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Encyclopedia > Breast cancer
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) 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).
Typical macroscopic (gross) 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).
Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma).
Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma).

Breast cancer is a cancer that starts in the cells of the breast.[1] Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% 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] Image File history File links Mergefrom. ... Inflammatory breast cancer[1] is an especially aggressive[2] type of breast cancer that can occur in women of any age (and, although extremely rarely, in men). ... Image File history File links Metadata No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // C00-D48 - Neoplasms (C00-C14) Malignant neoplasms, lip, oral cavity and pharynx (C00) Malignant neoplasm of lip (C01) Malignant neoplasm of base of tongue (C02) Malignant neoplasm of other and unspecified parts of tongue (C03) Malignant neoplasm of gum (C04) Malignant neoplasm of floor of mouth (C05) Malignant neoplasm of... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... 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 to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Image File history File links Metadata No higher resolution available. ... Image File history File links Metadata No higher resolution available. ... Gross examination or grossing is the process by which pathology specimens are inspected with the naked eye to obtain diagnostic information, while being processed for further microscopic examination. ... In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. ... In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the... For other uses, see Breast (disambiguation). ... Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. ...


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 per 100,000 women are 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] In the United States the incidence is 141 among white women and 122 among African American women.[7]


North American women have the highest incidence of breast cancer in the world.[8] Among women in the U.S., breast cancer is the most common cancer and the second-most common cause of cancer death (after lung cancer).[8] Women in the U.S. 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 U.S. (7% of cancer deaths; almost 2% of all deaths).[9]


In the U.S., both incidence and death rates for breast cancer have been declining in the last few years.[10][9] Nevertheless, a U.S. 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.[12] Society for Womens Health Research Logo 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 and advocacy. ... Heart disease is an umbrella term for a number of different diseases which affect the heart and as of 2007 it is the leading cause of death in the United States,[1] and England and Wales. ...


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]

Contents

Classification

Breast cancers are described along four different classification schemes, or groups, each based on different criteria and serving a different purpose: Image File history File links No higher resolution available. ...

  • Pathology - A pathologist will categorize each tumor based on its histological (microscopic anatomy) appearance and other criteria. 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.
  • Grade of tumor - The histological grade of a tumor is determined by a pathologist under a microscope. 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. These tests are usually done by immunohistochemistry and are presented in a pathologist's report. The profile of expression of a given tumor helps predict its prognosis, or outlook, and helps an oncologist choose the most appropriate treatment. More genes and/or proteins may be tested in the future.
  • Stage of a tumour - The currently accepted staging scheme for breast cancer is the TNM classification.

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): A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... Anatomic pathology is a medical specialty (a branch of pathology) that is concerned with the diagnosis of disease based on the gross, microscopic, and molecular examination of cells and tissues. ... A thin section of lung tissue stained with hematoxylin and eosin. ... Ductal carcinoma can refer to: Infiltrating ductal carcinoma Ductal carcinoma in situ This is a disambiguation page: a list of articles associated with the same title. ... In medicine, malignant is a clinical term that means to be severe and become progressively worse, as in malignant hypertension. ... 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[1][2] which can be determined without the use of a microscope (at the gross anatomy level. ... The Bloom-Richardson grade (BR grade) is a a histologic grade assigned by pathologists to breast cancers. ... For malignant tumors specifically, see cancer. ... Protein expression is a subcomponent of gene expression. ... Gene expression, or simply expression, is the process by which the inheritable information which comprises a gene, such as the DNA sequence, is made manifest as a physical and biologically functional gene product, such as protein or RNA. Several steps in the gene expression process may be modulated, including the... The estrogen receptor is a receptor for estradiol (the main endogenous estrogen); it is located intracellularly, in parallel with other steroid hormone receptors. ... The progesterone receptor is an intracellular steroid receptor that specifically binds progesterone. ... HER2/neu (also known as ErbB-2) is a member of the epidermal growth factor receptor (EGFR) family and is notable for its role in the pathogenesis of breast cancer and as a target of treatment. ... Immunohistochemistry or IHC refers to the process of localizing proteins in cells of a tissue section exploiting the principle of antibodies binding specifically to antigens in biological tissues. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... See cancer for the biology of the disease, as well as a list of malignant diseases. ... For other uses, see TNM (disambiguation). ...

