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| __NOTOC__ | | __NOTOC__ |
| {{Breast cancer}} | | {{Breast cancer}} |
| {{CMG}}; '''Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]] | | {{CMG}}; {{AE}} {{Ammu}} |
| | ==Overview== |
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| | ==Historical Perspective== |
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| | ==Pathophysiology== |
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| | ==Causes== |
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| ==Overview== | | ==Differentiating Epithelioid sarcoma from other Diseases== |
| '''Breast cancer''' is a [[cancer]] of the glandular [[breast]] tissue.
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| ==Epidemiology and Demographics== | | ==Epidemiology and Demographics== |
| Worldwide, breast cancer is the fifth most common cause of cancer death (after [[lung cancer]], [[stomach cancer]], [[liver cancer]], and [[colon cancer]]).<ref name="who fact sheet">{{cite web |author=[[World Health Organization]] |month=February |year=2006 |title=Fact sheet No. 297: Cancer |url=http://www.who.int/mediacentre/factsheets/fs297/en/index.html |accessdate=2007-04-26}}</ref> In 2005, breast cancer caused 502,000 deaths (7% of cancer deaths; almost 1% of all deaths) worldwide.<ref name="who fact sheet" /> Among women worldwide, breast cancer is the most common cause of death due to cancer.<ref name="who fact sheet" />
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| In the United States, breast cancer is the third most common cause of cancer death (after lung cancer and colon cancer). In 2007, breast cancer caused approximately 40,910 deaths (7% of cancer deaths; almost 2% of all deaths) in the U.S.<!--
| | ==Risk Factors== |
| --><ref name="acs cancer facts 2007">{{cite web |author=[[American Cancer Society]] |year=2007 |title=Cancer Facts & Figures 2007 |url=http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf |accessdate=2007-04-26}}</ref>
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| Among women in the U.S., breast cancer is the most common form of cancer and the second- most common cause of cancer death (after lung cancer).<ref name="acs cancer facts 2007" /> Women in the U.S. have a 1 in 8 lifetime chance of developing invasive breast cancer and a 1 in 33 chance of breast cancer causing their death.<!--
| | ==Natural history, Complications and Prognosis== |
| --><ref name="acs bc key stats">{{cite web |author=[[American Cancer Society]] |month=September 18, |year=2006 |title=What Are the Key Statistics for Breast Cancer? |url=http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_breast_cancer_5.asp |accessdate=2007-04-26}}</ref> A U.S. study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease,<ref>{{cite press release |title=Women's Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared Disease | publisher=Society for Women's Health Research | date=2005-07-07 | url=http://www.womenshealthresearch.org/site/News2?page=NewsArticle&id=5459&news_iv_ctrl=0&abbr=press_ |accessdate=2007-10-15 }}
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| </ref> even though [[heart disease]] is a much more common cause of death amongst women.<ref>{{cite web |url=http://www.nhlbi.nih.gov/health/hearttruth/press/infograph_dressgraph.pdf |title=Leading Causes of Death for American Women 2004 |accessdate=2007-10-15 |format=PDF |work=National Heart Lung and Blood Institute }}</ref>
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| The number of cases has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.<ref name="indy">{{cite news
| | ==Staging== |
| | last = Laurance
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| | first = Jeremy
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| | title = Breast cancer cases rise 80% since Seventies
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| | work = [[The Independent]]
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| | date = 2006-09-29
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| | url = http://news.independent.co.uk/uk/health_medical/article1771835.ece
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| | accessdate = 2006-10-09 }}</ref><ref>{{cite web
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| | title = Breast Cancer: Statistics on Incidence, Survival, and Screening
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| | work = [http://imaginis.com Imaginis Corporation]
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| | date = 2006
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| | url = http://imaginis.com/breasthealth/statistics.asp
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| | accessdate = 2006-10-09 }}</ref> Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, although it is less common.<ref name="Dave">{{cite web
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| | title = Male Breast Cancer Treatment - National Cancer Institute
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| | work = [http://www.cancer.gov/ National Cancer Institute]
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| | date = 2006
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| | url = http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/healthprofessional
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| | accessdate = 2006-10-16 }}</ref>
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| [[Epidemiological]] risk factors for a disease can provide important clues regarding the [[etiology]] of a disease. The first work 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.
| | ==History and Symptoms== |
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| Today, breast cancer, like other forms of cancer, is considered to be the final outcome of multiple environmental and hereditary factors. Some of the effects of environmental and hereditary factors that ultimately cause breast cancer are:
| | ==Physical Examination== |
| # Lesions to [[DNA]] such as [[genetic mutations]]. Exposure to estrogen has been experimentally linked to the mutations that cause breast cancer.<ref name="pmid16675129">{{cite journal |author=Cavalieri E, Chakravarti D, Guttenplan J, ''et al'' |title=Catechol estrogen quinones as initiators of breast and other human cancers: implications for biomarkers of susceptibility and cancer prevention |journal=Biochim. Biophys. Acta |volume=1766 |issue=1 |pages=63-78 |year=2006 |pmid=16675129 |doi=10.1016/j.bbcan.2006.03.001}}</ref> Beyond the contribution of estrogen, research has implicated viral oncogenesis and the contribution of [[ionizing radiation]].
