Breast Cancer

Classes of Chemotherapy Drugs Used to Treat Breast Cancer

2008-06-05T09:08:00.000-07:00

Chemotherapy drugs—anthracyclines: Anthracyclines are a certain group of chemotherapy drugs. While anthracyclines can be very effective against breast and other cancers, they pose a risk of cardiotoxicity (severe heart problems) and therefore, they are typically used in limited doses. Patients should also be closely monitored for any heart problems during treatment. Anthracyclines work by deforming the DNA structure of cancer cells and terminating their biological function. The drugs Adriamycin (generic name, doxorubicin) and Ellence (generic name, epirubicin) are examples of anthracyclines used to treat breast cancer. Anthracyclines are commonly used in combination with other chemotherapy drugs to help decrease the risk of side effects.

Chemotherapy drugs—taxanes: Taxanes are a certain group of chemotherapy drugs that prevent cancer cells from dividing. Taxanes affect microtubules of cells, which are normally formed when cells divide. Normally, once cells stop dividing, the microtubules are broken down. However, taxanes stop microtubules from breaking down, thereby "clogging" cancer cells with microtubules so they cannot divide. The drugs Taxol (generic name, paclitaxel) and Taxotere (generic name, docetaxel) are examples of taxanes used to treat breast cancer. Taxanes are often used in combination with other chemotherapy agents.

Chemotherapy drugs—alkylating agents: Alkylating agents are a certain group of chemotherapy drugs that target the DNA of cancer cells to prevent the cells from growing or reproducing. Alkylating agents attack cancer cells in all phases. The drug Cytoxan (generic name, cyclophosphamide) is a common alkylating agent used to treat breast cancer. Cytoxan is typically used in combination with other chemotherapy drugs.

Drugs Used to Treat Bone Metastases
When breast cancer spreads past the breast and axillary (armpit) lymph nodes, it often spreads first to the bone. These breast cancer tumors in the bone are called "bone metastases." As advanced breast cancer dissolves portions of bone, a variety of problems can occur. Bone metastases can cause pain, decreased activity, and potentially severe problems such as fractures. Other complications that can arise from bone metastases include the surgical treatment for fractures, hypercalcemia (abnormally high levels of calcium), and spinal cord compression (vertebral damage due to pressure on the spinal cord). A class of drugs called bisphosphonates can beneficial for breast cancer patients whose cancer has spread to the bone.

Bisphosphonates are currently used to help treat osteoporosis, a degenerative bone disease affecting mainly post-menopausal women. In patients with osteoporosis, the bone loses a significant portion of its density, greatly increasing the risk of serious fractures.

Types of bisphosphonates that may be helpful in treating bone metastases include:

Didronel (generic name, etidronate)
Bonefos, Clostoban, Loron, Ostac (generic name, clodronate)
Skelid (generic name, tiludronate)
Fosamax (generic name, alendronate)
Zometa (generic name, zoledronate)

Click here for profiles of individual breast cancer drugs.

Classes of Drugs Used to Treat Breast Cancer

2008-06-05T09:01:00.000-07:00

SERMs (selective estrogen-receptor modulators): These drugs bare a chemical resemblance to the hormone estrogen. Many breast cancers are "estrogen-dependent," meaning that they depend on estrogen in order to survive and reproduce. Because SERMs mimic estrogen, they are able to bind to estrogen receptors in breast cancer cells. By binding to these receptors, they block estrogen from breast cancer cells, thereby starving the cancer cells.

Tamoxifen is currently the most commonly prescribed SERM. Tamoxifen is approved by the U.S. Food and Drug Administration (FDA) to help treat both early and advanced stages of breast cancer. Recently, tamoxifen also received FDA approval for use in post-menopausal women at high risk of breast cancer after a large clinical trial showed that tamoxifen could reduce the risk of breast cancer by 49%. The drug Fareston (generic name, toremifene) is another SERM used to treat advanced breast cancer.

Another SERM, Evista (generic name, raloxifene) is used to treat osteoporosis, a degenerative bone disease. In clinical trials, raloxifene was shown to reduce the risk of breast cancer in high-risk post-menopausal women by 44 to 71 percent.