  • Tx - Primary tumor cannot be assessed.
  • T0 - No evidence of primary tumor.
  • Tis - Carcinoma in situ.
    • Tis(DCIS) - Intracuctal Carcinoma in situ.
    • Tis(LCIS) - Lobular Carcinoma in situ.
    • Tis(Paget's) - Paget's disease of the nipple with no tumor.
  • 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:

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. Ductal carcinoma can refer to: Infiltrating ductal carcinoma Ductal carcinoma in situ This is a disambiguation page: a list of articles associated with the same title. ... Pagets disease of the breast, also known as Pagets disease of the nipple, is a condition that outwardly may have the appearance of eczema - with skin changes involving the nipple of the breast. ... This page is about the condition called edema. ... The French term peau dorange means orange skin. It is used in medicine to describe something with the look (orange colour) and texture (dimpled appearance) of an orange peel, for example the skin of the breast in inflammatory breast cancer, or the retina in Pseudoxanthoma elasticum. ... Inflammatory breast cancer[1] is an especially aggressive[2] type of breast cancer that can occur in women of any age (and, although extremely rarely, in men). ... Lymph nodes are components 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 effected breast.
  • N2 - metastasis to fixed regional axillary lymph nodes, or metastasis to the internal mammary lymph nodes, on the same side as the effected 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.g. to bone, brain, lung). For the musical composition, see Metastasis (Xenakis composition). ...


Pathologic types

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

Invasive breast carcinomas

  • Invasive ductal carcinoma
    • Most are "not otherwise specified"
    • The remainder are given subtypes:
      • Mixed type carcinoma
      • Pleomorphic carcinoma
      • Carcinoma with osteoclastic giant cells
      • Carcinoma with choriocarcinomatous features
      • Carcinoma with melanotic features
  • Invasive lobular carcinoma
  • Tubular carcinoma
  • Invasive cribriform carcinoma
  • Medullary carcinoma
  • Mucinous carcinoma and other tumours with abundant mucin
    • Mucinous carcinoma
    • Cystadenocarcinoma and columnar cell mucinous carcinoma
    • Signet ring cell carcinoma
  • Neuroendocrine tumours
    • Solid neuroendocrine carcinoma (carcinoid of the breast)
    • Atypical carcinoid tumour
    • Small cell / oat cell carcinoma
    • Large cell neuroendocrine carcioma
  • Invasive papillary carcinoma
  • Invasive micropapillary carcinoma
  • Apocrine carcinoma
  • Metaplastic carcinomas
  • Lipid-rich carcinoma
  • Secretory carcinoma
  • Oncocytic carcinoma
  • Adenoid cystic carcinoma
  • Acinic cell carcinoma
  • Glycogen-rich clear cell carcinoma
  • Sebaceous carcinoma
  • Inflammatory carcinoma
  • Bilateral breast carcinoma

Mesenchymal tumors (including sarcoma) Ductal carcinoma can refer to: Infiltrating ductal carcinoma Ductal carcinoma in situ This is a disambiguation page: a list of articles associated with the same title. ... Gastric signet ring cell carcinoma. ... redirect Template:Db-reason synaptophysin ... Picture of a carcinoid tumour that encroaches into lumen of the small bowel. ... Oat cell carcinoma is now referred to as the small cell carcinoma. ... Biopsy of a highly differentiated squamous cell carcinoma of the mouth. ... Mucoepidermoid carcinoma are a common type of tumor of the salivary glands. ... Inflammatory breast cancer[1] is an especially aggressive[2] type of breast cancer that can occur in women of any age (and, although extremely rarely, in men). ... A sarcoma is a cancer of the connective or supportive tissue (bone, cartilage, fat, muscle, blood vessels) and soft tissue. ...

  • Haemangioma
  • Angiomatosis
  • Haemangiopericytoma
  • Pseudoangiomatous stromal hyperplasia
  • Myofibroblastoma
  • Fibromatosis (aggressive)
  • Inflammatory myofibroblastic tumour
  • Lipoma
    • Angiolipoma
  • Granular cell tumour
  • Neurofibroma
  • Schwannoma
  • Angiosarcoma
  • Liposarcoma
  • Rhabdomyosarcoma
  • Osteosarcoma
  • Leiomyoma
  • Leiomysarcoma

Precursor lesions A lipoma is a common, benign tumor composed of fatty tissue. ... Neurofibromas are moderately firm, benign, encapsulated, slow-growing tumors of the nervous system arising from the supporting cells (Schwann cells) of peripheral nerves. ... Schwannomas, also referred to as Neurilomas, are slow-growing central nervous system tumours arising from the supporting cells of peripheral nerves, which include cranial and spinal nerve roots). ... A leiomyoma (plural is leiomyomata) is a benign smooth muscle neoplasm that is not premalignant. ...

