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Did You Know That Most Cancers Can Be Linked To Nutrition Deficiency?
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Breast cancer is the most common malignancy in women and
the second leading cause of cancer death (exceeded by lung
cancer in 1985). Breast cancer is three times more common
than all gynecologic malignancies put together. The incidence
of breast cancer has been increasing steadily from an incidence
of 1:20 in 1960 to 1:7 women today.
The American Cancer Society estimates that 211,000 new cases
of invasive breast cancer will be diagnosed this year and
43,300 patients will die from the disease. Breast cancer
is truly an epidemic among women and we don't know why.
Breast cancer is not exclusively a disease of women. For
every 100 women with breast cancer, 1 male will develop
the disease. The American Cancer society estimates that
1,600 men will develop the disease this year. The evaluation
of men with breast masses is similar to that in women, including
mammography.
The incidence of breast cancer is very low in the twenties
(age) gradually increases and plateaus at the age of forty-five
and increases dramatically after fifty. Fifty percent of
breast cancer is diagnosed in women over sixty-five indicating
the ongoing necessity of yearly screening throughout a woman's
life.
Breast cancer is considered a heterogenous disease, meaning
that it is a different disease in different women, a different
disease in different age groups and has different cell populations
within the tumor itself. Generally, breast cancer is a much
more aggressive disease in younger women. Autopsy studies
show that 2% of the population has undiagnosed breast cancer
at the time of death. Older women typically have much less
aggressive disease than younger women.
Early onset of menses and late menopause: Onset of the menstrual
cycle prior to the age of 12 and menopause after 50 causes
increased risk of developing breast cancer.
Diets high in saturated fat: The types
of fat are important. Monounsaturated fats such as canola
oil and olive oil do not appear to increase the risk of
developing breast cancer like polyunsaturated fats; corn
oil and meat.
Family history of breast cancer: Patients
with a positive family history of breast cancer are at increased
risk for developing the disease. However, 85% of women with
breast cancer have a negative family history!
Family history only includes immediate relatives, mother,
sisters and daughters. If a family member was post-menopausal
(fifty or older) when she was diagnosed with breast cancer,
the lifetime risk is only increased 5%. If the family member
was premenopausal, the lifetime risk is 18.6%. If the family
member was premenopausal and had bilateral breast cancer,
the lifetime risk is 50%.
Genetic testing
of the BRCA1 and BRCA2 genes is increasingly being integrated
into clinical care for appropriately counseled adults who
meet established criteria for this testing. The American
Society of Clinical Oncologists (ASCO) and the National
Comprehensive Cancer Network (NCCN) are among the professional
healthcare organizations who have published criteria for
genetic counseling/testing and cancer risk management. Increased
and earlier surveillance, chemoprevention (tamoxifen, oral
contraceptives) and surgical interventions (mastectomy,
oophorectomy - removal of the ovaries and fallopian tubes)
are among the current early detection and risk-reducing
strategies discussed with women undergoing BRCA testing.
In contrast to breast cancer, there is no reliable early
detection for ovarian cancer, which is often fatal due to
late stage at diagnosis. Therefore, oophorectomy is generally
recommended between ages 35-40 or upon completion of childbearing
for women at high risk for ovarian cancer.
Despite initial concerns about insurance coverage discrimination,
many insurers, including major indemnity plans (BC/BS, Aetna,
Kaiser, etc.) recognize the healthcare benefits of this
BRCA testing and cover test and genetic counsultation fees
when demmed medically necessary. To date, more than 10,000
women and men have had BRCA testing.
Similar to other medical tests, BRCA test results are often
used to substantiate the need for the early detection and
risk-reducing options available for individuals at high-risk
for breast and ovarian cancers.
Late or no pregnancies: Pregnancies prior to the age of
twenty-six are somewhat protective. Nuns have a higher incidence
of breast cancer.
Moderate alcohol intake: Greater than two alcoholic beverages
per day.
