Breast cancer is a cancer that develops from the breast tissue. Signs of breast cancer may include breast lumps, breast shape changes, skin lesions, nipple discharge, reversed nipples, or red or scaly patches. In those with the spread of a distant disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.
Risk factors for developing breast cancer include women, obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having late or no children, older age, previous breast history. cancer, and family history. Approximately 5-10% of cases are caused by genes derived from one's parent, including BRCA1 and BRCA2 among others. Breast cancer most often develops in the cells of the lining of the milk ducts and lobules that supply the ducts with milk. Cancer developing from the duct is known as ductal carcinoma, while those developing from lobules are known as lobular carcinomas. In addition, there are more than 18 other sub-types of breast cancer. Some cancers, such as ductal carcinoma in situ, develop from pre-invasive lesions. The diagnosis of breast cancer is confirmed by taking a biopsy of the lump in question. After the diagnosis is done, further tests are conducted to determine whether the cancer has spread beyond the breasts and treatments that may be responded to.
The balance of benefits versus breast cancer screening hazards is still controversial. The 2013 Cochrane Review states that it is unclear whether mammography screening is better or harmful. A 2009 review for the US Prevention Services Task Force found evidence of benefits among those aged 40 to 70, and the organization recommends checks every two years in women aged 50 to 74. Drug tamoxifen or raloxifene can be used in an effort to prevent breast cancer in those at high risk of developing it. The surgical removal of both breasts is another precaution in some high-risk women. In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy, chemotherapy, hormonal therapy and targeted therapies. The type of surgery varies from breast surgery to mastectomy. Breast reconstruction may occur at the time of surgery or at a later date. In those whose cancers have spread to other parts of the body, most treatments are aimed at improving the quality of life and comfort.
The results for breast cancer vary depending on the type of cancer, disease level, and age of a person. The survival rate in developed countries is high, with between 80% and 90% of them in the UK and the United States living for at least 5 years. In developing countries the rate of survival is worse. Worldwide, breast cancer is a leading type of cancer in women, accounting for 25% of all cases. In 2012 it generated 1.68 million new cases and 522,000 deaths. This is more common in developed countries and more than 100 times more common in women than in men.
Video Breast cancer
Signs and symptoms
The first real symptoms of breast cancer are usually a lump that feels different from the rest of the breast tissue. More than 80% of cases of breast cancer are found when women feel a lump. Early breast cancer is detected by mammograms. Lumps found in lymph nodes located in the armpit can also show breast cancer.
Other breast cancer indications may include different thickening of other breast tissue, one becomes larger or lower, the nipple changes position or shape or becomes reversed, the skin contracts or dimples, the rash on or around the nipple, out of the nipple/s, constant pain in the breast or armpits, and swelling under the armpit or around the collarbone. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be an indication of other breast health problems.
Inflammatory breast cancer is a specific type of breast cancer that can pose a major diagnostic challenge. Symptoms may resemble breast inflammation and may include itching, pain, swelling, nipple reversal, warmth and redness across the breasts, as well as orange peel texture to the skin referred to as peau d'orange . Because inflammatory breast cancer is not present as a lump, there is sometimes a delay in diagnosis.
Another reported symptom of breast cancer is Paget's disease in the breast. This syndrome appears as skin changes that resemble eczema, such as redness, discoloration, or slight nipple skin exfoliation. As Paget's disease in the breast develops, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be fluid from the nipple. About half of the women diagnosed with Paget's breast disease also have a lump in the breast.
In rare cases, which initially emerged as fibroadenomas (a hard, moving non-cancerous lump) can actually be a phyllodes tumor. Phyllodes tumors are formed in the stroma (connective tissue) of the breast and contain glands and stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified according to their appearance under a microscope as benign, borderline, or malignant.
Occasionally, breast cancer appears as a metastatic disease - a cancer that has spread beyond the original organ. The symptoms caused by metastatic breast cancer will depend on the location of the metastasis. Common sites of metastasis include bone, liver, lungs and brain. Unexplained weight loss can sometimes signal breast cancer, as well as symptoms of fever or chills. Bone or joint pain can sometimes be a manifestation of metastatic breast cancer, such as jaundice or neurological symptoms. These symptoms are called not specific , which means they can be a manifestation of many other diseases.
Most of the symptoms of breast disorders, including most of the lumps, are not proven to represent the underlying breast cancer. Less than 20% of the lumps, for example, are cancerous, and benign breast diseases such as mastitis and fibroadenoma in the breast are more likely to cause symptoms of breast disorders.
Maps Breast cancer
Risk factors
Risk factors can be divided into two categories:
- modifiable risk factors (things people can change themselves, such as the consumption of alcoholic beverages), and
- fixed risk factors (irreversible items, such as age and biological sex).
The main risk factors for breast cancer are women and older age. Other potential risk factors include genetics, lack of childbirth or lack of breastfeeding, certain hormone levels, certain dietary patterns, and higher obesity. One study showed that exposure to light pollution was a risk factor for the development of breast cancer.
