BREAST|PAYUDARA CANCER TREATMENT

Breast Cancer Prognosis

2009-07-14T14:55:00.000-07:00

ScienceDaily (June 24, 2009) — Dr. Arne Östman and colleagues at the Karolinska Institutet in Stockholm have identified a stromal marker for breast cancer progression.

Platelet-derived growth factor (PDGF) receptors are involved in multiple stages of cancer cell growth. However, the contribution of PDGFR expression in the stroma, or surrounding supportive tissue, of the tumor remains unclear.

Paulsson et al therefore characterized PDGFR expression in stroma of various tumors, including lymphoma and colon, ovarian, prostate, lung, and breast cancer. They found highly variable PDGFR expression in solid tumors, with colon and prostate tumors expressing the highest stromal levels of one type of PDGFR, PDGFβR. In breast cancer, stromal PDGFβR expression in pre-menopausal breast cancer patients significantly correlated with negative prognosis. These data highlight the importance of examining stromal as well as malignant cell expression of PDGF receptors in disease prognosis.

Paulsson et al suggest that "the findings in the present study of robust staining procedures for PDGF receptors should motivate continued studies of the response-predicative value of stromal PDGF receptor status."

Journal reference:

Paulsson J, Sjöblom T, Micke P, Pontén F, Landberg G, Heldin C-H, Bergh J, Brennan DJ, Jirström K, Östman A. Prognostic significance of stromal PDGF %u03B2-receptor expression in human breast cancer. Am J Pathol, 2009, 174: 2752-2764

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2009-05-15T14:29:00.000-07:00

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Early Symptoms of Breast Cancer - How to Detect Breast Cancer at Its Early Stage

2009-03-20T10:10:00.000-07:00

By Michael Lee

Breast cancer is one of the top ten cancers plaguing women all over the world. The risk of getting this disease is higher as one becomes older. Unlike other cancers, however, detecting early symptoms of breast cancer is easier.

It's always important to arm yourself with the proper knowledge. To help protect yourself, be aware if you're experiencing any of these early symptoms of breast cancer:

1) Tenderness in the Breast

While most women experience tenderness in the breast during their monthly cycle, it's not natural at all during the rest of her regular days. If you find yourself having to deal with this, perhaps it's time for a mammogram.

2) Unusual Lump in the Breast

One of the most common early symptoms of breast cancer is the presence of an unusual lump in the breast. Women have been taught to give themselves a self-breast exam, to feel for any bump inside the breast or even the armpit. This lump might be benign or malignant. However, it's not a good idea to take chances. Have it checked immediately.

3) Discharge from the Nipple

During the first few stages of breast cancer, you might notice a strange discharge from your nipple. This could either be bloody, yellow or greenish. Whatever color it might be, it is imperative that you go see a doctor at once. Breast cancer can progress very quickly; so the earlier you see a doctor, the better.

4) Swelling of the Breast

Similar to tenderness of the breast, this sort of thing might naturally occur in women during the days of her cycle. This is another reason why doctors encourage the practice of a monthly self-breast exam. This way, you will be able to see just how much of a difference there is in your breast size, and get a check-up immediately if you notice any of the early symptoms of breast cancer.

5) Change in Texture

Doing monthly self exams also help you determine any change in your breast's texture. Be on the lookout for skin that has redness or skin that is dimpling. Be very sensitive to retraction of the nipple or the occurrence of a peau'd orange. A peau'd orange refers to a breast that resembles the skin of an orange.

When there is something wrong, your body will tell you in the form of symptoms. So don't take these early symptoms of breast cancer for granted. Remember, your health is at stake here. Prevention is better than cure.

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Article Source: http://EzineArticles.com/?expert=Michael_Lee
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CARA MEMPERBESAR PAYUDARA SECARA NATURAL

2009-03-08T09:16:00.000-07:00

If you are absorbed in breast amplification through accustomed herbal supplements you ar e not alone. Over the accomplished few years, this way has become added and added popular. Do you apperceive the affidavit for this?

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Additionally, with accustomed herbal supplements you do accept to abide surgery. If a woman elects for breast amplification via artificial anaplasty they accept to be accustomed anesthetic, and again cut open. While this can be done successfully, what is the point in accomplishing so if you do not accept to?

