ROJoson PEP Talk: Breast Cancer Development - Fundamentals and Generalities

Nov.
13, 2021
Empowerment 1400H - 1500H
objective - for Via Zoom
Cancer Course laypeople to have an
– understanding of the
Fundamentals FUNDAMENTALS
and and GENERALITIES in
Generalities in the DEVELOPMENT
BREAST of BREAST CANCER
CANCER as a health disorder
Development or medical disease.
Empowerment
objective - for
Empowerment
objective - for ROJoson PEP Talk
– I have a Patient
understanding of the Empowerment
Fundamentals FUNDAMENTALS Program in which I
and and GENERALITIES in like to empower the
Generalities in the DEVELOPMENT lay people or
BREAST of BREAST CANCER patients to take
CANCER as a health disorder control in the
Development management of
or medical disease. their health.
There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
My PEP TALK today
Empowerment is entitled:
objective - for Fundamentals and
Cancer Course laypeople to have an Generalities in
– understanding of the Development of
Fundamentals FUNDAMENTALS Breast Cancer, which
and and GENERALITIES in is part of the Cancer
Generalities in the DEVELOPMENT Course.
Fundamentals Definition of Terms in Title AND Delimitation of
and Coverage of Talk:
Generalities
Fundamentals – simplest and essential facts and
in BREAST theories which can serve as a basis or foundation
CANCER and support for advanced information
Development
Generalities – general statements of info, not
covering specifics and details
Development of breast cancer – appearance;

growth of breast cancer
Fundamentals Contents:
and • What is a breast cancer?
Generalities • How common is breast cancer?
in BREAST • What are the different types of breast cancer?
• What are the possible and theorized causes of
CANCER
breast cancer?
Development • Can breast cancer be prevented?
• Who are at higher risk for developing breast
cancer?
• What are the behaviors of breast cancers?
• How does breast cancer kill a patient?
• Is breast cancer curable?
Fundamentals What is a breast cancer?
and
Generalities
in BREAST
CANCER
Development
Fundamentals What is a breast cancer?
and Breast cancer is a medical disease when
Generalities some of the breast cells grow
in BREAST uncontrollably with a potential to invade
CANCER the adjacent body tissues or organs and to
Development spread to distant tissues or organs.
A breast cancer presents as a solid tumor not
liquid tumor.
It is also known as breast malignancy or
malignant tumor of the breast.
(To differentiate it from benign tumor of the
breast which does not invade and spread.)
Fundamentals How common is breast cancer?
and
Generalities
in BREAST
CANCER
Development
Fundamentals How common is breast cancer?
and
Breast cancer is the most common cancer
Generalities
in the world and in the Philippines (both
in BREAST
sexes) – GLOBOCAN, 2020
CANCER
Development It is more common in females than in
males (100:1).
It is more common in older than younger

females (usually about 40 years old and
older).
Fundamentals What are the different types of breast
and cancer?
Generalities
in BREAST
CANCER
Development
and cancer?
Generalities
NOT all breast cancers are the same.
in BREAST
CANCER It is important to know the specific type as
Development this affects decisions on treatment and
prognosis.
and cancer?
Generalities
There are so many different ways of
in BREAST
describing the types of cancer.
CANCER
Development There may be more than 20 types
depending on how the description is done.
and cancer?
Generalities
Primarily based on origin in specific parts
in BREAST
of the breasts –lobules, ducts and
CANCER
connective tissues in between.
Development
• Lobules – where milk is produced
• Ducts carry breast milk from the lobules
to the nipple
• Connective tissues – blood vessels, fat,
muscles in the breasts
and cancer?
Generalities
Primarily based on origin in specific parts
in BREAST
of the breasts – lobules, ducts and
CANCER
connective tissues in between.
Development
• Lobules – where milk is produced Adenocarcinoma
• Ducts carry breast milk from the lobules Lobular
to the nipple Ductal
• Connective tissues – blood vessels, fat, Sarcoma
muscles in the breasts
and cancer?
Generalities Adenocarcinoma
Then, on the unique appearance of the
in BREAST
cancer cells
CANCER • Tubular
Development • Mucinous
• Medullary
• Papillary
and cancer?
Generalities
Then, on the specific cells of origin
in BREAST • Angiosarcoma – lining of blood / lymph
CANCER
vessels
Development • Malignant phyllodes tumor - stroma
• Liposarcoma - fat
and cancer?
Generalities
Then, on special types
in BREAST
CANCER • Paget’s disease of the nipple – affecting
Development
the skin of the nipple and areola
• Inflammatory breast carcinoma –
obstructive cancer cells in the skin’s
lymph vessels
and cancer?
Generalities
Then, based on whether there is invasion Adenocarcinoma
in BREAST
already or not
CANCER • Non-invasive adenocarcinoma
Development
(carcinoma-in-situ) – still within cell
• Invasive adenocarcinoma – outside cell
and cancer?
Generalities
Then, based on whether the cancer cells Adenocarcinoma
in BREAST
can be fuelled by hormones
CANCER • Hormone-receptor negative
Development • Hormone-receptor positive
• Estrogen receptors -/+