Lifestyle
Smoking tobacco seems to increase the risk of breast cancer, with more smoking and an earlier age of smoking, the higher the risks. In those with long-term smokers, the risk increases 35% to 50%. Lack of physical activity has been associated with about 10% of cases. Sitting regularly for long periods is associated with higher mortality of breast cancer. The risk is not negated by regular exercise, even if it is lowered.
There is a relationship between the use of hormonal contraceptives and the development of premenopausal breast cancer, but whether oral contraceptive use can actually cause premenopausal breast cancer is a matter of debate. If there is a link, the absolute effect is small. In addition, it is unclear whether there is any association with the control of newer hormonal births. In those with mutations in the susceptible genes of breast cancer BRCA1 or BRCA2 , or who have a family history of breast cancer, the use of modern oral contraceptives does not appear to affect the risk. breast cancer.
The relationship between breastfeeding and breast cancer has not been clearly defined; some research finds support for associations while others do not. In the 1980s, the abortion-breast cancer hypothesis suggested that induced abortion increases the risk of developing breast cancer. This hypothesis is the subject of extensive scientific investigation, which concludes that no miscarriage or abortion is associated with a high risk for breast cancer.
A number of dietary factors have been linked to breast cancer risk. Dietary factors that can increase risk include high-fat diets, high alcohol intake, and high cholesterol levels associated with obesity. Lack of dietary iodine can also play a role. The evidence for fiber is unclear. A review of 2015 found that studies attempting to link fiber intake to breast cancer produced mixed results. In 2016 a tentative association between low fiber intake during adolescence and breast cancer was observed.
Other risk factors include radiation and shift work. A number of chemicals have also been linked, including polychlorinated biphenyls, polycyclic aromatic hydrocarbons, and organic solvents. Although radiation from mammography is low dose, it is estimated that the annual screening from 40 to 80 years will cause about 225 fatal cases. breast cancer per million women screened.
Genetics
Some genetic susceptibility can play a small role in many cases. Overall, however, genetics is believed to be the leading cause of 5-10% of all cases. Women whose mothers were diagnosed before 50 had an increased risk of 1.7 and those whose mothers were diagnosed at age 50 or after had an increased risk of 1.4. In those with zero, one or two affected relatives, the risk of breast cancer before age 80 was 7.8%, 13.3%, and 21.1% with subsequent deaths from 2.3%, 4.2% and 7.6% respectively. In those with a relative first degree with the disease, the risk of breast cancer between the ages of 40 and 50 is twice that of the general population.
In less than 5% of cases, genetics plays a more significant role by causing hereditary ovary-breast cancer syndrome. This includes those carrying the gene mutations BRCA1 and BRCA2 . This mutation accounts for up to 90% of the total genetic influence with 60-80% breast cancer risk in those affected. Other significant mutations include p53 (Li-Fraumeni syndrome), PTEN (Cowden syndrome), and STK11 (Peutz-Jeghers syndrome), > CHEK2, ATM, BRIP1 , and PALB2 . In 2012, researchers say that there are four different types of breast cancer that are genetically different and in each type, the characteristics of genetic changes cause many cancers. Medical condition
Breast changes such as atypical duct hyperplasia and in situ lobular carcinoma are found in benign breast conditions such as fibrocystic breast changes, correlated with an increased risk of breast cancer. Diabetes mellitus may also increase the risk of breast cancer. Autoimmune diseases such as lupus erythematosus also appear to increase the risk for breast cancer acquisition.
Pathophysiology
Breast cancer, like other cancers, occurs because of the interaction between environmental factors (external) and genetically susceptible hosts. Normal cells divide as much as needed and stop. They stick to other cells and remain in place on the network. Cells become cancerous when they lose the ability to stop splitting, stick to other cells, to stay in place, and die at the right time.
Normal cells will commit cell suicide (programmed cell death) when they are no longer needed. Until then, they are protected from cell suicide by several groups of proteins and pathways. One of the paths of protection is the PI3K/AKT line; the other is the RAS/MEK/ERK path. Sometimes genes along these protective pathways mutate in a way that turns them permanently into "on", making the cell incapable of committing suicide when it is no longer necessary. This is one of the steps that causes cancer in combination with other mutations. Typically, the PTEN protein kills the PI3K/AKT pathway when the cell is ready for programmed cell death. In some breast cancers, the genes for the PTEN protein mutate, so the PI3K/AKT pathways are trapped in the "on" position, and the cancer cells do not commit suicide.
Mutations that can cause breast cancer are experimentally associated with estrogen exposure.
Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate the growth of malignant cells. In breast adipose tissue, excessive expression of leptin leads to increased cell proliferation and cancer.