  • Lobular neoplasia
    • lobular carcinoma in situ
  • Intraductal proliferative lesions
  • Microinvasive carcinoma
  • Intraductal papillary neoplasms
    • Central papilloma
    • Peripheral papilloma
    • Atypical papilloma
    • Intraductal papillary carcinoma
    • Intracystic papillary carcinoma

Benign epithelial lesions 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. ...

  • Adenosis, includin variants
    • Sclerosing adenosis
    • Apocrine adenosis
    • Blunt duct adenosis
    • Microglandular adenosis
    • Adenomyoepithelial adenosis
  • Radial scar / complex sclerosing lesion
  • Adenomas

Myoepithelial lesions Pleomorphic adenoma is the most common type of parotid gland tumor. ...

  • Myoepitheliosis
  • Adenomyoepithelial adenosis
  • Adenomyoepithelioma
  • Malignant myoepithelioma

Fibroepithelial tumours

  • Fibroadenoma
  • Phyllodes tumour
    • Benign
    • Borderline
    • Malignant
  • Periductal stromal sarcoma, low grade
  • Mammary hamartoma

Tumours of the nipple Fibroadenoma of the breast is a 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 large, fast growing masses that form from the periductal stroma of the breast. ... A hamartoma is a common benign tumor in an organ composed of tissue elements normally found at that site but that are growing in a disorganized mass. ...

Malignant lymphoma Sir James Paget, a prolific surgeon and pathologist, described several diseases, all called Pagets disease: The term is most commonly used to refer to Pagets disease of bone It can also mean Pagets disease of the breast Or: Pagets disease of the penis. ... This article is about lymphoma in humans. ...


Metastatic tumours


Tumours of the male breast

The classifications above show that breast cancer is usually, but not always, classified by its histological appearance. Rare variants are defined on the basis of physical exam findings. 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.[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).[citation needed] Gynecomastia, or gynaecomastia, pronounced is the development of abnormally large mammary glands in males resulting in breast enlargement, which can sometimes cause secretion of milk. ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Inflammatory breast cancer[1] is an especially aggressive[2] type of breast cancer that can occur in women of any age (and, although extremely rarely, in men). ... In medicine, carcinoma is any cancer that arises from epithelial cells. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...


Signs and symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different than the surrounding breast tissue. According to the Merck Manual, greater than 80% of breast cancer cases are discovered as a lump by the woman herself.[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.[9] Lumps found in lymph nodes located in the armpits[18] and/or collarbone[citation needed] can also indicate breast cancer. A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... The Merck Manual of Diagnosis and Therapy (often referred to simply as The Merck Manual) is one of the worlds most widely used medical textbooks. ... The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy and service. ... In medicine, a sign is a feature of disease as detected by the doctor during physical examination of a patient. ...


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.[9][18][19] // Breast Cancer cancerous cells enhabit the breast area causeing damage Breast Pain Also called: fibrocystic breast disease, Chronic cystic mastitis, Diffuse cystic mastopathy, Mammary dysplasia Nipples mastitis Inverted nipple Breast Mammary gland Pagets Disease of Breast Mondors disease Mastalgia Accessory breast Categories: | | | ... Mastalgia, mastodynia or mammalgia are names for a medical symptom that means - pain in the breast (from the Greek masto-, breast and algos, pain). ...


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. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. 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] Pagets disease of the breast, also known as Pagets disease of the nipple, is a condition that outwardly may have the appearance of eczema - with skin changes involving the nipple of the breast. ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... For the beetle, see Exema. ...


Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. 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] Metastasis (Greek: change of the state) is the spread of cancer from its primary site to other places in the body. ...


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. 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] Mastitis is the inflammation of the mammalian breast caused by the blocking of the milk ducts while the mother is lactating (see breastfeeding). ... Fibroadenoma of the breast is a benign tumor characterized by proliferation of both glandular and stromal elements. ...


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. 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.[23][verification needed][24] Epidemiological risk factors for a disease can provide important clues as to the etiology 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 interest of public health and preventive medicine. ... This article is about the medical term. ... Case-control studies are one type of epidemiological study design. ... 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 and case-control studies. ...


