Saturday, April 7, 2012

Breast Cancer

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Cancers are a group of diseases that cause cells in the body to change and grow out of control. Most types of cancer cells form a lump or mass called a tumor, and are named after the part of the body where the tumor first starts. Breast cancer begins in breast tissue, which is made up of glands for milk production, called lobules, and the ducts that connect lobules to the nipple. The remainder of the breast is made up of fatty, connective, and lymphatic tissue. Most types of tumors that form in the breast are benign; that is, they are not cancer at all. Benign breast tumors are abnormal growths, but they do not grow and spread like cancer does, and are not life threatening. Some breast tumors are cancerous, but are called in situ, because they have not spread beyond the area where they began. In situ breast cancers are confined within the ducts or lobules of the breast. Excluding cancers of the skin, breast cancer is the most common cancer among women, accounting for nearly one of every three cancers diagnosed in American women.


In 001, approximately 1,00 new cases of invasive breast cancer were diagnosed among women, as were nearly 47,100 additional cases of in situ breast cancer. Also in 001, 40,00 women died from this disease . Only lung cancer accounts for more cancer deaths in women. About 1,500 cases and 400 deaths from breast cancer were among men in 001, accounting for about 1% of all breast cancers. Even though men are at low risk of developing breast cancer, they should be aware of risk factors, especially family history, and report any change in their breasts to a physician. The incidence and death rates from breast cancer increase with age. Seventy-seven percent of new cases and 84% of breast cancer deaths reported between 14-18 occur in women ages 50 and older. After age 40, white women are more likely to be diagnosed with breast cancer than black women. With the exception of black women between the ages of 0-4, black women under age 40 have a slightly higher incidence than white women. Black women are more likely to die from breast cancer than are white women.


A number of factors consistently associated with increased risk of breast cancer such as age, family history, age at first birth, early menarche, late menopause are not modifiable. Other factors such as alcohol consumption, use of post menopausal hormones, and obesity after menopause are modifiable. Some factors directly increase lifetime exposure of breast tissue to circulating sex hormones (early menarche, late menopause). At present, there is no scientific evidence that shows an association between either underwire bras or antiperspirants and breast cancer. Besides being female, age is a womans single most important risk factor for developing breast cancer. Currently, a woman living in the United States has a 1.5%, or a 1 in 8, lifetime risk of developing breast cancer. However, a large portion of the overall lifetime risk is due to the risks at older ages. Women with a family history of breast cancer, especially in a first-degree relative (mother, sister, or daughter), have an increased risk of developing breast cancer themselves. The risk is even higher if more than one first degree relative had breast cancer, or if the relative developed breast cancer at an early age, or in both breasts. Studies suggest that reproductive hormones influence breast cancer risk through effects on cell proliferation and DNA damage, as well as promotion of cancer growth. Early menarche, late menopause, late age at first full-term pregnancy, and fewer pregnancies all increase a womans risk of breast cancer by affecting endogenous reproductive hormones.


At this time, there is no known strategy to eliminate all risk of breast cancer. A womans best strategy, besides early detection through mammography, is to reduce her known risk factors whenever possible, by increasing physical activity, minimizing alcohol intake, and avoiding obesity. Also, recent clinical research has provided important information on ways that women at very high risk can further reduce their risk of breast cancer using the antiestrogen drug tamoxifen. The most important physical symptom of breast cancer is a painless mass. Up to 10% of patients, however, have breast pain and no mass. Less common symptoms include persistent changes to the breast, such as thickening, swelling, skin irritation or distortion, and nipple symptoms, including spontaneous discharge, erosion, inversion, or tenderness. Early breast cancer, when it is most treatable, typically does not produce any symptoms. It is, therefore, very important for women to follow recommended guidelines for finding breast cancer


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before symptoms develop. Early detection of breast cancer greatly improves the treatment options, the chances for successful treatment, and survival. American Cancer Society guidelines for the early detection of breast cancer change with age and include mammography, clinical breast examination (CBE), and breast self-examination (BSE). These guidelines are for women with no symptoms of breast cancer who have not been identified to be at significantly higher risk.