Finally, if you await on it you can save affluence of money. Instead of paying bags of dollars for artificial surgery, you can instead buy a accustomed herbal supplement for much, abundant less.

If you are not abiding of the allowances of it, you will wish to get in blow with your doctor. They will be able to accord you admonition on demography these supplements as able-bodied as accepting surgery. Remember, this is not a accommodation that you should yield lightly. If you are not adequate with demography it you should ask your doctor first.

Over the next few years, it is alone traveling to abide to access in popularity. If you accept anytime accustomed this the aboriginal bit of thought, you will wish to attending into affairs what you charge today. You will never accept to anguish about the amount and complications of surgery. You owe it to yourself to accede this anytime accepted method.

You accept two options if you are absorbed in breast enlargement. Aboriginal off, you can pay bags of dollars for a artificial surgeon to advice you out. While this may assume like a acceptable idea, it can be absolutely pricey. Not to acknowledgment the actuality that there are abounding risks involved.

Your added advantage is to attending into breast amplification through accustomed herbal supplements. Abounding humans are a bit put off by this because they do not anticipate that it works. Additionally, they feel that this is not a safe option. But if it comes down to it, breast amplification through accustomed herbal supplements is in fact absolutely safe. After all, abounding women accept approved this process, and in about-face concluded up with beyond breasts after accepting to pay bags of dollars or go beneath the knife.

Breast amplification through accustomed herbal supplements is actual safe. As the name implies, this is done by the use of accustomed supplements that your physique will acknowledge to. And back you are alone application accustomed herbal supplements, you never accept to anguish about putting your bloom at risk.

If you are still a bit afraid about breast amplification through accustomed herbal supplements, get in blow with your doctor. Tell your doctor what you are absorbed in doing. They will again be able to accord you a abundant address on what to expect, etc.

All in all, breast amplification through accustomed herbal supplements is safe. If you are annoyed of your baby breast, you should attending into application accustomed herbal supplements to your advantage; you will be animated that you did in the end.

Study says pregnancy doesn't worsen breast cancer

2009-02-09T10:22:00.000-08:00

AFP/Keystone/File – A pink ribbon is seen as a symbol of breast cancer awareness. Post-menopausal women who take combined …

ATLANTA – Pregnant women who develop breast cancer do not have worse odds of death or of cancer returning than other young breast cancer patients, a new study has found.

The study is one of the largest to look at whether breast cancer hits pregnant and recently pregnant women harder than other women. It contradicts some smaller, earlier studies that suggested maternity made things worse.

"If we can get them early, we can treat them aggressively and have good and promising outcomes for both woman and child," said the study's lead author, Dr. Beth Beadle of the University of Texas M.D. Anderson Cancer Center.

The Houston hospital has the world's largest registry of pregnant breast cancer patients and their children.

Frightening for any woman, a breast cancer diagnosis is particularly terrifying for a pregnant woman. It presents complicated decisions about how to treat the mother and not harm the fetus. Some doctors recommend abortion so they can focus on treating the mother.

In the new study, being published Monday in the journal Cancer, researchers analyzed data from 652 women ages 35 and younger who were treated for breast cancer at M.D. Anderson from 1973 through 2006.

The study group included 104 women with pregnancy-associated cancers — 51 who had breast cancer during pregnancy, and 53 who developed the illness within a year after.

The rates of cancer recurrence, cancer spread and survival were about the same for the women with pregnancy-associated breast cancers as they were for the other women, the researchers found. The researchers calculated the rates for 10 years after the cancer diagnosis.

The women who were pregnant had tumors at a more advanced stage, probably because women and their doctors may have discounted breast changes, attributing them to breast feeding or pregnancy, the researchers believe.

Generally, breast cancers are more aggressive in younger women, and survival rates are significantly lower. While age may be a factor, it's not clear that pregnancy is: There was no evidence in the new study that tumors were faster growing in the pregnant women, said Beadle, a radiation oncologist.

Radiation — dangerous to a fetus — is commonly used in mammography and breast cancer treatment. But ultrasound can be used to look for breast tumors instead. And surgery and certain kinds of chemotherapy can treat the cancer without poisoning the womb.