Estrogen replacement therapy: Most studies indicate that
taking estrogen longer than ten years may lead to a slight
increase in risk for developing breast cancer. However,
these studies indicate that the positive benefits of taking
estrogen as far as reducing the risk for osteoporosis, heart
disease and now more recently Alzheimer's and colon cancer,
far outweigh the slight increase in risk that may be associated
with estrogen replacement therapy.
Caution should be exercised in those women with a significantly
positive family history of breast cancer or atypical intraductal
hyperplasia. Women with breast cancer are not currently
give estrogen replacement. There are no scientific studies
currently justifying this practice. However, until those
studies are available, by convention, women are taken off
estrogen.
History of prior breast cancer: Patients with a prior history
of breast cancer are at increased risk for developing breast
cancer in the other breast. This risk is 1% per year or
a lifetime risk of 10%. The reason for close clinical follow-up
after the diagnosis of breast cancer is not only to detect
recurrence of the disease, but also to detect breast cancer
in the opposite breast.
Female: The mere fact that being female
increases the risk of developing breast cancer. However,
for every 100 women with breast cancer, 1 male will develop
the disease.
Therapeutic irradiation to chest wall i.e., for Hodgkins
Disease (cancer of lymph nodes): Patients who have had therapeutic
irradiation to the chest are at increased risk for developing
breast cancer approximately 10 years later and consideration
should be given to earlier screening in this population.
Moderate obesity: The relationship of breast
cancer to obesity is more complex but associated with an
increased risk.
Ductal Carcinoma in-situ: Generally divided
into comedo (blackhead, the cut surface of the tumor demonstrates
extrusion of dead and necrotic tumor cells similar to a
blackhead) and non-comedo types.
DCIS is early breast cancer confined to the inside of the
ductal system. The distinction between comedo and non-comedo
types is important as comedocarcinoma in-situ generally
behaves more aggressively and may show areas of microinvasion
(small areas of invasion through the ductal wall into surrounding
tissue).
The surgical management is the same as for other types of
breast cancer except axillary node sampling is not done,
as only 1% of these lesions will have axillary metastasis.
We recommend, however, that irradiation be given if treated
with conservative breast surgery to reduce the recurrence
rate from 21% without irradiation, to 5%-10% with irradiation.
This is a controversial area of the treatment of breast
cancer.
Infiltrating Ductal: The most common type
of breast cancer representing 78% of all malignancies. These
lesions can be stellate (star like in appearance on mammography)
in appearance or well circumscribed (rounded). The stellate
lesions generally have a poorer prognosis.
Medullary Carcinoma: Comprise 15% of breast
cancers. These lesions are generally well circumscribed
and may be difficult to distinguish from fibroadenoma by
mammography or sonography. Medullary carcinoma is estrogen
and progesterone receptor (prognostic indicator) negative
90% of the time. Medullary carcinoma usually has a better
prognosis than ordinary breast cancer.
Infiltrating Lobular: Representing 15%
of breast cancer these lesions generally present in the
upper outer quadrant of the breast as a subtle thickening
and are difficult to diagnose by mammography. Infiltrating
lobular can be bilateral (involve both breasts). Microscopically,
these tumors exhibit a linear array of cells (Indian filing)
and grow around the ducts and lobules (targeting).
Tubular Carcinoma: Orderly or well differentiated
carcinoma of the breast. These lesions make up about 2%
of breast cancer. They have a favorable prognosis with nearly
a 95% 10-year survival.
Mucinous Carcinoma: Represents 1%-2% of carcinoma of the
breast and has a favorable prognosis. These lesions are
usually well circumscribed (rounded).
What are the Stages of Breast Cancer
No Matter Your Stage, You Have Many Options for Treatment
There are many different varieties of breast cancer. Some
are fast-growing and unpredictable. Some are slow and steady.
Some are stimulated by the estrogen in your body; some result
from a wildly out-of-control oncogene (a cancer gene). You
and your doctors will plan your treatment based on the special
characteristics of your breast cancer. To help you understand
the traits of your cancer, and your treatment options, here's
information from the National Cancer Institute.