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. 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.[citation needed]
  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. For example, tumors can induce blood vessel growth (angiogenesis) by secreting various growth factors further facilitating cancer growth.[citation needed]
  4. Inherited defects in DNA repair genes, such as BRCA1, BRCA2[27] and p53.[citation needed]

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] The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... For linguistic mutation, see Apophony. ... Radiation hazard symbol. ... Growth factor is a protein that acts as a signaling molecule between cells (like cytokines and hormones) that attaches to specific receptors on the surface of a target cell and promotes differentiation and maturation of these cells. ... Stromal Cells Connective tissue cells of an organ found in the loose connective tissue. ... In zootomy, epithelium is a tissue composed of a layer of cells. ... Angiogenesis is the physiological process involving the growth of new blood vessels from pre-existing vessels. ... DNA damage resulting in multiple broken chromosomes DNA repair is a process constantly operating in cells; it is essential to survival because it protects the genome from damage and harmful mutations. ...


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) have all been correlated to lowered breast cancer risk in large studies.[38] In addition, exercising three times a week for one hour each has been found to lower breast cancer by up to 40%.[citation needed]


Phytoestrogens and soy

Phytoestrogens such as found in soybeans have been extensively studied in animal and human in-vitro and epidemiological studies. The literature support the following conclusions: Phytoestrogens are chemicals produced by plants that act like estrogens in animal/+human cells and bodies. ... Binomial name Glycine max Soybeans (US) or soya beans (UK) (Glycine max) are a high-protein legume (Family Fabaceae) grown as food for both humans and livestock. ...

  1. Plant estrogen intake, such as from soy products, in early adolescence may protect against breast cancer later in life.[39]
  2. Plant estrogen intake later in life is not likely to influence breast cancer incidence either positively or negatively.[40]

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"[41] and "women who drink alcohol and have a high folate intake are not at increased risk of cancer."[42][43][44] 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.[45] Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... Image File history File links Emblem-important. ...


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.[46] In addition to breast cancer, studies have also associated diets low in folate with increased risk of pancreatic, and colon cancer.[47][48] Pancreatic cancer is a malignant tumor within the pancreatic gland. ...


Foods rich in folate include citrus fruits, citrus juices, dark green leafy vegetables (such as spinach), dried beans, and peas. Vitamin B9 can also be taken in a multivitamin pill. Species & major hybrids Species Citrus maxima - Pomelo Citrus medica - Citron Citrus reticulata - Mandarin & Tangerine Major hybrids Citrus x aurantifolia - Lime Citrus x aurantium - Bitter Orange Citrus x bergamia - Bergamot Citrus x hystrix - Kaffir Lime Citrus x ichangensis - Ichang Lemon Citrus x limon - Lemon Citrus x limonia - Rangpur Citrus x paradisi... Chinese cabbage Swiss chard Leaf vegetables, also called greens or leafy greens, are plant leaves eaten as a vegetable, sometimes accompanied by tender petioles and shoots. ... Binomial name Spinacia oleracea L. Percentages are relative to US recommendations for adults. ... Green beans Bean is a common name for large plant seeds of several genera of Fabaceae (formerly Leguminosae) used for food or feed. ... Binomial name L. Percentages are relative to US recommendations for adults. ...


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[49] and the US Surgeon General[50] has concluded that the evidence is "suggestive," one step below causal. 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.[51] Tobacco smoking is the act of smoking tobacco products, especially cigarettes and cigars. ... The California Environmental Protection Agency (Cal/EPA) was created in 1991 by Governor Pete Wilson, through an executive order. ... Surgeon General can have several different meanings. ...


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%.[52] Oophorectomy is the surgical removal of the ovaries of a female animal. ...


Medications

Hormonal therapy has been used for chemoprevention in individuals at high risk for breast cancer. 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.[53][verification needed][54][55] Hormonal therapy is one of the major modalities of medical treatment for cancer, others being cytotoxic chemotherapy and targeted therapy (biotherapeutics). ... Clinical practice guidelines are collections of practical information for use by doctors and other medical professionals. ... According to the Agency for Healthcare Research Quality, US Preventive Services Task Force is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. ...


Selective estrogen receptor modulators (SERMs)

The guidelines[clarify] were based on studies of SERMs from the MORE, BCPT P-1, and Italian trials. In the MORE trial, the relative risk reduction for raloxifene was 76%.[56] 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).[57][58] The Italian trial showed benefit from tamoxifen.[59] Selective estrogen receptor modulators (SERMs) is a class of medication that acts on the estrogen receptor. ... The relative risk reduction is a measure used in epidemiology. ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). ... HRPC redirects here. ...


