Breast Cancer Classification and external resources
Histopathologic image from ductal cell carcinoma in situ (DCIS) of breast. Hematoxylin-eosin stain.
ICD-10	C50.
ICD-9	174-175
OMIM	114480
DiseasesDB	1598
MedlinePlus	000913
eMedicine	med/2808
MeSH	D001943

Typical macroscopic (gross examination) appearance of the cut surface of a mastectomy specimen containing a cancer (in this case, an invasive ductal carcinoma of the breast, pale area at the center). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Gross examination or "grossing" is the process by which Pathology specimens are inspected with the naked eye to obtain diagnostic information while being In Medicine, mastectomy is the medical term for the surgical removal of one or both Breasts partially or completely

Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma). In Medicine, mastectomy is the medical term for the surgical removal of one or both Breasts partially or completely

Breast cancer is a cancer that starts in the cells of the breast. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled The cell is the structural and functional unit of all known living Organisms It is the smallest unit of an organism that is classified as living and is often called The breast is the upper Ventral region of an animal’s Torso, particularly that of Mammals including Human beings. ^[1] Worldwide, breast cancer is the second most common type of cancer after lung cancer (10. Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung. 4% of all cancer incidence, both sexes counted)^[2] and the fifth most common cause of cancer death. ^[3] Worldwide, breast cancer is by far the most common cancer amongst women, with an incidence rate more than twice that of colorectal cancer and cervical cancer and about three times that of lung cancer. However breast cancer mortality worldwide is just 25% greater than that of lung cancer in women. ^[2] In 2005, breast cancer caused 502,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). ^[3] The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world. ^[4][5]

The incidence of breast cancer varies greatly around the world, being lower in less-developed countries and greatest in the more-developed countries. In the twelve world regions, the annual age-standardised incidence rates per 100,000 women are as follows: in Eastern Asia, 18; South Central Asia, 22; sub-Saharan Africa, 22; South-Eastern Asia, 26; North Africa and Western Asia, 28; South and Central America, 42; Eastern Europe, 49; Southern Europe, 56; Northern Europe, 73; Oceania, 74; Western Europe, 78; and in North America, 90. ^[6]

Women in the United States have the highest incidence rates of breast cancer in the world; 141 among white women and 122 among African American women. ^[7][8] Among women in the US, breast cancer is the most common cancer and the second-most common cause of cancer death (after lung cancer). ^[8] Women in the US have a 1 in 8 (12. 5%) lifetime chance of developing invasive breast cancer and a 1 in 35 (3%) chance of breast cancer causing their death. ^[8] In 2007, breast cancer was expected to cause 40,910 deaths in the US (7% of cancer deaths; almost 2% of all deaths). ^[9]

In the US, both incidence and death rates for breast cancer have been declining in the last few years. ^[10][9] Nevertheless, a US study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease,^[11] even though heart disease is a much more common cause of death among women. The Society for Women’s Health Research ( SWHR) is a non-profit organization in the United States whose mission is to improve the health of all women through research education Heart disease is an Umbrella term for a variety for different diseases affecting the Heart. ^[12]

Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males. ^[13][14] Incidences of breast cancer in men are approximately 100 times less common than in women, but men with breast cancer are considered to have the same statistical survival rates as women. ^[15]

Classification

Breast cancers are described along four different classification schemes, or groups, each based on different criteria and serving a different purpose:

• Pathology - A pathologist will categorize each tumor based on its histological (microscopic anatomy) appearance and other criteria. Pathology (from Greek grc πάθος pathos, "fate harm" and grc -λογία -logia) is the study and Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and The most common pathologic types of breast cancer are invasive ductal carcinoma, malignant cancer in the breast's ducts, and invasive lobular carcinoma, malignant cancer in the breast's lobules. Malignant (from the Latin roots mal- = "bad" and -genus = "born" is a medical term used to describe a severe and progressively worsening disease In Anatomy and Physiology, a duct is a circumscribed channel leading from an Exocrine gland or organ. In Anatomy, a lobe is a clear anatomical division or extension that can be determined without the use of a Microscope (at the Gross anatomy level
• Grade of tumor - The histological grade of a tumor is determined by a pathologist under a microscope. The Bloom-Richardson grade (BR grade is a a histologic grade assigned by Pathologists to Breast cancers It is the most common type of cancer grade system See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic A well-differentiated (low grade) tumor resembles normal tissue. A poorly differentiated (high grade) tumor is composed of disorganized cells and, therefore, does not look like normal tissue. Moderately differentiated (intermediate grade) tumors are somewhere in between.
• Protein & gene expression status - Currently, all breast cancers should be tested for expression, or detectable effect, of the estrogen receptor (ER), progesterone receptor (PR) and HER2/neu proteins. Protein expression is a subcomponent of Gene expression. It consists of the stages after DNA has been translated into Amino acid chains which are ultimately folded Gene expression is the process by which inheritable information from a Gene, such as the DNA sequence, is made into a functional Gene product, such The estrogen receptor (ER is a member of the nuclear hormone family of Intracellular receptors which is activated by the Hormone 17β-estradiol The progesterone receptor ( PR) also known as NR3C3 ( Nuclear receptor subfamily 3 group C member 3 is an intracellular Steroid receptor that HER2/neu (also known as ErbB-2) stands for "Human Epidermal growth factor Receptor 2" and is a protein giving higher aggressiveness in Breast cancers It is a These tests are usually done by immunohistochemistry and are presented in a pathologist's report. Immunohistochemistry or IHC refers to the process of localizing proteins in cells of a tissue section exploiting the principle of antibodies binding specifically The profile of expression of a given tumor helps predict its prognosis, or outlook, and helps an oncologist choose the most appropriate treatment. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the Oncology is the branch of medicine that studies Tumors ( Cancer) and seeks to understand their development diagnosis treatment and prevention More genes and/or proteins may be tested in the future.
• Stage of a tumor - The currently accepted staging scheme for breast cancer is the TNM classification. The TNM Classification of Malignant Tumours ( TNM) is a Cancer staging system that describes the extent of Cancer in a patient’s body

