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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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Notes

The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).

Breast Cancer

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

 

Drug Side-Effects and Interactions

Drugs to Avoid in Women Taking Tamoxifen

Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study (BMJ 2010) “Conclusion Paroxetine use during tamoxifen treatment is associated with an increased risk of death from breast cancer, supporting the hypothesis that paroxetine can reduce or abolish the benefit of tamoxifen in women with breast cancer.”

Effects of Tamoxifen and Exemestane on Cognitive Functioning of Postmenopausal Patients With Breast Cancer: Results From the Neuropsychological Side Study of the Tamoxifen and Exemestane Adjuvant Multinational Trial (Journal of Clinical Oncology 2010)

Drugs

Early Recurrence Risk: Aromatase Inhibitors versus Tamoxifen (Expert Rev Anticancer Ther. 2010)

Aspirin Intake and Survival After Breast Cancer (Journal of Clinical Oncology 2010)

Exercise

Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial. (Arch Phys Med Rehabil. 2010)

Exercise, green tea may lessen breast cancer blues “Although exercise and drinking green tea seemed to lower depression in this group of Chinese women, breast cancer survivors "should not overdose themselves," Shu cautioned in an email to Reuters Health. He noted that excessive exercise and tea drinking may not have the same benefit on mood. Also, further investigations are necessary to clarify these findings since women in other countries, who may undergo different breast cancer treatment regimens, may react differently.”

General Information

Alcohol consumption after breast cancer diagnosis may increase recurrence risk “The study reported an increase in risk of breast cancer recurrence and breast cancer death, but no effect on total mortality, to be associated with consumption of 3 to 4 or more drinks per week when compared with women not drinking following their cancer diagnosis.”

Are breast conservation and mastectomy equally effective in the treatment of young women with early breast cancer? Long-term results of a population-based cohort of 1,451 patients aged =40 years. (Breast Cancer Res Treat. 2010)

Vitamin D deficiency and bone mineral density in postmenopausal women receiving aromatase inhibitors for early breast cancer. (Maturitas. 2010)

New Debate on Breast Removal to Prevent Cancer

Preventive Mastectomy May Not Lower Risks “Removing a breast after the other breast has been treated for breast cancer does not improve the odds that women with two genetic mutations will be free of disease or live longer, new research has found. Women with the mutations -- which affect the genes known as BRCA1 and BRCA2 -- have a much higher risk for developing cancer. Some women choose to have their breasts removed as a preventive measure, called a preventive mastectomy, even without a cancer diagnosis.”

Survival in Metastatic Breast Cancer Patients Is Improving: Targeted Therapies Have Contributed

Most early stage breast cancer patients may not need radiation after mastectomy “Breast cancer patients with early stage disease that has spread to only one lymph node may not benefit from radiation after mastectomy, because of the low present-day risk of recurrence following modern surgery and systemic therapy, a finding that could one day change the course of treatment for thousands of women diagnosed each year, according to researchers at The University of Texas M. D. Anderson Cancer.”

Long waits for radiotherapy linked to increased recurrence of breast cancer “The implication of a continuous relationship between start of radiotherapy and local recurrence is that there is no "safe" threshold in terms of waiting time and that radiotherapy should therefore be started as soon as possible, say the authors. The cost of increasing capacity to ensure uniformly short waiting times could be substantial and would need to be weighed against the small absolute benefit in local recurrence, they add. But, given the known negative impact of local recurrence on overall survival, and the large numbers of women treated with radiotherapy for breast cancer, it seems appropriate to consider whether this is a price we should be prepared to pay, they conclude. Minimising delay improves outcomes, so investment and planning are needed, say Ruth Jack and Lars Holmberg from King's College London, in an accompanying editorial.”

Obesity and weight change in relation to breast cancer survival. (Breast Cancer Res Treat. 2010) “Our study suggests that obesity and weight change after diagnosis are inversely associated with breast cancer prognosis. Weight control is important among women with breast cancer.”

Guidelines

NGC - ACR Appropriateness Criteria® stage I breast carcinoma. (2009)

Preventive Mastectomy in Opposite Breast Boosts Survival Only Slightly “Those most likely to derive a survival benefit, she said, were those younger than 50 who had been diagnosed with early-stage cancers that were estrogen receptor (ER)-negative. ER-negative tumors don't require estrogen to grow, as do ER-positive tumors, and the prognosis is poorer for the ER-negative cancers, according to the American Cancer Society. The study is published online Feb. 25 in the Journal of the National Cancer Institute.”

NCCN Clinical Practice Guidelines in Oncology™ Breast Cancer (2010)

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

Other

Radiation-Chemotherapy

Other Treatments

Experimental

Radiotherapy

Early-Stage Breast Cancer: Short-Term Radiation Therapy Is Successful

Supplements-Vitamins-CAM

Surgery

Transplantation

 

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