• Progesterone receptors -/+
and cancer?
Generalities
Then, based on genetic make-up of the Adenocarcinoma
in BREAST
cancer cells
CANCER • HER2 gene
Development • Other tumor markers
and cancer?
Generalities
Then, based on grouping of information on Adenocarcinoma
in BREAST
the cancer cells using receptor-assay and
CANCER
HER2 gene
Development • ERA + / PRA+ / HER2 neg
• ERA + / PRA neg / HER2 neg
• ERA neg / PRA neg / HER2 +
• ERA neg / PRA neg / HER2 neg (triple
negative)
Fundamentals What are the possible and theorized
and causes of breast cancer?
Generalities
in BREAST
CANCER
Development
Generalities
in BREAST Unfortunately, up to now,
CANCER most of the time, (90 to 95%)
Development nobody knows the exact cause of breast
cancer developing in a patient as most of
the time, the cause is multifactorial.
In only 5 to 10% are breast cancers due to

inherited gene mutation from parents.
90 to 95% are “sporadic.”
Generalities
All diseases including breast cancers have
in BREAST underlying, antecedent and immediate causes.
CANCER All diseases have predisposing, precipitating and
Development perpetuating factors.
However, it is difficult to pinpoint the exact cause,

a single cause at that, as oftentimes the cause is
multifactorial.
At best, we can only theorize the possible causes
and factors.
Fundamentals What are the possible and theorized All diseases have
and causes of breast cancer? underlying,
antecedent and
Generalities For a patient with breast cancer, an example in immediate causes.
in BREAST the analysis or theorized causation for the
CANCER development of cancer could be as follows: All diseases have
Development predisposing,
- genetic predisposition could be an underlying precipitating and
cause; perpetuating factors.
- long-term unhealthy lifestyle could be the
antecedent cause or precipitating and
perpetuating factor; and
- gene mutation is the immediate cause.
antecedent and
- long-term unhealthy lifestyle could be the
antecedent and
- excessive exposure to radiation could be the
antecedent and
Generalities For a patient with breast cancer, another example immediate causes.
in BREAST in the analysis or theorized causation for the
- no genetic predisposition but the precipitating and
underlying cause may be from chemicals which perpetuating factors.
now also becomes the antecedent cause or
precipitating and perpetuating factor; and
and causes of breast cancer? Thus, one can say that
Generalities At the present stage of knowledge, for the breast cancer is a
in BREAST “sporadic” cases, not the inherited gene genetic disease—that
CANCER mutations from parents, it seems that the last, is, it is caused by
Development ultimate or proximate cause of cancer is changes changes to genes that
(or mutations) to the DNA within cells – the gene. control the way our
cells function,
especially how they
grow and divide.
Generalities The three most common theorized ways by
in BREAST which a gene mutation can instruct a
CANCER healthy cell to form cancer are the
Development following:
Generalities •Allow rapid growth.
in BREAST
CANCER A gene mutation (oncogenes) can tell a cell
Development to grow and divide more rapidly. This
creates many new cells that all have that
same mutation.
Generalities •Fail to stop uncontrolled cell growth.
in BREAST
CANCER Normal cells know when to stop growing so that
Development you have just the right number of each type of
cell.
Cancer cells lose the controls (tumor suppressor
genes) that tell them when to stop growing.
A mutation in a tumor suppressor gene allows

