Despite being the second most common malignancy affecting pregnancy, breast cancer during pregnancy is rare. Known as Pregnancy-Associated Breast Cancer (PABC), it affects approximately one in 3000 pregnancies. PABC is, in fact, defined as breast cancer that is diagnosed during pregnancy or in the first year postpartum. The aim with diagnosis and treatment of breast cancer during pregnancy is to follow, as closely as possible, the normal standards of care for patients of the same age who are not pregnant. That being said, some modifications may be required in order to minimise risks to the developing baby. **Diagnosis** ------------- Most breast cancers are diagnosed following self-examination and [identification of a lump](https://nabtahealth.com/is-the-first-sign-of-breast-cancer-always-a-lump/) in the breast tissue. During pregnancy, the breasts change in shape and size as they prepare for breastfeeding. It is not uncommon for them to feel lumpy and inconsistent as the milk producing ducts and glands start to fill with milk. This can make it difficult for women to establish which changes are normal and which are a cause for concern. All abnormal masses should be investigated, although, fortunately, 80% will be [benign](https://nabtahealth.com/glossary/benign/) in nature. The first diagnostic test a doctor will use is ultrasound. This uses soundwaves and is entirely safe for the unborn baby. It will characterise any unusual masses and identify whether there are features of concern within the mass. At around the same time a needle aspiration and/or core [biopsy](https://nabtahealth.com/glossary/biopsy/) may be taken. This enables doctors to explore the cells of the breast in more detail. Particular care will need to be implemented for analysing the results as, during pregnancy, it is not unusual for cells to become more proliferative in nature. Rapidly proliferating cells under normal conditions can serve as a warning sign that something is amiss. Mammograms will be used, however, they are known to lack sensitivity in pregnant or lactating females. As a mammogram involves radiation, doctors will endeavor to shield the baby from exposure. Newer digital mammograms might improve the sensitivity of the technique in women under 40 years of age. CT scans and bone scans, which are a normal part of the diagnostic process in non-pregnant females, are avoided during pregnancy, due to the dangers of radiation to the developing foetus. These methods are normally employed to check for [metastasis](https://nabtahealth.com/glossary/metastasis/), and thus, metastatic disease can be harder to detect in pregnant women. **Treatment** ------------- Most women with PABC will undergo surgery as the first-line treatment option, usually in the form of a modified radical mastectomy. It is generally safe to undergo anaesthesia whilst pregnant, but in order to limit the time you are under general anaesthetic, your doctor will probably recommend postponing reconstructive surgery until after delivery. [Radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) is not recommended during pregnancy and wherever possible your doctor will attempt to delay this type of treatment until after delivery. This is because it increases the risk of [foetal malformations](https://nabtahealth.com/glossary/foetal-malformations/) and can delay [neurocognitive](https://nabtahealth.com/glossary/neurocognitive/) development. If breast preservation is desired, the disease is not advanced and diagnosis has occurred towards the end of pregnancy, it may be possible to treat with immediate lumpectomy and [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) after delivery. It has been shown that a six week window between lumpectomy and commencement of [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) does not have a detrimental effect on outcome. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) should not be given during the first [14 weeks of pregnancy](https://nabtahealth.com/articles/week-by-week-pregnancy-weeks-14-26/). It can cause severe [teratogenicity](https://nabtahealth.com/glossary/teratogenicity/) during organ development, which primarily occurs in the first trimester. In the second and third trimester, [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) can be administered. There have been no reports of later ill effects in children born to mothers who had [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) at this stage of their pregnancy. Most doctors will recommend stopping [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) at about week 36 to reduce the risk of infection or bleeding during delivery. Hormone therapy is not recommended for women who are pregnant or breastfeeding. Whilst, there are treatment options for women with PABC, additional work is required to establish a more effective treatment approach for these women. Certainly, as women postpone having children, the rates of PABC are likely to increase over the next few years. **Prognosis** ------------- The prognosis for women with PABC is generally lower than for women with breast cancer who are not pregnant. This is likely due to: * Less aggressive therapy being used due to concerns over the effect of harsher regimens on the developing baby. * Later stage of diagnosis because of difficulty in distinguishing physiologically-relevant changes from normal pregnancy-related changes. * The pregnancy having a direct effect on outcome, although knowledge regarding the exact mechanisms relating to this is currently lacking. * An increased percentage of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) receptor negative cases. This is known to be associated with an increased risk of metastatic disease, which has a poorer prognosis. In terms of the developing foetus, women with PABC should be reassured that there are no reports of breast cancer spreading from the mother to the baby during pregnancy. In rare cases cancer cells will be found in the [placenta](https://nabtahealth.com/glossary/placenta/), so the doctor will always check this immediately after delivery. During pregnancy, a woman should remain under observation by a multidisciplinary team of healthcare professionals, including gynaecologists and oncologists to ensure that the support she receives is optimal for both her and her baby. Growth scans will be performed regularly to ensure that the baby is developing as he or she should be. If possible, the medical team will try to ensure that the woman delivers her baby as close to her due delivery date as possible. After delivery, treatment options will be reassessed. Get yourself the [post-surgery pack](https://nabtahealth.com/product/post-surgery-selfcare-pack-copy/) Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#99e0f8f5f5f8d9f7f8fbedf8f1fcf8f5edf1b7faf6f4) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Breast Cancer.” Breast Cancer during Pregnancy | Cancer Research UK, 21 Nov. 2017, [https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/breast-cancer-during-pregnancy](https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/breast-cancer-during-pregnancy). * “Breast Cancer, Pregnancy and (Green-Top Guideline No. 12).” Royal College of Obstetricians & Gynaecologists, [https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg12/](https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg12/). * Johansson, A L V, et al. “Diagnostic Pathways and Management in Women with Pregnancy-Associated Breast Cancer (PABC): No Evidence of Treatment Delays Following a First Healthcare Contact.” Breast Cancer Research and Treatment, vol. 174, no. 2, Apr. 2019, pp. 489–503., doi:10.1007/s10549-018-05083-x. * Keyser, E A, et al. “Pregnancy-Associated Breast Cancer.” Reviews in Obstetrics & Gynecology, vol. 5, no. 2, 2012, pp. 94–99.