There are five tumor classification values (Tis, T1, T2, T3 or T4) which depend on the presence or absence of invasive cancer, the dimensions of the invasive cancer, and the presence or absence of invasion outside of the breast (e. g. to the skin of the breast, to the muscle or to the rib cage underneath):

• Tx - Primary tumor cannot be assessed.
• T0 - No evidence of primary tumor.
• Tis - Carcinoma in situ.
  • Tis(DCIS) - Intraductal Carcinoma in situ.
  • Tis(LCIS) - Lobular Carcinoma in situ.
  • Tis(Paget's) - Paget's disease of the nipple with no tumor. Paget's disease of the Breast, also known as Paget's disease of the Nipple, is a condition that outwardly may have the appearance of Eczema -
• T1 - Tumor 2cm or less in its greatest dimension.
  • T1mic - Microinvasion 0. 1cm or less in greatest dimension.
  • T1a - Tumor more then 0. 1cm but not more than 0. 5cm in its greatest dimension.
  • T1b - Tumor more than 0. 5cm but not more than 1. 0cm in its greatest dimension.
  • T1c - Tumor more than 1. 0cm but not more than 2. 0cm in its greatest dimension.
• T2 - Tumor more than 2. 0cm but not more than 5. 0cm in its greatest dimension.
• T3 - Tumor more than 5cm in its greatest dimension.
• T4 - Tumor of any size with direct extension to (a) chest wall or (b) skin as described below:
  • T4a - Extension to chest wall.
  • T4b - Edema (including peau d'orange) or ulceration of the breast skin, or satellite skin nodules confined to the same breast. Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling The French term peau d'orange means "orange skin" It is used in medicine to describe something with the look (orange colour and texture (dimpled appearance of an
  • T4c - Both T4a and T4b.
  • T4d - Inflammatory breast cancer. Inflammatory breast cancer is an especially aggressive type of Breast cancer that can occur in women of any age (and although extremely rarely in men

Lymph Node - There are four lymph node classification values (N0, N1, N2 or N3) which depend on the number, size and location of breast cancer cell deposits in lymph nodes. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system.

• Nx - regional lymph nodes cannot be assessed. Perhaps due to previous removal.
• N0 - no regional lymph node metastasis.
• N1 - metastasis to movable regional axillary lymph nodes on the same side as the affected breast.
• N2 - metastasis to fixed regional axillary lymph nodes, or metastasis to the internal mammary lymph nodes, on the same side as the affected breast.
• N3 - metastasis to supraclavicular lymph nodes or infraclavicular lymph nodes or metastasis to the internal mammary lymph nodes with metastasis to the axillary lymph nodes.

Metastases - There are two metastatic classification values (M0 or M1) which depend on the presence or absence of breast cancer cells in locations other than the breast and lymph nodes (so-called distant metastases, e. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, g. to bone, brain, lung).

Pathologic types

Note: The following table includes benign tumours (non cancers) as well as malignant tumours (cancers)

The latest (2003) World Health Organization (WHO) classification of tumors of the breast^[16] recommends the following pathological types:

The classifications above show that breast cancer is usually, but not always, classified by its histological appearance. Signet ring cell carcinoma is an epilethial Malignancy characterized by the histologic appearance of Signet ring cells It is a form of Neuroendocrine nʊəroʊˈɛndəkrɪn cells are cells that release a hormone into the circulating blood in response to a neural stimulus Carcinoid (also carcinoid tumour or carcinoid tumor) is a slow-growing but Malignant type of Neuroendocrine tumour, originating in the cells Small cell carcinoma is a type of Carcinoma usually associated with the Lung, though it can be associated with other topographies such as in Cervical cancer In Medicine, squamous cell carcinoma (SCC is a form of Cancer of the Carcinoma type that may occur in many different organs including the Skin Mucoepidermoid carcinoma is the most common type of Salivary gland malignancy in children Inflammatory breast cancer is an especially aggressive type of Breast cancer that can occur in women of any age (and although extremely rarely in men A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat A lipoma is a Benign tumor composed of fatty tissue. These are the most common form of Soft tissue tumor Neurofibroma is a type of Nerve sheath tumor. In contrast to Schwannomas -- another type of Tumor arising from the Schwann cells -- neurofibromas A schwannoma is a kind of Tumor originating from the Schwann cells The insulating Myelin sheath which covers peripheral nerves is produced by the Schwann A leiomyoma (plural is 'leiomyomata' is a Benign Smooth muscle Neoplasm that is not Premalignant. Hyperplasia (or "hypergenesis" is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen in e Papilloma refers to a Benign Epithelial Tumor growing exophytically (outwardly projecting in finger-like fronds Pleomorphic Adenoma is a benign neoplastic tumor of the salivary glands Fibroadenoma of the breast is an encapsulated Benign Tumor characterized by proliferation of both Glandular and stromal elements Phyllodes tumors (from Greek: phullon leaf also cystosarcoma phyllodes, cystosarcoma phylloides and phylloides tumor, are typically A hamartoma is a benign focal malformation that resembles a neoplasm in the tissue of its origin Lymphoma a type of Neoplasm that originates in Lymphocytes (a type of White blood cell in the vertebrate Immune system) Gynecomastia, or gynaecomastia, ˌgaɪnəkoʊˈmæstiə is the development of abnormally large Mammary glands in Males resulting in breast enlargement which Rare variants are defined on the basis of physical exam findings. Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs For example, Inflammatory breast cancer (IBC), a form of ductal carcinoma or malignant cancer in the ducts, is distinguished from other carcinomas by the inflamed appearance of the affected breast. Inflammatory breast cancer is an especially aggressive type of Breast cancer that can occur in women of any age (and although extremely rarely in men A carcinoma is any Malignant Cancer that arises from epithelial cells. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens ^[17] In the future, some pathologic classifications may be changed. For example, a subset of ductal carcinomas may be re-named basal-like carcinoma (part of the "triple-negative" tumors). The basal-like carcinoma is a newly proposed subtype of Breast cancer defined by its Gene expression and protein expression profile It is now commonly understood that Breast cancer is not one form of Cancer, but many different "subtypes" of cancer