However, it remains a complicated medical situation that can depend on the severity of the cancer and how far into the pregnancy the mother is, said Dr. Ruth O'Regan, an associate professor at Emory University's Winship Cancer Institute in Atlanta.

"It's quite complicated, but all of us have been able to treat pregnant women successfully," O'Regan said.

The study did not present data on how well the children did. Other research at M.D. Anderson has not found developmental problems in those children, Beadle said.

One success story was Emily Behrend, 35, who gave birth to a healthy baby girl last spring.

Behrend was diagnosed roughly four months into her pregnancy. On New Year's Day last year, she felt a lump at the top of her right breast. "It didn't feel like your typical swollen gland," said Behrend, a tax auditor from Tomball, Texas.

Doctors diagnosed cancer. She talked to several physicians about what to do, including one who suggested an abortion. "That was never an option for me," said Behrend, noting this was going to be her first child.

She went to M.D. Anderson, where surgeons removed the lump. She also had three chemotherapy treatments before she gave birth in May. Her daughter, Julia Grace, was healthy with a full head of blonde hair.

"I looked for that right away," said Behrend, who had lost her hair during the chemotherapy.

Behrend underwent additional chemo after the birth and her cancer is in remission. She called the whole experience "a blessing."

Her advice to other pregnant women: Don't be shy about signs you think might be related to breast cancer. "I would definitely ask your doctor," she said.

Breast cancer medication

2009-02-01T14:39:00.000-08:00

An erratic and unwanted growth of cells in the breast tissues can lead to breast cancer. This can be in the form of a lump called as tumor. Breast cancer can either be malignant or benign . It can spread to other parts of the body and also invade healthy tissues . Spread of cancer cells to other parts of the body is called as metastasis . There are different types of tumors that can form in different areas of breast. Usually it is seen that most of the tumors in the breast are a result of non-cancerous or benign changes in the breast .
Treatment options for breast cancer

When a woman is diagnosed with breast cancer then the treatment is based on a number of factors.

Stage of the disease

General health of the patient

Other health complications

Location and size of the tumor

The treatment options for breast cancer include :

Surgery

Radiation therapy

Chemotherapy

Biological therapy

Combination therapy

However here we will be taking about the breast cancer medication that comes under chemotherapy. The breast cancer medication is either given orally or by injection and it acts by either killing the cancer cells or stopping their growth .

Breast cancer medication

There are a number of drugs that are used in the treatment of breast cancer which can be used with or without surgery.

Some of the medicines are used for the treatment of breast cancer include:

Herceptin: This is used for the treatment of breast cancer in patients who show more of HER2 protein receptor

Tamoxifen: This is the most widely used drug in the treatment of breast cancer . It helps by stopping and slowing the growth of breast cancer cells .

Taxol: It is used in the treatment of early and advanced stages of breast cancer

Ellence : It is used in combination with cyclophosphamide and fluorouracil in the treatment of early stage of breast cancer

Docetaxel: It is used again in combination with cyclophosphamide and fluorouracil in the treatment of advanced stage of breast cancer .

Aromasin: This is used in breast cancer cases that develop post-menopause .

Cyclophosphamide: Acts by killing or slowing the growth of cancer cells

Epirubicin: used in combination with other drugs

5-Fluorouracil or 5 FU: Main drug that is used in most of the breast cancer cases

Methotrexate: Used either single or in combination with other drugs

Mitomycin : used in the treatment of both advanced or early stages of cancer

Mitozantrone (mitoxantrone) : usually used in combination with other drugs

Doxorubicin (Adriamycin): used in combination with other drugs for treatment of both advanced and early stages of breast cancer

Docetaxel (Taxotere): interfers with the DNA synthesis of the cancer cells

Different types of breast cancer medication

The breast cancer medication can be used in three different ways. These are as mentioned:

Adjuvant therapy: This is applied when breast cancer medication is used after surgery or radiation therapy . This is done so that the chances of recurrence of cancer can be lowered . When breast cancer medication is used then the growth of the cancer cells that are likely to have spread to other areas is controlled and gradually stopped.

Neo adjuvant therapy: This is where the breast cancer medication is used to reduce the size of the tumor and then surgery is carried out . This makes management of the disease easier.