cancer cells to continue growing and
accumulating.
Generalities •Make mistakes when repairing DNA
in BREAST
CANCER errors.
Development DNA repair genes look for errors in a cell’s
DNA and make corrections.
A mutation in a DNA repair gene may

mean that other errors aren’t corrected,
leading cells to become cancerous.
antecedent and
Generalities What causes gene mutations? immediate causes.
in BREAST What are the underlying and antecedent
CANCER and immediate causes? All diseases have
Development What are the predisposing, precipitating predisposing,
precipitating and
and perpetuating factors? perpetuating factors.
Generalities Gene mutations can occur for several
in BREAST reasons, for instance:
CANCER
Development
Generalities
Gene mutations you’re born with.
in BREAST
CANCER You may be born with a genetic mutation
Development that you inherited from your parents.
This type of mutation accounts for a small

percentage of cancers.
[Underlying / Predisposing Cause]

Generalities
Gene mutations that occur after
in BREAST
CANCER birth.
Development Most gene mutations occur after you’re born and
aren’t inherited.
A number of forces can cause gene mutations,
such as smoking, radiation, viruses, cancer-
causing chemicals (carcinogens), obesity,
hormones, chronic inflammation and a lack of
exercise. [Antecedent / Precipitating /
Perpetuating Cause]
Generalities
The gene mutations you’re born with
in BREAST
CANCER and those that you acquire
Development throughout your life work together
to cause cancer.
Fundamentals Can breast cancer be prevented?
and
Generalities
in BREAST
CANCER
Development
and YES, but not all – not 100% preventable.
Generalities
in BREAST Breast cancers develop through multiple
CANCER factors such as genetic predisposition;
Development environmental factors including lifestyle;
and aging that it is difficult to identify a
sure-shot specific strategy of prevention.
Generalities
in BREAST There are some things that can increase
CANCER the risk of cancer that we can't change.
Development
These include things like damaged DNA
inherited from a parent; family history;
and getting older.
and AGE as a risk factor
Generalities in DNA CHANGE –
in BREAST gene mutation –
CANCER cancer
Development development
More mutations in
older people!
Generalities
in BREAST Though managing certain controllable risk
CANCER factors – such as diet, physical activity and
Development other lifestyle choices – can lower your
chances of developing breast cancer,
But NO guarantee – best effort!

Fundamentals Who are at higher risk for developing
and breast cancer?
Generalities
in BREAST
CANCER
Development
and breast cancer?
Generalities The exact specific cause of breast cancer
in BREAST developing in a particular patient is
CANCER difficult to pinpoint.
Development
For a preventive program against breast
cancers, know the risk factors; know the
controllable ones and then, control and
mitigate them.
and breast cancer?
Generalities Risk factors if present affect your chances
in BREAST of getting a breast cancer, but having a risk
CANCER factor does not mean that you are
Development guaranteed to get it.
and breast cancer?
Generalities Again, to emphasize –
in BREAST
CANCER Though managing certain controllable risk
Development factors – such as diet, physical activity and
other lifestyle choices – can lower your
chances of developing breast cancer,
But NO guarantee – best effort!

