Breast cancer in women is a major health burden both in developed and developing countries

Breast cancer in women is a major health burden both in developed and developing countries

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Breast cancer in women is a major health burden both in developed and developing countries. It is the second leading cause of death in women worldwide as well as in Bangladesh. Recent global cancer statistics shows that global incidence is rising at a faster rate especially in developing countries like Bangladesh. But still breast cancer is not on the top of the priority list for the policy maker’s, donors and health professionals. But the prevailing situation can be more devastated if early attention is not given. To concentrate on this fast growing health problem will need to know the overall situation concerning incidence, prevalence, risk group, diagnostic and treatment status survival and mortality rate first to make a comprehensive policy to cope with breast cancer situation in Bangladesh. To evaluate the knowledge and practices about breast cancer among women, this present study was conducted. Data were collected from 250 female respondents by a pre-structured questionnaire in different locations of Dhaka. The data were coded, entered, and analyzed using the Microsoft Excel 2010. The data were analyzed by descriptive studies and expressed as percentage and plotted with pie and bar diagrams. Breast cancer was known to 70% women (n=250).In our present study 74% respondents were married and 87% respondents had children. Knowledge about sign, symptoms, diagnosis and treatment was good among the women. Results showed that 21% women had knowledge about performing breast self-exam and 17% had heard about mammography. Overall, to controlling the morbidity and mortality rate of breast cancer we should increase the level of knowledge and we should take some steps to spread the knowledge and awareness about breast cancer.

Key words: Breast Cancer, Women in Dhaka, Breast-self Exam, Mammography, Clinical Breast Exam.

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1.3 The Normal Breast

Breasts are made of connective tissue, glandular tissue, and fatty tissue. Connective tissue

and glandular tissue look dense, or white on a mammogram. Fatty tissue is non-dense, or

black on a mammogram. Dense breasts can make mammograms harder to interpret.

Breasts have lobes, lobules, ducts, an areola, and a nipple.

• Lobes are sections of the glandular tissue. Lobes have smaller sections called lobules

that end in tiny bulbs that can make milk.

• Ducts are thin tubes that connect the lobes and lobules. Milk flows from the lobules

through the ducts to the nipple.

• The nipple is the small raised area at the tip of the breast. Milk flows through the

nipple. The areola is the area of darker-colored skin around the nipple. Each breast also has

lymph vessels (National Cancer Institute, 2014).

1.4 The Lymph System of the Breast

The lymphatic system, which is a part of body's defense system, contains lymph vessels and

lymph nodes.

• Lymph vessels are thin tubes that carry a fluid called lymph and white blood cells.

• Lymph vessels lead to small, bean-shaped organs called lymph nodes. Lymph nodes

are found near breast, under arm, above collarbone, in chest, and in other parts of body.

• Lymph nodes filter substances in lymph to help fight infection and disease. They also

store disease-fighting white blood cells called lymphocytes (National Cancer Institute, 2014).

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1.5 Types of Cancer

There are more than 100 types of cancer. Types of cancer are usually named for the organs or

tissues where the cancers form. For example, lung cancer starts in cells of the lung, and brain

cancer starts in cells of the brain. Cancers also may be described by the type of cell that

formed them, such as an epithelial cell or a squamous cell (National Cancer Institute, 2014).

Here are some categories of cancers that begin in specific types of cells:

1.5.1 Carcinoma

Carcinomas are the most common type of cancer. They are formed by epithelial cells, which

are the cells that cover the inside and outside surfaces of the body. There are many types of

epithelial cells, which often have a column-like shape when viewed under a microscope.

Carcinomas that begin in different epithelial cell types have specific names:

Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids or mucus.

Tissues with this type of epithelial cell are sometimes called glandular tissues. Most cancers

of the breast, colon, and prostate are adenocarcinomas. Basal cell carcinoma is a cancer that

begins in the lower or basal (base) layer of the epidermis, which is a person’s outer layer of


Squamous cell carcinoma is a cancer that forms in squamous cells, which are epithelial cells

that lie just beneath the outer surface of the skin. Squamous cells also line many other organs,

including the stomach, intestines, lungs, bladder, and kidneys. Squamous cells look flat, like

fish scales, when viewed under a microscope. Squamous cell carcinomas are sometimes

called epidermoid carcinomas.