Researchers are also investigating another SERM called arzoxifene for the treatment of breast cancer. Arzoxifene is made by the same company as raloxifene (Eli Lilly and Company) and is described to be a next-generation SERM. The drug is currently in Phase III clinical trials.

Aromatase inhibitors: These drugs work by binding to the body’s aromastase enzyme, an enzyme responsible for producing estrogen. Many breast cancer cells depend on estrogen to grow and multiply quickly. Once the aromatase inhibitor has binded to the aromastase enzyme, estrogen cannot be produced by the enzyme. This lack of estrogen starves cancer cells, preventing them from growing and dividing.

There are several aromatase inhibitors that are used to help treat advanced breast cancer including:

Aromasin (generic name, exemestane)
Femara (generic name, letrozole)
Arimidex (generic name, anastrozole)
Megace (generic name, megestrol)

Recent studies suggest that some aromatase inhibitors may be more effective than tamoxifen in treating advanced breast cancer or may be useful after patients become resistant to tamoxifen. For example, Femara was recently FDA approved as an initial treatment option in advanced breast cancer patients after data showed that Femara may work better than tamoxifen in some patients (i.e., slows the growth of cancer and improves survival time). Recent studies also show that both Arimidex and Femara many be more effective than Megace for treating breast cancer.

Biologic response modifiers: These drugs bind with certain proteins on breast cancer cells, preventing their growth. The drug Herceptin (generic name, trastuzumab) is a monoclonal antibody that attaches itself to HER2 (also written HER2/neu), a protein found on breast cancer cells. Approximately 30% of breast cancer patients have extra copies of the HER2 protein, which can signal more aggressive cancers. Herceptin binds to HER2 receptors on breast cancer cells, preventing them from growing and dividing. Herceptin is only indicated for breast cancer patients who overexpress the HER2 protein. Patients should be tested for HER2 expression to determine whether Herceptin is a viable treatment option.

Other hormonal therapies: Hormone therapies are used to treat breast cancers that are dependent on estrogen for survival. In addition to SERMs and aromatase inhibitors, there are several other hormonal therapies used to treat breast cancer. For example, the drug Zoladex (generic name, goserelin acetate) is a synthetic form of the body’s lutenizing hormone-releasing hormone (LHRH). Zoladex blocks the release of estrogen in breast cancer patients (and testosterone in prostate cancer patients), preventing breast and prostate cancer cells from growing.

Another hormone therapy, Faslodex (generic name, fulvestrant), appears to be effective for women who have become resistant to tamoxifen, according to recent studies. Instead of binding to estrogen receptors in breast cancer cells like tamoxifen, Faslodex destroys estrogen receptors in cancer cells.

Breast Cancer Drug Raloxifene

2008-06-05T08:30:00.000-07:00

The drug raloxifene (Evista®) did not prevent heart problems in postmenopausal women with, or at high risk for, coronary heart disease. The drug did significantly reduce the risk of invasive breast cancer and spinal fractures, but also increased the incidence of blood clots and death from stroke.

Background

Recent large clinical trials have shown that the drug raloxifene, which was originally developed to help prevent osteoporosis, can also reduce the risk of breast cancer in postmenopausal women at high risk of the disease.

In the Multiple Outcomes of Raloxifene (MORE) trial, the drug lowered breast cancer incidence in postmenopausal women with osteoporosis by 72 percent over four years, compared to a placebo. The Study of Tamoxifen and Raloxifene (STAR) trial compared raloxifene to tamoxifen for the prevention of breast cancer in postmenopausal women at increased risk for breast cancer. Both tamoxifen and raloxifene reduced the risk of developing invasive breast cancer by about 50 percent (see the NCI press release about STAR).

The Raloxifene Use for The Heart (RUTH) trial, described in this summary, was originally designed to determine whether raloxifene can reduce the risk of coronary heart disease in postmenopausal women at increased risk for the disease. (Coronary heart disease – damage to the coronary arteries that supply blood to the heart - is the most common form of heart disease.) When results from the MORE trial showed a reduction in breast-cancer risk with use of the drug, the RUTH team expanded their study to look at raloxifene’s breast cancer risk effect, as well.