Signs and symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different than the surrounding breast tissue. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from According to the Merck Manual, greater than 80% of breast cancer cases are discovered as a lump by the woman herself. The Merck Manual of Diagnosis and Therapy, often called simply The Merck Manual, is the world's best-selling medical textbook ^[18] According to the American Cancer Society (ACS), the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram. The American Cancer Society ( ACS) is the "nationwide community-based voluntary health organization dedicated to A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician ^[9] Lumps found in lymph nodes located in the armpits^[18] and/or collarbone can also indicate breast cancer.

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 is an unreliable tool in determining the presence of breast cancer, but may be indicative of other breast-related health issues such as mastodynia. This article deals with health related issues of Breast. Breast diseases can be classified either with disorders of the Integuement, or Mastodynia, mastalgia or mammalgia are names for a medical symptom that means - pain in the breast (from the Greek masto-, breast ^[9][18][19]

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. ^[18]

Another reported symptom complex of breast cancer is Paget's disease of the breast. Paget's disease of the Breast, also known as Paget's disease of the Nipple, is a condition that outwardly may have the appearance of Eczema - This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician Eczema (from Greek έκζεμα) is a form of Dermatitis, or Inflammation of the Epidermis. 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. ^[20]

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, Metastatic breast cancer will cause symptoms that depend on the location of metastasis. More common sites of metastasis include bone, liver, lung and brain. 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. ^[21]

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. Mastitis is the Inflammation of the Parenchyma of the Mammary gland ( Breast in Primates Udder in other mammals Fibroadenoma of the breast is an encapsulated Benign Tumor characterized by proliferation of both Glandular and stromal elements 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. ^[22]

Epidemiology and etiology

Main article: Epidemiology and etiology of breast cancer

Epidemiological risk factors for a disease can provide important clues as to the etiology, or cause, of a disease. Epidemiological risk factors for a disease can provide important clues as to the Etiology, or cause of a disease Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the Etiology (alternatively aetiology, aitiology) is the study of causation. The first case-controlled study on breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health. Case-control is a type of Epidemiological Study design. Case-control studies are used to identify factors that may contribute to a medical condition by comparing subjects Janet Elizabeth Lane-Claypon (1877–1967 was an English physician and one of the founders of the science of Epidemiology, pioneering the use of so-called cohort studies ^[23][24]

Today, breast cancer, like other forms of cancer, is considered to be the final outcome of multiple environmental and hereditary factors. Some of these factors include:

1. Lesions to DNA such as genetic mutations. Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure. ^[25] Beyond the contribution of estrogen, research has implicated viral oncogenesis and the contribution of ionizing radiation in causing genetic mutations. Image talkNew_radiation_symbol_ISO_21482svg for details --> Ionizing radiation
2. Failure of immune surveillance, a theory in which the immune system removes malignant cells throughout one's life. ^[26]
3. Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth. The term growth factor refers to a naturally occurring Protein capable of stimulating cellular growth proliferation and Cellular differentiation. In Cell biology, stromal cells are Connective tissue cells of an organ found in the loose connective tissue In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body For example, tumors can induce blood vessel growth (angiogenesis) by secreting various growth factors further facilitating cancer growth. Angiogenesis is a physiological process involving the growth of new Blood vessels from pre-existing vessels
4. Inherited defects in DNA repair genes, such as BRCA1, BRCA2^[27] and p53. DNA repair refers to a collection of processes by which a cell identifies and corrects damage to the DNA molecules that encode its Genome.

Although many epidemiological risk factors have been identified, the cause of any individual breast cancer is often unknowable. In other words, epidemiological research informs the patterns of breast cancer incidence across certain populations, but not in a given individual. The primary risk factors that have been identified are sex,^[28] age,^[29] childbearing, hormones,^[30] a high-fat diet,^[31] alcohol intake,^[32][33] obesity,^[34] and environmental factors such as tobacco use, radiation^[27] and shiftwork. ^[35]

No etiology is known for 95% of breast cancer cases, while approximately 5% of new breast cancers are attributable to hereditary syndromes. ^[36] 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. ^[37]

Prevention

Lower age of first childbirth (less than 24 years maternal age), having more children (about 7% lowered risk per child), and breastfeeding (4% per breastfeeding year, with an average relative risk around 0. In Statistics and mathematical Epidemiology, relative risk (RR is the risk of an event (or of developing a disease relative to exposure 7^[38][39]) have all been correlated to lowered breast cancer risk in large studies. ^[40] In addition, exercising three times a week for one hour each has been found to lower breast cancer by up to 40%.