In the United States, 10 to 20 percent of people with breast cancer and people with ovarian cancer have first or second levels with any of these diseases. The family's tendency to develop this cancer is called hereditary ovary-breast cancer syndrome. The most famous of these, the BRCA mutation, provides a lifetime risk of breast cancer between 60 and 85 percent and the lifetime risk of ovarian cancer between 15 and 40 percent. Some cancer-related mutations, such as p53 , BRCA1 and BRCA2 , occur in a mechanism to correct errors in DNA. These mutations are inherited or acquired after birth. Presumably, they allow for further mutations, allowing uncontrolled division, lack of attachment, and metastasis to distant organs. However, there is strong evidence of residual risk variations that transcend the BRCA BRCA mutations derivatives between carrier families. This is caused by unobserved risk factors. This has implications for environmental causes and others as a trigger for breast cancer. Inherited mutations in the BRCA1 or BRCA2 genes may interfere with the repair of crosslinked DNA and the breakdown of double-stranded DNA (known functions of encoded proteins). These carcinogens cause DNA damage such as crosslinked DNA and multiple strand breaks that often require repair via pathways containing BRCA1 and BRCA2. However, mutations in the BRCA genes account for only 2 to 3 percent of all breast cancers. Levin et al. says that cancer may be unavoidable for all carriers BRCA1 and BRCA2 mutations. About half of the hereditary ovary-breast cancer syndrome involves an unknown gene.
GATA-3 directly controls the expression of estrogen receptor (ER) and other genes associated with epithelial differentiation, and the loss of GATA-3 leads to loss of differentiation and poor prognosis due to cancer cell invasion and metastasis.
Diagnosis
Most types of breast cancer are easily diagnosed by microscopic analysis of the sample - or biopsy - of the affected breast area. Also, there are types of breast cancer that require special lab checks.
Two of the most commonly used screening methods, physical examination of breasts by health care providers and mammography, can offer a possible estimate that the lump is cancerous, and may also detect some other lesions, such as simple cysts. When this examination can not be concluded, the health care provider can remove the liquid sample in the lump for microscopic analysis (a procedure known as fine needle aspiration, or fine needle aspiration and cytology - FNAC) to help establish the diagnosis. Needle aspiration may be performed at a healthcare provider's office or clinic using local anesthesia if necessary. The discovery of a clear liquid makes the lump very unlikely to become cancerous, but bloody fluids can be sent for examination under a microscope for cancer cells. Together, physical examination of the breast, mammography, and FNAC can be used to diagnose breast cancer with a good degree of accuracy.
Other options for biopsy include a core or breast biopsy biopsy with the help of a vacuum, which is a procedure in which parts of the breast lump are removed; or an excisional biopsy, in which all the bumps are removed. Very often the results of physical examination by health care providers, mammography, and additional tests that can be performed under special circumstances (such as imaging by ultrasound or MRI) are sufficient to ensure excisional biopsy as a definitive primary diagnostic and treatment method.
Classification
Women can reduce the risk of breast cancer by maintaining a healthy weight, reducing alcohol use, increasing physical activity, and breastfeeding. This modification may prevent 38% of breast cancers in the US, 42% in the UK, 28% in Brazil, and 20% in China. The benefits with moderate exercise such as brisk walking are seen in all age groups including postmenopausal women. A high level of physical activity reduces the risk of breast cancer by about 14%. Strategies that encourage regular physical activity and reduce obesity can also have other benefits, such as reducing the risk of cardiovascular disease and diabetes.
High intake of citrus fruits has been associated with a 10% reduction in breast cancer risk.
Omega-3 marine polyunsaturated fatty acids reduce the risk. High consumption of soy-based foods can reduce the risk.
Pre-emptive surgery
The removal of both breasts before any cancer has been diagnosed or suspicious lumps or other lesions have emerged (a procedure known as bilateral prophylactic mastectomy) may be considered in people with BRCA1 and BRCA2 mutations, which are associated with a much higher risk for ultimately the diagnosis of breast cancer. The evidence is not strong enough to support this procedure to anyone but those at highest risk. The BRCA test is recommended for those at high family risk after genetic counseling. It is not recommended routinely. This is because there are many forms of BRCA gene change , ranging from harmless polymorphism to a clearly dangerous frameshift mutation. The effects of most of the changes identified in the gene are uncertain. Testing on average-risk people is very likely to return one of these useless and useless results. It is unclear whether removing a second breast in those who suffer from breast cancer in one is beneficial.
Drugs
Selective estrogen receptor modulators (such as tamoxifen) reduce the risk of breast cancer but increase the risk of thromboembolism and endometrial cancer. There is no overall change in the risk of death. They are thus not recommended for the prevention of breast cancer in women with an average risk but may be offered for those at high risk. The benefits of breast cancer reduction continue for at least five years after discontinuing treatment with these drugs.
Screening
Breast cancer screening refers to testing healthy women for breast cancer in an attempt to achieve a prior diagnosis assuming that early detection will improve results. A number of screening tests have been used including clinical examination and breast self-examination, mammography, genetic screening, ultrasound, and magnetic resonance imaging.
Clinical or self-examination of the breast involves breast feelings for lumps or other abnormalities. Clinical breast examination is performed by the health care provider, while breast self-examination is performed by the person himself. The evidence does not support the effectiveness of both types of breast examination, because at the time the bump is large enough to be discovered it may have grown for several years and thus soon is large enough to be found without an exam. Mammography screening for breast cancer uses X-rays to examine breasts for any mass or unusual lumps. During the examination, the breast is compressed and the technician takes photos from various angles. The general mammogram takes a photo of the entire breast, while a diagnostic mammogram focuses on a particular lump or area of ​​concern.
