Breast Cancer

• Breast Cancer Warning Signs
• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Risk Factors
• Risk Reduction
• Treatment

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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."

Types of breast cancer "Common types of breast cancer The most common types of breast cancer begin either in your breast's milk ducts (ductal carcinoma) or in the milk-producing glands (lobular carcinoma). The point of origin is determined by the appearance of the cancer cells under a microscope. In situ breast cancer In situ (noninvasive) breast cancer refers to cancer in which the cells have remained within their place of origin — they haven't spread to breast tissue around the duct or lobule. The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS), which is confined to the lining of the milk ducts. The abnormal cells haven't spread through the duct walls into surrounding breast tissue. With appropriate treatment, DCIS has an excellent prognosis. Invasive breast cancer Invasive (infiltrating) breast cancers spread outside the membrane that lines a duct or lobule, invading the surrounding tissues. The cancer cells can then travel to other parts of your body, such as the lymph nodes. Invasive ductal carcinoma (IDC). IDC accounts for about 70 percent of all breast cancers. The cancer cells form in the lining of your milk duct, then break through the ductal wall and invade nearby breast tissue. The cancer cells may remain localized — staying near the site of origin — or spread (metastasize) throughout your body, carried by your bloodstream or lymphatic system. Invasive lobular carcinoma (ILC). Although less common than IDC, this type of breast cancer invades in a similar way, starting in the milk-producing lobules and then breaking into the surrounding breast tissue. ILC can also spread to more distant parts of your body. With this type of cancer, you typically won't feel a distinct, firm lump but rather a fullness or area of thickening."

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

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Safety profiles of aromatase inhibitors and selective estrogen-receptor modulators in the treatment of early breast cancer. (Int J Clin Oncol. 2008)

Aromatase inhibitor-associated bone loss in breast cancer patients is distinct from postmenopausal osteoporosis. (Crit Rev Oncol Hematol. 2008)

Taxanes May Increase Risk for Significant Psychological Symptoms

Anastrozole Associated With Joint Symptoms in Patients With Breast Cancer

Trastuzumab-induced cardiomyopathy. (J Card Fail. 2008)

The risk of developing uterine sarcoma after tamoxifen use. (Int J Gynecol Cancer. 2008)

Drugs

Tamoxifen for early breast cancer. (Cochrane Database Syst Rev. 2008)

Efficacy and safety of aromatase inhibitors in early breast cancer. (Expert Opin Drug Saf. 2008)

Extending the benefits of adjuvant therapy in early HR+ breast cancer. (Breast Cancer Res Treat. 2008)

HER-2 Improves Survival in Patients With Breast Cancer Brain Metastasis “The researchers note that overall survival was modestly improved compared with that of historical controls from the 1980s and 1990s, suggesting an improvement in treatment. However, the team concludes that better treatments are still needed, as more than half of the patients in their study died of CNS disease progression. “

Zoledronic Acid Improves Early Breast Cancer Treatment

Bone drug Zometa helps fight breast cancer spread

Reducing early recurrence with adjuvant aromatase inhibitors: What is the evidence? (Breast. 2008)

Taxane Combinations Marginally Better Than Anthracyclines for Metastatic Breast Cancer

Paclitaxel Versus Docetaxel for Early Breast Cancer

Weekly paclitaxel in the adjuvant treatment of breast cancer. (N Engl J Med. 2008) “CONCLUSIONS: Weekly paclitaxel after standard adjuvant chemotherapy with doxorubicin and cyclophosphamide improves disease-free and overall survival in women with breast cancer.”

