenous route, they spread to whole body. Since administration of multiple agents simultaneously creates stronger effect, they are administered in various combinations. Chemotherapy is given in cycles or courses. Four to six cycles are planned. Approximately 3 weeks elapse between two cycles. This results in 3 to 5 months in total to complete a chemotherapy regimen.
For some cases, it is necessary to supplement surgery with chemotherapy.
Even if postoperative work-up shows no residue, chemotherapy can be given for prophylaxis or as a preventive measure. This therapy is referred as adjuvant chemotherapy.
Neoadjuvant chemotherapy is employed to reduce size of Stage 3 tumor or to prepare the patient for the surgery. Another benefit derived from the neoadjuvant chemotherapy is to monitor efficiency of the chemotherapy. Please click for further details about chemotherapy.
Some breast cancer cells are estrogen-sensitive, which is mediated by hormone receptors of those cells. In other words, estrogen hormone plays a role in enlargement or growth of those cancer cells. Hormone therapy intends preventing occurrence of the cancer by eliminating effects of estrogen in estrogen-sensitive cancers.
There are two main types of surgery to remove breast cancer in iran:
1.Breast-conserving surgery (also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy) – A surgery in which only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much of the breast is removed depends on the size and location of the tumor and other factors.
2.Mastectomy – A surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also get a double mastectomy, in which both breasts are removed.
Your surgeon will probably operate with a kind of electric scalpel that uses heat to minimize bleeding (an electrocautery knife). Most surgeons use curved incisions (like a smile or a frown) that follow the natural curve of your breast and allow for better healing. If the tumor can be seen or felt, the surgeon will remove it along with a rim of healthy tissue around it.
Sometimes, but not always, a rubber tube called a drain will be surgically inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The drain is connected to a plastic bulb that creates suction to help remove fluid. Finally, your surgeon will stitch the incision closed and dress the wound.
A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present.
A negative SLNB result suggests that cancer has not developed the ability to spread to nearby lymph nodes or other organs. A positive SLNB result indicates that cancer is present in the sentinel lymph node and may be present in other nearby lymph nodes (called regional lymph nodes) and, possibly, other organs. This information can help a doctor determine the stage of the cancer (extent of the disease within the body) and develop an appropriate treatment plan.