The Study

The RUTH trial was an international randomized clinical trial designed to determine if raloxifene can reduce the incidence of coronary events and invasive breast cancer in postmenopausal women who had coronary heart disease (CHD) or who were at high risk of CHD. Coronary events included death from a heart attack, from heart failure, or during heart surgery; a nonfatal heart attack; or hospitalization for other heart problems.

Between June 1998 and August 2000, investigators from 26 countries enrolled 10,101 eligible women into the trial. Participating women were randomly assigned to receive either 60 milligrams of raloxifene a day (5,044 patients), or an identical placebo pill (5,057 patients).

Researchers checked on the women’s health status and compliance with their medication schedule twice a year. In addition, an electrocardiography (a test used to measure the condition of the heart) was performed at the beginning of the study, during year 2 and year 4 of follow-up, and during the last follow-up visit. Mammograms and clinical breast examinations were performed at the start and every two years during follow-up. Patients’ cholesterol levels were measured at the beginning of the study, during year 1 and year 5 of follow-up, and during the last follow-up visit.

Investigators recorded occurrences of coronary events; breast cancer; noncoronary events such as stroke and venous thromboembolism (blood clots in the cardiovascular system); bone fractures; and death. Side effects were reported voluntarily by the participants during their checkups.

Results

In both the raloxifene and placebo groups, patients were followed for a median of 5.56 years. About 80 percent of patients in both groups completed the study, and about 70 percent in both groups took at least 70 percent of the assigned medication.

The number of women reporting side effects was not significantly different between the two groups, though more women in the raloxifene group stopped use of the study drug because of side effects.

Investigators did not see any significant differences between the two groups in the number of deaths from coronary causes, nonfatal heart attacks, or hospitalizations for an acute coronary syndrome. These results were unaffected by whether women already had CHD or were at increased risk for CHD.

Levels of low-density lipoprotein (‘bad’) cholesterol declined significantly and levels of high-density (‘good’) lipoprotein cholesterol increased significantly in the raloxifene group. However, these changes did not correspond to a protective effect on the heart.

Raloxifene did reduce the risk of estrogen-receptor positive invasive breast cancer by 55 percent and the incidence of clinical vertebral fractures by 35 percent. The reduction in breast-cancer risk did not differ significantly between women at increased risk and women at normal risk of breast cancer.

However, raloxifene did cause more fatal strokes: 59 women in the raloxifene group (1 percent) and 39 in the placebo group (0.7 percent) died from stroke, which translates into a statistically significant 49 percent higher risk on raloxifene. Similarly, though the absolute numbers were small, women on raloxifene were 44 percent more likely to suffer a noncoronary blood clot than those on placebo.

Breast Cancer Treatment Option Overview

2008-06-05T08:13:00.000-07:00

There are different types of treatment for patients with breast cancer.

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it.
Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.

Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.

Other types of surgery include the following:

Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.

Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.

Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel. Before the decision to get an implant is made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) or visit the FDA's Web site for more information on breast implants.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.

For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.

For more info, please visit --> cancer.gov

Life Insurance UK

Search and compare 100s of
life insurance policies today!

www.protected.co.uk

Breast Cancer - Stage

2008-05-27T10:51:00.000-07:00

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:

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>
Stage IIB – T > 5 cm, N negative, or T 2-5 cm and N positive (<>
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 <>
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+). Receptor status modifies the treatment as, for instance, only ER-positive tumors, not ER-negative tumors, are sensitive to hormonal therapy.

Breast Cancer - Screening

2008-05-27T10:40:00.000-07:00

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. 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.

Genetic testing

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

"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.
"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.

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

1. 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."

2. "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."

