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Breast Cancer

Breast Cancer:

Breast cancer is a cancer that starts in the breast, usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormone therapy and chemotherapy), and radiation.[1].

Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted)[2] and the fifth most common cause of cancer death.[3] In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).[3] Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes.

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Click Here to see the image of Chronic Breast Cancer

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File:Mammo breast cancer.jpgSigns and symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the surrounding breast tissue. According to the The Merck Manual, more than 80% of breast cancer cases are discovered when the woman feels a lump.[11] According to the American Cancer Society, the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered bymammogram.[12] Lumps found in lymph nodes located in the armpits[11] can also indicate breast cancer.

Mammograms showing a normal breast (left) and a breast cancer (right).

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain (“mastodynia“) is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.[11][12][13]

When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d’orange.[11]

Another reported symptom complex of breast cancer is Paget’s disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget’s advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget’s also have a lump in the breast.[14]

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.[15] Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are “non-specific”, meaning they can also be manifestations of many other illnesses.[16]

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis andfibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

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Risk factors

The primary risk factors that have been identified are sex,[21] age,[22] lack of childbearing or breastfeeding,[23][24] and higher hormone levels,[25] [26].

In a study published in 1995, well-established risk factors accounted for 47% of cases while only 5% were attributable to hereditary syndromes.[27] In particular, carriers of the breast cancer susceptibility genes,BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs.[28].

In more recent years, research has indicated the impact of diet and other behaviors on breast cancer. These additional risk factors include a high-fat diet,[29] alcohol intake,[30][31] obesity,[32] and environmental factors such as tobacco use, radiation[33]endocrine disruptors and shiftwork.[34] Although the radiation from mammography is a low dose, the cumulative effect can cause cancer.[35] [36]

In addition to the risk factors specified above, demographic and medical risk factors include:

  • Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: A woman’s risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother’s or father’s family) may also increase a woman’s risk.
  • Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
  • Race: Breast cancer is diagnosed more often in Caucasian women than Latina, Asian, or African American women.

Abortion has not been found to be a risk factor for breast cancer. The breast cancer abortion hypothesis, however, continues to be promoted by some pro-life groups.[37][38][39]

The United Kingdom is the member of International Cancer Genome Consortium that is leading efforts to map breast cancer’s complete genome.

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Pathophysiology

Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues. Cells become cancerous when mutations destroy their ability to stop dividing, to attach to other cells and to stay where they belong. When cells divide, their DNA is normally copied with many mistakes. Error-correcting proteins fix those mistakes. The mutations known to cause cancer, such as p53,BRCA1 and BRCA2, occur in the error-correcting mechanisms. These mutations are either inherited or acquired after birth. Presumably, they allow the other mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs.[33][40] Normal cells will commit cell suicide (apoptosis) when they are no longer needed. Until then, they are protected from cell suicide by several protein clusers and pathways. One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently “on”, rendering the cell incapable of committing suicide when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations. Normally, the PTEN protein turns off the PI3K/AKT pathway when the cell is ready for cell suicide. In some breast cancers, the gene for the PTEN protein is mutated, so the PI3K/AKT pathway is stuck in the “on” position, and the cancer cell does not commit suicide.[41]

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Society and culture

The widespread acceptance of second opinions before surgery, less invasive surgical procedures, support groups, and other advances in patient care have stemmed, in part, from the breast cancer advocacy movement.[87]

October is recognized as National Breast Cancer Awareness Month by the media as well as survivors, family and friends of survivors and/or victims of the disease.[88]pink ribbon is worn to recognize the struggle that sufferers face when battling with the cancer.[89]

The patron saint of breast cancer is Agatha of Sicily.[90]

In the fall of 1991, Susan G. Komen for the Cure handed out pink ribbons to participants in its New York City race for breast cancer survivors. [91]

The pink and blue ribbon was designed in 1996 by Nancy Nick, President and Founder of the John W. Nick Foundation to bring awareness that “Men Get Breast Cancer Too!”[92]
In 2009 the male breast cancer advocacy groups Out of the Shadow of Pink, A Man’s Pink and the Brandon Greening Foundation for Breast Cancer in Men joined together to globally establish the third week of October as “Male Breast Cancer Awareness Week”[93]

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See also

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References

  1. ^ “Merck Manual Online, Breast Cancer”.
  2. ^ CancerMath.net Calculates survival with breast cancer based on prognostic factors and treatment. From the Laboratory for Quantitative Medicine, Massachusetts General Hospital.
  3. a b “World Cancer Report”International Agency for Research on Cancer. June 2003. Retrieved 2009-03-26.
  4. a b “Fact sheet No. 297: Cancer”World Health Organization. February 2006. Retrieved 2009-03-26.
  5. ^ “Male Breast Cancer Treatment”National Cancer Institute. 2006. Retrieved 2006-10-16.
  6. ^ “Breast Cancer in Men”. Cancer Research UK. 2007. Retrieved 2007-11-06.
  7. ^ “What Are the Key Statistics About Breast Cancer in Men?”American Cancer Society. September 27, 2007. Retrieved 2008-02-03.
  8. ^ Muss HB, Berry DA, Cirrincione CT, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med. 2009 May 14;360(20):2055-65.
  9. ^ Buchholz TA. N Engl J Med. 2009 Jan 1;360(1):63-70. Radiation therapy for early-stage breast cancer after breast-conserving surgery.
  10. ^ Merck Manual, Professional Edition, Ch. 253, Breast Cancer.

January 27, 2010 - Posted by | Blood, Cancers, Cells, Muscles

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