Treatment of metastatic disease: Breast cancer medication is the best treatment if breast cancer would have metastasized to other parts of the body other than the breast and lymph nodes .

The type of therapy that is used and when is it started depends on the condition of the patient . When the doctor diagnoses the breast cancer then he would keep the best treatment options in front of you and would give you the advantages and disadvantages of each treatment type. Before taking any decision you should always consult your doctor and few other physicians to decide which would be the best for you. As per researches it is seen that combination of the breast cancer medication results in increase in the survival rate and minimizes the chances of recurrence of the disease.

If the woman under treatment is still having monthly cycles then the breast cancer medication can be of more help as it can inhibit the ovaries from producing estrogen and hence stop the stimulation of the growth of the cancer cells. But this can also lead to pre mature menopause and at times infertility also . However, there are cases where even after breast cancer medication the ovaries have shown to function properly. It mostly depends on the stage in which the breast cancer is and the age in which the patient is treated .

Administration of breast cancer medication

Breast cancer medication can either be given orally or can be injected. The breast cancer medication is given over a period of time depending on the drug and the stage that is being treated and the patient is given rest for 3-4 weeks between two consecutive sessions to give time for the normal cells to recover . The breast cancer medication treatment is usually given for a treatment period of 8 cycles, which comes up to a total time period of 8 months .

Depending on the breast cancer medication that is being given the patient is required to stay in the hospital for administration of the drug for some days so that any side effects or difficulties can be monitored.

When on breast cancer medication it is also important that the patient gets alternative therapy in the form of painkillers, vitamin and mineral supplements a proper balanced diet so that the quality of life is improved.

www.fireworkszone.com

Many Women Who Survived Childhood Cancer Do Not Undergo Recommended Breast Cancer Screening

2009-02-01T14:31:00.000-08:00

ScienceDaily (Jan. 27, 2009) — Despite recommendations and being at an increased risk of breast cancer, most young women who were treated with chest radiation for a childhood cancer do not undergo appropriate mammography screening, according to a new study.

Women treated with chest radiation for a pediatric malignancy face a significantly increased risk of breast cancer at a young age. "The risk of breast cancer begins to increase as early as 8 years after radiation and the median [midpoint] age of breast cancer diagnosis ranges from 32 to 35 years," the authors write. By age 45 years, it is estimated that from 12 percent to 20 percent of women treated with moderate- to high-dose chest radiation will be diagnosed with breast cancer.

Experts recommend annual screening mammography for women exposed to moderate- to high-dose chest radiation, starting at 25 years of age or 8 years after radiation, whichever occurs last. It is estimated that in the United States there are approximately 20,000 to 25,000 women who are 25 years or older and were treated for a pediatric malignancy with moderate- to high-dose chest radiation. There is limited published information regarding the breast cancer screening practices of women who were treated with chest radiation for a childhood malignancy, according to background information in the article.

Kevin C. Oeffinger, M.D., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues conducted a study that included 625 women, age 25 through 50 years, who had survived pediatric cancer, had been treated with chest radiation and were participating in the Childhood Cancer Survivor Study (CCSS), a North American group of long-term survivors diagnosed from 1970-1986. Participants received a 114-item questionnaire. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the siblings of the CCSS group (n = 712). Of 1,976 cancer survivors and siblings who were contacted, 87.9 percent participated.

Among women age 25 through 39 years who had received chest radiation therapy (RT), 36.5 percent reported a screening mammogram within the past 2 years; 47.3 percent had never had a mammogram; and only 23.3 percent had a screening or diagnostic mammogram within the previous year.

Women age 40 through 50 years who had received chest RT were more likely to report mammography than their younger counterparts, with 76.5 percent reporting a screening mammogram within the past 2 years compared with 70.0 percent for the group without chest RT and 67.0 percent for the CCSS sibling group. Only 52.6 percent of women in this age group with chest RT had regular screening (at least 2 mammograms within 4 years). This was not significantly higher than for women with no chest RT and only modestly higher than the CCSS siblings.