Breast cancer treatment will depend on the [stage of the cancer](https://nabtahealth.com/breast-cancer-staging/) at diagnosis. Usually those with stage I – III breast cancer will be offered surgery, in combination with [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) and some form of drug treatment ([chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) and/or hormone treatment). The type of surgery will depend on tumour size and location, as well as personal preference. Breast-conserving surgery, known as a lumpectomy, removes the tumour, whilst preserving as much of the breast tissue as possible. A mastectomy removes the entire breast and can be unilateral (one-sided) or bilateral (both breasts). Breast reconstruction surgery is an option for those who want to preserve the appearance of their breasts, although it should be noted that any reconstructed tissue will have little, if any, sensation. Of course, not all women will want to undergo breast reconstruction. Some will choose to use removable prosthetics or simply ‘go flat’. The most important thing is for each woman to take the time to consider which option is best for her. **When to undergo breast reconstruction surgery** ------------------------------------------------- Breast reconstruction can be immediate, delayed or staged. * **Immediate**. Performed at the same time as a mastectomy/lumpectomy. The advantages to this are that it provides a neater cosmetic result with less scarring and will probably require fewer surgical procedures. The disadvantages are that the reconstruction might be damaged by subsequent [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) and if there are complications during the procedure, it might delay the start of [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Women who have [prophylactic](https://nabtahealth.com/glossary/prophylactic/) breast removal, i.e. a preventative mastectomy because they are at high risk of developing cancer, will usually undergo immediate breast reconstruction. * **Delayed**. Reconstructive surgery can be performed weeks, or even months after breast cancer surgery. This can be advantageous as it gives a woman time to carefully consider her options. It also means that subsequent treatment will be unaffected by the reconstructive surgery. The drawbacks are that it can result in more scarring and the woman will spend time with no breast (or breasts), which could impact her confidence and quality of life. * **Staged**. Some reconstruction is performed during the mastectomy or lumpectomy, with additional procedures later on. This usually involves inserting a temporary expander to preserve the shape of the breast for the short-term. It can then be replaced with a permanent implant once the next stage of treatment is complete. Also called delayed-immediate reconstruction. ### **Types of reconstruction** Implants can be artificial or made from a flap of tissue taken from elsewhere in the body (autologous). * **Artificial implant**. An implant made of either saline or silicon is inserted either underneath or on top of the pectoral chest muscles. Implants can be teardrop-shaped, or round; smooth, or slightly rough. The advantages to artificial implants are that they generally require a shorter recovery time and fewer surgical procedures, as there is no need for concurrent surgery at a donor site. Scarring can also be kept to a minimum by using the same incision site that was used during the mastectomy. The disadvantages to this type of reconstruction are that with time the implant might need replacing; most have a lifespan of between 10 and 20 years. There is also a risk of deflation, rupture and contracture of the implant. Women who have unilateral breast cancer may choose to have artificial implants inserted into their healthy breast too, so that both sides match. * **Autologous reconstruction**. A ‘flap’ of tissue is taken from elsewhere in the body, formed into the shape of a breast and used to manufacture an implant. The tissue taken is skin, fat or muscle and it is most often taken from the abdomen, the back, the buttocks or the inner thigh. The abdomen is the preferred donor site. “Free flaps” are completely separated from their original blood vessels and reattached to blood vessels within the chest wall. This requires advanced skills in microsurgery. “Pedicled flaps” are tissue samples that are moved underneath the skin and remain attached to their original blood vessels. This is considered to be a simpler technique. Autologous reconstruction can be delayed or immediate. Advantages to this technique include a more natural looking result, with no risk of implant rupture. These implants also tolerate [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) more than artificial implants. The disadvantages include more extensive surgery and a longer recovery time; as well as multiple surgical sites. Women who undergo this procedure risk experiencing complications, such as hernias and muscle damage, at the donor site. Women that are of a slim build may require “stacked flaps”, whereby multiple free flaps are taken and layered to form the implant. * **Combination**. Sometimes tissue flap procedures are used in combination with an implant. For example, when a latissimus dorsi flap is taken from the tissue of the back, it is often used alongside an artificial implant to enhance the overall appearance of the reconstructed breast. **Reconstruction after breast-conserving surgery** -------------------------------------------------- Some women do not need a complete mastectomy and it is considered sufficient to remove the part of the breast where the tumour is located using a lumpectomy. Reconstruction is often not needed in these cases, but for those women who are left with a prominent dent, or a large discrepancy between breasts after surgery, there are options available. * **Quadrantectomy and mini flap reconstruction**. In a quadrantectomy the surgeon will remove about a quarter of the breast tissue, which can leave the patient with a noticeably smaller breast. To fill the gap, living tissue is taken from elsewhere in the body, often from the patient’s back. * **Reshaping**. This is also known as therapeutic mammoplasty and is more suitable for women with larger breasts. The doctor will remove the part of the breast where the cancer is located and then reshape the remaining breast tissue, so that the breast is smaller, but fully formed. Women who undergo this procedure might opt to have a simultaneous breast reduction on their healthy breast, so that the two sides match. Most breast-conserving surgeries will be followed by a course of [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) to the remaining breast tissue to reduce the chances of the cancer returning. **Additional surgery** ---------------------- Nipple and areola reconstruction is usually done 3-4 months after the original procedure, so that the breast has had time to heal. Normally the artificial nipple is formed from the tissue of the new breast and the surgeon will attempt to match the position, size and projection of it to the other nipple. Tattooing is used to match the colour. Some women choose to have surgery on their healthy breast, to make both sides match. This is a matter of personal choice and something to discuss with you doctor when considering options. After the surgery try Nabta’s [Post-surgery pack](https://nabtahealth.com/product/post-surgery-selfcare-pack-copy). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary/menopause/)[menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#ea938b86868baa848b889e8b828f8b869e82c4898587) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Breast Cancer.” About Breast Reconstruction | Breast Cancer Surgery | Cancer Research UK, 25 Oct. 2017, [https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/breast-reconstruction/about](https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/breast-reconstruction/about). * “Breast Reconstruction Options.” American Cancer Society, [https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html](https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html). * Djohan, R., et al. “Breast Reconstruction Options Following Mastectomy.” Cleveland Clinic Journal of Medicine, vol. 75, no. Suppl\_1, Mar. 2008, pp. 17–23., doi:10.3949/ccjm.75.suppl\_1.s17. * Farhangkhoee, Hana, et al. “Trends and Concepts in Post-Mastectomy Breast Reconstruction.” Journal of Surgical Oncology, vol. 113, no. 8, June 2016, pp. 891–894., doi:10.1002/jso.24201. * “Types of Breast Reconstruction.” Breastcancer.org, 29 Aug. 2019, [https://www.breastcancer.org/treatment/surgery/reconstruction/types](https://www.breastcancer.org/treatment/surgery/reconstruction/types).
