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Breast Cancer

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Breast Cancer

NIH - Medical Encyclopedia Breast cancer "There are several different types of breast cancer. Ductal carcinoma begins in the cells lining the ducts that bring milk to the nipple and accounts for more than 75% of breast cancers. Lobular carcinoma begins in the milk-secreting glands of the breast but is otherwise fairly similar in its behavior to ductal carcinoma. Other varieties of breast cancer can arise from the skin, fat, connective tissues, and other cells present in the breast. … Some women have what is known as HER2-positive breast cancer. HER2, short for human epidermal growth factor receptor-2, is a gene that helps control cell growth, division, and repair. When cells have too many copies of this gene, cell growth speeds up. It’s believed that HER2 plays a key role in turning healthy cells into cancerous ones. Some women with breast cancer have too much HER2, and are therefore considered HER2-positive. … Some families appear to have a genetic tendency for breast cancer. Two variant genes have been found that appear to account for this: BRCA1 and BRCA2. … The body's reduced ability to get rid of abnormal cells leads to damage that gradually accumulates. Women carrying mutated BRCA1 and/or BRCA2 genes start with pre-existing dysfunction of this system and have a "head start" in this damaging process. Hormones are important because they encourage cell growth. High levels of hormones during a woman's reproductive years, especially when they are not interrupted by the hormonal changes of pregnancy, appear to increase the chances that genetically damaged cells will grow and cause cancer."

Breast lumps: Types of lumps and what they mean "Causes Breast lump causes: Breast cancer Breast cyst Fibroadenoma Fibrocystic changes Hamartoma Injury or trauma to the breast Intraductal papilloma Lipoma Mastitis Milk cyst (galactocele) Phyllodes tumor. "

NIH – Breast Cancer “Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include • Age - the chance of getting breast cancer rises as a woman gets older • Genes - there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested. • Personal factors - beginning periods before age 12 or going through menopause after age 55 Other risks include being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts. Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy. “

NHS – Breast Cancer “Types of breast cancer: There are several different types of breast cancer, which can develop in different parts of the breast. The most common is known as ductal breast cancer, which develops in the cells that line the breast ducts. Ductal breast cancer accounts for about 80% of all cases of breast cancer. Other, less common types of breast cancer include lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer, and Paget's disease of the breast. It is possible for breast cancer to spread to other parts of the body, such as the liver, bones, or lymph nodes (small glands that filter bacteria from the body). … Symptoms: The main symptom of breast cancer is usually a lump, or thickened area of tissue, in your breast. The majority of breast lumps are found by the women who have them, and it is very important that you are aware of any lumps, or changes in the appearance, feel, or shape of your breasts. This is important because the sooner a cancerous lump is detected, the better the chances are that it will be treated successfully. Changes to look out for You should see your GP if you notice any of the following: • a lump, or thickened area of tissue, in either breast, • discharge from either of your nipples (which may be streaked with blood), • a lump or swelling in either of your armpits,a change in the size, or shape, of one, or both, of your breasts, • dimpling on the skin of your breasts, • a rash on, or around, your nipple,a change in the appearance of your nipple, such as becoming sunken into your breast, or • pain in either of your breasts or armpits which is not related to your period. If you have a lump in your breast, it is important to remember that it may not be the result of breast cancer. In fact, 90% of breast lumps are benign (non-cancerous). For example, a breast lump may be caused by a harmless cyst (a small fluid-filled lump), or fibroadenoma (benign growths that are very common). You may also find that your breasts feel lumpy just before your period. However, if you notice any changes to one, or both, of your breasts, as listed above, you should always get it checked by your GP. “

NHS – Breast Cancer Expert (Video)

NHS – Breast Cancer Screening (Video)

Highlighted Articles

Primary tumor location impacts breast cancer survival. (Am J Surg. 2008) “CONCLUSIONS: Upper-outer quadrant breast cancers have a more favorable survival advantage when compared with tumors in other locations. Factors that negatively impacted survival included high-grade tumors, advanced stage, and race.”

Adulthood Lifetime Physical Activity and Breast Cancer. (Epidemiology. 2008) “Women who increased their recreational activity in their 50s had significantly reduced risk, with those in the highest tertile of change being at a 27% lower risk. CONCLUSIONS:: Leisure-time moderate-to-vigorous activities reduce breast cancer risk irrespective of underlying host characteristics.”

Cruciferous vegetables, the GSTP1 Ile105Val genetic polymorphism, and breast cancer risk. (Am J Clin Nutr. 2008) “CONCLUSIONS: Cruciferous vegetable intake consistent with high isothiocyanate exposure may reduce breast cancer risk. Cruciferous vegetable intake also may ameliorate the effects of the GSTP1 genotype.”

Breast Cancer: Benign Breast Lumps (2007) “Eighty percent of all breast lumps are benign, which means they're not cancerous. Benign breast lumps usually have smooth edges and can be moved slightly when you push against them. They are often found in both breasts.

Mammographic Breast Density as a General Marker of Breast Cancer Risk (Cancer Epidemiology Biomarkers & Prevention 2007) "Overall mammographic density seems to represent a general marker of breast cancer risk that is not specific to breast side or location of the eventual cancer."

Lifetime physical activity and the risk of breast cancer: A case-control study. (Cancer Detect Prev. 2007) "Conclusions: These data are in concordance with the hypothesis that lifetime total physical activity is associated with decreased breast cancer risk. They also suggest that recreational physical activity at ages 14-20 years is the most beneficial. In addition, these findings confirm the majority of previous reports which implicated physical inactivity as important risk factor for breast cancer."