Transitional cell carcinoma is a cancer that forms in a type of epithelial tissue called

transitional epithelium, or urothelium. This tissue, which is made up of many layers of

epithelial cells that can get bigger and smaller, is found in the linings of the bladder, ureters,

and part of the kidneys (renal pelvis), and a few other organs. Some cancers of the bladder,

ureters, and kidneys are transitional cell carcinomas (National Cancer Institute, 2014).

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1.5.2 Sarcoma

Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood vessels,

lymph vessels, and fibrous tissue (such as tendons and ligaments).

Osteosarcoma is the most common cancer of bone. The most common types of soft tissue

sarcoma are leiomyosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma,

and dermatofibrosarcomaprotuberans (National Cancer Institute, 2014).

1.5.3 Leukemia

Cancers that begin in the blood-forming tissue of the bone marrow are called leukemias.

These cancers do not form solid tumors. Instead, large numbers of abnormal white blood

cells (leukemia cells and leukemic blast cells) build up in the blood and bone marrow,

crowding out normal blood cells. The low level of normal blood cells can make it harder for

the body to get oxygen to its tissues, control bleeding, or fight infections.

There are four common types of leukemia, which are grouped based on how quickly the

disease gets worse (acute or chronic) and on the type of blood cell the cancer starts in

(lymphoblastic or myeloid) (National Cancer Institute, 2014).

1.5.4 Lymphoma

Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are diseasefighting

white blood cells that are part of the immune system. In lymphoma, abnormal

lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the


There are two main types of lymphoma:

Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called

Reed-Sternberg cells. These cells usually form from B cells.

Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The

cancers can grow quickly or slowly and can form from B cells or T cells (National Cancer

Institute, 2014).

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1.5.5 Multiple Myeloma

Multiple myeloma is cancer that begins in plasma cells, another type of immune cell. The

abnormal plasma cells, called myeloma cells, build up in the bone marrow and form tumors

in bones all through the body. Multiple myeloma is also called plasma cell myeloma and

Kahler disease (National Cancer Institute, 2014).

1.5.6 Melanoma

Melanoma is cancer that begins in cells that become melanocytes, which are specialized cells

that make melanin (the pigment that gives skin its color). Most melanomas form on the skin,

but melanomas can also form in other pigmented tissues, such as the eye (National Cancer

Institute, 2014).

1.5.7 Brain and Spinal Cord Tumors

There are different types of brain and spinal cord tumors. These tumors are named based on

the type of cell in which they formed and where the tumor first formed in the central nervous

system. For example, an astrocytic tumor begins in star-shaped brain cells called astrocytes,

which help keep nerve cells healthy. Brain tumors can be benign (not cancer) or malignant

(cancer) (National Cancer Institute,2014).

1.5.8 Other Types of Tumors

Germ Cell Tumors

Germ cell tumors are a type of tumor that begins in the cells that give rise to sperm or eggs.

These tumors can occur almost anywhere in the body and can be either benign or malignant.

Neuroendocrine Tumors

Neuroendocrine tumors form from cells that release hormones into the blood in response to a

signal from the nervous system. These tumors, which may make higher-than-normal amounts

of hormones, can cause many different symptoms. Neuroendocrine tumors may be benign or


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Carcinoid Tumors

Carcinoid tumors are a type of neuroendocrine tumor. They are slow-growing tumors that are

usually found in the gastrointestinal system (most often in the rectum and small intestine).

Carcinoid tumors may spread to the liver or other sites in the body, and they may secrete

substances such as serotonin or prostaglandins, causing carcinoid syndrome (National Cancer

Institute, 2014).

1.6 Risk Factor

1.6.1 Gender

Simply being a woman is the main risk factor for developing breast cancer. Men can develop

breast cancer, but this disease is about 100 times more common among women than men.

This is probably because men have less of the female hormones estrogen and progesterone,

which can promote breast cancer cell growth (National Cancer Institute, 2012).

1.6.2 Aging

Risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast

cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are

found in women age 55 or older (National Cancer Institute, 2012).

1.6.3 Genetic alterations (changes)

Inherited changes in certain genes (including BRCA1, BRCA2, and others) increase the risk

of breast cancer. These changes are estimated to account for no more than about 10 percent

of all breast cancers. However, women who carry changes in these genes have a much higher

risk of breast cancer than women who do not carry these changes (National Cancer Institute,


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1.6.4 Mammographic breast density

The glandular (milk-producing) and connective tissue of the breast are mammographically

dense—that is, they appear white on a mammogram. In contrast, fatty tissue of the breast is

not mammographically dense and appears dark. Women who have a high percentage of

breast tissue that appears dense on a mammogram have a higher risk of breast cancer than

women of similar age who have little or no dense breast tissue. In general, younger women

have denser breasts than older women. As a woman ages, the amount of glandular tissue

normally decreases and the amount of fatty tissue increases. Abnormalities, such as tumors,

in dense breasts can be more difficult to detect on a mammogram because tumors often also

appear white (National Cancer Institute, 2012).