Phytoestrogens and soy

Phytoestrogens such as found in soybeans have been extensively studied in animal and human in-vitro and epidemiological studies. Phytoestrogens, sometimes called "dietary estrogens" are a diverse group of naturally occurring non steroidal plant compounds that because of their structural similarity with The literature support the following conclusions:

1. Plant estrogen intake, such as from soy products, in early adolescence may protect against breast cancer later in life. ^[41]
2. Plant estrogen intake later in life is not likely to influence breast cancer incidence either positively or negatively. ^[42]

Folic acid (folate)

Main article: Folic acid#Folic acid and cancer

Studies have found that "folate intake counteracts breast cancer risk associated with alcohol consumption"^[43] and "women who drink alcohol and have a high folate intake are not at increased risk of cancer. Folic acid (also known as Vitamin M and Folacin) and Folate (the Anionic form are forms of the water-soluble Vitamin B9 "^[44][45][46] A prospective study of over 17,000 women found that those who consume 40 grams of alcohol (about 3-4 drinks) per day have a higher risk of breast cancer. However, in women who take 200 micrograms of folate (folic acid or Vitamin B9) every day, the risk of breast cancer drops below that of alcohol abstainers. ^[47]

Folate is involved in the synthesis, repair, and functioning of DNA, the body’s genetic map, and a deficiency of folate may result in damage to DNA that may lead to cancer. ^[48] In addition to breast cancer, studies have also associated diets low in folate with increased risk of pancreatic, and colon cancer. Pancreatic cancer is a malignant tumor of the Pancreas. Each year about 37680 individuals in the United States are diagnosed with this condition and 34290 ^[49][50]

Foods rich in folate include citrus fruits, citrus juices, dark green leafy vegetables (such as spinach), dried beans, and peas. Citrus is a common term and Genus of Flowering plants in the family Rutaceae, originating in tropical and subtropical southeast regions of Leaf vegetables, also called potherbs, greens, or leafy greens, are plant leaves eaten as a Vegetable, sometimes accompanied Spinach ( Spinacia oleracea) is a Flowering plant in the family of Amaranthaceae. Bean is a common name for large plant Seeds of several genera of the family Fabaceae (formerly Leguminosae used for human food or animal A pea (inaccurately called a '''sweet pea''' by food distubutors is most commonly the small spherical Seed or the seed-pod of the Legume Pisum Vitamin B9 can also be taken in a multivitamin pill.

Avoiding exposure to secondhand tobacco smoke

Breathing secondhand smoke increases breast cancer risk by 70% in younger, primarily pre-menopausal women. The California Environmental Protection Agency has concluded that passive smoking causes breast cancer^[51] and the US Surgeon General^[52] has concluded that the evidence is "suggestive," one step below causal. The California Environmental Protection Agency (Cal/EPA is a state Cabinet -level agency within the Government of California. There is some evidence that exposure to tobacco smoke is most problematic between puberty and first childbirth. The reason that breast tissue appears most sensitive to chemical carcinogens in this phase is that breast cells are not fully differentiated until lactation. ^[53]

Oophorectomy and mastectomy

Prophylactic oophorectomy (removal of ovaries), in high-risk individuals, when child-bearing is complete, reduces the risk of developing breast cancer by 60%, as well as reducing the risk of developing ovarian cancer by 96%. Oophorectomy (or ovariectomy) is the surgical removal of an Ovary or ovaries ^[54]

Medications

Hormonal therapy has been used for chemoprevention in individuals at high risk for breast cancer. Hormonal therapy is one of the major modalities of medical treatment for cancer others being cytotoxic chemotherapy and Targeted therapy (biotherapeutics In 2002, a clinical practice guideline by the US Preventive Services Task Force (USPSTF) recommended that "clinicians discuss chemoprevention with women at high risk for breast cancer and at low risk for adverse effects of chemoprevention" with a grade B recommendation. A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions ^[55][56][57]

Selective estrogen receptor modulators (SERMs)

The guidelines were based on studies of SERMs from the MORE, BCPT P-1, and Italian trials. Selective Estrogen Receptor Modulators ( SERMs) are a class of Medication that acts on the Estrogen receptor. In the MORE trial, the relative risk reduction for raloxifene was 76%. The relative risk reduction is a measure used in Epidemiology. ^[58] The P-1 preventative study demonstrated that tamoxifen can prevent breast cancer in high-risk individuals. The relative risk reduction was up to 50% of new breast cancers, though the cancers prevented were more likely estrogen-receptor positive (this is analogous to the effect of finasteride on the prevention of prostate cancer, in which only low-grade prostate cancers were prevented). Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, ^[59][60] The Italian trial showed benefit from tamoxifen. ^[61]

Additional randomized controlled trials have been published since the guidelines. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The IBIS trial found benefit from tamoxifen. ^[62] In 2006, the NSABP STAR trial demonstrated that raloxifene had equal efficacy in preventing breast cancer compared with tamoxifen, but that there were fewer side effects with raloxifene. ^[63] The RUTH Trial concluded that "benefits of raloxifene in reducing the risks of invasive breast cancer and vertebral fracture should be weighed against the increased risks of venous thromboembolism and fatal stroke". ^[64] On September 14, 2007, the US Food and Drug Administration approved raloxifene (Evista) to prevent invasive breast cancer in postmenopausal women. Events 81 - Domitian becomes Emperor of the Roman Empire upon the death of his brother Titus. Raloxifene is an oral Selective estrogen receptor modulator (SERM that has estrogenic actions on bone and anti-estrogenic actions on the uterus and breast ^[65]

Screening

Main article: Breast cancer screening

Breast cancer screening is an attempt to find unsuspected cancers. Breast cancer screening refers to checking (" screening " for potential Breast cancer before any symptoms appear in the hopes of detecting any existing cancer The most common screening methods are self and clinical breast exams, x-ray mammography, and breast Magnetic resonance imaging (MRI)

X-ray mammography

Mammography is still the modality of choice for screening of early breast cancer, since it is relatively fast, reasonably accurate, and widely available in developed countries.