A number of national agencies recommend breast cancer screening. For the average woman, the US Prevention Services Task Force recommends mammography every two years in women between the ages of 50 and 74, the Council recommends mammography between 50 and 69 with most programs using 2-year frequency, and in Canada. recommended between the ages of 50 and 74 at a frequency of 2 to 3 years. The report of this task force shows that in addition to unnecessary surgery and anxiety, the risk of a more frequent mammogram includes a small but significant increase in breast cancer caused by radiation.
The Cochrane Collaboration (2013) states that the best quality evidence does not indicate a specific reduction in cancer, or reduction of all causes of death from mammography screening. When less rigorous tests were added to the analysis there was a 0.05% decrease in mortality from breast cancer (a decrease of 1 in 2000 deaths from breast cancer for 10 years or a relative decrease of 15% from breast cancer). Screening over 10 years results in a 30% increase in over-diagnosis and over-treatment rates (3 to 14 per 1000) and more than half will have at least one false-positive test. This leads to the view that it is unclear whether mammography screening is better or harmful. Cochrane states that, because of the recent improvements in the treatment of breast cancer, and the false-positive risks of breast cancer screening leading to unnecessary treatment, "it no longer seems useful to attend breast cancer screening" at any age. Does MRI as a screening method have more hazards or benefits when compared to unknown standard mammography.
Management
Handling of breast cancer depends on various factors, including the stage of cancer and a person's age. Treatment is more aggressive when the prognosis is worse or there is a higher risk of recurrence of cancer after treatment.
Breast cancer is usually treated with surgery, which may be followed by chemotherapy or radiation therapy, or both. A multidisciplinary approach is preferred. Positive-receptor hormones are often treated with hormone-inhibiting therapy for several years. Monoclonal antibodies, or other immune modulation treatments, may be given in certain cases of metastasis and advanced stage breast cancer.
Surgery
Surgery involves removal of the tumor physically, usually along with several surrounding tissues. One or more lymph nodes may be biopsied during surgery; the more lymph node sampling performed by a sentinel lymph node biopsy.
Standard surgery includes:
- Mastectomy: Appointment of all breasts.
- Quadrantectomy: Eliminates a quarter of the breasts.
- Lumpectomy: Eliminate a small portion of the breast.
Once the tumor has been removed, if the desired person, breast reconstruction surgery, type of plastic surgery, then can be done to improve the aesthetic appearance of the treated site. Alternatively, women use breast prostheses to simulate breasts under clothing, or choose a flat chest. The nipple prosthesis can be used anytime after mastectomy.
Medication
Medications used after and in addition to surgery are called adjuvant therapy. Chemotherapy or other type of therapy before surgery is called neoadjuvant therapy. Aspirin can reduce mortality from breast cancer.
There are currently three main groups of drugs used for the treatment of adjuvant breast cancer: hormone blocking agents, chemotherapy, and monoclonal antibodies.
Hormone blocking therapy
- Some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen (ER) receptors and progesterone (PR) receptors on the surface (sometimes referred to together as hormone receptors). ER cancers can be treated with drugs that block receptors, eg. tamoxifen, or alternatively blocking estrogen production by aromatase inhibitors, eg. anastrozole or letrozole. Use of tamoxifen is recommended for 10 years. Letrozole is recommended for 5 years. Aromatase inhibitors are only suitable for women after menopause; However, in this group, they look better than tamoxifen. This is because the active aromatase in postmenopausal women differs from the general form in premenopausal women, and therefore this agent is ineffective in inhibiting the dominant aromatase of premenopausal women. Aromatase inhibitors should not be given to premenopausal women with intact ovarian function (unless they are also being treated to stop their ovaries from working).
Chemotherapy
- Chemotherapy is mostly used for cases of breast cancer gradually 2-4, and is very beneficial in estrogen-negative receptor disease (ER-). Chemotherapy drugs are given in combination, usually for a period of 3-6 months. One of the most common regimens, known as "AC", combines cyclophosphamide with doxorubicin. Sometimes taxane drugs, such as docetaxel, are added, and this regime came to be known as "CAT". Other common treatments are cyclophosphamide, methotrexate, and fluorouracil (or "CMF"). Most chemotherapy drugs work by destroying rapidly growing and/or rapidly replicating cancer cells, either by causing DNA damage during replication or by other mechanisms. However, drugs also damage normal cells that grow rapidly, which can cause serious side effects. Damage to the heart muscle is the most dangerous complication of doxorubicin, for example.
Monoclonal antibodies Trastuzumab, a monoclonal antibody to HER2 (a highly active cell receptor in some breast cancer cells), has improved the 5-year-old free survival of breast cancer stage 1-3 HER2 to about 87% (overall survival 95% ). When stimulated by certain growth factors, HER2 causes cellular growth and division; in the absence of stimulation by growth factors, the cells will usually stop growing. Between 25% and 30% overexpress breast cancer of HER2 gene or its protein products, and HER2 overexpression in breast cancer is associated with an increased disease recurrence and a worse prognosis. When trastuzumab binds to HER2 in breast cancer cells that expose excessive receptors, trastuzumab prevents growth factors from binding ability and stimulates receptors, which effectively inhibit cancer cell growth. Trastuzumab, however, is very expensive, and its use can cause serious side effects (about 2% of people who receive it suffer significant heart damage).