The breast self-examination in front of a mirror is the “look at your breast” section. While you’re not feeling your breasts, it is important to perform a certain set of actions to properly “look” at your breasts. The order is below: a. Look at your breasts with your arms hanging by your sides b. Lift your arms above your head: do you see any dimpling, changes in nipples, or change in the shape of one or both breasts? c. Lastly, place your palms as if you’re getting ready to scold someone (!) and tighten your chest muscles: again, check for dimpling, nipple changes, and contour of the breast. Continue to [Part 3](../). Source: Breastcancer.org
The sun produces ultraviolet (UV) rays, which are damaging to the skin, causing premature signs of aging and increasing the risk of skin cancer. The best way of protecting against sun-induced damage is to regularly apply natural oils sunscreen. All sunscreen has a sun protection factor (SPF); the higher the SPF the more effective the protection against UV damage. The oils found naturally in fruit and vegetable seeds have been found to provide some protection against UV rays. Whilst too unstable to be used on their own, when combined with other ingredients, these oils have many properties that make them ideal for use on the skin. They are light, low in viscosity and less occlusive, meaning that they can be easily absorbed by the skin. #### Natural-based sunscreen Many natural-based sunscreens already contain oil extracts, including almond, avocado, coconut, cottonseed, olive, peanut, sesame and soybean. Due to their hydrating properties, natural oils such as these, provide soothing and non-toxic relief to those with dry or hypersensitive skin. It can be caused by eczema, or following [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) and/or [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/). Adding these oils to moisturisers not only enhances the nourishing properties, but also provides a small amount of daily sun protection. Almond oil, for example, has an SPF of almost 5. It is found in the [Ozalys Soothing Care Soft Scalp Milk](../). Developed to soothe and moisturise the delicate skin of the scalp after hair loss, this product is ideal for use before, during and after sun exposure. #### Remember…. Please note that whilst it is always advisable to use additional protective measures, such as a sunscreen with an SPF of at least 30. However, hats and scarves help, care should be taken when choosing a sunscreen. Those with hypersensitive skin should avoid sunscreens that contain chemical filters, such as oxybenzone and retinyl palmitate. As these compounds can penetrate the skin, producing free radicals and, ultimately, causing more damage to the underlying cells. Instead, select products designed for use on sensitive skin, which are free from harsh chemicals, yet still provide sufficient UV protection. #### **About Ozalys** Ozalys’ products have been designed with women who have been affected by cancer in mind. Ozalys allows women to continue to care for themselves every day using products. That innovate through their formulas, optimal absorption and packaging. It’s specially-formulated solutions are catered for physiological conditions that cause dermal sensitivity. It is also for the side effects of certain treatments that may result in olfactory and dermal ultra-sensitivity. It’s personal hygiene, face and body care products have all been developed with the utmost care. Minimising preservatives and excluding all substances suspected of being harmful to the body. Their highly soothing, moisturising and protective properties. As well as their delicate application and scent, turn daily beauty routines into moments of well-being and comfort. **Sources:** * Kaur, C D, and Saraf, S. “In Vitro Sun Protection Factor Determination of Herbal Oils Used in Cosmetics.” _Pharmacognosy Research_, vol. 2, no. 1, Jan. 2010, pp. 22–25., doi: 10.4103/0974-8490.60586. * Floris. “Let’s Talk: Sunscreen — What You Should Know about Sun Protection.” Amazingy, 28 June 2018, [amazingy.com/magazine/sunscreen-uv-filters-nano-particles/](http://amazingy.com/magazine/sunscreen-uv-filters-nano-particles/).
 **[Perimenopause](https://nabtahealth.com/glossary/perimenopause/)** is a natural process in a woman’s life caused by a normal biological decline in reproductive hormones. [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) onset varies from woman to woman and can take place at any stage from a woman’s mid-30s (premature [menopause](https://nabtahealth.com/glossary/menopause/)) into her late 50s. Also known as the ‘[menopause](https://nabtahealth.com/glossary/menopause/) transition’, [perimenopause](https://nabtahealth.com/glossary/perimenopause/) lasts between three and 10 years. The average length of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) is 4-5 years, and the average age of [menopause](https://nabtahealth.com/glossary/menopause/) is 51 years. **[Menopause](https://nabtahealth.com/glossary/menopause/)** marks the end of [perimenopause](https://nabtahealth.com/glossary/perimenopause/), when a woman has gone a full 12 months without menstruating. After a year of no menstrual periods a woman is considered to have gone through [menopause](https://nabtahealth.com/glossary/menopause/) to her post-menopausal phase. **Induced [menopause](https://nabtahealth.com/glossary/menopause/)** is when a woman’s menstrual periods stop due to medical treatments or intervention. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) or radiation damage to the [ovaries](https://nabtahealth.com/glossary/ovaries/), and surgical removal of the [ovaries](https://nabtahealth.com/glossary/ovaries/) result in medically induced [menopause](https://nabtahealth.com/glossary/menopause/). **[Postmenopause](https://nabtahealth.com/glossary/postmenopause/)** is the ongoing phase of a woman’s life after [menopause](https://nabtahealth.com/glossary/menopause/). It’s important to note that many women continue to experience the classic [menopause](https://nabtahealth.com/glossary/menopause/) symptoms for years after their ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What happens to a woman’s body when she is perimenopausal? The hormones that flooded a woman’s body during [puberty](https://nabtahealth.com/glossary/puberty/) and her fertile years start to fluctuate due to the decline in the female reproductive hormones (estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/)) produced by her [ovaries](https://nabtahealth.com/glossary/ovaries/). These hormonal deficiencies [lead](https://nabtahealth.com/glossary/lead/) to many physical changes taking place in a woman’s body long before her ‘official’ [menopause](https://nabtahealth.com/glossary/menopause/). #### What are the symptoms of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/)? * Hot flashes / flushes * Night sweats * Vaginal dryness * Irregular periods * Hair loss * Weight gain and slowed [metabolism](https://nabtahealth.com/glossary/metabolism/) * Itchy or dry skin * Disturbed sleep * Urinary incontinence * Mood swings and anxiety * Brain fog or memory loss * Low libido The physical changes and symptoms women experience due to the reduction in hormones can be debilitating. #### What are the long-term health risks of [menopause](https://nabtahealth.com/glossary/menopause/)? Long-term hormone deficiency increases women’s risk of chronic health conditions including cardiovascular disease, [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), type 2 diabetes, dementia, and bowel cancer. #### How is [perimenopause](https://nabtahealth.com/glossary/perimenopause/) diagnosed? A doctor will assess symptoms and may recommend a blood test to check follicle-stimulating hormone ([FSH](https://nabtahealth.com/glossary/fsh/)) and estrogen levels. As