and breast cancer?
Generalities Uncontrollable risk factors:
in BREAST • Female
CANCER • Aging
Development • Family history of breast cancers
• History of breast cancer on one breast
• Inherited breast cancer genes from
parents
and breast cancer?
Generalities Controllable risk factors:
in BREAST • Being overweight and obese
CANCER • Lacking adequate amount of exercise
Development • Drinking alcohol excessively
• Using hormone replacement therapy
• Smoking tobacco or exposing to
tobacco smoke
• Exposing to excessive radiation
particularly to the chest
and Cancer Prevention - Mitigation Tips on
Generalities Controllable Risk Factors:
in BREAST 1. Maintain a healthy weight.
CANCER 2. Have adequate amount of exercise.
3. Drink alcohol in moderation.
Development
4. Limit use of hormone replacement therapy.
5. Avoid exposure to tobacco smoke.
6. Avoid excessive radiation exposure.
7. Eat healthy diet (more of plant-based diet)
8. Be in touch with reliable medical information
on breast cancer risk and prevention.
Fundamentals What are the behaviors of breast cancers?
and
Generalities Once a breast cancer develops, it has the
in BREAST potential to grow and invade or infiltrate adjacent
organs or tissues and also the potential to spread
CANCER to distant sites in the body.
Development
The rate of growth and spread of the cancer is
dependent primarily on the behavior of the
mutated genes and secondarily on the presence
of promoting factors in the person’s body like
medications and hormonal levels and in the
environment like cancer-causing chemicals.
and
Generalities A breast cancer that has spread to
in BREAST another place in the body is called
CANCER metastatic cancer.
Development
The process by which cancer cells spread
to other parts of the body is called
metastasis.
and
Generalities Metastatic cancer has the same name and
in BREAST the same type of cancer cells as the
CANCER original, or primary, cancer.
Development
For example, breast cancer that forms a
metastatic tumor in the lung is metastatic
breast cancer, not lung cancer.
and
Generalities The most common regional site of spread
in BREAST is the armpit lymph node.
CANCER
Development The more common distant sites of spread
are:
• Bone
• Lungs
• Brain
• Liver
Fundamentals How does a breast cancer kill a patient?
and
Generalities
in BREAST
CANCER
Development
and Breast cancer can directly kill a patient Direct causes of
Generalities when it death in breast
in BREAST • invades (spreads or metastasizes to) cancer
CANCER essential organs, like lungs, bone, liver,
Development and/or brain and stops them from
functioning properly.
and Breast cancer can kill a patient secondarily
Generalities (indirectly) through: Indirect or
in BREAST • Complications during surgery secondary causes
CANCER • Complications from other forms of of death in breast
Development treatment such as chemotherapy cancers
• Infection due to compromised immune
system
• Malnutrition
and Two of the leading causes of death for those with
Generalities breast cancer are: Indirect or
in BREAST •Venous thrombosis secondary causes
CANCER •Pulmonary embolism of death in breast
Development cancers
Both of these conditions come from blood clots.
They may end up getting stuck in another part of
your body, like your brain or lungs. When the
blood clot gets lodged in one of these areas,
blood flow gets cut off, and the result can be
deadly.
Fundamentals Is breast cancer curable?
and
Generalities
in BREAST
CANCER
Development
and Before I answer this question, let’s have a
Generalities definition of MEDICAL CURE.
in BREAST
CANCER The conventional definition of “medical cure”: a
medical condition that’s completely gone and will
Development
never come back.
For example, if you have appendicitis and doctors

remove your appendix, you’ve been cured.
If you have gallbladder stones and doctors
remove your gallbladder with the stones, you’ve
been cured of the problem.
and For breast cancers, there are patients who after
Generalities treatment do not have their cancers coming back
in BREAST 10, 15 years after or even longer.
CANCER
Strictly speaking, they can be considered
Development
“CURED.”
However, doctors do not want to categorically use

the word “CURE” for them. They use the word
“IN REMISSION.”
and Doctors can talk of “curative goal” at the time of
Generalities treatment when eradicating the cancers entirely
in BREAST can be done with known effective treatment. At
CANCER this time, they will just hope the cancers will not
recur.
Development
The end effect of “curative treatment” can be
“CURE” if no cancer recurs after so many years.
However, doctors will never say and guarantee