Due to the high incidence of breast cancer among older women, screening is now recommended in many countries. Recommended screening methods include breast self-examination and mammography. Breast self-examination (BSE is an easy but unreliable method for finding possible Breast cancer. Mammography is the process of using low-dose X-rays (usually around 0 Mammography has been estimated to reduce breast cancer-related mortality by 20-30%. ^[66] Routine (annual) mammography of women older than age 40 or 50 is recommended by numerous organizations as a screening method to diagnose early breast cancer and has demonstrated a protective effect in multiple clinical trials. ^[67] The evidence in favor of mammographic screening comes from eight randomized clinical trials from the 1960s through 1980s. Many of these trials have been criticised for methodological errors, and the results were summarized in a review article published in 1993. ^[68]

Improvements in mortality due to screening are hard to measure; similar difficulty exists in measuring the impact of Pap smear testing on cervical cancer, though worldwide, the impact of that test is likely enormous. The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in Gynecology Cervical cancer is Malignant Cancer of the Cervix uteri or cervical area Nationwide mortality due to cancer before and after the institution of a screening test is a surrogate indicator about the effectiveness of screening, and results of mammography are favorable.

Normal (left) versus cancerous (right) mammography image.

The U. S. National Cancer Institute recommends screening mammography every one to two years beginning at age 40. The National Cancer Institute (NCI is part of the United States Federal government's National Institutes of Health. ^[69] In the UK, women are invited for screening once every three years beginning at age 50. Women with one or more first-degree relatives (mother, sister, daughter) with premenopausal breast cancer should begin screening at an earlier age. It is usually suggested to start screening at an age that is 10 years less than the age at which the relative was diagnosed with breast cancer.

A clinical practice guideline by the US Preventive Services Task Force recommended "screening mammography, with or without clinical breast examination (CBE), every 1 to 2 years for women aged 40 and older. "^[70] The Task Force gave a grade B recommendation. ^[55]

In 2005, 67. 9% of all U. S. women age 40–64 had a mammogram in the past two years (74. 5% of women with private health insurance, 56. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses 1% of women with Medicaid insurance, 38. Medicaid is the United States health program for eligible individuals and families with low incomes and resources 1% of currently uninsured women, and 32. Health care in the United States is provided by many separate legal entities 9% of women uninsured for > 12 months). ^[71]

Criticisms of screening mammography

Several scientific groups however have expressed concern about the public's perceptions of the benefits of breast screening. ^[72] In 2001, a controversial review published in The Lancet claimed that "there is no reliable evidence that screening for breast cancer reduces mortality". This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. ^[73][74]The Cochrane Collaboration concluded, "for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm. "^[75]

False positives are a major problem of mammographic breast cancer screening. Data reported in the UK Million Woman Study indicates that if 134 mammograms are performed, 20 women will be called back for suspicious findings, and four biopsies will be necessary, to diagnose one cancer. Recall rates are higher in the U. S. than in the UK. ^[76] The contribution of mammography to the early diagnosis of cancer is controversial, and for those found with benign lesions, mammography can create a high psychological and financial cost.

Mammography in women less than 50 years old

Part of the difficulty in interpreting mammograms in younger women stems from the problem of breast density. Radiographically, a dense breast has a preponderance of glandular tissue, and younger age or estrogen hormone replacement therapy contribute to mammographic breast density. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male After menopause, the breast glandular tissue gradually is replaced by fatty tissue, making mammographic interpretation much more accurate. Some authors speculate that part of the contribution of estrogen hormone replacement therapy to breast cancer mortality arises from the issue of increased mammographic breast density. Breast density is an independent adverse prognostic factor on breast cancer prognosis.

A systematic review by the American College of Physicians concluded "Although few women 50 years of age or older have risks from mammography that outweigh the benefits, the evidence suggests that more women 40 to 49 years of age have such risks". A systematic review is a Literature review focused on a single question which tries to identify appraise select and synthesize all high quality research evidence relevant to The American College of Physicians (ACP is a national organization of doctors of Internal medicine (internists physicians who specialize in the prevention detection and treatment ^[77].

A report released November 27, 2007 by the Journal of the National Cancer Institute showed that the formula doctors use to calculate a woman's risk of breast cancer underestimates the danger for black women most of the time and especially for those age 50 and older — the age when they are most likely to benefit from screening tests and protective drugs, according to the first major reassessment of the widely used tool. ^[78]

Enhancements to mammography

CAD is especially established in US and the Netherlands. It is used in addition to the human evaluation of the diagnostician.

Breast MRI

Magnetic resonance imaging (MRI) has been shown to detect cancers not visible on mammograms, but has long been regarded to have disadvantages. For example, although it is 27-36% more sensitive, it is less specific than mammography. ^[79] As a result, MRI studies will have more false positives (up to 5%), which may have undesirable financial and psychological costs. In Statistics, the terms Type I error (also α error, or false positive) and type II error ( β error, or a false negative It is also a relatively expensive procedure, and one which requires the intravenous injection of a chemical agent (from which there are side effects, potentially serious in a small number of people) to be effective. Proposed indications for using MRI for screening include:^[80]

• Strong family history of breast cancer
• Patients with BRCA-1 or BRCA-2 tumour suppressor gene mutations
• Evaluation of women with breast implants
• History of previous lumpectomy or breast biopsy surgeries
• Axillary metastasis with an unknown primary tumor
• Very dense or scarred breast tissue

However, two studies published in 2007 demonstrated the strengths of MRI-based screening:

• In March 2007, an article published in the New England Journal of Medicine demonstrated that in 3. The New England Journal of Medicine ( N Engl J Med or NEJM) is an English-language Peer-reviewed Medical journal published 1% of patients with breast cancer, whose contralateral breast was clinically and mammographically tumor-free, MRI could detect breast cancer. In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species Sensitivity for detection of breast cancer in this study was 91%, specificity 88%. ^[81]