Additional randomized controlled trials have been published since the guidelines. The IBIS trial found benefit from tamoxifen.[60] 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.[61] 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".[62] On September 14, 2007, the US Food and Drug Administration approved raloxifene (Evista) to prevent invasive breast cancer in postmenopausal women.[63] A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... is the 257th day of the year (258th in leap years) in the Gregorian calendar. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... Raloxifene is an oral selective estrogen receptor modulator which is used in the prevention of osteoporosis in postmenopausal women. ...


Screening

Breast cancer screening is an attempt to find unsuspected cancers. The most common screening methods are self and clinical breast exams, x-ray mammography, and breast Magnetic resonance imaging (MRI) Breast cancer is cancer of breast tissue. ...


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. Mammography has been estimated to reduce breast cancer-related mortality by 20-30%.[64] 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.[65] 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.[66] Breast self-examination (BSE) is an easy but unreliable method for finding possible breast cancer. ... Mammography. ...


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. 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. The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ... Cervical cancer is a malignant cancer of the cervix. ...

Normal (left) versus cancerous (right) mammography image.
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.[67] 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. Image File history File links Mammo_breast_cancer. ... Image File history File links Mammo_breast_cancer. ... The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ...


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."[68] The Task Force gave a grade B recommendation.[53][verification needed]


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, 56.1% of women with Medicaid insurance, 38.1% of currently uninsured women, and 32.9% of women uninsured for > 12 months).[69] The term health insurance is generally used to describe a form of insurance that pays for medical expenses. ... Medicaid is the US health insurance program for individuals and families with low incomes and resources. ... Health care in the United States is provided by many separate legal entities. ...


Criticisms of screening mammography

Several scientific groups however have expressed concern about the public's perceptions of the benefits of breast screening.[70] In 2001, a controversial review published in The Lancet claimed that "there is no reliable evidence that screening for breast cancer reduces mortality".[71][72]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."[73] The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ...


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.[74] 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. 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. Estriol. ... Hormone replacement therapy (HRT) is a system of medical treatment for perimenopausal and postmenopausal women, based on the assumption that it may prevent discomfort and health problems caused by diminished circulating estrogen hormones. ...


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".[75]. Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ... 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 of illnesses in adults. ...


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.[76]


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.[77] As a result, MRI studies will have more false positives (up to 5%), which may have undesirable financial and psychological costs. 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:[78] MRI redirects here. ... Type I errors (or α error, or false positive) and type II errors (β error, or a false negative) are two terms used to describe statistical errors. ...

  • 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 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.[80] The author of a comment published in the same issue of The Lancet concludes that "MRI outperforms mammography in tumour detection and diagnosis."[81]

The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... It has been suggested that Human Anatomical Terms be merged into this article or section. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The positive predictive value is the proportion of patients with positive test results who are correctly diagnosed. ...

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. 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.[82] 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.[27] Breast self-examination (BSE) is an easy but unreliable method for finding possible breast cancer. ... The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy and service. ...


Genetic testing

A clinical practice guideline by the US Preventive Services Task Force :[68]

  • "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.[53][verification needed]
  • "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.[53][verification needed]

The Task Force noted that about 2% of women have family histories that indicate increased risk as defined by: 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 or transmitting it, and the options open to them in management and family planning in order to prevent, avoid or... BRCA1 (breast cancer 1, early onset) is a human gene that belongs to a class of genes known as tumor suppressors, which regulate the cell cycle and prevent uncontrolled proliferation. ... BRCA2 refers to either a gene (BReast-CAncer susceptibility gene 2, located on human chromosome 13, 13q12-13) or the protein coded for by that gene. ...

  • 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. 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. Blood tumor marker testing is not routinely performed for the screening of breast cancer, and has poor performance characteristics for this purpose. Image File history File links Question_book-3. ... Frontal chest X-ray. ... Drawing shows patient lying on a table that slides under the scanner, a technician operating the scanner, and a monitor that will show images made during the scan. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... Tumor markers are substances found in the blood, urine or body tissues that can be elevated in cancer. ...


Staging

Breast cancer is staged according to the TNM system, updated in the AJCC Staging Manual, now on its sixth edition. 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: Image File history File links No higher resolution available. ... 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. ...