1.6.5 Family history

A woman’s chance of developing breast cancer increases if her mother, sister, and/or

daughter have been diagnosed with the disease, especially if they were diagnosed before age

50. Having a close male blood relative with breast cancer also increases a woman's risk of

developing the disease (National Cancer Institute, 2012).

1.6.6 Personal history of breast cancer

Women had breast cancer are more likely to develop a second breast cancer (National Cancer

Institute, 2012).

1.6.7 Certain breast changes found on biopsy

Looking at breast tissue under a microscope allows doctors to determine whether a

suspicious finding (one detected by a mammogram, for example) represents cancer or

another type of breast change. Most breast changes turn out not to be cancer, but some may

increase the risk of developing breast cancer. Changes that are associated with an increased

risk of breast cancer include atypical hyperplasia (a noncancerous condition in which cells

have abnormal features and are increased in number), lobular carcinoma in situ (LCIS)

(abnormal cells are found in the lobules of the breast), and ductal carcinoma in situ (DCIS;

abnormal cells are found in the lining of breast ducts). Because some cases of DCIS will

eventually become cancer, this type of breast change is actively treated. Women with

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atypical hyperplasia or LCIS are usually monitored carefully and not actively treated. In

addition, women who have had two or more breast biopsies for other noncancerous

conditions also have an increased risk of developing breast cancer. This increased risk is due

to the conditions that led to the biopsies and not to the biopsy procedures themselves

(National Cancer Institute, 2012).

1.6.8 Alcohol

Studies indicate that the more alcohol a woman drinks, the greater her risk of breast cancer

(National Cancer Institute, 2012).

1.6.9 Reproductive and menstrual history

Women who had their first menstrual period before age 12 or who went through menopause

after age 55 have an increased risk of developing breast cancer. Women who had their first

full-term pregnancy after age 30 or who have never had a full-term pregnancy are also at

increased risk of breast cancer (National Cancer Institute, 2012).

1.6.11 Long-term use of menopausal hormone therapy

Women have combined estrogen and progestin menopausal hormone therapy for more than

5 years have an increased chance of developing breast cancer (National Cancer Institute,

2012). DES (diethylstilbestrol)

The drug DES was given to some pregnant women in the United States between 1940 and

1971 to prevent miscarriage. Women who took DES during pregnancy have a slightly

increased risk of breast cancer. Women who were exposed to DES in utero—that is, whose

mothers took DES while they were pregnant—may have a slightly increased risk of breast

cancer after age 40 (National Cancer Institute, 2012).

9 | P a g e Body weight

Studies have found that among postmenopausal women who have not used menopausal

hormone therapy, the chance of getting breast cancer is higher in women who are overweight

or obese than in women of a healthy weight (National Cancer Institute, 2012). Physical activity level

Women are physically inactive throughout life may have an increased risk of breast cancer

(National Cancer Institute, 2012). Race

In the United States, breast cancer is diagnosed more often in white women than in African

American/black, Hispanic/Latina, Asian/Pacific Islander, or American Indian/Alaska Native

women (National Cancer Institute, 2012).

1.7 Signs and Symptoms of Breast Cancer

The most common symptom of breast cancer is a new lump or mass. A painless, hard mass

that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft,

or rounded. They can even be painful. For this reason, it is important to have any new breast

mass or lump or breast change checked by a health care professional experienced in

diagnosing breast diseases (American Cancer Society, 2013).

Other possible signs of breast cancer include:

• Swelling of all or part of a breast (even if no distinct lump is felt)

• Skin irritation or dimpling

• Nipple retraction (turning inward)

• Redness, scaliness, or thickening of the nipple or breast skin

• Nipple discharge (other than breast milk) (American Cancer Society, 2013).

• Rashes on or around the nipple

• Pain or discomfort in the breast or armpit that is not related to periods

• Change in the size or shape of the breast (American Cancer Society, 2013).

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had more false positive results, leading to nearly twice as many biopsies with benign (not

cancer) results as women who did not do breast self-exams (Susan, 2014).

1.8.2 Clinical Breast Exam

Clinical Breast Exam (CBE) is

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