Dahlia McDaniel, Contributor

Twenty years ago, a medical intern told me about prophylactic mastectomy, a term which was totally new to me at the time. He suggested that having breasts was itself a risk factor for breast cancer. So theoretically, if all cancer-free women were to have their breasts surgically removed, there would be no breast cancer in women.

Prophylactic (or risk-reducing) mastectomy is an option for breast cancer prevention. It is considered in women who do not have breast cancer but are at high risk of developing the disease. The risk depends on the client's personal medical history, family history and genes. The procedure does not guarantee that the client will not develop the disease in the future since breast tissue is distributed in areas such as the chest wall, muscles and armpit.

Chemotherapy

Other prevention options include regular breast self- examinations and other screening tests to detect cancer at its earliest stage, and chemo-preventive drug therapy to prevent breast cancer or reduce its risk.

For clients who already have breast cancer, management involves surgery, radiotherapy, drug therapy or a combination of these. The main considerations when deciding on the most appropriate treatment include the extent of the cancerous growth within the breast, whether it has spread to other body parts, whether it is oestrogen-sensitive (that is, steroid hormone-receptor-positive), and whether the client is pre- or post-menopausal.

Surgery - The surgical procedure varies depending on size and position of the tumour.

Radiation therapy uses high energy X-rays or other types of radiation to kill cancer cells which may still linger after surgery the radiation is focused on cancer cells, it damages normal cells too. This treatment is relatively easy to tolerate and side effects are usually limited to the treated area.

Chemotherapy is the use of drugs to treat cancer; the drugs include alkylating agents for example, cyclophosphamide, anitmetabolites for example, methotrexate, and cytotoxic antibiotics for example, doxorubicin.

Chemotherapy is used after surgery to prevent recurrence or spreading of the cancer throughout the body. Chemotherapy interferes with the rapidly dividing cancer cells, but cells such as blood-producing cells in the bone marrow, cells inside the mouth, intestinal tract, nose, vagina, and hair are constantly rapidly dividing too, and are significantly affected by chemotherapy.

This produces the side effects associated with 'chemo' — nausea, vomiting, excessive bleeding, symptoms of anaemia (weakness and fatigue), hair loss, hot flushes, increased risk of infection, mouth sores and changes in taste and smell.

Pain medications prescribed for cancer survivors, for example, morphine, also have side effects. All these side effects may be treated with drugs and lifestyle changes. Several cycles of treatment are required, and each cycle must be carefully scheduled for the essential body cells to recover between cycles.

Hormone antagonist therapy, for example, tamoxifen, anastrozole or letrozole, counteracts the effects of the hormone, oestrogen, which stimulates the growth of some breast cancers.

Monoclonal antibody (targeted) therapy employs genetically engineered antibodies to identify cancer cells for destruction by the body's immune system. Trastuzumab (Herceptin) is one such new drug which blocks the effects of the growth factor protein HER-2 which transmits growth signals to breast cancer cells.