hormones fluctuate during [perimenopause](https://nabtahealth.com/glossary/perimenopause/) the test may be repeated after a few months if the results are inconclusive. Women who want to confirm their symptoms can also take a [perimenopause](https://nabtahealth.com/glossary/perimenopause/) test measuring the levels of three hormones [from the comfort of their home](https://nabtahealth.com/product/perimenopause-test/). However, a hormone test isn’t always necessary, and some doctors will diagnose [perimenopause](https://nabtahealth.com/glossary/perimenopause/) based on physical symptoms. #### Can [perimenopause](https://nabtahealth.com/glossary/perimenopause/) be treated? [Perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) are natural biological processes in a woman’s body and cannot be delayed or halted with treatment. That said, a healthcare professional may discuss Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) and lifestyle adjustments to help manage the physical impacts of hormone deficiency. #### What is [HRT](https://nabtahealth.com/glossary/hrt/)? [HRT](https://nabtahealth.com/glossary/hrt/) replaces the hormones the body is no longer producing. The hormone treatment includes estrogen, and sometimes [progesterone](https://nabtahealth.com/glossary/progesterone/) and [testosterone](https://nabtahealth.com/glossary/testosterone/) if needed, and is given as a skin patch, gel, spray, or pill. Most women report their [perimenopause](https://nabtahealth.com/glossary/perimenopause/) symptoms improving within 3-6 months of starting [HRT](https://nabtahealth.com/glossary/hrt/). Taking [HRT](https://nabtahealth.com/glossary/hrt/) reduces the risk of developing [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), cardiovascular disease, type 2 diabetes, bowel cancer, osteoarthritis, and other health conditions due to hormone deficiency. There are risks associated with [HRT](https://nabtahealth.com/glossary/hrt/), including a small increased risk of breast cancer and blood clots in women with a family history. However, research has shown that for most women who take [HRT](https://nabtahealth.com/glossary/hrt/) the benefits outweigh the risks. A woman should always have a conversation with her healthcare team to decide the best approach for her individual circumstances. #### Are there natural ways to reduce the symptoms of [menopause](https://nabtahealth.com/glossary/menopause/)? Lifestyle adjustments can also be beneficial in managing perimenopausal symptoms. Women should try to eat a balanced diet with plenty of fresh fruit and vegetables, protein, whole foods, and foods rich in omega-3 fatty acids and calcium. Phytoestrogens can mimic the effects of estrogen in the body and occur naturally in foods including flaxseeds, sesame seeds, beans, soy, garlic, and cruciferous vegetables. Stop smoking and cut back on foods that might disturb sleep or trigger hot flashes, such as caffeine and alcohol. And exercise is essential. The decline in hormones affects bone and joint health, so it is more important than ever to maintain strength and flexibility with regular cardio and weight bearing exercise. As a woman’s [metabolism](https://nabtahealth.com/glossary/metabolism/) naturally changes with age, exercise will also help with weight control. #### Can I still become pregnant during [perimenopause](https://nabtahealth.com/glossary/perimenopause/)? While you are still having your period you can become pregnant. If you don’t want to be pregnant you should continue to use contraceptives until you are postmenopausal. #### Understanding [menopause](https://nabtahealth.com/glossary/menopause/) Health organisations and governments are increasingly recognising the gaps in knowledge and understanding of [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and [menopause](https://nabtahealth.com/glossary/menopause/) and its enormous impact on women’s health and wellbeing. Efforts are now being made to address gender inequalities in broader healthcare provision and rebalance the lack of [menopause](https://nabtahealth.com/glossary/menopause/) research. The last few years have seen investment in improving education around [perimenopause](https://nabtahealth.com/glossary/perimenopause/) with the goal of empowering the more than 50% of the world’s population who will go through [menopause](https://nabtahealth.com/glossary/menopause/) with evidence-based therapeutic support. Sources: Internal > [What is](https://nabtahealth.com/articles/what-you-need-to-know-about-perimenopause/) [Perimenopause](https://nabtahealth.com/glossary/perimenopause/)? External: > [](https://www.balance-menopause.com/menopause-library/)[Menopause](https://nabtahealth.com/glossary/menopause/) Library https://www.mayoclinic.org/diseases-conditions/[menopause](https://nabtahealth.com/glossary/menopause/)/symptoms-causes/syc-20353397 https://flo.health/menstrual-cycle/[menopause](https://nabtahealth.com/glossary/menopause/)/changes/[menopause](https://nabtahealth.com/glossary/menopause/)\-symptoms-and-stages
* If you are diagnosed with breast cancer, you will find your doctors use a universal breast cancer staging system. * This cancer staging system uses TNM letters with numbers * The universal breast cancer staging system helps determine the best treatment for each individual case. Following a breast cancer diagnosis, it is very important for your doctor to determine precisely where the cancer is located, how much it has grown, [what is the sign](https://nabtahealth.com/is-the-first-sign-of-breast-cancer-always-a-lump/), and if/where it has spread to. With the majority of solid tumours, including those found in the breast, there is a universal staging system that can be implemented to optimize the best treatment approach and determine prognosis on a case-by-case basis. How the **TNM Cancer Staging System** Works ------------------------------------------- **T**: Tumour size, measured in mm. T0 – No evidence of primary tumour. Tis – Carcinoma in situ. Cancer is only found in the ducts of the breast tissue. T1 – Tumour is 20mm or smaller. T2 – Tumour is larger than 20mm but smaller than 50mm. T3 – Tumour is larger than 50mm. T4 – Tumour has grown into the chest wall or the skin of the breast tissue AND/OR inflammatory breast cancer is detected. **N**: Lymph node involvement. N0 – No cancer detected in the lymph nodes OR cancer cells found that are less than 0.2mm. N1 – Cancer has spread to 1-3 axillary lymph nodes. N2 – Cancer has spread to 4-9 axillary lymph nodes OR to internal mammary lymph nodes. N3 – Cancer has spread to 10 or more axillary lymph nodes OR to lymph nodes above or below the collarbone AND/OR to internal mammary lymph nodes. **M**: [Metastasis](https://nabtahealth.com/glossary/metastasis/); whether cancer has spread to other parts of the body. M0 – No [metastasis](https://nabtahealth.com/glossary/metastasis/). M1 – Breast cancer cells growing in other organs of the body. #### **Breast Cancer Stages** **Stage 0**: Cancer is only present in the ducts of the breast tissue, no evidence of cancer cells in the neighboring breast tissue. Defined as non-invasive ductal carcinoma in situ. **Tis N0 M0** **Stage IA**: Tumour is 20mm or smaller and cancer has not spread outside the breast. **T1, N0, M0** **Stage IB**: No tumour in the breast, but small groups of cancer cells in the lymph nodes (0.2-2mm). **T0, N1, M0** OR Tumour smaller than 20mm in breast and small groups of cancer cells in the lymph nodes (0.2-2mm). **T1, N1, M0** **Stage IIA**: No tumour in the breast, but cancer cells (larger than 2mm) found in 1-3 axillary nodes or in the lymph nodes near the breast bone. **T0, N1, M0** OR Tumour is 20mm or smaller and cancer cells have spread to axillary lymph nodes. **T1, N1, M0** OR Tumour is larger than 20mm and smaller than 50mm and cancer cells have