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.


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).
  • 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+).[83] Receptor status modifies the treatment as, for instance, only ER-positive tumors, not ER-negative tumors, are sensitive to hormonal therapy. Carcinoma in situ is present when a tumor has been detected that has the characteristics of malignancy but has not invaded other tissues. ...


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 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.[84] Trastuzumab (more commonly known under the trade name Herceptin) is a humanized monoclonal antibody that acts on the HER2/neu (erbB2) receptor. ... In medicine, adjuvants are agents which modify the effect of other agents while having few if any direct effects when given by themselves. ...


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. 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. 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. ... “Surgeon” redirects here. ... Tamoxifen is an orally active selective estrogen receptor modulator (SERM) which is used in the treatment of breast cancer and is currently the worlds largest selling drug for this indication. ... Aromatase inhibitors (AI) are a class of drugs used in the treatment of breast cancer in post- menopausal women. ... 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 cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ...


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. 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.[85] Oncotype DX™, created by Genomic Health, is a diagnostic test that quantifies the likelihood of disease recurrence in women with early-stage breast cancer and assesses the likely benefit from certain types of chemotherapy. ... A DNA microarray (also DNA chip or gene chip in common speech) is a piece of glass or plastic on which pieces of DNA have been affixed in a microscopic array. ... MammaPrint is the commercial product, marketed by Agendia, based on the well-known 70-gene breast cancer microarray signature as published by van t Veer et al in Nature 2002. ... “FDA” redirects here. ...


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 [86]. A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these structures. ...


Alternative treatments

Alternative approaches to the treatment of breast cancer have included the Hoxsey Therapy, Essiac tea, the Gerson therapy, Laetrile, Dr. Kelley’s Enzyme Therapy, Burzynski’s Antineoplastons, Protocel, Oxygen therapy, the Budwig Diet (Flaxseed oil and Cottage cheese), The Rife Machine, 714X and Cesium High pH Therapy [87]. Testing of flaxseed (the highest source of mammalian lignans) on rats led to reduction and regression of tumours. This led to a formal randomized, placebo-controlled, double-blind study involving 32 postmenopausal patients confirming that 25g flaxseed daily intake significantly reduced cell proliferation, increased apoptosis and reduced c-erbB2 expression of human breast cancer cells [88]. The preliminary research into flax seeds indicates that flax can significantly change breast cancer growth and metastasis, and enhance the inhibitory effect of tamoxifen on estrogen-dependent tumors.[89][90][91][92]. Hoxsey Therapy is a practice promoted as a cure for cancer. ... Essiac or Essiac Tea is a blend of herbs used to make a tea that is believed by some and questioned by others to have cancer-treating properties. ... Amygdalin (from the Greek amugdale, almond), C20H27NO11, is a glucoside isolated from bitter almonds by H. E. Robiquet and A. F. Boutron-Charlard in 1830, and subsequently investigated by Liebig and Wöhler, and others. ... StanisÅ‚aw Burzynski (born 1943 in Lublin, Poland) is a Polish biochemist and physician, the discoverer of the controversial Antioneoplastons, a unique cancer treatment. ... Oxygen first aid kit showing a demand valve and a constant flow mask Oxygen therapy is the administration of oxygen as a therapeutic modality. ... Johanna Budwig (died in 2003) was a German chemist who believed that cancer is easily treatable through a specially-designed diet. ... Linseed oil is a yellowish drying oil derived from the dried ripe seeds of the flax plant (Linum usitatissimum, Linaceae). ... A tub of cottage cheese Cottage cheese comes from chickens and is a cheese curd product with a mild flavor. ... Information in this article or section has not been verified against sources and may not be reliable. ... 714-X or 714X, also called trimethylbicyclonitramineoheptane chloride, is a drug that is alleged to cure cancer, multiple sclerosis, fibromyalgia, and other degenerative diseases [1]. It was developed by Gaston Naessens, a native of France who has lived and worked in Quebec since the early 1970s. ... General Name, Symbol, Number Caesium, Cs, 55 Series Alkali metals Group, Period, Block 1(IA), 6, s Density, Hardness 1879 kg/m3, 0. ... For other uses, see PH (disambiguation). ... Binomial name Linum usitatissimum L. Linnaeus, 17?? Common flax (also known as linseed) is a member of the Linaceae family, which includes about 150 plant species widely distributed around the world. ... A lignan is a chemical compound found in plants. ... The double blind is ray charles is ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesof the scientific method, used to prevent research... Menopause (also known as the Change of life or climacteric) is a stage of the human female reproductive cycle that occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ...