• In August 2007, an article published in The Lancet compared MRI breast cancer screening to conventional mammographic screening in 7,319 women. MRI screening was highly more sensitive (97% in the MRI group vs. 56% in the mammography group) in recognizing early high-grade Ductal Carcinoma in situ (DCIS), the most important precursor of invasive carcinoma. Despite the high sensitivity, MRI screening had a positive predictive value of 52%, which is totally accepted for cancer screening tests. The positive predictive value, or precision rate, or post-test probability of disease, is the proportion of patients with positive test results who are correctly diagnosed ^[82] The author of a comment published in the same issue of The Lancet concludes that "MRI outperforms mammography in tumour detection and diagnosis. "^[83]

Breast self-exam

Breast self-examination (BSE) was widely discussed in the 1990s as a useful modality for detecting breast cancer at an earlier stage of presentation. Breast self-examination (BSE is an easy but unreliable method for finding possible Breast cancer. A large clinical trial in China reduced enthusiasm for breast self-exam. In the trial, reported in the Journal of the National Cancer Institute first in 1997 and updated in 2002, 132,979 female Chinese factory workers were taught by nurses at their factories to perform monthly breast self-exam, while 133,085 other workers were not taught self-exam. The women taught self-exam tended to detect more breast nodules, but their breast cancer mortality rate was no different from that of women in the control group. In other words, women taught breast self-exam were mostly likely to detect benign breast disease, but were just as likely to die of breast cancer. ^[84] In 2003, the American Cancer Society relegated structured BSE to an 'optional' method of detecting breast cancer, citing self awareness as more important than structured self exams based on recent research. The American Cancer Society ( ACS) is the "nationwide community-based voluntary health organization dedicated to ^[27]

Genetic testing

A clinical practice guideline by the US Preventive Services Task Force :^[70]

• "recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2)" The Task Force gave a grade D recommendation. Genetic counseling is the process by which patients or relatives at risk of an inherited disorder are advised of the consequences and nature of the disorder the probability of developing BRCA1 ( Breast cancer 1 early onset is a Human Gene, some mutations of which are associated with a significant increase in the risk of Breast cancer BRCA2 (Breast Cancer Type 2 susceptibility protein is a Human Gene that is involved in the repair of chromosomal ^[55]
• "recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. " The Task Force gave a grade B recommendation. ^[55]

The Task Force noted that about 2% of women have family histories that indicate increased risk as defined by:

• For non–Ashkenazi Jewish women, any of the following:
  • "2 first-degree relatives with breast cancer, 1 of whom received the diagnosis at age 50 years or younger"
  • "3 or more first- or second-degree relatives with breast cancer regardless of age at diagnosis"
  • "both breast and ovarian cancer among first- and second- degree relatives"
  • "a first-degree relative with bilateral breast cancer"
  • "a combination of 2 or more first- or second-degree relatives with ovarian cancer regardless of age at diagnosis"
  • "a first- or second-degree relative with both breast and ovarian cancer at any age"
  • "a history of breast cancer in a male relative. "
• "For women of Ashkenazi Jewish heritage, an increased-risk family history includes any first-degree relative (or 2 second-degree relatives on the same side of the family) with breast or ovarian cancer. "

Diagnosis

Breast cancer is diagnosed by the examination of surgically removed breast tissue. A number of procedures can obtain tissue or cells prior to definitive treatment for histological or cytological examination. Such procedures include fine-needle aspiration, nipple aspirates, ductal lavage, core needle biopsy, and local surgical excision. These diagnostic steps, when coupled with radiographic imaging, are usually accurate in diagnosing a breast lesion as cancer. Occasionally, pre-surgical procedures such as fine needle aspirate may not yield enough tissue to make a diagnosis, or may miss the cancer entirely. Imaging tests are sometimes used to detect metastasis and include chest X-ray, bone scan, Cat scan, MRI, and PET scanning. A chest X-ray, commonly abbreviated CXR, is a projection radiograph ( X-ray) taken by a Radiographer, of the Thorax which is used Bone imaging is a study to visually detect Bone abnormalities Computed tomography (CT is a Medical imaging method employing Tomography. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the While imaging studies are useful in determining the presence of metastatic disease, they are not in and of themselves diagnostic of cancer. Only microscopic evaluation of a biopsy specimen can yield a cancer diagnosis. Ca 15. 3 (carbohydrate antigen 15. 3, epithelial mucin) is a tumor marker determined in blood which can be used to follow disease activity over time after definitive treatment. A tumor marker is a substance found in the Blood, Urine, or body tissues that can be elevated in Cancer, among other tissue types Blood tumor marker testing is not routinely performed for the screening of breast cancer, and has poor performance characteristics for this purpose.

Staging

Breast cancer is staged according to the TNM system, updated in the AJCC Staging Manual, now on its sixth edition. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread The American Joint Committee on Cancer (AJCC is an organization best known for defining and popularizing Cancer staging standards officially the AJCC staging system Prognosis is closely linked to results of staging, and staging is also used to allocate patients to treatments both in clinical trials and clinical practice. The information for staging is as follows:

TX: Primary tumor cannot be assessed. T0: No evidence of tumor. Tis: Carcinoma in situ, no invasion T1: Tumor is 2 cm or less T2: Tumor is more than 2 cm but not more than 5 cm T3: Tumor is more than 5 cm T4: Tumor of any size growing into the chest wall or skin, or inflammatory breast cancer

NX: Nearby lymph nodes cannot be assessed N0: Cancer has not spread to regional lymph nodes. N1: Cancer has spread to 1 to 3 axillary or one internal mammary lymph node N2: Cancer has spread to 4 to 9 axillary lymph nodes or multiple internal mammary lymph nodes N3: One of the following applies:

Cancer has spread to 10 or more axillary lymph nodes, or Cancer has spread to the lymph nodes under the clavicle (collar bone), or Cancer has spread to the lymph nodes above the clavicle, or Cancer involves axillary lymph nodes and has enlarged the internal mammary lymph nodes, or Cancer involves 4 or more axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy. The sentinel lymph node is the hypothetical first Lymph node or group of nodes reached by metastasizing Cancer cells from a Tumor.