In all groups, women who were older were more likely to have been screened in the prior 2 years or to have received regular screening. For each 5-year incremental increase in age, the likelihood of reporting a mammogram increased nearly 2-fold. The strongest predictor of mammography in women ages 25 through 39 years was having a physician recommend the test, with the likelihood of reporting a mammogram 3 times higher among women who reported a physician recommendation than women who did not.

"In summary, our study suggests that most young women at risk of breast cancer following chest radiation for a pediatric cancer, including women at highest risk (Hodgkin lymphoma survivors), are not being appropriately screened. Findings from this study should provide the foundation for targeted interventions involving both clinicians and cancer survivors," the authors conclude.

Editorial: Surveillance for Breast Cancer After Childhood Cancer

In an accompanying editorial, Aliki J. Taylor, M.D., M.P.H., Ph.D., of the University of Birmingham, United Kingdom, and Roger E. Taylor, M.D., M.A., of Swansea University, United Kingdom, write that the findings of Oeffinger and colleagues highlight several important issues.

"These include the relatively low uptake of screening mammography in a high-risk population, the importance of clinician recommendation to improve the uptake of screening mammography, and the continuing need to educate clinicians and patients about the risks of breast cancer after chest irradiation in childhood through well-designed education programs. The risk of breast cancer after exposure to annual low-dose irradiation in the form of x-ray mammography should be explored in future studies as well as the role of magnetic resonance imaging as a replacement for x-ray mammography rather than as an adjunctive examination in this group of young women. In addition, it is important to explore whether the rate of screening uptake could be improved if survivors were provided with screening at no extra cost."

www.sciencedaily.com

Breast Cancer Symptoms

2009-02-01T14:11:00.000-08:00

Common symptoms of breast cancer include:

A change in how the breast or nipple feels

A lump or thickening in or near the breast or in the underarm area

Nipple tenderness

A change in how the breast or nipple looks

A change in the size or shape of the breast

A nipple turned inward into the breast

The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.

Nipple discharge (fluid)

Early breast cancer usually does not cause pain. Still, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not due to cancer. Other health problems may also cause them. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

How is breast cancer diagnosed?

If you have a symptom or screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.

Clinical breast exam

Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.

Diagnostic mammogram

Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

Ultrasound

An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues. A computer uses the echoes to create a picture. Your doctor can view these pictures on a monitor. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.

Biopsy

Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Fluid or tissue is removed from your breast to help find out if there is cancer.

Some suspicious areas can be seen on a mammogram but cannot be felt during a clinical breast exam. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.

Doctors can remove tissue from the breast in different ways:

Fine-needle aspiration: Your doctor uses a thin needle to remove fluid from a breast lump. If the fluid appears to contain cells, a pathologist at a lab checks them for cancer with a microscope. If the fluid is clear, it may not need to be checked by a lab.

Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.

Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells.

An incisional biopsy takes a sample of a lump or abnormal area.
An excisional biopsy takes the entire lump or area.

If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. Abnormal cells are found in the lining of the ducts. Lobular carcinoma is another type. Abnormal cells are found in the lobules.

You may want to ask your doctor the following questions before having a biopsy:

What kind of biopsy will I have? Why?
How long will it take? Will I be awake? Will it hurt? Will I have anesthesia? What kind?
Are there any risks? What are the chances of infection or bleeding after the biopsy?
How soon will I know the results?
If I do have cancer, who will talk with me about the next steps? When?

Additional tests

If you are diagnosed with cancer, your doctor may order special lab tests on the breast tissue that was removed. These tests help your doctor learn more about the cancer and plan treatment:

Hormone receptor test: This test shows whether the tissue has certain hormone receptors. Tissue with these receptors needs hormones (estrogen or progesterone) to grow.

HER2 test: This test shows whether the tissue has a protein called human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. Having too much protein or too many copies of the gene in the tissue may increase the chance that the breast cancer will come back after treatment.

www.medicinenet.com

Study sheds light on breast cancer drug failure

2009-02-01T14:01:00.000-08:00

LONDON (Reuters) - The most commonly used breast cancer drug may cause tumors to spread in a small number of women with low levels of a protein which makes cells stick together, British researchers said on Thursday.

The findings could lead to new tests to determine which women are not likely to benefit from tamoxifen and who should be given other drugs, said Stephen Hiscox, a cancer researcher at Cardiff University, who led the study.