Alternative prevention methods include nutrition, the use of natural progesterone (as opposed to progestins) to alleviate estrogen dominance, and the avoidance of exposure to xenoestrogens [93]. This article lacks information on the importance of the subject matter. ... The Nutrition Facts table indicates the amounts of nutrients which experts recommend you limit or consume in adequate amounts. ... Natural is defined as of or relating to nature; this applies to both definitions of nature: essence (ones true nature) and the untouched world (force of nature). Natural is often used meaning good, healthy, or belonging to human nature. This use can be questioned, as many freely growing plants... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... A progestin is a synthetic progestagen. ... Estriol. ... Xenoestrogens are synthetic substances that differ from those produced by living organisms and imitate or enhance the effect of estrogens. ...


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. Image File history File links Question_book-3. ...


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. In medicine, hormone therapy is the use of hormones in medical treatment and covers various types of hormones including growth hormones and sex hormones. ...


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) are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent 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. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment. Cancer support groups provide a setting in which cancer patients can talk about living with cancer with others who may be having similar experiences. ...


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] Image File history File links Merge-arrows. ... Epidemiological risk factors for a disease can provide important clues as to the etiology of a disease. ... 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. ...


Metastasis

Most people understand breast cancer as something that happens in the breast. However it can metastasise (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. For the musical composition, see Metastasis (Xenakis composition). ...


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 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. 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. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up to the 1970s. Image File history File links Question_book-3. ... Plates vi & vii of the Edwin Smith Papyrus at the Rare Book Room, New York Academy of Medicine The Edwin Smith Papyrus is the only surviving copy of part of an Ancient Egyptian textbook on trauma surgery. ... Cauterization is a medical term describing the burning of the body to remove or close a part of it. ... Lymph nodes are components of the lymphatic system. ... Jean-Louis Petit (1674-1750) was a French surgeon. ... Dr Benjamin Bell (1749 - 1806) was a Scottish surgeon. ... The Four Doctors by John Singer Sargent, 1905. ... Radical mastectomy is a surgical procedure in which the breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla are removed as a treatment for breast cancer. ...


Cultural references

In the month of October, breast cancer is recognized by survivors, family and friends of survivors and/or victims of the disease.[104] A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer.[105] Image File history File links Pink_ribbon. ... Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention and cure. ... Pink Ribbon is an international symbol that is being used by people, companies and organizations as they are engaging themselves to breast cancer awareness. ...


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. 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] 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, in support of Breast Cancer Awareness, because October is the month of Breast Cancer Awareness. ...


The patron saint of breast cancer is Saint Agatha of Sicily.[107] Saint Agatha (died AD 251) is a Christian saint. ...


See also

Actress Greta Garbo was a breast cancer patient This list of notable breast cancer patients includes people who made significant contributions to their chosen field and who were diagnosed with breast cancer at some point in their lives, as confirmed by public information. ... It has been suggested that this article or section be merged with List of notable breast cancer patients. ... 1. ... A mammary tumor is a tumor originating in the mammary gland. ... Breast reconstruction is the rebuilding of a breast, usually in women. ... Considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol[1] indicates the NIAAA.[2] 3. ... The Mammography Quality Standards Act (MQSA) was enacted by the United States Congress to regulate the quality of care in mammography. ... The National Breast Cancer Coalition (NBCC) is a grassroots membership organization, comprised of hundreds of member organizations and tens of thousands of individuals dedicated to ending breast cancer through action and advocacy. ... National Comprehensive Cancer Network is an alliance of twenty-one cancer centers from across the United States. ... To meet Wikipedias quality standards, this article may require cleanup. ... Breakthrough Breast Cancer is a British medical research charity dedicated to the curing of the breast cancer. ... Dr. Barron Lerner is a physician and historian who teaches at the Columbia University College of Physicians and Surgeons. ... The International Agency for Research on Cancer (IARC, or CIRC in its French acronym) is an intergovernmental agency forming part of the World Health Organisation of the United Nations. ... Established in 1997 by The Endocrine Society as its public education affiliate, The Hormone Foundation serves as a resource for physicians, patients, and the public by promoting the prevention, treatment and cure of hormone-related conditions through outreach and education. ... Susan G. Komen for the Cure, formerly known as The Susan G. Komen Breast Cancer Foundation, is an organization supporting breast cancer research. ...