Overview: When Cancer
Is Found
The most common type of breast cancer is ductal carcinoma.
It begins in the lining of the ducts. Another type, called
lobular carcinoma, arises in the lobules. When cancer is
found, the pathologist can tell what kind of cancer it is
(whether it began in a duct or a lobule) and whether it
is invasive (has invaded nearby tissues in the breast).
Special lab tests of the tissue help the doctor learn more
about the cancer. For example, hormone receptor tests (estrogen
and progesterone receptor tests) can help determine whether
hormones help the cancer to grow. If test results show that
hormones do affect the cancer's growth (a positive test
result), the cancer is likely to respond to hormonal therapy.
This therapy deprives the cancer cells of estrogen.
Other tests are sometimes done to help the doctor predict
whether the cancer is likely to progress. For example, the
doctor may order x-rays and lab tests. Sometimes a sample
of breast tissue is checked for a gene (the human epidermal
growth factor receptor-2 or HER-2 gene) that is associated
with a higher risk that the breast cancer will come back.
The doctor may also order special exams of the bones, liver,
or lungs because breast cancer may spread to these areas.
A woman's treatment options depend on
a number of factors. These factors include her age and menopausal
status; her general health; the size and location of the
tumor and the stage of the cancer; the results of lab tests;
and the size of her breast. Certain features of the tumor
cells (such as whether they depend on hormones to grow)
are also considered.
In most cases, the most important factor
is the stage of the disease. The stage is based on the size
of the tumor and whether the cancer has spread. The following
are brief descriptions of the stages of breast cancer and
the treatments most often used for each stage. (Other treatments
may sometimes be appropriate.)
Stage 0
Stage 0 is sometimes called noninvasive carcinoma or carcinoma
in situ. Lobular carcinoma in situ (LCIS) refers to abnormal
cells in the lining of a lobule. These abnormal cells seldom
become invasive cancer. However, their presence is a sign
that a woman has an increased risk of developing breast
cancer. This risk of cancer is increased for both breasts.
Some women with LCIS may take a drug called tamoxifen, which
can reduce the risk of developing breast cancer. Others
may take part in studies of other promising new preventive
treatments. Some women may choose not to have treatment,
but to return to the doctor regularly for checkups. And,
occasionally, women with LCIS may decide to have surgery
to remove both breasts to try to prevent cancer from developing.
(In most cases, removal of underarm lymph nodes is not necessary.)
Ductal carcinoma in situ (DCIS) refers
to abnormal cells in the lining of a duct. DCIS is also
called intraductal carcinoma. The abnormal cells have not
spread beyond the duct to invade the surrounding breast
tissue. However, women with DCIS are at an increased risk
of getting invasive breast cancer. Some women with DCIS
have breast-sparing surgery followed by radiation therapy.
Or they may choose to have a mastectomy, with or without
breast reconstruction (plastic surgery) to rebuild the breast.
Underarm lymph nodes are not usually removed. Also, women
with DCIS may want to talk with their doctor about tamoxifen
to reduce the risk of developing invasive breast cancer.
Stage I and II
Stage I and stage II are early stages of breast cancer in
which the cancer has spread beyond the lobe or duct and
invaded nearby tissue. Stage I means that the tumor is no
more than about an inch across and cancer cells have not
spread beyond the breast. Stage II means one of the following:
the tumor in the breast is less than 1 inch across and the
cancer has spread to the lymph nodes under the arm; or the
tumor is between 1 and 2 inches (with or without spread
to the lymph nodes under the arm); or the tumor is larger
than 2 inches but has not spread to the lymph nodes under
the arm.Women with early stage breast cancer may have breast-sparing
surgery followed by radiation therapy to the breast, or
they may have a mastectomy, with or without breast reconstruction
to rebuild the breast. These approaches are equally effective
in treating early stage breast cancer. (Sometimes radiation
therapy is also given after mastectomy.)
