Aging changes in the Breast

With aging, a woman's breasts lose fat, tissue, and mammary glands, reducing breast size, firmness, and fullness. The breasts lose support. These changes are mostly due to a decrease in the hormone, estrogen.

Aging breasts commonly flatten and sag, and the nipple may turn in slightly. The area surrounding the nipple (the areola) becomes smaller and may nearly disappear. Loss of hair around the nipple is common.

Breasts may change in size as a woman grows older. Lumps are common around the time of menopause. These are often noncancerous cysts. However, if you notice a lump, make an appointment with your doctor. Breast cancer risk increases with age. Women should perform monthly breast self-examinations. However, because breast self-exams do not always pick up early stages of breast cancer, women should also talk to their health care provider about mammograms.


Breast Cancer
Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include
Age - the chance of getting breast cancer rises as a woman gets older
Genes - there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
Personal factors - beginning periods before age 12 or going through menopause after age 55

Other risks include being overweight, using hormone replacement therapy (also called menopausal hormone therapy), taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.
Symptoms
Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.

Men can have breast cancer, too, but the number of cases is small.

Breast Biopsy
A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders. Several different types of biopsy may be done. This article discusses open breast biopsy. An open biopsy involves making a small cut in the breast and removing breast tissue.

An open biopsy may remove part (incisional biopsy) or all (excisional biopsy) of the area of interest. If the entire lump or area of interest is removed, this method may also be called a lumpectomy.

If the surgeon cannot easily feel the lump or cyst, breast ultrasound or mammography may be used before the biopsy. A needle or wire is placed in the area of interest. This will be left in to help the surgeon.

The biopsy will be done in an operating room.
Usually, you lie on your back for the procedure. You may receive local anesthesia with medicine to make you sleepy or you may receive general anesthesia.
A surgical cut is made in the skin. The wire and breast tissue around it are removed. Sometimes, testing is done at the time of the procedure, but a final diagnosis takes more time.
After the tissue sample is taken, the cut is closed with sutures. A dressing and bandage are applied.

If you receive general anesthesia, your vital signs (temperature, pulse, rate of breathing, blood pressure) will be monitored for at least an hour after the procedure. Your health care provider may prescribe pain medication.

How to Prepare for the Test

The health care provider will ask questions about your medical history and perform a manual breast exam.

You must sign an informed consent form. If you are going to have general anesthesia, you may be asked not to eat or drink anything for 8 - 12 hours before the test.

If you take medications (including aspirin or herbal medications), ask your doctor whether you need to stop taking these before the biopsy.

Tell your doctor if you may be pregnant before having an open biopsy.

Do not wear lotion, perfume, powder, or deodorant underneath your arms or on your breasts.
How the Test Will Feel

After the test, the breast may be sore and tender to the touch for several days. If a surgical cut is made, your doctor may prescribe pain medication.

You will probably go home the day of the procedure.

Do not do any heavy lifting for 24 hours after the biopsy. Do not take a shower for the first 24 hours.
Why the Test is Performed

A biopsy may be done if the doctor is concerned about breast cancer because of abnormal findings on a mammogram or breast ultrasound, or seen during a physical exam.

To determine whether someone has breast cancer, a biopsy must be done. Cells from the abnormal area are removed and examined under a microscope.
Normal Results

A normal result means there is no sign of cancer.

Your doctor or nurse will let you know when you need a follow-up mammogram or other tests.
What Abnormal Results Mean

Biopsy may identify a number of breast conditions that are not cancer or precancer, including:
Adenofibroma
Fibrocystic breast disease
Intraductal papilloma
Mammary fat necrosis

Biopsy results may show the following precancerous breast conditions:
Atypical ductal hyperplasia
Atypical lobular hyperplasia

Two main types of breast cancer may be found:
Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
Lobular carcinoma starts in parts of the breast called lobules, which produce milk.

Depending on the biopsy results, you may need further surgery or treatment.
Risks

There is a slight chance of infection at the injection or incision site.

Excessive bleeding is rare, but may require draining or re-bandaging. Bruising is common.

There will be a small scar. Depending on the amount of tissue removed and how the breast heals, the appearance of the breast may be affected.
Alternative Names

Biopsy - breast; Open breast biopsy



Most women experience breast changes at some time. Your age, hormone levels and medicines you take may cause lumps, bumps and discharges.

If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer.

Some common causes of breast changes are
Fibrocystic breast condition - lumpiness, thickening and swelling, often associated with a woman's period
Cysts - fluid-filled lumps
Fibroadenomas - solid, round, rubbery lumps that move easily when pushed, occurring most in younger women
Intraductal papillomas - growths similar to warts near the nipple
Blocked or clogged milk ducts
Milk production when a woman is not breastfeeding
Injury

NIH: National Cancer Instituteclick to expand your study

The various cancer therapy treatments

Chemotherapy is the treatment of cancer with drugs that can destroy cancer cells by impeding their growth and reproduction.

At Cancer Treatment Centers of America (CTCA), we work closely with our patients to meet your individual needs before, during and after chemotherapy. Our supportive therapies help you relax and minimize side effects.

During chemoembolization, chemotherapy is injected through a catheter directly into a tumor using image guidance. The chemotherapy drugs are mixed with particles, called microspheres, which block the flow of blood to the tumor. Without a blood supply, the tumor no longer has the oxygen and nutrients it needs to grow.