not spread to axillary lymph nodes. **T2, N0, M0** **Stage IIB**: Tumour is larger than 20mm and smaller than 50mm and there are small groups of cancer cells in the lymph nodes (0.2-2mm). **T2, N1, M0** OR Tumour is larger than 20mm and smaller than 50mm and cancer cells have spread to 1-3 axillary lymph nodes or to lymph nodes near the breast bone. **T2, N1, M0** OR Tumour is larger than 50mm. Cancer cells have not spread to lymph nodes. **T3, N0, M0** **Stage IIIA**: Tumour of any size and cancer cells have spread to 4-9 axillary lymph nodes, but not to the rest of the body. **T0/T1/T2/T3, N2, M0** OR Tumour is larger than 50mm and cancer cells have spread to 1-3 axillary lymph nodes or to lymph nodes near the breast bone. **T3, N1, M0** **Stage IIIB**: Tumour of any size and cancer cells have spread to the chest wall and/or the skin of the breast, causing swelling or ulceration. AND Cancer cells may be present in up to 9 axillary lymph nodes or in the lymph nodes near the breast bone. **T4, N0/N1/N2, M0** Stage IIIB breast cancer can also be inflammatory. This is when there is reddening of the breast skin and the breast feels warm or swollen to the touch. **Stage IIIC**: Tumour of any size, may have spread to the chest wall and/or the skin of the breast AND Cancer cells are found in 10 or more axillary lymph nodes and/or in the lymph nodes above and below the collarbone and/or in the lymph nodes near the breast bone. **T0/T1/T2/T3, N3, M0** **Stage IV (metastatic)**: Tumour of any size. Cancer cells have spread to other organs, such as the brain, the liver, the bones, the lungs, and distant lymph nodes. De novo stage IV breast cancer occurs when cancer has already metastasised upon diagnosis. This is rare. Usually, [metastasis](https://nabtahealth.com/glossary/metastasis/) occurs following the recurrence of previous disease. **T0/T1/T2/T3, N0/N1/N2/N3, M1** **Additional classification of breast cancer** ---------------------------------------------- In 2018 the guidelines for the staging of breast cancer changed to incorporate cancer characteristics into the TNM system. This means tumour cells are graded by: * Appearance – how different from normal cells they look. * [Oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) receptor status. * HER2 status – whether there is overexpression/amplification of the HER2 receptor. Doctors may also use a measure of proliferation to investigate how quickly the cells are replicating and what [pill use increase your breast](https://nabtahealth.com/the-pill-and-breast-cancer/) [cancer](https://nabtahealth.com/the-pill-and-breast-cancer/) [risk](https://nabtahealth.com/the-pill-and-breast-cancer/). Adding the results of these tests to the TNM system can affect how a patient’s disease is staged. For example, those who have the triple-negative disease ([oestrogen](https://nabtahealth.com/glossary/oestrogen/) receptor-negative, [progesterone](https://nabtahealth.com/glossary/progesterone/) receptor-negative, and HER2 negative) typically have a worse prognosis than those who are not triple-negative. Thus, they may be graded more severely than they would be by following the TNM system in isolation. These additional classifications do add further complexity to the staging of the disease (breast cancer staging), but they also make the diagnosis more accurate and allow for a more personalised, optimal treatment regimen to be instigated. [Nabta](https://nabtahealth.com/) is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#95ecf4f9f9f4d5fbf4f7e1f4fdf0f4f9e1fdbbf6faf8) if you have any questions about this article or any aspect of women’s health. We’re here for you and you can also download our [app](https://play.google.com/store/apps/details?id=com.nabtahealth.nabta) for support wherever you are. #### **Sources:** “Breast Cancer – Stages.” Cancer.Net, 26 Aug. 2019, [https://www.cancer.net/cancer-types/breast-cancer/stages](https://www.cancer.net/cancer-types/breast-cancer/stages). “Breast Cancer Stages: 0 Through IV.” Breastcancer.org, 23 July 2019, [https://www.breastcancer.org/symptoms/diagnosis/staging](https://www.breastcancer.org/symptoms/diagnosis/staging). Hortobagyi, Gabriel N., et al. “New and Important Changes in the TNM Staging System for Breast Cancer.” American Society of Clinical Oncology Educational Book, no. 38, 23 May 2018, pp. 457–467., doi:10.1200/edbk\_201313. Li, Xiaoxian, et al. “Triple-Negative Breast Cancer Has Worse Overall Survival and Cause-Specific Survival than Non-Triple-Negative Breast Cancer.” Breast Cancer Research and Treatment, vol. 161, no. 2, Jan. 2017, pp. 279–287., doi:10.1007/s10549-016-4059-6.
* There is no conclusive evidence that deodorants and antiperspirants cause breast cancer. * There are theories that the aluminum in deocorants may stimulate production of the hormone estrogen, which may [lead](https://nabtahealth.com/glossary/lead/) to increased breast cancer risk. * No studies have proven these theories. Some people worry that deodorants and antiperspirants stop the body from sweating out toxins, which then build up in the lymph glands under the armpit, causing breast cancer. However, our bodies have several ways of getting rid of toxins and, while sweating is one of them, it does not involve the lymph glands. #### Deodorant and Antiperspirants For the majority of us, using deodorant is a daily routine that we barely think about. We don’t want to smell and sweat. Actually it is not our sweat that smells, it is the reaction it has when it mixes with the bacteria on your skin. The bacteria releases body odour, often unpleasant. Deodorants and antiperspirants work in different ways to cover up body odour (or BO). **Deodorants** work by masking the smell with a more pleasant scent. They may also create a more acidic environment where applied, which may prevent the bacteria from releasing odours. **Antiperspirants** use ingredients, usually aluminum-based, to block sweat glands, reducing the amount of perspiration released. #### Do the chemicals in deodorants and antiperspirants cause breast cancer? There is also no conclusive evidence that ingredients in deodorants and antiperspirants – such as aluminum or chemicals called parabens – cause breast cancer. [The National Cancer Institute notes](https://www.cancer.gov/about-cancer/causes-prevention/risk/myths/antiperspirants-fact-sheet) that studies looking at ingredients in deodorants and antiperspirants and the potential [risk of breast cancer](https://www.cancercenter.com/cancer-types/breast-cancer/risk-factors) focus on the use of [aluminium](https://nabtahealth.com/glossary/aluminium/). The theory is that the aluminum in these products may stimulate production of the hormone estrogen, which may [lead](https://nabtahealth.com/glossary/lead/) to increased breast cancer risk. This postulates that aluminum is absorbed through the skin, especially in women who shave their underarms, inadvertently causing small nicks or cuts. It’s through these [small nicks to the skin](https://www.cancer.org/cancer/cancer-causes/antiperspirants-and-breast-cancer-risk.html) that chemicals from the antiperspirant may gain access to the [lymph nodes](https://www.cancercenter.com/lymph-nodes), which could cause cells to mutate and develop into cancer. Men would be at lower risk because most men don’t shave their underarms. However, no studies have proved these theories. Women are advised to avoid using a deodorant, antiperspirant or talc containing aluminum when they go for a mammogram only because the aluminum might show up on the x-ray image and give an inaccurate reading. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) [Get in touch](/cdn-cgi/l/email-protection#381d0a0841595454597856595a4c59505d59544c50165b5755) if you have any questions about this article or any aspect of women’s health. We’re here for you.