Radiation
Radiotherapy is given after surgery to the tumor bed area and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on the tumor microenvironment. Radiation therapy may be given as an external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventional radiotherapy is given after surgery for breast cancer. Radiation can also be given during surgery on breast cancer. Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3 risk reduction) when administered in the appropriate dosage and is considered important when breast cancer is treated by simply lifting the lump (Lumpectomy or Local wide staining).
Prognosis
Prognostic factors
Breast cancer stage is the most important component of the traditional classification method of breast cancer, because it has a greater effect on prognosis than other considerations. Staging considers size, local involvement, lymph node status and whether there is metastatic disease. The higher the stage at diagnosis, the worse the prognosis. The stage is generated by the invasion of the disease into the lymph nodes, chest wall, skin or outside, and the aggressiveness of cancer cells. The stage is lowered by a cancer-free zone and near-normal cell behavior (gradation). Size is not a factor in staging unless cancer is invasive. For example, Ductal Carcinoma In Situ (DCIS) involving all breasts will remain a zero stage and as a result is a very good prognosis with a 10% free disease-free survival of about 98%.
- Cancer stage 1 (and DCIS, LCIS) has a very good prognosis and is generally treated with lumpectomy and sometimes radiation.
- Stage 2 and 3 cancer with an increasingly poor prognosis and greater recurrence risk are generally treated by surgery (lumpectomy or mastectomy with or without lymph node transfer), chemotherapy (plus trastuzumab for HER2 cancer) and sometimes radiation ( especially after major cancers, some positive nodes or lumpectomy).
- Stage 4, metastatic cancer, (ie, spread to distant places) has a poor prognosis and is managed by various combinations of all treatments from surgery, radiation, chemotherapy, and targeted therapies. The 10-year survival rate is 5% without treatment and 10% with optimal care.
The rate of breast cancer is assessed by comparison of breast cancer cells with normal breast cells. The closer to normal cancer cells, the slower the growth and the better the prognosis. If cells are not well differentiated, they will appear immature, will split faster, and will tend to spread. Differentiated with either 1, while grade 2, while poor or undifferentiated are rated higher than 3 or 4 (depending on the scale used). The most widely used scoring system is the Nottingham scheme;
Younger women younger than 40 years or women over 80 years tend to have a worse prognosis than postmenopausal women due to several factors. The breasts may change with their menstrual cycle, they may breastfeed the baby, and they may not be aware of changes in their breasts. Therefore, younger women are usually at a higher stage when diagnosed. There may also be biological factors that contribute to a higher risk of disease recurrence for younger women with breast cancer.
Psychological aspects
Not all people with breast cancer experience their disease in the same way. Factors such as age can have a significant impact on how a person overcomes the diagnosis of breast cancer. Pre-menopausal women with estrogen receptor positive breast cancer should face the problem of early menopause caused by the many chemotherapy regimens used to treat their breast cancer, especially those using hormones to fight ovarian function.
Epidemiology
Worldwide, breast cancer is the most common invasive cancer in women. It affects about 12% of women worldwide. (The most common form of cancer is non-invasive non-melanoma skin cancer, non-invasive cancer is generally easily curable, causes very little death, and is routinely excluded from cancer statistics.) Breast cancer consists of 22.9% of invasive cancers in women and 16% of all female cancers. In 2012, it consists of 25.2% of cancer diagnosed in women, making it the most common female cancer.
In 2008, breast cancer caused 458,503 deaths worldwide (13.7% cancer deaths in women and 6.0% of all cancer deaths for men and women together). Lung cancer, the second most common cause of cancer-related death in women, accounts for 12.8% of cancer deaths in women (18.2% of all cancer deaths for men and women together).
The incidence of breast cancer varies widely around the world: this cancer is lowest in developing and largest countries in more developed countries. In twelve regions of the world, the annual incidence rate of annualized standards per 100,000 women is as follows: in East Asia, 18; South Central Asia, 22; sub-Saharan Africa, 22; Southeast Asia, 26; North Africa and West 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.
The number of cases worldwide has increased significantly since the 1970s, a phenomenon that is partly due to the modern lifestyle. Breast cancer is strongly associated with age with only 5% of all breast cancers that occur in women under 40 years. There are over 41,000 new cases of breast cancer enrolled in the UK in 2011, about 80% of these cases are in women aged 50 or older. Based on US statistics in 2015 there are 2.8 million women affected by breast cancer. In the United States, the incidence of breast cancer per 100,000 women adjusted for age per year increased from about 102 cases per year in the 1970s to about 141 in the late 1990s, and has since fallen, steadily stabilizing around 125 since 2003. However, adjusted mortality due to breast cancer per 100,000 women only increased slightly from 31.4 in 1975 to 33.2 in 1989 and has since declined steadily to 20.5 by 2014.