Breast Cancer - Screening

2008-05-27T10:33:00.000-07:00

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. 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:

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

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

In March 2007, an article published in the New England Journal of Medicine demonstrated that in 3.1% of patients with breast cancer, whose contralateral breast was clinically and mammographically tumor-free, MRI could detect breast cancer. Sensitivity for detection of breast cancer in this study was 91%, specificity 88%.
In August 2007, an article published in The Lancet compared MRI breast cancer screening to conventional mammographic screening in 7,319 women. MRI screening was highly more sensitive (97% in the MRI group vs. 56% in the mammography group) in recognizing early high-grade Ductal Carcinoma in situ (DCIS), the most important precursor of invasive carcinoma. Despite the high sensitivity, MRI screening had a positive predictive value of 52%, which is totally accepted for cancer screening tests. The author of a comment published in the same issue of The Lancet concludes that "MRI outperforms mammography in tumour detection and diagnosis."

Breast Cancer - Screening

2008-05-27T10:29:00.000-07:00

Criticisms of screening mammography

Several scientific groups however have expressed concern about the public's perceptions of the benefits of breast screening. In 2001, a controversial review published in The Lancet claimed that "there is no reliable evidence that screening for breast cancer reduces mortality". 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."

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. 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.

A systematic review by the American College of Physicians concluded "Although few women 50 years of age or older have risks from mammography that outweigh the benefits, the evidence suggests that more women 40 to 49 years of age have such risks".

A 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.

Breast Cancer - Screening

2008-05-27T10:21:00.000-07:00

Main article: Breast cancer 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)

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%. 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. 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.

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.

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. In the UK, women are invited for screening once every three years beginning at age 50. Women with one or more first-degree relatives (mother, sister, daughter) with premenopausal breast cancer should begin screening at an earlier age. It is usually suggested to start screening at an age that is 10 years less than the age at which the relative was diagnosed with breast cancer.

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

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).

Breast Cancer - Epidemiology and etiology

2008-05-27T10:15:00.000-07:00

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.

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:

Lesions to DNA such as genetic mutations. Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure. Beyond the contribution of estrogen, research has implicated viral oncogenesis and the contribution of ionizing radiation in causing genetic mutations.

Failure of immune surveillance, a theory in which the immune system removes malignant cells throughout one's life.

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.

Inherited defects in DNA repair genes, such as BRCA1, BRCA2 and p53.

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, age, childbearing, hormones, a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use, radiation and shiftwork.

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

Breast Cancer Signs and Symptoms

2008-05-22T14:40:00.000-07:00

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. 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. Lumps found in lymph nodes located in the armpits and/or collarbone[citation needed] can also indicate breast cancer.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain is an unreliable tool in determining the presence of breast cancer, but may be indicative of other breast-related health issues such as mastodynia.

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.

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.

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.

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.

Breast Cancer Classification

2008-05-22T14:09:00.000-07:00

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

Pathology - A pathologist will categorize each tumor based on its histological (microscopic anatomy) appearance and other criteria. 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 tumor - 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):

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:

T4a - Extension to chest wall.
T4b - Edema (including peau d'orange) or ulceration of the breast skin, or satellite skin nodules confined to the same breast.
T4c - Both T4a and T4b.
T4d - Inflammatory breast cancer.

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.

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

Metastases - There are two metastatic classification values (M0 or M1) which depend on the presence or absence of breast cancer cells in locations other than the breast and lymph nodes (so-called distant metastases, e.g. to bone, brain, lung).

Life Insurance

Compare 300 life insurance plans
online. Search now!

www.protected.co.uk

Breast Cancer Info

2008-05-22T14:01:00.000-07:00

Breast cancer is a cancer that starts in the cells of the breast. Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. 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. In 2005, breast cancer caused 502,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.

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

Women in the United States have the highest incidence rates of breast cancer in the world; 141 among white women and 122 among African American women. Among women in the US, breast cancer is the most common cancer and the second-most common cause of cancer death (after lung cancer). Women in the US have a 1 in 8 (12.5%) lifetime chance of developing invasive breast cancer and a 1 in 35 (3%) chance of breast cancer causing their death. In 2007, breast cancer was expected to cause 40,910 deaths in the US (7% of cancer deaths; almost 2% of all deaths).

In the US, both incidence and death rates for breast cancer have been declining in the last few years. Nevertheless, a US study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease, even though heart disease is a much more common cause of death among women.

Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males. 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.