Weekly Doses of Taxol Prolonged Lives of Breast Cancer Patients “Women who take the drug Taxol weekly after receiving chemotherapy for 12 weeks live longer and live longer without a recurrence of their breast cancer, compared to women who take four taxol treatments every three weeks. The study also evaluated another drug in the same family, called Taxotere (docetaxel), but found that weekly Taxol (paclitaxel) was more effective. "The findings suggest that weekly Taxol for 12 weeks is more effective than four cycles of Taxol and should be considered a new standard," said study author Dr. Joseph A. Sparano. The findings are detailed in the April 17 issue of the New England Journal of Medicine. Prior to this study, four cycles of Taxol was considered the standard, although many oncologists were administering the drug weekly.“

Aromatase inhibitors in the management of early breast cancer. (Eur J Surg Oncol. 2008)

New Trastuzumab Regimen for Early-Stage Breast Cancer Appears to Have Low Rate of Cardiotoxicity

Optimizing Adjuvant Treatment for High-Risk Early Breast Cancer: An Expert Interview With Dr. Clifford Hudis

Adjuvant therapy for premenopausal patients with early breast cancer. (Curr Opin Obstet Gynecol. 2008)

Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. (Lancet. 2008)

Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials. (J Clin Oncol. 2008)

Exercise

Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. (Oncol Nurs Forum. 2008)

Effect of exercise on the caloric intake of breast cancer patients undergoing treatment. (Braz J Med Biol Res. 2008)

Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. (Yonsei Med J. 2008)

Physical Activity and Survival after Diagnosis of Invasive Breast Cancer. (Cancer Epidemiol Biomarkers Prev. 2008) "This study provides support for reduced overall mortality and mortality from breast cancer among women who engage in physical activity after breast cancer diagnosis."

General Information

Trying to Prevent Lymphedema After Breast Cancer “Hospitals in about a dozen states are testing whether some simple steps, such as arm-strengthening exercises, could reduce the risk of one of breast cancer's troubling legacies -- the painful and sometimes severe arm swelling called lymphedema. Lymphedema has long been a neglected side effect of cancer surgery and radiation: Many women say they never were warned, even though spotting this problem early improves outcomes. … When lymph nodes under a breast cancer patient's arm are removed or damaged by biopsy, surgery or radiation, lymph fluid can build up and cause anything from mild swelling to a ballooning of the arm.”

When Breast Cancer Treatment Ends: Helping Survivors Stay Healthy (Medscape Hematology-Oncology. 2008)

Certain chemotherapy combinations work best “Greek researchers have identified the chemotherapy combinations that appear to help women with advanced breast cancer live longest, they reported Tuesday. Women who took a combination of a taxane-based therapy such as Taxol or paclitaxel, or Sanofi Aventis's Taxotere, known generically as docetaxel, with other drugs lived a year longer than women who did not get chemotherapy. Women given either a single taxane drug or a combination that included an anthracycline such as Adriamycin with older chemotherapy drugs lived an extra eight months compared to untreated women, said John Ioannidis of the University of Ioannina School of Medicine in Greece.“

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.”

Esophageal metastasis of breast carcinoma. (Breast Cancer. 2008)

Premenopausal endocrine-responsive early breast cancer: who receives chemotherapy? (Annals of Oncology 2008) “Conclusions: The perceived estimation of increased risk of relapse is the primary determinant for using chemotherapy despite uncertainties regarding the degree of benefit it offers when added to combined endocrine therapy in this population.”

Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. (J Clin Oncol. 2008) "CONCLUSION: PMRT after a diagnosis of BC sharply increased the risk of second primary LC, especially in the ipsilateral lung, among ever-smokers. Clinicians should consider including smoking history in their discussions with patients about the risks and benefits of PMRT."

Outcome of HER-2-Positive Breast Cancer Tied to Hormone Receptor Status "HER-2-positive, hormone receptor-negative breast cancer patients have a high risk of failure after chemotherapy, and the most common site of cancer recurrence after treatment failure is the brain, Mayo Clinic researchers reported at the San Antonio Breast Cancer Symposium. Breast cancers that are estrogen-receptor and progesterone-receptor negative are associated with the worst outcomes, and require aggressive treatment right from the time of diagnosis, Dr. Laura Vallow of the Mayo Clinic in Rochester, Minnesota, told Reuters Health."