Highlighted Internet Sites

NCI - Breast Cancer

NCI – What You Need To Know About Breast Cancer

NCI - Characteristics of Breast Cancer Cases (graphic data)

NIH – Breast Cancer

NCI - Breast Cancer (PDQ®): Prevention

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Breast Cancer

Diagnosis, Imaging, and Screening

NEWS:

A Better Way to Detect Breast Cancer?

Accuracy of mammography varies by facility “New research suggests that the correct interpretation of mammography results varies between facilities. Moreover, there are characteristics that predict which facilities are likely to provide more accurate readings. The findings from a number of studies have indicated that the accuracy varies greatly among radiologists. "What's unique about this study is that we looked at variation in mammography interpretations across facilities where mammography is performed," lead author Dr. Stephen Taplin, from the National Institutes of Health in Bethesda, Maryland, told Reuters Health. In the study, reported in the Journal of the National Cancer Institute, significant variation in specificity, the number of women testing negative for cancer; positive predictive value, the number with positive results who were actually positive; and the likelihood of cancer among women referred for biopsy; was noted between facilities. “

Can Breast MRI Help Evaluate Cancer?

Faster Tumor Growth Rate Proof Younger Women Need Yearly Mammograms

Ladies, give your breasts a rest, research says: Permission to skip self-exams a relief for some, perplexing for others

Mammogram most effective 12 months after radiation treatment “Breast cancer patients who receive breast-conserving therapy and radiation do not need a follow-up mammogram until 12 months after radiation, despite current American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines that recommend follow-up mammograms at between six and 12 months after radiation, according to a November 15 study in the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.”

Mammograms Should Continue Up to Age 75 Years, and 3-Year Intervals Are Sufficient

Media Coverage About Breast Self-Exam Misleading, Say Experts “ “"The news stories seem to suggest that this is the final word on breast self-exam, and that the practice is ineffective or even harmful," said Dr. Goldstein, senior scientist and chairman of the board at MammaCare, in Gainesville, Florida. "And that's not the case at all." … The American College of Obstetricians and Gynecologists has kept BSE in its most recent breast cancer screening guidelines. "Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended," the guidelines state. Several advocacy groups also continue to recommend BSE, including San Francisco–based Breast Cancer Action, which states that annual clinical breast exams by trained health professionals and breast self-exams are essential aspects of breast cancer screening. Our Bodies Ourselves, also known as the Boston Women’s Health Book Collective, a nonprofit public-interest women’s health education and advocacy organization, points out that BSE is rarely used as a sole screening method, is generally combined with clinical breast exam and mammography, and is the only detection method that women have control over with their own 2 hands. Most breast cancers are palpable and are usually discovered by the women themselves, Drs. Goldstein and Pennypacker note. When the biomedical research team at the University of Florida and MammaCare were first investigating optimal palpation procedures, they found that skill training using tactually accurate breast models with small simulated lesions enabled women and healthcare practitioners to reliably detect 3 mm breast lesions, which is 10 times smaller than the average lesion found by accident. "Published evidence documents that a large proportion of breast cancers are palpable and self-detected, that some breast cancers are mammographically invisible, that the components of effective breast self-examination are now known and validated, that the skill can be learned, and that women who learn and practice proficient breast examination possess an advantage in protecting their health and their life," they write.”

MRI Highly Sensitive in Breast Cancer Detection “Pooled data from numerous studies indicate that contrast-enhanced magnetic resonance (MR) imaging has a high specificity in detection of breast cancer in patients with breast lesions, Dutch researchers report in the January issue of Radiology. However, lead investigator Dr. Nicky H. G. M. Peters told Reuters Health that "MR mammography can improve diagnosis and treatment of patients with breast cancer, but biopsy remains necessary to definitively characterize lesions.” “

Report from ASCO: Studies reveal pros and cons of breast MRI “MRI's changing status as an instrument for breast cancer diagnosis and evaluation was apparent last month at the 2008 American Society of Clinical Oncology meeting. One study suggested that MR's growing popularity for treatment planning may had led to more mastectomies, and another trial added to growing evidence about its ability to identify metastatic lymph nodes. The mastectomy findings arose from Fox Chase Cancer Center in Philadelphia. Lead author Dr. Richard Bleicher, codirector of Fox Chase's breast surgery fellowship program, reported that women who received an MRI had an 80% higher chance of having a mastectomy rather than a breast-conserving lumpectomy. The findings were drawn from the medical records of 577 breast cancer patients, 130 of whom had MRIs prior to treatment. Bleicher believes the high number of false-positive findings associated with MRI may be leading to unnecessary breast removal. “

Using Breast Density to Predict Breast Cancer Risk

Regular self-examination or clinical examination for early detection of breast cancer (Cochrane Reviews 2008)

ARTICLES:

Breast Self Exam Tool

Is it breast cancer? Procedures to evaluate breast lumps

Slide show: Stages of breast cancer

JOURNAL ARTICLES:

Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer (JAMA 2008)

Defining the clinical diagnosis of inflammatory breast cancer. (Semin Oncol. 2008)

How many sentinel lymph nodes are enough during sentinel lymph node dissection for breast cancer? (Cancer. 2008) “CONCLUSIONS.: In general, the removal of a maximum of 5 SLNs at surgery allowed for the recovery of >99% of positive SLNs in patients with breast cancer. The current findings indicated that tumor histology, patient race, and tumor size and location may influence this number.”

Molecular breast imaging: A review of the Mayo Clinic experience. (Am J Surg. 2008)

Physical activity and mammographic breast density in a Mediterranean population: The EPIC Florence longitudinal study. (Int J Cancer. 2008)

Staging procedures in primary breast cancer. (Anticancer Res. 2008)

 

 

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