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| # Failure of immune surveillance, which usually removes malignancies at early phases of their natural history.
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| # Abnormal [[growth factor]] signaling in the interaction between [[stromal cells]] and [[epithelial cells]], for example in the [[angiogenesis]] necessary to promote new blood vessel growth near new cancers.
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| # Inherited defects in [[DNA repair genes]], such as ''BRCA1'', ''BRCA2'' and ''p53''.
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| Although many epidemiological risk factors have been identified, the specific cause of any individual breast cancer is often unknown. In other words, epidemiological research is able to provide information regarding the patterns of breast cancer incidence across certain populations, but not in a given individual. Approximately 5% of new breast cancers are attributable to hereditary syndromes, while no [[etiology]] is known for the other 95% of cases.<ref name="Madigan_1995">{{cite journal | author = Madigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN | title = Proportion of breast cancer cases in the United States explained by well-established risk factors | journal = J. Natl. Cancer Inst. | volume = 87 | issue = 22 | pages = 1681-5 | year = 1995 | pmid = 7473816 | doi = | accessdate = 2007-05-26}}</ref>
| | ==MRI== |
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| The primary risk factors that have been identified are: sex,<ref name="Giordano">{{cite journal | last = Giordano | first = Sharon H | authorlink = | coauthors = Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN | title = Breast carcinoma in men | journal = Cancer | volume = 101 | issue = 1 | pages = 51-57 | publisher =American Cancer Society | date = May 2004 | url= http://www3.interscience.wiley.com/cgi-bin/fulltext/108565241/HTMLSTART | doi = | id = | accessdate = }}</ref> age,<ref>{{cite web | title = Individual Risk Factors| publisher = BreastCancer.org | url = http://www.breastcancer.org/cmn_who_indrisk.html | accessdate = 2007-03-11}}</ref> childbearing, hormones,<ref>{{cite journal |author=Yager JD |coauthors=Davidson NE |title=Estrogen carcinogenesis in breast cancer |journal=New Engl J Med |volume=354 |issue=3 |year=2006 |pages=270-82 |id=PMID 16421368}}</ref> a high-fat diet,<ref>{{cite journal | author = Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al. | title = Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study (WINS). | journal =J Natl Cancer Inst | volume =98 | issue =24 | pages =1767-1776 | pmid = 17179478 | url =}}</ref> alcohol intake,<ref name="Boffetta_2006">{{cite journal | last = Boffetta | first = Paolo | coauthors = Hashibe, Mia; La Vecchia, Carlo; Zatonski, Witold; Rehm, Jürgen | title = The burden of cancer attributable to alcohol drinking | journal = International Journal of Cancer | volume = 119 | issue = 4 | pages = 884–887 | publisher = Wiley-Liss, Inc | date = 2006-03-23 | url = http://www3.interscience.wiley.com/cgi-bin/abstract/112550783/ABSTRACT | doi = 10.1002/ijc.21903 | accessdate = 2006-10-09 | pmid=16557583 }}</ref> obesity,<ref>BBC report [http://news.bbc.co.uk/1/hi/health/5171838.stm Weight link to breast cancer risk]</ref> and environmental factors such as tobacco use and radiation.<ref name="acs bc facts 2005-6">{{cite web |author=[[American Cancer Society|ACS]] |year=2005 |title=Breast Cancer Facts & Figures 2005-2006 |url=http://www.cancer.org/downloads/STT/CAFF2005BrFacspdf2005.pdf |accessdate=2007-04-26}}</ref>
| | ==Other Diagnostic Studies== |
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| ==Diagnosis== | | ==Biopsy== |
| 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 [[Positron emission tomography|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.
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| ==Treatment== | | ==Medical Therapy== |
| The mainstay of breast cancer treatment is [[surgery]] during which 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.
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| In planning treatment, doctors can also use PCR tests such as [[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.<ref name="NewsMax">"[http://newsmax.com/archives/articles/2007/2/6/130740.shtml FDA Approves New Breast Cancer Test]". Associated Press, February 6, 2007.</ref>
| | ==Surgery== |
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| | [[Category:Dermatology]] |
| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Types of cancer]] | | [[Category:Types of cancer]] |
| [[Category:Breast]]
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| [[Category:Hereditary cancers]]
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| [[Category:Mature chapter]]
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| {{WH}} | | {{WikiDoc Help Menu}} |
| {{WS}} | | {{WikiDoc Sources}} |