Difference between revisions of "Breast cancer"
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Breast self-examination carried out every month, ideally one week after beginning a [[menstrual period]], is a common-sense preventive measure, but current research shows that it may not actually reduce mortality. It is still recommended.<ref> http://www.kidshealth.org/teen/sexual_health/girls/bse.html </ref> For women over the age of 40, [[mammogram]] screenings are another preventive measure that can detect cancer earlier, when it is easier to treat. However, not all medical authorities agree on whether there is any benefit from having annual mammograms below the age of 50. <ref> http://www.cnn.com/HEALTH/women/9909/27/bcam.mammography/</ref> | Breast self-examination carried out every month, ideally one week after beginning a [[menstrual period]], is a common-sense preventive measure, but current research shows that it may not actually reduce mortality. It is still recommended.<ref> http://www.kidshealth.org/teen/sexual_health/girls/bse.html </ref> For women over the age of 40, [[mammogram]] screenings are another preventive measure that can detect cancer earlier, when it is easier to treat. However, not all medical authorities agree on whether there is any benefit from having annual mammograms below the age of 50. <ref> http://www.cnn.com/HEALTH/women/9909/27/bcam.mammography/</ref> | ||
| − | Breast-feeding lowers risk. {{fact}} Term pregnancies reduce risk, as an interruption to estrogen exposure, decrease risk compared to women with no pregnancies. | + | Breast-feeding lowers risk. {{fact}} Term pregnancies reduce risk, as an interruption to estrogen exposure, decrease risk compared to women with no pregnancies. However, no one has studied getting pregnant as a method of risk-reduction. |
==Diagnosis== | ==Diagnosis== | ||
Revision as of 20:54, April 10, 2007
Under construction
Contents
Introduction
Breast cancer is the most common female cancer in the United States, the second most common cause of cancer death in women, and the one of the leading causes of death in women of all ages [1].
The most important risk factors are family history and hormonal factors. The term "breast cancer" itself refers to a number of distinct disease entities. Breast cancer occurs 100 times more frequently in women than in men.
Risk factors
Many factors affect the incidence of breast cancer in any given population of women including:
- Age: this is a complex relationship, with the steepest rise in diagnosis occurring between the ages of 40 and 60, however pre- and post-menopausal breast cancers tend to behave differently. Increasing age increases the risk that at some point in her life a woman will contract breast cancer, rising from 1 in 231 (0.5% risk) aged under 40 to 1 in 7 at age 90. [2].[3]
- Diet [4]
- Race/ethnicity: not a strong risk factor in the development of breast cancer, but affects time of diagnosis, and access to care.[5]
- Benign breast disease confers a slightly higher risk
- Obesity: this is a more significant risk factor in postmenopausal women. Before menopause, the effect is unclear. [6]
- Family history if such a history involves having several generations affected by breast cancer or having many relatives diagnosed with breast cancer at less than 50 years old [7]
- Prolonged uninterrupted exposure to estrogen (e.g. by having an early menarche and late menopause or by having no full-term pregnancies).[8]
- Personal history of breast cancer
This concept of risk should be put into the context of other risks A woman's risk of dying of breast cancer is similar to her risk from radon by living in Cornwall, England. [9]
Some studies have claimed that Abortion has been found to be a cause of breast cancer, but this has not been corroborated by any major medical groups and foundations.[10][11] The National Breast Cancer Coalition does not endorse the view that induced abortions increase the risk of breast cancer.[12] Nor do the American Cancer Society, the US National Cancer Institute [13] and the World Health Organisation[14] endorse this view. This would seem to be borne out by the experience of the Republic of Ireland, where abortion is illegal, and yet it has one of the highest rates of both breast cancer incidence and mortality in the EU. [15]
A higher risk factor for breast cancer than abortion, recent research reveals, is the eating of red meat. [16]
Ways of reducing the risk
Maintaining a healthy weight and a healthy diet reduces the risk.[17] [18]
Breast self-examination carried out every month, ideally one week after beginning a menstrual period, is a common-sense preventive measure, but current research shows that it may not actually reduce mortality. It is still recommended.[19] For women over the age of 40, mammogram screenings are another preventive measure that can detect cancer earlier, when it is easier to treat. However, not all medical authorities agree on whether there is any benefit from having annual mammograms below the age of 50. [20]
Breast-feeding lowers risk.[Citation Needed] Term pregnancies reduce risk, as an interruption to estrogen exposure, decrease risk compared to women with no pregnancies. However, no one has studied getting pregnant as a method of risk-reduction.