"We found something that could be potentially used as a biomarker to determine which kind of drugs they should get because they have low levels of this protein," he said in a telephone interview.

Breast cancer is the leading cause of cancer deaths among women worldwide, according to the American Cancer Society. The group estimates about 465,000 women died of breast cancer globally in 2007 and 1.3 million new cases were diagnosed.

Declining death rates from breast cancer in developed countries have been attributed to early detection through mammography screening and to improved treatment.

Tamoxifen is given to most women for five years after they are diagnosed with breast cancer to prevent the disease from returning, but some develop resistance, which means their tumor is more likely to recur.

Last month, a British team identified another protein -- called Pax2 -- which helped explain why some women developed resistance to tamoxifen. The generic drug works by blocking oestrogen from causing wild cell growth in breast cancer.

In their study published in the BioMed Central journal Breast Cancer Research, Hiscox and colleagues analyzed breast cancer cells in a lab and a protein which makes cells stick together called E-cadherin.

They found when the protein was at reduced levels tamoxifen caused cancer cells to move around much more aggressively, an initial step in the spread of a tumor, he said.

The researchers did not determine an actual level of the protein that would cause tamoxifen to fail but Hiscox said this would be the next step in their work.

The lab results could also lead to a clinical test to pinpoint women who should be given so-called aromatase inhibitors such as AstraZeneca Plc's Arimidex which deplete oestrogen in a different way, he said.

"People with low levels of E-cadherin may be more suited to these other drugs," Hiscox said.

(Reporting by Michael Kahn; Editing by David Holmes)

reuters.com

Breast Cancer Information

2009-02-01T10:30:00.000-08:00

Introduction

History of the Procedure

Over the greater part of the last century, all forms of breast cancer have been treated by aggressive surgical resection. In 1894, Halsted described the procedure of en bloc removal of all breast tissue, draining lymph nodes and pectoralis muscles for the treatment of breast cancer. This technique of radical mastectomy became the standard of care for decades based on an understanding that cancer growth proceeded in stepwise fashion via the lymphatics, thus could be controlled with surgical excision.

In 1971, Fisher et al challenged this standard and demonstrated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 trial that radical mastectomy had no survival benefit over mastectomy with radiation or mastectomy with delayed axillary dissection. In a subsequent study, NSABP B-06, patients were randomized to total mastectomy versus lumpectomy and radiation therapy (XRT), and no survival benefit of total mastectomy was found. However, benefit was observed in the decreased rate of local recurrence in women receiving XRT. Development of new chemotherapeutic and hormonal agents has further revolutionized the management of breast cancer.

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center, Women's Health Center, and Imaging Center. Also, see eMedicine's patient education articles Breast Cancer, Mastectomy, Breast Lumps and Pain, Breast Self-Exam, and Mammogram.

Problem

Worldwide, the overall incidence of breast cancer varies markedly but appears to be rising. Far eastern countries such as Japan, which historically have enjoyed low rates in comparison to the United States, are seeing a rapid rise in incidence. Although the United States has the highest reported incidence of breast cancer in the world, several western European nations such as Iceland, Italy, France, Sweden, and the United Kingdom trail closely behind. Incidence has been historically lower in Eastern Europe, the Middle East, and the Far East, but countries such as Japan and Singapore have seen a 2-fold rise over the past few decades.

Frequency

Of American women, 13% will be diagnosed with breast cancer in their lifetimes, making it the most common nonskin cancer among women. In addition, more than 3% will die from the disease. Breast cancer has surpassed lung cancer as the leading cause of cancer death in women worldwide, accounting for more than 400,000 deaths per year. In the United States, breast cancer trails only lung cancer as the second most common cause of cancer death in women. In 2002, more than 1.15 million new cases were diagnosed worldwide. More than 200,000 of these were in the United States alone.

The 1980s saw the greatest rise in incidence, which may have been due to a combination of improvements in screening techniques, data collection, and treatment modalities. Despite this surge in newly-diagnosed cases, mortality rates have been declining over the last decade. The decline is widely attributed to earlier detection via screening mammography and improvements in hormonal therapy and chemotherapy.