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The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy and service. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 34th day of the year in the Gregorian calendar. ... WHO redirects here. ... The International Agency for Research on Cancer (IARC, or CIRC in its French acronym) is an intergovernmental agency forming part of the World Health Organisation of the United Nations. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 34th day of the year in the Gregorian calendar. ... 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Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 116th day of the year (117th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 313th day of the year (314th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 188th day of the year (189th in leap years) in the Gregorian calendar. ... For information on Wikipedia press releases, see Wikipedia:Press releases. ... 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A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The Merck Manual of Diagnosis and Therapy (often referred to simply as The Merck Manual) is one of the worlds most widely used medical textbooks. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 36th day of the year in the Gregorian calendar. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 36th day of the year in the Gregorian calendar. ... The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 37th day of the year in the Gregorian calendar. ... The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 37th day of the year in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 36th day of the year in the Gregorian calendar. ... 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 and case-control studies. ... The Online Computer Library Center (OCLC) was founded in 1967 and originally named the Ohio College Library Center. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 365th day of the year (366th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 41st day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 116th day of the year (117th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 70th day of the year (71st in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 282nd day of the year (283rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 146th day of the year (147th in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... April 8 is the 98th day of the year (99th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... is the 177th day of the year (178th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 280th day of the year (281st in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 146th day of the year (147th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 254th day of the year (255th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 94th day of the year (95th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 94th day of the year (95th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 336th day of the year (337th in leap years) in the Gregorian calendar. ... The Associated Press, or AP, is an American news agency, the worlds largest such organization. ... is the 37th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... Hachette Book Group USA (HBG) is a publishing company owned by Hachette Livre, the largest publishing company in France. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Also see: 2002 (number). ... is the 84th day of the year (85th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 282nd day of the year (283rd in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 4th day of the year in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 4th day of the year in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 4th day of the year in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 4th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... The United States Department of Health and Human Services, often abbreviated HHS, is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... Cornell redirects here. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... The Radiological Society of North America (RSNA), founded in 1915, has the purpose to promote and develop the highest standards of radiology and related sciences through education and research. The society publishes the journals Radiology and RadioGraphics. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 307th day of the year (308th in leap years) in the Gregorian calendar. ...

External links

Wikimedia Commons has media related to:
Breast cancer
Wikibooks
Wikibooks Sexual Health has a page on the topic of
Cancer#Breast Cancer

Thyroid cancer is cancer of the thyroid gland. ... Thyroid cancer is cancer of the thyroid gland. ... Adrenocortical carcinoma is a carcinoma of the cortex (outer layer) of the adrenal gland. ... A phaeochromocytoma (pheochromocytoma in the US) is a neuroendocrine tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline (epinephrine and norepinephrine in the US). ... Pituitary adenomas are tumors that occur in the pituitary gland, and account for about 10% of intracranial neoplasms. ... A tumor suppressor gene is a gene that reduces the probability that a cell in a multicellular organism will turn into a tumor cell. ... An oncogene is a modified gene that increases the malignancy of a tumor cell. ... The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... In pathology, Grading is a measure of the progress of tumors. ... Cancers are caused by a series of mutations. ... Look up carcinogen in Wiktionary, the free dictionary. ... Cancer research is research into cancer in order to identify causes and develop strategies for prevention, diagnosis, treatments and cure. ... A paraneoplastic phenomenon is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. ... This is a list of terms related to oncology. ...


  Results from FactBites:
 
Breast Cancer (191 words)
Breast cancer may be one of the oldest known forms of cancer tumors in humans.
The oldest description of cancer (although the term cancer was not used) 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, with a tool called "the fire drill." The writing says about the disease, "There is no treatment." At least one of the described cases is male.
Breast Cancer Causes, Symptoms, and Treatment on eMedicineHealth.com (707 words)
BRCA, known as the "breast cancer gene," is one of several genetic mutations (alterations in the body's genetic material) that have been associated with the development of breast and ovarian cancer.
Breast cancer is the most common type of cancer in women with the exception of nonmelanoma skin cancers.
In 2007, the American Cancer Society estimated that 178,480 new cases of invasive breast cancer would be diagnosed among women in the United States, and that a further 62,030 new cases of in-situ (noninvasive) breast cancer would be diagnosed.
  More results at FactBites »

 
 

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