Diagnosis
In the modern era, the majority of breast cancers are diagnosed as a result of an abnormal mammogram and subsequent biopsy. Up to 20 percent of new breast cancers are not detected or visible on a mammogram. MRI is becoming an important diagnostic test in certain situations.[21]
Staging
There are a few different staging schemes. Staging is primarily accomplished surgically. A common current method is "sentinel node biopsy" which identifies the nearest lymph node draining the tumor, avoiding the need for more invasive lymph node dissection. One common staging system follows:
- Early stage
- Stage I: this is defined as tumor <2cm with no positive lymph nodes
- Stage II: <2cm tumor with lymph nodes involved on the same side, or tumor >2cm without positive nodes.
- Stage III: Locally advanced: extensive lymph node involvement, direct extension of tumor outside of the breast
- Stage IV, metastatic disease. Breast cancer cells found outside of the immediate area of the original tumor.
Treatment
under construction
Treatment is based on several factors, including the stage of the disease, age and menopausal status of the patient, and the hormone-receptor status of the tumor. Surgery, radiation therapy, chemotherapy, and hormonal therapy are used alone or in combination.
- Surgery: There are many surgical options, depending on tumor size and lymph node status. For small, localized tumors, lumpectomy followed by radiation is as effective as mastectomy.
- Hormone therapy: really, a subset of chemotherapy, hormone therapy cuts the tumor off from chemicals it needs to grow.
- Chemotherapy: this therapy will kill tumor cells throughout the body.
Prognosis
Under construction
Outcomes in breast cancer depend on the stage of the disease at diagnosis, the hormone receptor status, and a variety of other factors.
References
- ↑ CDC Breast Cancer Statistics
- ↑ http://www.breastcancer.org/cmn_who_indrisk.html
- ↑ http://www.breastcancer.org/cmn_who_indrisk.html
- ↑ http://unisci.com/stories/20021/0104023.htm
- ↑ http://www.womenshealthnetwork.org/advocacy/wocbreastca/natam.htm
- ↑ http://society.guardian.co.uk/cancer/story/0,,686105,00.html
- ↑ http://www.breastcancer.org/cmn_who_indrisk.html
- ↑ http://www.breastcancer.org/cmn_who_indrisk.html
- ↑ http://www.cplusc.co.uk/risks.html
- ↑ [1]
- ↑ Abortion and Breast Cancer
- ↑ http://www.natlbcc.org/bin/index.asp?strid=364&depid=9
- ↑ http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Can_Having_an_Abortion_Cause_or_Contribute_to_Breast_Cancer.asp
- ↑ http://www.who.int/mediacentre/factsheets/fs240/en/index.html
- ↑ http://www.allirelandnci.org/pdf/publications/Stat-Report-1998-2000/4a.pdf
- ↑ http://www.telegraph.co.uk/global/main.jhtml?xml=/global/2007/04/04/nmeat04.xml
- ↑ http://society.guardian.co.uk/cancer/story/0,,686105,00.html
- ↑ http://unisci.com/stories/20021/0104023.htm
- ↑ http://www.kidshealth.org/teen/sexual_health/girls/bse.html
- ↑ http://www.cnn.com/HEALTH/women/9909/27/bcam.mammography/
- ↑ Kriege, M. "Efficacy Of MRI and Mammography for Breast-Cancer Screening in Women With a Familial or Genetic Predisposition." New England Journal of Medicine. July 29, 2004, Vol. 351, No. 5, pp. 427-437.