History
Because of its visibility, breast cancer is the most commonly described form of cancer in ancient documents. Because autopsies are scarce, internal organ cancers are essentially invisible to ancient medicine. Breast cancer, however, can be felt through the skin, and in advanced circumstances it often develops into a fungating lesion: the tumor becomes necrotic (dead from the inside, causing the tumor to appear broken) and slits through the skin, crying, dark liquid.
The earliest known evidence of breast cancer comes from Egypt and dates from 4200 years, to the Sixth Dynasty. The study of female remains of the Qubbet el-Hawa necropolis shows typical destructive destruction due to metastatic spread. The Edwin Smith Papyrus describes 8 cases of tumors or boils from breast treated with cautery. The article says about the disease, "There is no treatment." For centuries, doctors have described similar cases in their practice, with the same conclusion. Ancient medicine, from the time of the Greeks to the 17th century, is based on humoralism, and thus believes that breast cancer is generally caused by an imbalance in the fundamental fluid that controls the body, especially the excess black bile. Or it is seen as divine punishment. In the 18th century, various medical explanations were proposed, including lack of sexual activity, too much sexual activity, physical injuries to the breast, thickened milk, and various forms of lymphatic blockage, both internal and for restrictive clothing.. In the 19th century, Scottish surgeon John Rodman said that the fear of cancer causes cancer, and that this anxiety, studied with examples from mothers, contributes to the tendency of breast cancer to run in families.
Although breast cancer was known in ancient times, it was not common until the 19th century, when improved sanitation and control of infectious diseases resulted in dramatic increases in lifespan. Previously, most women died too young to develop breast cancer. In addition, early and frequent breastfeeding and breast-feeding may reduce the rate of progression of breast cancer in women who survive to middle age.
Because ancient medicine believes that the cause is systemic, not local, and because surgery carries a high mortality rate, preferred treatments tend to be more pharmacological than surgical. Preparation of herbs and minerals, especially those involving arsenic poison, is relatively common.
Mastectomy for breast cancer was performed at least as early as 548 AD, when it was proposed by Aetios court doctors from Amida to Theodora. It was not until doctors reached a greater understanding of the circulatory system in the 17th century that they could connect the spread of breast cancer to lymph nodes in the armpits. French surgeon Jean Louis Petit (1674-1750) performed a total mastectomy including removing the axillary lymph nodes, as he admitted that this reduced the recurrence. Petit's work was built by another French surgeon, Bernard Peyrilhe (1737-1804), who also excluded the underlying pectoral muscles of the breast, as he considered that this greatly improved the prognosis. The Scottish surgeon, Benjamin Bell (1749-1806) advocated the removal of the entire breast, though only partly affected.
Their successful work was done by William Stewart Halsted who started a radical mastectomy in 1882, greatly assisted by advances in general surgical technology, such as aseptic techniques and anesthesia. Halsted radical mastectomy often involves lifting both breasts, associated lymph nodes, and underlying chest muscles. This often causes long-term pain and disability, but it is deemed necessary to prevent recurrent cancer. Before the rise of Halsted's radical mastectomy, the 20-year survival rate was only 10%; Halsted's operation raised the rate to 50%. Extending Halsted's work, Jerome Urban promoted the superradis mastectomy, took more tissue, until 1963, when ten-year survival rates proved to be the same as less damaging radical mastectomy.
Radical mastectomy remained the standard of care in America until the 1970s, but in Europe, the procedure of breast-saving, often followed by radiation therapy, was generally adopted in the 1950s. One of the reasons for the striking difference in this approach is probably the structure of the medical profession: European surgeons, descendants of barber surgeons, less valued than doctors; in America, the surgeon is the king of the medical profession. In addition, there are more European female surgeons: Fewer than one percent of American cancer surgeons are women, but some European breast cancer wards are boasting half-female medical staff. American health insurance companies also pay more surgeons for radical mastectomies than they perform more complicated breast surgery.
Breast cancer staging systems were developed in the 1920s and 1930s.
During the 1970s, a new understanding of metastasis led to the observation of cancer as a systemic and localized disease, and more sparing procedures developed that proved equally effective. Modern chemotherapy developed after World War II.
Leading women who died of breast cancer included Anne of Austria, mother of Louis XIV of France; Mary Washington, George's mother, and Rachel Carson, environmentalists.
The first case-controlled study on epidemiology of breast cancer was conducted by Janet Lane-Claypon, who published a comparative study in 1926 of 500 cases of breast cancer and 500 controls of the same background and lifestyle for the UK Ministry of Health.
In the 1980s and 1990s, thousands of women who had successfully completed standard treatment then demanded and received high-dose bone marrow transplants, thinking this would lead to better long-term survival. However, it proved completely ineffective, and 15-20% of women died of brutal treatment.
The 1995 report of the Nurses' Health Study and the 2002 conclusions from the Women's Health Initiative trial conclusively proved that hormone replacement therapy significantly increased the incidence of breast cancer.
Society and culture
Before the 20th century, breast cancer was feared and discussed in a hushed tone, as if it were embarrassing. Because little can be done safely with primitive surgery techniques, women tend to suffer in silence rather than seek treatment. As surgery progresses, and long-term survival rates improve, women begin to raise awareness of the disease and the possibility of successful treatment. The "Women's Field Army", run by the American Society for Control of Cancer (later American Cancer Society) during the 1930s and 1940s was one of the first organized campaigns. In 1952, the first peer-to-peer support group, called "Reach to Recovery", began providing post-mastectomy, a hospital visit of women who survived breast cancer.