MX: Presence of distant spread (metastasis) cannot be assessed. M0: No distant spread. M1: Spread to distant organs, not including the supraclavicular lymph node, has occurred

Summary of stages:

• Stage 0 - Carcinoma in situ
• Stage I - Tumor (T) does not involve axillary lymph nodes (N). Carcinoma in situ (CIS is an early form of Carcinoma defined by the absence of invasion of surrounding tissues
• Stage IIA – T 2-5 cm, N negative, or T <2 cm and N positive.
• Stage IIB – T > 5 cm, N negative, or T 2-5 cm and N positive (< 4 axillary nodes).
• Stage IIIA – T > 5 cm, N positive, or T 2-5 cm with 4 or more axillary nodes
• Stage IIIB – T has penetrated chest wall or skin, and may have spread to < 10 axillary N
• Stage IIIC – T has > 10 axillary N, 1 or more supraclavicular or infraclavicular N, or internal mammary N.
• Stage IV – Distant metastasis (M)

Breast lesions are examined for certain markers, notably sex steroid hormone receptors. About two thirds of postmenopausal breast cancers are estrogen receptor positive (ER+) and progesterone receptor positive (PR+). ^[85] Receptor status modifies the treatment as, for instance, only ER-positive tumors, not ER-negative tumors, are sensitive to hormonal therapy.

Human epidermal growth factor two (HER2)

The breast cancer is also usually tested for the presence of human epidermal growth factor receptor 2, a protein also known as HER2, neu or erbB2. HER2/neu (also known as ErbB-2) stands for "Human Epidermal growth factor Receptor 2" and is a protein giving higher aggressiveness in Breast cancers It is a HER2/neu (also known as ErbB-2) stands for "Human Epidermal growth factor Receptor 2" and is a protein giving higher aggressiveness in Breast cancers It is a HER2 is a cell-surface protein involved in cell development. In normal cells, HER2 controls aspects of cell growth and division. When activated in cancer cells, HER2 accelerates tumor formation. About 20-30% of breast cancers overexpress HER2. Those patients may be candidates for the drug trastuzumab, both in the postsurgical setting (so-called "adjuvant" therapy), and in the metastatic setting. Trastuzumab (more commonly known under the Trade ^[86]

Treatment

Main article: Breast cancer treatment

The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy. The mainstay of Breast cancer treatment is Surgery when the tumor is localized with possible adjuvant hormonal therapy (with Tamoxifen or an Aromatase inhibitor Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Tamoxifen is an orally active Selective estrogen receptor modulator (SERM that is used in the treatment of Breast cancer and is currently the world's largest Aromatase inhibitors ( AI) are a class of drugs used in the treatment of Breast cancer and Ovarian cancer in postmenopausal women that Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant At present, the treatment recommendations after surgery (adjuvant therapy) follow a pattern. This pattern is subject to change, as every two years, a worldwide conference takes place in St. Gallen, Switzerland, to discuss the actual results of worldwide multi-center studies. Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases, with each risk category following different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy.

In planning treatment, doctors can also use PCR tests like Oncotype DX or microarray tests like MammaPrint that predict breast cancer recurrence risk based on gene expression. Onco type DX, created by Genomic Health, is a diagnostic test that quantifies the likelihood of disease recurrence in women with early-stage Breast cancer MammaPrint is a molecular diagnostic test that is used to assess the risk that a breast tumor will spread to other parts of the body (metastasis In February 2007, the MammaPrint test became the first breast cancer predictor to win formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated. ^[87]

Interstitial laser thermotherapy (ILT) is an innovative method of treating breast cancer in a minimally invasive manner and without the need for surgical removal, and with the absence of any adverse effect on the health and survival of the patient during intermediate followup ^[88]. The term laser interstitial thermal therapy ( LITT, also referred to as laser-induced interstitial thermotherapy or laser-induced thermotherapy or interstitial Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma

Radiation treatment is also used to help destroy cancer cells that may linger after surgery. Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3rds reduction of risk) when delivered in the correct dose. ^[89]

Early-stage research

In mice, flaxseed oil reduced the growth and metastasis of breast cancer tumors that were cultured in the laboratory and implanted in mice. In humans, flaxseed oil reduced markers that are associated with cancer growth. ^{[90][91][92][93]}

Prognosis

A prognosis is the medical team's "best guess" in how cancer will affect a patient. There are many prognostic factors associated with breast cancer: staging, tumour size and location, grade, whether disease is systemic (has metastasized, or traveled to other parts of the body), recurrence of the disease, and age of patient.

Stage is the most important, as it takes into consideration size, local involvement, lymph node status and whether metastatic disease is present. The higher the stage at diagnosis, the worse the prognosis. Larger tumours, invasiveness of disease to lymph nodes, chest wall, skin or beyond, and aggressiveness of the cancer cells raise the stage, while smaller tumours, cancer-free zones, and close to normal cell behaviour (grading) lower it.

Grading is based on how cultured biopsied cells behave. The closer to normal cancer cells are, the slower their growth and a better prognosis. If cells are not well differentiated, they appear immature, divide more rapidly, and tend to spread. Well differentiated is given a grade of 1, moderate is grade 2, while poor or undifferentiated is given a higher grade of 3 or 4 (depending upon the scale used).