CURE to any cancer patient after any type of
treatment.
Fundamentals Is breast cancer curable? There are theories on how
gene mutations lead to
and Why no doctors guarantee cure for cancer (that it cancer development:
Generalities will not come back even after treatment) - Allowing rapid growth
There are several reasons for this: - Failure to stop
in BREAST uncontrolled growth
CANCER 1. Doctors don’t know everything about - Makes mistakes when
Development breast cancer as a disease yet. repairing DNA errors
The best knowledge so far is that the ultimate or EXACT MECHANISMS –
proximate cause of cancer is changes (or NOT DEFINITELY KNOWN
mutations) to the DNA (genes) within cells; that YET!
Thus, the targeted cancer
cancer is a genetic disease caused by changes therapies on the molecular
to genes that control the way our cells function, or gene level are not yet
especially how they grow and divide. 100% successful.
and Why no doctors guarantee cure for cancer (that it
Generalities will not come back even after treatment)
in BREAST There are several reasons for this:
CANCER 2. The usual cancer treatment modalities
Development (surgery, chemotherapy, and radiotherapy)
are strictly not treating the primary cause
of the cancer. They just extirpate, kill with
drugs, and burn the cancer. If the primary
cause is still around, there is always the
possibility of recurrence after treatment.
Generalities will not come back even after treatment)
in BREAST There are several reasons for this:
CANCER 3. No two cancers are the same. Each
Development individual cancer possesses different biological
characteristics, even cancers of the same type and
same extent. Some are slow growing while some
are fast growing. Usually, the biologic behavior of
the cancer is not known at the time of treatment.
Thus, only time will tell the outcome of
treatment.
Generalities will not come back even after treatment) At the time there are
There are several reasons for this: no symptoms of
in BREAST
4. After treatment, some cancer cells may cancer, doctors use
CANCER the word
Development remain somewhere in the body (unnoticed “REMISSION.” They
and patients are asymptomatic) for a long do not guarantee
time, even as long as 10 years, but can completely no more
eventually grow, divide, invade, spread to cancer.
distant areas and become a nuisance. (A Some cancer cells may
RECURRENCE) be present but
unnoticed.
and Complete remission means that tests,
Generalities physical exams, and scans show that all
in BREAST signs of your cancer are gone.
CANCER Some doctors also refer to complete
Development remission as “no evidence of disease
(NED)” or “no evidence of recurrence
(NER)”.
COMPLETE REMISSION DOESN’T MEAN

CURE.
and RECURRENCE
Generalities Some cancer cells can remain unnoticed in
in BREAST the body for years after treatment.
CANCER
Development If a cancer returns after it has been in
remission, it’s called a “recurrence.”
A cancer can recur in the same place it was

originally diagnosed, or it can recur in a
different part of the body.
and So, up to now, strictly speaking, there is
Generalities NO true “cure” for cancer (NO guarantee it
in BREAST will not recur).
CANCER Physicians do not talk of “cure.” They use
Development the word “remission” if there are no signs
of recurrence.
But they together with the patients always
hope for a cure especially for those
cancers which are recognized, diagnosed
and treated early and with known track
record of slow growth in behavior.
and To boost the morale of breast cancer
Generalities patients though, one may say that a
in BREAST patient is cured already if there is no
CANCER recurrence after 10 years or more. (Note:
Development there is always exception to this, though).
LONG REMISSION is usually seen in

patients diagnosed and treated early.
Fundamentals Contents: Summary
and • What is a breast cancer? Conclusion
Generalities • How common is breast cancer?
•
Take Away
in BREAST What are the different types of breast cancer?
• What are the possible and theorized causes of
CANCER
breast cancer?
Development • Can breast cancer be prevented?
• Who are at higher risk for developing breast
cancer?
• What are the behaviors of breast cancers?
• How does breast cancer kill a patient?
• Is breast cancer curable?
Fundamentals Be always in touch with reliable medical Take Away in
and information on fundamentals and relation to
Generalities generalities in breast cancer development. Patient
in BREAST Empowerment
Knowledge is power; it gives power.
CANCER
Development
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to prevent breast cancer and in case it is
not prevented, to gain greater control over
decisions in management.
Empowerment
objective - for

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Nov.

Development of breast cancer – appearance;

It is more common in older than younger

• Estrogen receptors -/+

In only 5 to 10% are breast cancers due to

However, it is difficult to pinpoint the exact cause,

A mutation in a tumor suppressor gene allows

A mutation in a DNA repair gene may

This type of mutation accounts for a small

[Underlying / Predisposing Cause]

But NO guarantee – best effort!

But NO guarantee – best effort!

For example, if you have appendicitis and doctors

However, doctors do not want to categorically use

However, doctors will never say and guarantee

COMPLETE REMISSION DOESN’T MEAN

A cancer can recur in the same place it was

LONG REMISSION is usually seen in

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