Breast cancer movement in the 1980s and 1990s evolved from a larger feminist movement and the women's health movement in the 20th century. This series of political and educational campaigns, partly inspired by the politically and socially effective AIDS awareness campaign, resulted in widespread acceptance of a second opinion before the operation, less invasive surgical procedures, support groups, and other advances in care.
Pink ribbon
The pink ribbon is the most prominent symbol of breast cancer awareness. The pink ribbon, which can be made cheap, is sometimes sold as a fundraiser, like a poppy flower on Memorial Day. They may be used to honor those who have been diagnosed with breast cancer, or to identify products that manufacturers want to sell to consumers interested in breast cancer.
The pink ribbon is associated with the individual's generosity, faith in scientific progress, and a "can-do" attitude. This encourages consumers to focus on the emotional ultimate vision of a cure for breast cancer, rather than on the full path between current knowledge and future medicine.
Wearing or displaying pink ribbons has been criticized by opponents of this practice as a kind of slacktivism, as it has no practical positive effect. It has also been criticized as hypocrisy, as some people wear pink ribbons to show goodwill toward women with breast cancer, but then defy this woman's practical goals, such as patient rights and anti-pollution laws. Critics say that the pleasing nature of pink ribbons and pink consumption distracts people from the lack of progress in preventing and curing breast cancer. It has also been criticized for reinforcing gender stereotypes and vilifying women and their breasts. Breast Cancer Action launched the "Think Before You Pink" campaign, and said that businesses have co-opted a pink campaign to promote products that cause breast cancer, such as alcoholic beverages.
Culture of breast cancer
The culture of breast cancer, or pink ribbon culture, is a series of activities, attitudes, and values ​​that surround and shape breast cancer in public. Dominant values ​​are unselfishness, joy, unity, and optimism. It seems to have suffered courageously is a passport into the culture.
Women with breast cancer are given a cultural template that limits their emotional and social responses to socially acceptable discourse: She should use emotional trauma to be diagnosed with breast cancer and suffer long treatment to transform herself into stronger, happier and more sensitive people who are grateful for the chance to become a better person. Breast cancer therapy becomes a transitional rite rather than a disease. In order to fit this mold, women with breast cancer need to normalize and feminize their appearance, and minimize the disruption that health problems cause to others. Anger, sadness, and negativity must be silenced.
Like most cultural models, people who fit the model are given a social status, in this case as cancer survivors. Women who reject models are shunned, punished and humiliated.
Culture is criticized for treating adult women like little girls, as evidenced by "baby" toys like teddy pink dolls given to adult women.
The main purpose or goal of breast cancer culture is to maintain the dominance of breast cancer as a pre-predecessor women's health issue, to promote the appearance that society is "doing something" effective about breast cancer, and to maintain and expand social, political, and financial strength breast cancer activists.
Emphasis
Compared to other diseases or other cancers, breast cancer receives a proportionately larger share of resources and attention. In 2001 MP Ian Gibson, chairman of the House of Commons of United Kingdom all groups of parties to cancer stated "The treatment has been tilted by the lobby, there is no doubt about it.Tom breast cancer patients get better care in terms of bedding, facilities and doctors and nurses. "Breast cancer also received much more media coverage than any other cancer, equally prevalent, with research by the Prostate Coalition showing 2.6 stories of breast cancer for each that included prostate cancer. In the end there is a concern that supporting breast cancer patients with funding and disproportionate research on their behalf may be sacrificing life elsewhere. Partly because of its relatively high prevalence and long-term survival rates, research is biased against breast cancer. Some subjects, such as cancer-related fatigue, have been studied little except in women with breast cancer.
One result of high breast cancer visibility is that statistical results can sometimes be misinterpreted, such as claims that one in eight women will be diagnosed with breast cancer during their lifetime - a claim that depends on the unrealistic assumption that no woman will die from other diseases before the age of 95 years. This obscures the fact, that is about ten times as many women will die of heart disease or stroke than from breast cancer.
Emphasis on breast cancer screening can harm women by subjecting them to unnecessary radiation, biopsy, and surgery. One-third of diagnosed breast cancers can subside by themselves. Mammography screening efficiently found asymptomatic and asymptomatic breast cancer without asymptomatic and pre-cancerous, even when facing a serious cancer. According to H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, research on mammography screening has taken a "brain dead approach that says the best test is the one that finds most cancers" rather than finding the danger. cancer.
Pregnancy
Breast cancer occurs during pregnancy at the same rate as breast cancer in women who are not pregnant at the same age. Breast cancer then becomes more common within 5 or 10 years after pregnancy but then becomes less common than among the general population. This cancer is known as postpartum breast cancer and has poorer outcomes including an increased risk of spreading illness and mortality. Other cancers found during or shortly after pregnancy appear at levels more or less the same as other cancers in women of the same age.