Younger women tend to have a poorer prognosis than post-menopausal women due to several factors. Their breasts are active with their cycles, they may be nursing infants, and may be unaware of changes in their breasts. Therefore, younger women are usually at a more advanced stage when diagnosed.

The presence of estrogen and progesterone receptors in the cancer cell, while not prognostic, is important in guiding treatment. Those who do not test positive for these specific receptors will not respond to hormone therapy. Hormone therapy, or hormonal therapy is the use of Hormones in medical treatment

Likewise, HER2/neu status directs the course of treatment. Patients whose cancer cells are positive for HER2/neu have more aggressive disease and may be treated with trastuzumab, a monoclonal antibody that targets this protein. Monoclonal antibodies ( mAb or moAb) are monospecific antibodies that are identical because they are produced by one type of immune cell

Psychological aspects of diagnosis and treatment

The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which can help patients cope with the many issues that come up in a supportive environment with other people with experience with similar issues. Cancer support groups provide a setting in which Cancer patients can talk about living with cancer with others who may be having similar experiences Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.

Not all breast cancer patients experience their illness in the same manner. Factors such as age can have a significant impact on the way a patient copes with a breast cancer diagnosis. For example, a recent study conducted by researchers at the College of Public Health of the University of Georgia showed that older women may face a more difficult recovery from breast cancer than their younger counterparts. ^[94] As the incidence of breast cancer in women over 50 rises and survival rates increase, breast cancer is increasingly becoming a geriatric issue that warrants both further research and the expansion of specialized cancer support services tailored for specific age groups. ^[95]

Racial disparities in diagnosis and treatment

Several studies have found that black women in the U. S. are more likely to die from breast cancer even though white women are more likely to be diagnosed with the disease. Even after diagnosis, black women are less likely to get treatment compared to white women. ^[96][97][98] Scholars have advanced several theories for the disparities, including inadequate access to screening, reduced availability of the most advanced surgical and medical techniques, or some biological characteristic of the disease in the African American population. ^[99] Some studies suggest that the racial disparity in breast cancer outcomes may reflect cultural biases more than biological disease differences. ^[100] Research is currently ongoing to define the contribution of both biological and cultural factors. ^[101][97]

Metastasis

Most people understand breast cancer as something that happens in the breast. However it can metastasize (spread) via lymphatics to nearby lymph nodes, usually those under the arm. That is why surgery for breast cancer always involves some type of surgery for the glands under the arm — either axillary clearance, sampling, or sentinel node biopsy.

Breast cancer can also spread to other parts of the body via blood vessels or the lymphatic system. So it can spread to the lungs, pleura (the lining of the lungs), liver, brain, and most commonly to the bones. ^[102] Seventy percent of the time that breast cancer spreads to other locations, it spreads to bone, especially the vertebrae and the long bones of the arms, legs, and ribs. Breast cancer cells "set up house" in the bones and form tumors. Usually when breast cancer spreads to bone, it eats away healthy bone, causing weak spots, where the bones can break easily. That is why breast cancer patients are often seen wearing braces or using a wheelchair, and have aching bones.

When breast cancer is found in bones, it has usually spread to more than one site. At this stage, it is treatable, often for many years, but it is not curable. Like normal breast cells, these tumors in the bone often thrive on female hormones, especially estrogen. Therefore treatment with medicines that lower estrogen levels may be prescribed.

History

Breast cancer may be one of the oldest known forms of cancer tumors in humans. The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization. The Edwin Smith Papyrus is the only surviving copy of part of an Ancient Egyptian Textbook on trauma Surgery. Cauterize redirects here For the band see Cauterize (band Cauterization is a medical term describing the burning of the body to remove The writing says about the disease, "There is no treatment. "^[103] For centuries, physicians described similar cases in their practises, with the same sad conclusion. It wasn't until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. The French surgeon Jean Louis Petit (1674-1750) and later the Scottish surgeon Benjamin Bell (1749-1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Jean-Louis Petit (1674-1750 was a French surgeon He was first enthusiastic about anatomy received a master's certificate in surgery in Paris in 1700 Dr Benjamin Bell (1749 - 1806 was a Scottish surgeon Bell was born in Dumfries and educated in that town Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. William Stewart Halsted ( September 23 1852 &ndash September 7 1922) is considered by many to be the most innovative influential and important Radical mastectomy is a surgical procedure in which the breast underlying chest muscle (including Pectoralis major and Pectoralis minor) and Lymph nodes He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up to the 1970s.

Cultural references

In the month of October, breast cancer is recognized by survivors, family and friends of survivors and/or victims of the disease. Breast Cancer Awareness Month (BCAM (also referred to locally as National Breast Cancer Awareness Month (NBCAM) is an annual international health campaign organized by major ^[104] A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer. The pink ribbon is an international symbol of Breast cancer awareness ^[105]

Pink for October is an initiative started by Matthew Oliphant, which asks that any sites willing to help make people aware of breast cancer, change their template or layout to include the color pink, so that when visitors view the site, they see that the majority of the site is pink. Pink for October is an initiative started in August of 2006, in which sites all over the world change their templates to include the color Pink Then after reading a short amount of information about breast cancer, or being redirected to another site, they are aware of the disease itself. ^[106]

The patron saint of breast cancer is Saint Agatha of Sicily. For communities named after St Agatha see Sainte-Agathe. Saint Agatha of Sicily or Saint Agatha (died 251 is a Christian ^[107]

See also

References

External links

• Breast cancer at the Open Directory Project
• Breast cancer at the Yahoo! Directory
• The Wiktionary definition of Breast cancer. The Open Directory Project ( ODP) also known as dmoz (from directory The Yahoo! Directory is a Web directory which rivals the Open Directory Project in size Wiktionary (a Portmanteau of Wiki and Dictionary) is a multilingual, Web -based project to create a Free