Breast cancer is a cancer that starts in the cells of the breast in men and women. Worldwide, breast cancer is the second most common type of cancer after lung cancer   and the fifth most common cause of cancer death.   However breast cancer mortality worldwide is just 25% greater than that of lung cancer in women.  In 2005, breast cancer caused 502,000 deaths worldwide . The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.

Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males.  Incidences of breast cancer in men are approximately 100 times less common than in women, but men with breast cancer are considered to have the same statistical survival rates as women.

Signs and Symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different than the surrounding breast tissue. According to the Merck Manual, greater than 80% of breast cancer cases are discovered as a lump by the woman herself.   According to the American Cancer Society (ACS), the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain is an unreliable tool in determining the presence of breast cancer, but may be indicative of other breast-related health issues such as mastodynia.

When breast cancer cells invade the dermal lymphatics, small lymph vessels in the skin of the breast, its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange peel texture to the skin referred to as peau d’orange.

Another reported symptom complex of breast cancer is Paget’s disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget’s advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget’s also have a lump in the breast.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. More common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are “non-specific,” meaning they can also be manifestations of many other illnesses.

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Steps to Prevent Breast Cancer

1. Maintain a healthy body weight (BMI less than 25) throughout your life. Weight gain in midlife, independent of BMI, has been shown to significantly increase breast cancer risk. Additionally, and elevated BMI has been conclusively shown to increase the risk of post-menopausal breast cancer.

2. Minimize or avoid alcohol. Alcohol use is the most well established dietary risk factor for breast cancer. The Harvard Nurses’ Health study, along with several others, has shown consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.

3. Consume as many fruits and vegetables as possible. Eat seven or more servings daily. The superstars for breast cancer protection include all cruciferous vegetables (broccoli, cabbage, brussels sprouts, cauliflower) ; dark leafy greens (collards, kale, spinach) ; carrots and tomatoes. The superstar fruits include citrus, berries and cherries. Note: it is best to eat cruciferous vegetables raw or lightly cooked, as some of the phytochemicals believed to offer protection against breast cancer are destroyed by heat.

4. Exercise regularly the rest of your life. Many studies have shown that regular exercise provides powerful protection against breast cancer. Aim for 30 minutes or more of moderate aerobic activity (brisk walking) five or more days a week. Consistency and duration, not intensity, are key!

5. Do your fats right! The type of fat in your diet can affect your breast cancer risk. Minimize consumption of omega-6 fats (sunflower, safflower, corn and cottonseed oils), saturated fats and trans fats. Maximize your intake of omega-3 fats, especially from oily fish (salmon, tuna, mackerel, sardines, lake trout and herring). Consume monounsaturated oils (canola, olive oil, nuts/seeds, avocados) as your primary fat source, as these foods have potential anticancer properties. Specifically, canola oil is a good source of omega-3 fats; extra virgin olive oil is a potent source of antioxidant polyphenols, including squalene; and nuts and seeds provide you with the cancer protective mineral, selenium.

6. Do your carbs right! Minimize consumption of the high glycemic index, “Great White Hazards” – white flour, white rice, white potatoes, sugar and products containing them. These foods trigger hormonal changes that promote cellular growth in breast tissue. Replace these “wrong” carbs with whole grains and beans/legumes. Beans/legumes because of their high fiber and lignan content are especially special.

7. Consume whole food soy products regularly, such as tofu, tempeh, edamame, roasted soy nuts, soy milk and miso. Only consume organic, non-GMO (genetically modified) soy. Epidemiologic studies have shown a positive association between soy consumption and reduced breast cancer risk.

8. Minimize exposure to pharmacologic estrogens and xeno-estrogens. Do not take prescription estrogens unless medically indicated. Lifetime exposure to estrogen plays a fundamental role in the development of breast cancer. Also avoid estrogen-like compounds found in environmental pollutants, such as pesticides and industrial chemicals. Buy organic produce if you can afford it; otherwise, thoroughly wash all non-organic produce. Minimize exposure to residual hormones found in non-organic dairy products, meat and poultry.