Etiology

Risk factors for the development of invasive breast cancer include female gender, age, family history, age at the time of first parturition, personal history of previous breast cancer, hormone replacement therapy, history of atypical hyperplasia or noninvasive lesions, and genetics.

Female gender: The incidence of breast cancer in women exceeds that in men by 100:1. Overall, 1 of every 8 American women develops breast cancer in her lifetime.
Age: In American women, risk increases from 1:5900 to 1:290 between the third and eighth decades. A woman aged 60-79 years has a 1:14 chance of developing invasive breast cancer, compared with a woman younger than 39 years, who has a 1:225 probability.
Age at birth of first child: If aged 30 years or older, relative risk is 2 times that of patients who gave birth when younger than 20 years.
Personal history of breast cancer: This also is a recognized risk factor. This factor depends on patient age at time of diagnosis. Risk is increased for younger women.
Noninvasive carcinoma (ductal carcinoma in situ [DCIS]/lobular carcinoma in situ [LCIS]) on previous biopsy: This also is a marker for development of invasive lesions.
Benign proliferative changes with atypical hyperplasia: These may increase relative risk by 4 times. Atypical hyperplasia may be observed in as many as 10% of specimens from biopsy.
Early menarche and late menopause: These also are associated weakly with increased relative risk of breast cancer.
Menopausal hormone replacement therapy: Multiple studies, including the Women's Health Initiative and the Million Women Study in the United Kingdom, have shown an increased risk of breast cancer in postmenopausal women who are either recent or current users of estrogen alone or in combination with progestin. In addition, the combination use of estrogen with progestin has been associated with an even greater risk of breast cancer, particularly of lobular carcinoma. Increased risk is also related to increased duration of use; this risk can be reduced over time, following the termination of hormone replacement therapy.
Family history: Degree of relativity of the family member with breast cancer affects individual risk. For example, the relative risk of patients with an affected first-degree relative is 1.5-2 times higher when compared to controls without affected family members. Even more significantly, having two first-degree relatives affected (female or male) increases relative risk by more than 4-6 times when compared to patients without this risk factor. Third, age of the affected relative at time of diagnosis also influences risk. A patient with a mother diagnosed when younger than 60 years is at 2 times increased risk. Finally, bilateral cancer in a first-degree relative may increase risk by more than 6 times.
Genetic predisposition: Approximately 5-10% of breast cancer cases are primarily attributable to inherited factors. Claus et al estimated that 36% of breast cancer cases in women aged 20-29 years can be attributed to a single dominant susceptibility gene, while only 1% of women diagnosed with breast cancer over the age of 80 have such a gene. The risk of breast cancer in carriers of BRCA1 mutation is estimated to be 36-87%. Male breast cancer is also seen with BRCA1 mutations with a lifetime risk of 5%. Lifetime breast cancer risk for carriers of BRCA2 is 45-84%. BRCA2 mutations are associated with a 6% lifetime risk of male breast cancer. Genetic breast cancer syndromes are outlined in Table 1.

Table 1. Genetic Breast Cancer Syndromes.

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Table

Syndrome	Gene	Inheritance	Cancers	Other Features
Breast/ovarian	BRCA1	AD*	Breast, ovarian
Cancer syndrome	BRCA2	AD	Breast, ovarian, prostate, pancreatic	Fanconi anemia in homozygotes
Li-Fraumeni syndrome	TP53	AD	Breast, brain, soft tissue sarcomas, leukemia, adrenocortical, others
Cowden disease	PTEN	AD	Breast, ovary, follicular thyroid, colon	Adenomas of thyroid, fibroids, GI polyps
Peutz-Jegher syndrome	STKII/LKB1	AD	GI, breast	Hamartomas of bowel, pigmentation of buccal mucosa
Ataxia-telangiectasia	ATM	AD	Breast	Homozygotes: leukemia, lymphoma, cerebella ataxia, immune deficiency, telangiectasias
Site-specific	CHEK2	AD	Breast	Low penetrance
Muir-Torre syndrome	MSH2/MLH1	AD	Colorectal, breast