The [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/) has been widely used since the late 1950s and early 1960s when it became a revolutionary tool allowing women to take control of their family planning for the first time. However, in the decades since, questions and concerns have been raised over its long-term safety. One concern is that taking the pill could increase your risk of developing breast cancer. The association between breast cancer and the oral contraceptive pill is small, but significant. Studies suggest that those women who are currently on the pill are 20% to 24% more likely to receive a breast cancer diagnosis. The increased risk is lost once the pill is discontinued and after ten years, prior pill users are at no greater risk than never users of getting breast cancer. The risk also falls significantly once a woman goes through the [menopause](https://nabtahealth.com/glossary/menopause/). #### **Why would current pill use increase your breast cancer risk?** Pill use is associated with clinically challenging types of breast cancer, including the [triple negative](https://nabtahealth.com/breast-cancer-staging/) form, which usually has a worse prognosis and higher mortality rate. The exact mechanisms linking the two are unclear, although many breast cancers have a hormonal component. It is thought that increased lifetime exposure to oestrogens increases the risk of breast cancer, primarily because the hormone promotes or initiates tumour growth. Studies have failed to find an elevated risk of breast cancer in pill users with a family history of the disease. However, the data may be skewed by the fact that these women are less likely to use the pill due to their already increased susceptibility. #### **The mini pill and breast cancer** The established link between [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and breast cancer may [lead](https://nabtahealth.com/glossary/lead/) you to wonder whether using the progestin-only ‘mini pill’ would be a safer option. There have been very few studies on this form of contraception, probably because it is not as widely used as the combined pill (which contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and progestin). The work that has been performed has suggested that women who take the mini pill still have a higher risk of breast cancer than those who have never used oral contraceptives, perhaps by as much as 21%. The link between progestins and breast cancer is poorly understood and likely to be complex. However, it is validated by studies on postmenopausal women who take hormone replacement therapy. Those on combined [oestrogen](https://nabtahealth.com/glossary/oestrogen/) plus progestin therapy have a higher breast cancer risk than those who take just [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Thus, the mini pill is no longer considered a safer contraceptive option for those considered to be high risk for developing breast cancer. #### **Take home message** Women who are considered to be at higher risk of developing breast cancer, for example, those with a family history of the disease, will probably be encouraged to consider alternative forms of contraception. For many other women, the risks are low, becoming negligible once pill use is discontinued, and the benefits of the pill may well outweigh its negatives. To read more about a possible link between pill use and cancer risk click [here](https://nabtahealth.com/will-taking-the-pill-increase-my-risk-of-developing-cancer/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#fd849c91919cbd939c9f899c95989c918995d39e9290) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brynhildsen, Jan. “Combined Hormonal Contraceptives: Prescribing Patterns, Compliance, and Benefits versus Risks.” _Therapeutic Advances in Drug Safety_, vol. 5, no. 5, Oct. 2014, pp. 201–213., doi:10.1177/2042098614548857. * “Does the Contraceptive Pill Increase Cancer Risk?” _Cancer Research UK_, 4 Mar. 2019, [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk](https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk). * Gierisch, J. M., et al. “Oral Contraceptive Use and Risk of Breast, Cervical, Colorectal, and Endometrial Cancers: A Systematic Review.” _Cancer Epidemiology Biomarkers & Prevention_, vol. 22, no. 11, Nov. 2013, pp. 1931–1943., doi:10.1158/1055-9965.epi-13-0298. * Knowlden, Hilary A. “The Pill and Cancer: a Review of the Literature. A Case of Swings and Roundabouts?” _Journal of Advanced Nursing_, vol. 15, no. 9, Sept. 1990, pp. 1016–1020., doi:10.1111/j.1365-2648.1990.tb01981.x. * Li, Li, et al. “Association between Oral Contraceptive Use as a Risk Factor and Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis.” _Molecular and Clinical Oncology_, vol. 7, no. 1, 12 May 2017, pp. 76–80., doi:10.3892/mco.2017.1259. * Mørch, L S, et al. “Contemporary Hormonal Contraception and the Risk of Breast Cancer.” _New England Journal of Medicine_, vol. 377, no. 23, 7 Dec. 2017, pp. 2228–2239., doi:10.1056/NEJMoa1700732. * “Oral Contraceptives (Birth Control Pills) and Cancer Risk.” _National Cancer Institute_, [https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet). * Schairer, Catherine. “Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk.” _Jama_, vol. 283, no. 4, 26 Jan. 2000, pp. 485–491., doi:10.1001/jama.283.4.485. * Soroush, Ali, et al. “The Role of Oral Contraceptive Pills on Increased Risk of Breast Cancer in Iranian Populations: A Meta-Analysis.” _Journal of Cancer Prevention_, vol. 21, no. 4, 30 Dec. 2016, pp. 294–301., doi:10.15430/jcp.2016.21.4.294.