9. Take your supplements daily. A multivitamin, 500-1,000 mg of vitamin C in divided doses, 200-400 IUs of vitamin E as mixed tocopherols, and pharmaceutical grade fish oil. Also take 200 mcg of the mineral selenium or eat one to two Brazil nuts as an alternative. If you have a chronic medical condition or take prescription drugs, consult your physician first.

10. Maintain a positive mental outlook. Engage in self-nurturing behaviors regularly. Develop rich, warm and mutually beneficial relationships with family and friends. Get adequate sleep (7-8 hours per night). The mind-body associations with breast cancer are significant.

After a breast cancer diagnosis, you and your doctors will put together a treatment plan specific to your situation, based on your pathology report. Your treatment plan will be made up of one or more specific treatments that are intended to target the cancer cells in different ways and reduce the risk of future breast cancer recurrence. You and your doctor will base your treatment decisions on YOUR unique situation, including consideration of your overall medical condition and your personal style of making decisions. You may have to re-evaluate your decisions periodically. Your medical team will be your guide.

Treatment of Breast Cancer

There are two methods of treatment – local and systemic.

Local treatments are used to remove or destroy the cancer cells in a specific area. Surgery and Radiation therapy are examples of local treatments.

Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormonal therapy examples of systemic treatments.

The right treatment method, however, depends on the size and location of the breast tumor; the results of the pathologist’ s review of the tumor specimen, the woman’s age, menopausal status, and general health; and the stage of the disease.

Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, defined as mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated. Hypertension is considered to be present when a person’s systolic blood pressure is consistently 140 mmHg or greater, and/or their diastolic blood pressure is consistently 90 mmHg or greater.

Although no specific medical cause can be determined in essential hypertension, the most common form has several contributing factors. These include salt sensitivity, renin homeostasis, insulin resistance, genetics, and age. Certain medications, especially NSAIDS (Motrin/Ibuprofen) and steroids can cause hypertension. Licorice (Glycyrrhiza glabra) inhibits the 11-hydroxysteroid hydrogenase enzyme (catalyzes the reaction of cortisol to cortison) which allows cortisol to stimulate the Mineralocorticoid Receptor (MR) which will lead to effects similar to hyperaldosteronism, which itself is a cause of hypertension.

Hypertension is one of the most common complex disorders, with genetic heritability averaging 30%. Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their phenotypic expressions.

Signs and symptoms

Hypertension is usually found incidentally – “case finding” – by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing, transient insomnia or difficulty sleeping due to feeling hot or flushed, and tinnitus during beginning onset or prior to hypertention diagnosis.

Malignant hypertension (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage. Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety and/or irritability is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting .

Diagnosis

Diagnosis of hypertension is generally on the basis of a persistently high blood pressure. Usually this requires three separate measurements at least one week apart. Exceptionally, if the elevation is extreme, or end-organ damage is present then the diagnosis may be applied and treatment commenced immediately.

Obtaining reliable blood pressure measurements relies on following several rules and understanding the many factors that influence blood pressure reading.

For instance, measurements in control of hypertension should be at least 1 hour after caffeine, 30 minutes after smoking or strenuous exercise and without any stress. Cuff size is also important. The bladder should encircle and cover two-thirds of the length of the (upper) arm. The patient should be sitting upright in a chair with both feet flat on the floor for a minimum of five minutes prior to taking a reading. The patient should not be on any adrenergic stimulants, such as those found in many cold medications.