American women are more likely to choose overly aggressive treatments for breast cancer "Despite a 1990 consensus recommendation from the National Institutes of Health (NIH) that lumpectomy plus radiation was the treatment of choice for early stage breast cancer, the United States continues to have the highest rate of mastectomy surgery among industrialized countries. Why would a person knowingly undertake a far more severe form of treatment when a lesser one would suffice? A recent survey shows that only 74 percent of women diagnosed with early stage breast cancer (ductal carcinoma in situ or DCIS) chose breast-conserving surgery - even though 82 percent of their physicians had recommended the procedure. . The researchers suggest that increased efforts in education and intervention alone will not be enough to offset these implicit cultural biases. In order to understand why patients often choose difficult and expensive treatments that may not necessarily yield improvements in their quality of life or odds of survival, they reveal that we must also consider the deeply entrenched illness narratives that frame patient's interpretations of medical and risk information."

Guidelines

NGC - The role of aromatase inhibitors in adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: guideline recommendations. (2008)

NCCN Clinical Practice Guidelines in Oncology: Breast Cancer (2008)

New Guidelines Offer Distinct Algorithm for Inflammatory Breast Cancer

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

National Comprehensive Cancer Network

NCI - Breast Cancer (PDQ®): Treatment

NCI - Dictionary of Cancer Terms

NCI - Drug Dictionary

NCI - Overview of Nutrition in Cancer Care

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Dietary isoflavone intake and breast cancer risk in case-control studies in Japanese, Japanese Brazilians, and non-Japanese Brazilians. (Breast Cancer Res Treat. 2008)

Green Tea Ingredient Slows Breast Cancer: Antioxidant in Green Tea May Stop Breast Cancer Growth

Other

Radiation-Chemotherapy

Other Treatments

Experimental

New Anti-cancer Components Of Extra-virgin Olive Oil Revealed “Good quality extra-virgin olive oil contains health-relevant chemicals, ‘phytochemicals’, that can trigger cancer cell death. New research sheds more light on the suspected association between olive oil-rich Mediterranean diets and reductions in breast cancer risk. … Extra-virgin olive oil is the oil that results from pressing olives without the use of heat or chemical treatments. It contains phytochemicals that are otherwise lost in the refining process. Menendez and colleagues separated the oil into fractions and tested these against breast cancer cells in lab experiments. All the fractions containing the major extra-virgin phytochemical polyphenols (lignans and secoiridoids) were found to effectively inhibit HER2. Although these findings provide new insights on the mechanisms by which good quality oil, i.e. polyphenol-rich extra-virgin olive oil, might contribute to a lowering of breast cancer risk in a HER2-dependent manner, extreme caution must be applied when applying the lab results to the human situation. As the authors point out, “The active phytochemicals (i.e. lignans and secoiridoids) exhibited tumoricidal effects against cultured breast cancer cells at concentrations that are unlikely to be achieved in real life by consuming olive oil”.“

Radiotherapy

Some Breast Cancer Patients Facing Radiation After A Mastectomy May Be Over-Treated “A new study suggests standard radiation therapy for some breast cancer patients may not be medically required and may, therefore, be causing unnecessary serious side effects such as lymphedema and pulmonary problems. The research conducted at Fox Chase Cancer Center involved women who got a mastectomy, but whose lymph nodes were negative.”

Long-term Outcomes of IMRT for Breast Cancer: A Single-Institution Cohort Analysis. (Int J Radiat Oncol Biol Phys. 2008)

Supplements-Vitamins-CAM

Vitamin D insufficiency in a multiethnic cohort of breast cancer survivors (American Journal of Clinical Nutrition 2008) “Conclusions: In these breast cancer survivors, the prevalence of vitamin D insufficiency was high. Clinicians might consider monitoring vitamin D status in breast cancer patients, together with appropriate treatments, if necessary.”

Surgery

Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol. (Acta Oncol. 2008)

Transplantation

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