Diagnosing new cancers in pregnant women is difficult, partly because the symptoms are generally assumed to be the normal discomfort associated with pregnancy. As a result, cancer is usually found at a somewhat slower rate than the average in many pregnant or newly pregnant women. Some imaging procedures, such as MRI (magnetic resonance imaging), CT scan, ultrasound, and mammograms with fetal shields are considered safe during pregnancy; some others, such as PET scans are not.
Treatment is generally the same as women who are not pregnant. However, radiation is usually avoided during pregnancy, especially if the fetal dose may exceed 100 cGy. In some cases, some or all treatments are postponed until after birth if the cancer is diagnosed at the end of pregnancy. Early introduction to speed up the start of treatment is not uncommon. Surgery is generally considered safe during pregnancy, but some other treatments, especially certain chemotherapy drugs given during the first trimester, increase the risk of birth defects and miscarriages (spontaneous abortions and stillbirths). Elective abortion is not necessary and does not increase the likelihood of a survivor or being cured.
Radiation treatments may interfere with the mother's ability to breastfeed her baby because it reduces the ability of the breast to produce breast milk and increases the risk of mastitis. Also, when chemotherapy is given after birth, many drugs pass through breast milk to the baby, which can harm the baby.
Regarding future pregnancies among breast cancer sufferers, there is often a fear of cancer recurrence. On the other hand, many still consider pregnancy and parents to represent normalcy, happiness, and fulfillment of life.
Hormones
Birth control
In breast cancer patients, non-hormonal family planning methods should be used as first-line options. Progestogen-based methods such as depot medroxyprogesterone acetate, IUD with progestogen or progestogen-only pills only have a poor investigation but a possible increased risk of cancer recurrence, but can be used if positive effects outweigh the possible risks.
Menopausal hormone replacement
In breast cancer patients, it is recommended to first consider non-hormonal options for the effects of menopause, such as bisphosphonates or selective estrogen receptor modulators (SERMs) for osteoporosis, and vaginal estrogen for local symptoms. Observational studies of systemic hormone replacement therapy after breast cancer are generally reassuring. If hormone replacement is necessary after breast cancer, estrogen-only therapy or estrogen therapy with intrauterine devices with progestogen may be a safer option than joint systemic therapy.
Research
Care is being evaluated in trials. These include individual medicines, a combination of drugs, and surgical and radiation techniques. Investigations include new target therapy types, cancer vaccines, oncolytic virotherapy, and immunotherapy.
Recent research is reported every year at scientific meetings such as the American Society of Oncology, the San Antonio Breast Cancer Symposium, and St. St. Gallen Oncology Conference Gallen, Switzerland. These studies are reviewed by professional societies and other organizations, and formulated into guidelines for special treatment groups and risk categories.
Fenretinide, retinoid, is also being studied as a way to reduce the risk of breast cancer (retinoids are drugs associated with vitamin A).
Cryoablation
Until 2014 cryoablation is being studied to see if it can be a substitute for lumpectomy in small cancers. There is temporary evidence in those with tumors less than 2 cm. It can also be used on those who are in operation impossible. Other reviews suggest that cryoablation looks promising for early breast cancer with a small size.
Breast cancer cell line
Much of the current knowledge of breast carcinoma is based on in vivo and in vitro studies conducted with cell lines derived from breast cancer. It provides an unlimited source of self-replicating material, freely pollutes stromal cells, and is often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite the ongoing work in this area, the number of permanently obtained lines is very low (around 100). Indeed, efforts to cultivate breast cancer cell lines from primary tumors are largely unsuccessful. This poor efficiency is often due to technical difficulties associated with the extraction of viable tumor cells from the surrounding stroma. Most of the available breast cancer cells come from metastatic tumors, especially from pleural effusions. Effusion provides a large number of tumor cells that are separated and live with little or no contamination by fibroblasts and other tumor stromal cells. Many of the BCC lines currently in use were set up in the late 1970s. Very few of them, the MCF-7, T-47D, and MDA-MB-231, accounted for more than two-thirds of all abstract reporting studies on the breast cancer cell line mentioned, as concluded from the Medline-based survey.
Molecular marker
Transcription factors
NFAT transcription factor is involved in breast cancer, more specifically in the process of cell motility based on metastatic formation. Indeed, NFAT1 (NFATC2) and NFAT5 are pro-invasive and pro-migration in breast carcinoma and NFAT3 (NFATc4) are motility cell inhibitors. NFAT1 regulates TWEAKR expression and its ligand TWEAK with Lipocalin 2 to increase breast cancer cell invasion and NFAT3 inhibits lipocalin 2 expression to collect cell invasion.
Metabolic markers
Clinically, the most useful metabolic markers in breast cancer are estrogen and progesterone receptors used to predict a response to hormone therapy. New or potentially new markers for breast cancer include BRCA1 and BRCA2 to identify those at high risk for breast, HER-2 and SCD1, to predict a response to therapeutic regimens, and activator plasminogen urokinase, PA1-1 and SCD1 to assess prognosis.
Other animals
- Breast tumor for breast cancer in other animals
- Metastatic mouse breast cancer model
References
External links
- Breast cancer in Curlie (based on DMOZ)
Source of the article : Wikipedia
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