When taking manual measurements, the person taking the measurement should be careful to inflate the cuff suitably above anticipated systolic pressure. The person should inflate the cuff to 200 mmHg and then slowly release the air while palpating the radial pulse. After one minute, the cuff should be reinflated to 30 mmHg higher than the pressure at which the radial pulse was no longer palpable. A stethoscope should be placed lightly over the brachial artery. The cuff should be at the level of the heart and the cuff should be deflated at a rate of 2 to 3 mmHg/s. Systolic pressure is the pressure reading at the onset of the sounds described by Korotkoff . Diastolic pressure is then recorded as the pressure at which the sounds disappear (K5) or sometimes the K4 point, where the sound is abruptly muffled. Two measurements should be made at least 5 minutes apart, and, if there is a discrepancy of more than 5 mmHg, a third reading should be done. The readings should then be averaged. An initial measurement should include both arms. In elderly patients who particularly when treated may show orthostatic hypotension, measuring lying sitting and standing BP may be useful. The BP should at some time have been measured in each arm, and the higher pressure arm preferred for subsequent measurements.

BP varies with time of day, as may the effectiveness of treatment, and archetypes used to record the data should include the time taken. Analysis of this is rare at present.

Automated machines are commonly used and reduce the variability in manually collected readings . Routine measurements done in medical offices of patients with known hypertension may incorrectly diagnose 20% of patients with uncontrolled hypertension.

Home blood pressure monitoring can provide a measurement of a person’s blood pressure at different times throughout the day and in different environments, such as at home and at work. Home monitoring may assist in the diagnosis of high or low blood pressure. It may also be used to monitor the effects of medication or lifestyle changes taken to lower or regulate blood pressure levels.

Home monitoring of blood pressure can also assist in the diagnosis of white coat hypertension. The American Heart Association states, “You may have what’s called ‘white coat hypertension’; that means your blood pressure goes up when you’re at the doctor’s office. Monitoring at home will help you measure your true blood pressure and can provide your doctor with a log of blood pressure measurements over time. This is helpful in diagnosing and preventing potential health problems.”

Some home blood pressure monitoring devices also make use of blood pressure charting software. These charting methods provide printouts for the patient’s physician and reminders to take a blood pressure reading. However, a simple and cheap way is simply to manually record values with pen and paper, which can then be inspected by a doctor.

Treatment

Lifestyle modification (nonpharmacologic treatment)

Weight reduction and regular aerobic exercise (e.g., jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level.

Reducing sodium (salt) diet is proven very effective: it decreases blood pressure in about 60% of people . Many people choose to use a salt substitute to reduce their salt intake.

Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (Dietary Approaches to Stop Hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on National Institutes of Health sponsored research. In addition, an increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure.

Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension.

Relaxation therapy, such as meditation, that reduces environmental stress, reducing high sound levels and over-illumination can be an additional method of ameliorating hypertension. Jacobson’s Progressive Muscle Relaxation and biofeedback are also used particularly device guided paced breathing .

Medications

Unless hypertension is severe, lifestyle changes such as those discussed in the preceding section are strongly recommended before initiation of drug therapy. Adoption of the DASH diet is one example of lifestyle change repeatedly shown to effectively lower mildly-elevated blood pressure. If hypertension is high enough to justify immediate use of medications, lifestyle changes are initiated concomitantly.

There are many classes of medications for treating hypertension, together called antihypertensives, which – by varying means – act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.

The aim of treatment should be blood pressure control to <140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg). Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.

Commonly used drugs include:

ACE inhibitors such as creatine captopril, enalapril, fosinopril (Monopril), lisinopril (Zestril), quinapril, ramipril (Altace)

Angiotensin II receptor antagonists: eg, telmisartan (Micardis, Pritor), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan), candesartan (Amias)

Alpha blockers such as doxazosin, prazosin, or terazosin

Beta blockers such as atenolol, labetalol, metoprolol (Lopressor, Toprol-XL), propranolol.

Calcium channel blockers such as nifedipine (Adalat) amlodipine (Norvasc), diltiazem, verapamil

Direct renin inhibitors such as aliskiren (Tekturna)

Diuretics: eg, bendroflumethiazide, chlortalidone, hydrochlorothiazide (also called HCTZ)

Combination products (which usually contain HCTZ and one other drug)