Mention the words breast and lump and most people immediately think of cancer; and certainly it is true, an unusual mass felt in the breast is often the first symptom that a woman who goes on to receive a breast cancer diagnosis will notice. However, it is essential to remember that: 1) Not all breast lumps are cancerous 2) There are other symptoms that can precede a breast cancer diagnosis, so having a good awareness of the way your breasts normally look and feel is essential. #### **1\. Not all breast lumps are cancerous** A newly discovered breast lump should always be examined by a doctor; however, in up to 90% of cases it will not be cancer. There are many things that can cause lumps to form in the breasts. Fibrous tissue can form non-cancerous growths and a build-up of fluid can cause cysts. Lumps can also form during the menstrual cycle, which is why it is so important to understand your own body and self examine your breasts regularly. During pregnancy, your breasts may feel lumpy as the milk glands start to fill with [colostrum](https://nabtahealth.com/glossary/colostrum/) in preparation for your baby’s arrival. Some women also notice more lumps as they approach [menopause](https://nabtahealth.com/glossary/menopause/). There is no absolute rule with regards to how a lump that is cancerous will feel. Often those that are cancer will feel solid and have irregular edges; but some tumorous masses are tender, soft and round. #### **2\. Other symptoms of breast cancer** A study of 2316 women with breast cancer found that 83% of them reported a breast lump as one of the earliest symptoms. However, one in six of the women presented without a noticeable breast lump. In these cases, there were other early warning signs, which, broadly speaking, could be split into two categories: Non-lump breast symptoms – * Nipple abnormalities (becoming sunken or retracted) * Breast pain * Breast skin abnormalities (usually a dimpling that resembles orange peel, or a rash with dry, flaking skin) * Discharge or bleeding from the nipples. Non-breast symptoms – * Swelling of the lymph nodes under the armpit * Fatigue * Weight loss * Back pain. It immediately becomes obvious why without a palpable breast lump, breast cancer diagnosis is often significantly delayed. Many of the symptoms, particularly the non-breast ones, are vague and could be indicative of a number of different conditions. They have low predictive value in terms of diagnosis. One thing to be particularly aware of is new lumps under the armpit. Sometimes the lymph nodes swell before the tumour in the breast is large enough to be felt. It is always advisable to seek medical advice if the lymph nodes become sore or distended. Regarding the other potential symptoms, it would be very easy to panic and assume the worst; remember, many breast-related changes are hormonally-driven; alternatively they may be due to infections or cysts, which are undeniably uncomfortable and inconvenient, but usually relatively harmless. To conclude, try to regularly self examine your breasts, with a view to understanding what your ‘normal’ is. Identify whether your breasts undergo any changes in the run up to, or during your period, and monitor any abnormalities you see or feel. Finally, if you have any concerns at all, see a doctor. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#0871696464694866696a7c69606d69647c60266b6765) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Breast Cancer Signs and Symptoms: Most Common Symptoms.” American Cancer Society, [https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html](https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html). * “Breast Cancer: Symptoms, Diagnosis, Types, and More.” Breastcancer.org, 6 Aug. 2019, [https://www.breastcancer.org/symptoms](https://www.breastcancer.org/symptoms). * “Breast Changes and Conditions.” National Cancer Institute, [https://www.cancer.gov/types/breast/breast-changes](https://www.cancer.gov/types/breast/breast-changes). * Koo, M M, et al. “Typical and Atypical Presenting Symptoms of Breast Cancer and Their Associations with Diagnostic Intervals: Evidence from a National Audit of Cancer Diagnosis.” Cancer Epidemiology, vol. 48, June 2017, pp. 140–146., doi:10.1016/j.canep.2017.04.010. * “Symptoms – Breast Cancer in Women .” NHS Choices, NHS, [https://www.nhs.uk/conditions/breast-cancer/symptoms/](https://www.nhs.uk/conditions/breast-cancer/symptoms/).
Breast cancer mortality rates are falling and, whilst this is unquestionably a good thing, it is important that clinicians and researchers consider the long term quality of life experienced by breast cancer survivors. There are a number of latent disorders that have been shown to appear during or after treatment and if these are left unmanaged they can cause further complications, discomfort and pain. An area of the body that may be neglected during cancer treatment is the mouth, and oral complications can be a significant issue for cancer patients. Following a cancer diagnosis, and prior to commencing treatment, it is recommended that patients undergo a comprehensive dental examination. This way pre-existing conditions, such as residual cysts and partially erupted teeth, can be documented, managed and/or monitored. This lessens the burden of undergoing additional oral procedures once cancer treatment has commenced. During treatment, some of the main oral complications include mucositis ([inflammation](https://nabtahealth.com/glossary/inflammation/) and ulceration of the digestive tract), pain and mouth infections. Oral mucositis has a suspected overall incidence rate of 75-99% and is associated with a broad spectrum of chemotherapeutic agents, including anthracyclines and taxanes, which are both commonly used in breast cancer treatment. Specifically, women with breast cancer who undergo [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) (of any type) have a 4% chance of suffering from severe mucositis. This in turn can [lead](https://nabtahealth.com/glossary/lead/) to an inability, or unwillingness, to eat, causing nutritional deficiencies and weight loss. Thus, minimising the extent of the issue is of considerable importance. Unfortunately, there is no definitive treatment to eliminate oral mucositis and the main focus to date has been on providing symptomatic relief. One way of avoiding complications is to reduce the chance of infection. Ulcerative lesions can render a patient susceptible to bacterial infection. Adopting a meticulous oral hygiene approach, incorporating brushing, with a soft toothbrush, flossing and gentle mouth rinses, can reduce the likelihood of infection. Using a toothpaste that is designed specifically for people undergoing cancer treatment can make keeping on top of your oral hygiene a lot easier. The [Ozalys Essential Care Refreshing Toothpaste with Ginger](../) restores oral hygiene. Its [humectant-rich](../what-is-a-humectant-and-why-is-it-essential-for-cosmetics) blend of ingredients brings soothing relief to a mouth that might otherwise feel dry and uncomfortable. The addition of zingiber officinale (ginger root extract) can also help to alleviate some of the nausea that often accompanies [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) treatment, whilst the soft mint flavour freshens the mouth. **About Ozalys** Ozalys’ products have been designed with women who have been affected by cancer in mind. Ozalys allows women to continue to care for themselves every day using products that innovate through their formulas, optimal absorption and packaging. Ozalys’ specially-formulated solutions are catered for physiological conditions that cause dermal sensitivity, or for the side effects of certain treatments that may result in olfactory and dermal ultra-sensitivity. Ozalys’ personal hygiene, face and body care products have all been developed with the utmost care, minimising preservatives and excluding all substances suspected of being harmful to the body. Their highly soothing, moisturising and protective properties, as well as their delicate application and scent, turn daily beauty routines into moments of well-being and comfort. **Sources:** * Keefe, D M, et al. “Updated Clinical Practice Guidelines for the Prevention and Treatment of Mucositis.” _Cancer_, vol. 109, no. 5, 1 Mar. 2007, pp. 820–831., doi:10.1002/cncr.22484. * Mosel, D D, et al. “Oral Complications in the Treatment of Cancer Patients.” _Oral Diseases_, vol. 17, no. 6, Sept. 2011, pp. 550–559., doi:10.1111/j.1601-0825.2011.01788.x. * Ryan, J L, et al. “Ginger (Zingiber Officinale) Reduces Acute [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/)\-Induced Nausea: A URCC CCOP Study of 576 Patients.” _Support Care Cancer_, vol. 20, no. 7, July 2012, pp. 1479–1489., doi:10.1007/s00520-011-1236-3. * Wong, H M. “Oral Complications and Management Strategies for Patients Undergoing Cancer Therapy.” _The Scientific World Journal_, vol. 2014, no. 581795, 2014, doi:10.1155/2014/581795.