Chemoembolization allows high doses of chemotherapy drugs to be targeted directly to the cancerous tissue for a longer period of time, without exposing the entire body to the effect of the drugs.
chemeombolization:
This method of chemotherapy is primarily used for the treatment of liver cancer, but may also be used for the treatment of other cancers that have spread to the liver, such as pancreatic and colorectal cancers.




chronotherapy:
One of these methods is chronotherapy, in which our doctors time the delivery of chemotherapy drugs based on a patient’s individual biorhythms. We use drug-specific research and track a variety of symptoms to discover when tumor tissues may be most sensitive to the chemotherapy drugs.


Hyperthermic Intraperitoneal Chemotherapy (HIPEC):
this is a heated, sterilized chemotherapy solution which is delivered directly to the abdomen during a surgical procedure. First, surgical oncologists perform surgery to remove visible tumors within the abdomen. Then, using sophisticated technology and tools, the surgical oncologists administer the chemotherapy solution to penetrate and destroy cancer cells that remain in the abdomen after surgery.

HIPEC is a treatment option for people who have advanced surface spread of cancer within the abdomen, without disease involvement outside of the abdomen. It may be used to treat some cases of:
Colorectal cancer
Appendiceal cancer
Ovarian cancer
Stomach cancer
Primary peritoneal cancer

In comparison to traditional chemotherapy delivery, HIPEC allows for higher doses of chemotherapy treatment. Heating the solution (i.e., hyperthermia) also enhances the power of the chemotherapy, improving absorption by tumors and susceptibility of cancer cells to chemotherapy. Furthermore, because the chemotherapy is kept within the abdomen, it minimizes the rest of the body’s exposure to the treatment. This helps reduce some chemotherapy side effects.

As a result, chronotherapy helps to minimize the damage of chemotherapy to healthy tissues. By pinpointing the time of day that is best for treatment, we can deliver higher doses that do less harm to the rest of the body.



Intra- areterial chem otheraphy(IAC):
During IAC, your physician inserts a thin catheter through the femoral artery in the right leg. We perform an angiogram (injects dye under a special scope) to obtain a “roadmap” of the arteries. The physician then uses this roadmap to insert a line into the hepatic artery, which is the main blood vessel that delivers blood to the liver. Using dye from a syringe to make sure the line is in the correct position, the chemotherapy drug or drugs are injected directly into the artery.

Patients typically need to lay flat after the treatment to allow the chemotherapy to reach all areas of the spinal cord and brain. We offer a variety of supportive therapies to help make our patients comfortable during this time, including relaxation therapies from mind-body medicine and acupuncture.




intraperitoneal Chemotheraphy:
This innovative chemotherapy technique works by delivering chemotherapy drugs directly into the abdominal cavity through a catheter. Intraperitoneal chemotherapy directly targets cancer cells in the abdomen, minimizing drug exposure to healthy tissues.

Another innovative treatment we offer, hyperthermic intraperitoneal chemotherapy (HIPEC), circulates heated chemotherapy drugs in the abdomen during surgery.






intrathecal chemotherapy:
Intrathecal chemotherapy is delivered through a lumbar puncture (spinal tap) or a device placed under the scalp. Patients typically need to lay flat after the treatment to allow the chemotherapy to reach all areas of the spinal cord and brain. We offer a variety of supportive therapies to help make our patients comfortable during this time, including relaxation therapies from mind-body medicine and acupuncture.

Meet the five years apart twins

During the medical process, five embryos were created and two implanted in Mrs Blake, which resulted in the birth of their son Reuben, weighing 9lbs 5oz on 9 December 2006.

The couple, from Cheltenham, Gloucestershire, decided to try for another child in March last year using the three remaining frozen embryos.

Two of the embryos did not survive the defrosting process, but the final embryo was successfully implanted.

Against the odds, Floren arrived on 16 November 2011 weighing 8lbs 12oz - two weeks before her due date - but five years after her twin brother.

Simon, 45 and Jody Blake, 38, with their twins Reuben, five and Floren seven weeks./PA

So how were Mr and Mrs Blake able to have twins born five years apart?

Doctors at the Bristol Centre for Reproductive Medicine, based at Southmead Hospital, said the decision made by Mr and Mrs Blake to freeze their remaining embryos was a safer way to have twins.

[Relevant: One mum's £50,000 IVF struggle]

Dr Akande explained: “It's usually better to have one baby at a time rather than two because carrying twins is associated with greater risk. So we would very often recommend storing surplus embryos so that they can be used at a later date.

“In essence they haven't come from the same embryo but from the same batch of embryos. It does depend how you interpret the term 'twins' - twins generally means that they are born at the same time.

“But, yes, twins in that they have come from the same batch of embryos, collected from the same treatment cycle - so twins born at a different time - but not a twin pregnancy, when they have grown in the womb together.”

Twins Reuben Blake, five with his sister Floren seven weeks./PA

Speaking about his two children, Mr Blake, a lecturer at University College Birmingham told PA: “I find it very difficult to resist the temptation to say 'Oh and by the way they are twins'. It's almost just to see people's response. They are really amazed and surprised.”

Mother Jody, a programmes manager for the children's charity WellChild, said: “It does feel quite surreal. I think people are really, really surprised and it almost takes people a few minutes to get their heads around it.

“We obviously had nine months to get it straight and to think 'Gosh, we're having Reuben's twin', but it's incredibly special.

The couple said Reuben was a little apprehensive about having a sibling but has quickly settled into his role as the eldest.

Mr Blake said: “Since the day Floren was born, he's been really tender and loving with her. “

Reuben’s parents said he is aware of the special relationship he has with his seven-week-old sister but it would be a while before he fully understands.

His mother added: “He knows that she's been in the freezer - he likes to say she has been in the freezer with the chips and the chicken - so he is sort of aware that she is his twin, but obviously he doesn't really understand how it's all worked really.