Cancer & Women’s / Men’s Health Sample Essay
CANCER AND WOMEN’S AND MEN’S HEALTH
Institution of Affiliation
Breast cancer, although recently classified as systemic disease is the most common site specific malignancy in women. It is the leading cause of mortality in women of ages between 20 and 59 years. Females are more predisposed to breast cancer than males. However, less than 1 percent of all cases are males. In 2013, the estimated number of deaths due to breast cancer in the United States alone was 40,030. Geographical differences exist in terms of incidence and mortality of the disease. The incidence rates are highest among the Ashkenazi Jews as a variation in prevalence exist in terms of race, ethnicity and regional lifestyles. In general terms, the occurrence is lower in women of African and Asian origin, while it is higher in Caucasians. This variation has been attributed to the difference in lifestyles between individuals living in developed and those who live in the relatively underdeveloped nations. Attributable to this discrepancy is the reproductive and dietary patterns. Based on these, breast cancer has a number of well-known risk factors, different preventive modalities based on these risks and various treatment modalities once diagnosed.
Risk factors that contribute to the development of breast cancer are largely dependent on prolonged estrogen exposure. Estrogen stimulates breast epithelial and ductal proliferation, which if uncontrolled cellular division. Among the factors that increase the overall length of estrogen exposure are early menarche and late menopause. Late child bearing as occurs with the increased Westernization also leads to a prolonged period of uninterrupted menstrual cycles. The release of estrogen during these cycles overstimulates the breast tissue. Nulliparous females who have not had the estrogenic suppression due to the prolactin produced during breastfeeding also leads to an increased risk of breast cancer (Burstein, Lacchetti & Griggs, 2016). Women who take combined oral contraceptives with estrogen regimens are also more predisposed to cancer of the breast. Genetics and a family history of the disease are well established risk factors. Specific mutations of BRCA 1 and BRCA 2 genetic aberrations have a strong association with breast cancer. A family history of ovarian, colon and other gastrointestinal cancers also increases the risk for breast cancer. Modifiable risk factors include chronic alcohol use, diet rich in saturated fats and obesity. Some literature indicate that cigarette smoking is preventive against breast cancer (U.S. Preventive Services Task Force, 2014).
Risk factors for breast cancer determine the preventive measures. Individuals with a familial predisposition and a positive BRCA 1 or BRCA 2 genetic aberrations may befit from prophylactic mastectomy (U.S. Preventive Services Task Force, 2014). Modification of risk factors such as obesity, alcohol intake and diet are also well established preventive measures. Screening mammography is recommended for all women after 50 years for every year, even for women without family history. Self-breast examination is an easily implementable method of detecting breast lumps. Women who test positive for genetic mutations can benefit from daily dose of 20 mg of Tamoxifen, an estrogen receptor antagonist.
Drug Treatment Options
Treatment of breast cancer largely targets at reduction of tumor burden and clearance of micro-metastases. Chemotherapeutic agents as well as hormonal therapy has are widely used to achieve cure, for palliation or as neo-adjuvant regimens before surgery (DeSantis et al, 2014). Hormone manipulation is a preferred treatment in patients with estrogen or progesterone receptor positive cancers. The most commonly used drug is tamoxifen, which acts on the estrogen receptors thus reducing the stimulation effect of the hormone on breast proliferation (Arcangelo et al, 2017). Hormonal therapy may be used alone or in combination with chemotherapy for patients with advanced disease. Hormonal therapy is also first choice in secondary prophylaxis against contralateral breast cancer. No studies have supported an increased survival with the use of chemotherapy on advanced breast disease. In addition to these radiation to the breast bed after mastectomy or to sites of metastasis such as bone is beneficial in alleviation of pain.
For a long period of time a combination chemotherapy of cyclophosphamide, methotrexate and 5-fluorouracil has been used. Combination therapy is preferred to single agent treatment. Cyclophosphamide is an alkylating agent and acts by inhibition of replication of the deoxyribonucleic acid (DNA) (Arcangelo et al, 2017). The agent binds to the DNA guanine nucleosides preventing the uncoiling of the double strand. This renders the strand unable to produce daughter copies hence arresting the cell cycle of the cancer cells. Cyclophosphamide is administered as an intravenous infusion and its metabolism mainly occurs through the liver (Drugs.com., 2012). Some of the drug is eliminated unchanged via the urine and one of its well-known side effects is hemorrhagic cystitis. Methotrexate on the other hand is given orally as well as intravenously (Arcangelo et al, 2017). Methotrexate is an anti-metabolite that acts inhibits the function of the enzyme dihydrofolate reductase. This prevents the formation of the active form of folate which is essential in the cellular DNA synthesis. The drug is also metabolized in the liver.
Fluorouracil is an inhibitor of thymidylate synthase, an enzyme that catalyzes DNA synthesis. By this mechanism, fluorouracil prevents the rapid proliferation of cancer cells, hence indirectly inducing apoptosis (Arcangelo et al, 2017). The drug is administered via the intravenous route and is eliminated via the kidney. Paclitaxel, which is a cell cycle specific inhibitor of mitosis has become a common agent of use against breast cancer. Monoclonal antibodies with specific affinity to cancer cells have also been studied as alternatives to chemotherapy. These include, trastuzumab, Abemaciclib, Palbociclib, Lapatinib and several others still undergoing trials.
In summation, breast cancer is a leading cause of death in both developed and developing countries. The risk factors for the disease are related to age, race, ethnicity, genetics and family history as well as specific lifestyles. Prolonged estrogen exposure is the main pathophysiologic mechanism of the disease with women taking combined oral contraceptives at a higher risk. Prevention of the disease is through risk modification, screening for genetic predisposition and prophylactic surgery as well as tamoxifen for individuals with BRCA 1 and 2. Treatment is mainly by combination therapy of anti-hormonal drugs and chemotherapy. A common regimen is cyclophosphamide, fluorouracil and methotrexate.
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Burstein, H. J., Lacchetti, C., & Griggs, J. J. (2016). Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update on Ovarian Suppression Summary. Journal of oncology practice, 12(4), 390-393.
DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: a cancer journal for clinicians, 64(1), 52-62.
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U.S. Preventive Services Task Force. (2014).The Guide to Clinical Preventive Services: Section 2. Recommendations for Adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html