#### What is Glucan? Glucan, which is a component of the cell wall, can be sourced from a range of organisms, including baker’s yeast. It also comes from bacteria, fungus and cereal, with each variant having a different structure and different physiological function. Generally, glucans are modulators of the immune system, activating the cells that are responsible for wound repair. To ensure that it is water soluble, when added to cosmetic products it is in its carboxymethylated (CM-) form. The skin serves an important function, not only in providing a physical barrier against harmful pathogens, but also by playing an active role in the body’s immune response to damaging stimuli. If the skin’s surface is damaged or aggravated, its resident immune cells will respond, triggering a specific mechanism that will help to regulate the healing process. Phagocytes are specialised cells that have the ability to engulf (or phagocytose) harmful agents, such as bacteria. They also help in the resolution of [inflammation](https://nabtahealth.com/glossary/inflammation/), promoting wound repair. As the first point of contact for many infectious agents and irritants, the skin is highly susceptible to damage, and subsequent immune activation. It also serves as a useful visual tool for the identification of underlying health problems. Visit our Nabta shop and get yourself a [sustainable pack](https://nabtahealth.com/product/sustainable-selfcare-starter-pack/) and [multivitamin Booster](https://nabtahealth.com/product/energy-multivitamin-daily-booster/). For a detailed review of conditions that affect the skin, click [here](../conditions-that-cause-dry-skin). #### How does CM-glucan enhance the skin’s naturally occurring immune response? The human immune system is a complex and multi-factorial machine which is activated and inhibited according to the stimuli and stresses that a body undergoes. The ideal condition is one where the body reaches equilibrium after a burst of stimulation. Taking the skin as an example, a balanced immune response must be instigated for equilibrium and adequate tissue repair after injury or infection. As a rule of thumb, bacteria, yeast and viruses activate the part of the immune system which suppresses allergic-like responses. These responses, also known as skin sensitization, happen when the skin is exposed to irritants, resulting in the activation of an alternate immune response, which leads to allergies and hypersensitivity. The most common sign of hypersensitivity is [atopic dermatitis](https://nabtahealth.com/glossary/atopic-dermatitis/), or eczema, which manifests as dry, itchy, uncomfortable skin. Thus, Glucan, as a yeast derivative, plays an important role in rectifying the damage caused by over sensitisation by balancing the immune response and dampening allergy-type reactions. Glucan can also function in a protective role, exhibiting antimicrobial activity and inhibiting the growth of bacteria, such as Staphylococcus aureus, either directly, or via the recruitment of engulfing [macrophages](https://nabtahealth.com/glossary/macrophages/). Those with dry, damaged skin are particularly prone to infections. Glucan is also thought to promote wound repair by enhancing the growth rate of keratinocytes. When the skin is stressed and the immune system is compromised finding suitable cosmetic products can make a big difference. CM-Glucan, which enhances the immune response and improves the skin barrier function, also protects against [free-radical](../how-free-radicals-affect-the-skin) induced damage. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) and ionising radiation, two commonly used cancer treatments, both produce excess free radicals. Using products that contain CM-glucan in advance of undergoing treatment might help to reduce the detrimental effects caused by free radical accumulation. **Sources:** * Boniakowski, A E, et al. “Macrophage-Mediated [Inflammation](https://nabtahealth.com/glossary/inflammation/) in Normal and Diabetic Wound Healing.” _Journal of Immunology_, vol. 199, no. 1, 1 July 2017, pp. 17–24., doi:10.4049/jimmunol.1700223. * Majtan, J, and M Jesenak. “β-Glucans: Multi-Functional Modulator of Wound Healing.” _Molecules_, vol. 23, no. 4, 1 Apr. 2018, p. 806., doi:10.3390/molecules23040806. * Seo, G, et al. “The Wound Healing Effect of Four Types of Beta-Glucan.” _Applied Biological Chemistry_, vol. 62, no. 20, 6 Apr. 2019, doi:10.1186/s13765-019-0428-2. * Wandrey, F, et al. “Rebalancing the Th1 / Th2 Immune Response in Atopic Skin with Magnesium Carboxymethyl Beta-Glucan .” _International Federation of Societies of Cosmetic Chemists_, vol. 18, no. 4, 2015, Available from [https://mibellebiochemistry.com/cm-glucan-forte](https://mibellebiochemistry.com/cm-glucan-forte). * Zulli, F, et al. “Improving Skin Function with CM-Glucan, a Biological Response Modifier from Yeast.” _International Journal of Cosmetic Science_, vol. 20, no. 2, Apr. 1998, pp. 79–86., doi:10.1046/j.1467-2494.1998.171740.x.
During [](../skin-changes-after-chemotherapy)[chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) the skin often becomes inflamed, dry and painful. The protective skin barrier can become compromised, leaving the skin vulnerable to further damage. Using the right products can help to relieve the irritation and discomfort of dry skin, as well as repairing the weakened skin barrier. [Cancer packs](https://nabtahealth.com/product/cancer-care/) are designed to combat some of the physical symptoms of cancer, as well as minimising the damage caused by [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) and [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Each ingredient is carefully selected to provide maximum benefit. One of these ingredients is Pro-Vitamin B5. Also known as panthenol, Pro-Vitamin B5 is a highly effective [humectant](../what-is-a-humectant-and-why-is-it-essential-for-cosmetics), reducing water loss through the skin and, thus, restoring hydration. In addition to functioning as an effective moisturiser, Pro-Vitamin B5 also has regenerative properties. Studies have shown that when the skin barrier is damaged, Pro-Vitamin B5 can accelerate repair and reduce roughness and [inflammation](https://nabtahealth.com/glossary/inflammation/). When applied to the skin, Pro-Vitamin B5 is converted into pantothenic acid, which is a component of the coenzyme A synthesis process. Coenzyme A helps to synthesise the fatty acids and lipids that comprise the outer layer of the skin, the stratum corneum. The [Cancer pack](https://nabtahealth.com/product/cancer-care/) also contains Pro-Vitamin B5. Developed to protect the scalp following [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/)\-induced hair loss, this product also provides soothing relief to dry, painful skin. In addition to Pro-vitamin B5, it contains Aquacacteen and glycerine, which are both highly effective moisturisers. To ensure maximum absorption and effectiveness, the product should be thoroughly massaged into the skin. **Sources:** * Proksch, E, and H P Nissen. “Dexpanthenol Enhances Skin Barrier Repair and Reduces [Inflammation](https://nabtahealth.com/glossary/inflammation/) after Sodium Lauryl Sulphate-Induced Irritation.” The Journal of Dermatological Treatment, vol. 13, no. 4, Dec. 2002, pp. 173–178. * Dunn, C. “Skin Benefits of Pro Vitamin B5.” Livestrong.com, [http://www.livestrong.com/article/32305-skin-benefits-pro-vitamin-b5/](http://www.livestrong.com/article/32305-skin-benefits-pro-vitamin-b5/).