Mammography is the best method available for diagnosing breast cancer at a stage when it can be most effectively treated, since it can identify cancer several years before physical symptoms develop. Participating in mammography screening can provide peace of mind for women, since the large majority of women who are screened do not have breast cancer, and when cancer is discovered, it is found earlier, when treatments can be more successful. Mammography is a low-dose x-ray procedure that allows visualization of the internal structure of the breast. Mammography is highly accurate, but like most medical tests, it is not perfect. On average, mammography will detect about 0% of the breast cancers in women without symptoms, and it is somewhat more accurate in post menopausal women compared with pre menopausal women. The small percentage of breast cancers that are not identified by mammography may be missed for any one of the following circumstances breast density, faster growth rate, or simply failing to see the small, early signs of an abnormality. Although the overwhelming majority of women who undergo screening each year do not have breast cancer, it is common 5%-10% for women to have their mammograms interpreted as abnormal or inconclusive until further tests can be done. In most instances, additional imaging tests lead to a final normal interpretation.


A clinical examination performed by a trained health care professional offers substantial benefit in screening for breast cancer and should be performed in combination with mammography. Women should schedule their CBE to occur near the time, and before, their annual mammogram. For this examination, the woman undresses from the waist up. Using the pads of the fingers, the examiner will gently feel the breasts, giving special attention to their shape and texture, location of any lumps, and whether such lumps are attached to the skin or to deeper tissues. The area under both arms will also be examined.


A woman performs breast self exam, (BSE) in much the same way that a health care professional performs a clinical examination. A woman should do BSE monthly to become familiar with both the appearance and feel of her breasts so that she is aware of any change. Lumps are not necessarily abnormal, as they can come and go with a womans menstrual cycle. Of lumps detected and tested, the large majority is found not to be cancerous. If you are a menstruating woman with regular cycles, its best to conduct the BSE the week (-5 days) after your period ends, because thats the point in your cycle when your breasts will be the least tender. During the first part of the BSE, the visual examination, you are looking for changes in each breast. So if your breasts have always been mushy, thats not a concern unless this is a new change. The changes you are looking for include, shape, size, contour or symmetry, skin discoloration or dimpling, bumps/lumps, sores or scaly skin, discharge or puckering of the nipple. Stand in front of a mirror and look for these changes in your breasts, from both a frontal and profile view in different positions with your arms up behind your head, with your arms down at your sides, bending forward with your hands on your hips and shoulders turned in, and with your arms relaxed hanging in front of you.


The first thing you have to do is pick a pattern. For the BSE, you need to pick a pattern to feel your breasts and surrounding areas, which include the breast itself, between the breast and underarm, the underarm itself, the area above the breast up to the collarbone and across to your shoulder. It is important to check surrounding areas because breast cancer may be found in the lymph node tissue around your breast and underarm. You use the pads of your three middle fingers on your right hand pressed together flat to check your left breast, and do the opposite for the right breast. You should press on your breast with varying degrees of pressure light (move the skin without moving the tissue underneath), medium (midway into the tissue), hard (down to the ribs). When using any of the patterns, you should always be using a circular rubbing motion without lifting up your fingers. Once youve performed the tactile examination while standing up in front of a mirror, you should do the whole examination again, this time while lying down. Heres how to do so, put your left arm behind your head and use your right hand to examine your left breast, put a small pillow or towel under your left shoulder to aid you. Again, use the pads of your fingers of your right hand to check your left breast in the pattern of your choice of spiral, pie shape wedges, or up and down. Be sure to always use the same pattern, because its the best way to know if there are changes. And again, dont forget to feel your breast using light, medium, and hard pressure. After youre finished, you must repeat the procedure again for your right breast.


Treatment decisions are made by the patient and her physician, after consideration of the optimal treatment for the stage of cancer, the patients age and preferences, and the risks and benefits ascribed to each treatment protocol. Most women with breast cancer will have some type of surgery. Surgery is often combined with other treatments such as radiation therapy, chemotherapy, hormone therapy and/or monoclonal antibody therapy.


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