The choice of breast-sparing surgery or
mastectomy depends mostly on the size and location of the
tumor, the size of the woman's breast, certain features
of the cancer, and how the woman feels about preserving
her breast. With either approach, lymph nodes under the
arm usually are removed.
Many women with stage I and most with
stage II breast cancer have chemotherapy and/or hormonal
therapy after primary treatment with surgery or surgery
and radiation therapy. This added treatment is called adjuvant
therapy. If the systemic therapy is given to shrink the
tumor before surgery, this is called neoadjuvant therapy.
Systemic treatment is given to try to destroy any remaining
cancer cells and prevent the cancer from recurring, or coming
back, in the breast or elsewhere.
Stage III
Stage III is also called locally advanced cancer. In this
stage, the tumor in the breast is large (more than 2 inches
across) and the cancer has spread to the underarm lymph
nodes; or the cancer is extensive in the underarm lymph
nodes; or the cancer has spread to lymph nodes near the
breastbone or to other tissues near the breast.
Inflammatory breast cancer is a type of
locally advanced breast cancer. In this type of cancer the
breast looks red and swollen (or inflamed) because cancer
cells block the lymph vessels in the skin of the breast.
Patients with stage III breast cancer
usually have both local treatment to remove or destroy the
cancer in the breast and systemic treatment to stop the
disease from spreading. The local treatment may be surgery
and/or radiation therapy to the breast and underarm. The
systemic treatment may be chemotherapy, hormonal therapy,
or both. Systemic therapy may be given before local therapy
to shrink the tumor or afterward to prevent the disease
from recurring in the breast or elsewhere.
Stage IV
Stage IV is metastatic cancer. The cancer has spread beyond
the breast and underarm lymph nodes to other parts of the
body.
Women who have stage IV breast cancer
receive chemotherapy and/or hormonal therapy to destroy
cancer cells and control the disease. They may have surgery
or radiation therapy to control the cancer in the breast.
Radiation may also be useful to control tumors in other
parts of the body.
Recurrent Cancer
Recurrent cancer means the disease has come back in spite
of the initial treatment. Even when a tumor in the breast
seems to have been completely removed or destroyed, the
disease sometimes returns because undetected cancer cells
remained somewhere in the body after treatment.
Most recurrences appear within the first
2 or 3 years after treatment, but breast cancer can recur
many years later.
Cancer that returns only in the area of
the surgery is called a local recurrence. If the disease
returns in another part of the body, the distant recurrence
is called metastatic breast cancer. The patient may have
one type of treatment or a combination of treatments for
recurrent cancer.
Source: National Cancer Institute
Tumor size: As the size of the tumor increases
the risk of axillary and systemic metastasis increases.
Histologic Grade: the appearance of the
tumor cells under the microscope and graded from 1) well
differentiated, 2) Moderately differentiated and 3) poorly
differentiated. The survival diminishes with increasing
histologic grade.
Estrogen and Progesterone Receptors: Protein
plugs on the surface of the tumor cells to which estrogen
and progesterone bind. This complex moves inside the cell
causing cellular division. The presence of estrogen and
progesterone receptors is a good prognostic indicator. Tumors
displaying these receptors will respond to hormonal manipulation,
i.e., Tamoxifen.
Axillary Nodes: The most important prognostic
indicator. Patients with negative axillary nodes (microscopically)
have improved disease free and long-term survival.
DNA Flow Cytometry: Test that determines
the genetic material within the cell. Tumors with a normal
amount of DNA (diploid) have a better disease free and long-term
survival than those with an abnormal amount of DNA (aneuploid).
This study also determines the percentage of cells in active
division. Tumors with active cellular division of <10%
have a better prognosis.
Her-2/neu: Protein product secreted by
the tumor indicating a decreased disease free and long term
survival.
http://www.nationalbreastcancer.org/
signs_and_symptoms/index.html
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