Syndrome	Gene	Inheritance	Cancers	Other Features
Breast/ovarian	BRCA1	AD*	Breast, ovarian
Cancer syndrome	BRCA2	AD	Breast, ovarian, prostate, pancreatic	Fanconi anemia in homozygotes
Li-Fraumeni syndrome	TP53	AD	Breast, brain, soft tissue sarcomas, leukemia, adrenocortical, others
Cowden disease	PTEN	AD	Breast, ovary, follicular thyroid, colon	Adenomas of thyroid, fibroids, GI polyps
Peutz-Jegher syndrome	STKII/LKB1	AD	GI, breast	Hamartomas of bowel, pigmentation of buccal mucosa
Ataxia-telangiectasia	ATM	AD	Breast	Homozygotes: leukemia, lymphoma, cerebella ataxia, immune deficiency, telangiectasias
Site-specific	CHEK2	AD	Breast	Low penetrance
Muir-Torre syndrome	MSH2/MLH1	AD	Colorectal, breast

*AD = autosomal dominant

More controversial risk factors include obesity, low-dose radiation, and oral contraceptive use. The Breast Cancer Detection Demonstration Project (BCDDP) defined several factors not associated with increased risk, including oral contraceptive use, long-term (>15 y) menopausal estrogen use, modest alcohol use, and cigarette smoking. Various analyses of data from the Nurses’ Health Study also have shown no association between oral contraceptive use and breast cancer. Conflicting data preclude the recommendation of guidelines for risk modification in these areas.

Pathophysiology

The World Health Organization classification of breast tumors organizes both benign and malignant lesions by histologic pattern. Epithelial tumors comprise the largest group, including intraductal papilloma, adenomas, intraductal and lobular carcinoma in situ, invasive (ductal and lobular) carcinoma, and Paget disease of the nipple. Invasive ductal carcinoma is by far the most common type.

Phyllodes tumor, benign and malignant, and carcinosarcoma are rare lesions grouped as mixed connective tissue and epithelial tumors. Other common nonadenocarcinoma lesions of the breast include angiosarcoma and primary lymphoma.

Invasiveness is a key determinant in the prognosis and treatment of breast malignancy. Noninvasive lesions are by definition limited by the basement membrane and may be classified as DCIS or LCIS.

DCIS is by far more common than LCIS, and more importantly, it should be distinguished as a clearly malignant lesion. Ductal epithelial cells undergo malignant transformation and proliferate intraluminally. Eventually, the cells outstrip their blood supply and become necrotic centrally. This debris can calcify and be detected mammographically. Moreover, the lesions also may be palpable clinically. Five pathologic subtypes have been identified: comedo, papillary, micropapillary, solid, and cribriform. Most lesions represent a combination of at least two of these subtypes. The presence of comedo necrosis is an independent risk factor for subsequent ipsilateral breast cancer (NSABP-B17).
LCIS also arises from epithelial cells; however, their growth continues in a lobular pattern. In contrast to DCIS, these lesions rarely develop central necrosis, calcify, or become palpable. For this reason, LCIS rarely is detected by examination or mammography preoperatively and usually presents as an incidental finding on histologic review. Clinically, LCIS is considered more of a marker for development of invasive cancer rather than a malignant lesion. The risk of subsequent breast cancer is equal for both breasts irrespective of the index site. Moreover, most invasive cancers that develop are infiltrating ductal, which supports the concept that LCIS is not a malignant lesion.
Invasive breast cancers usually are epithelial tumors of ductal or lobular origin. Features such as size, status of surgical margin, estrogen receptors (ER) and progesterone receptors (PR), nuclear and histologic grade, DNA content, S-phase fraction, vascular invasion, tumor necrosis, and quantity of intraductal component are all important in deciding on a course of treatment for any breast tumor.
Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor. This lesion, which accounts for 75% of breast cancers, has no specific histologic characteristics other than invasion through the basement membrane. DCIS may be a frequently associated finding on pathologic examination. It also has a tendency to metastasize via lymphatics.
Infiltrating lobular carcinoma has a much lower incidence and comprises less than 15% of invasive breast cancer. It is characterized histologically by the Indian file arrangement of small tumor cells. Like ductal carcinoma, these typically metastasize to axillary lymph nodes first. However, it also has a tendency to be more multifocal. Despite this, the prognosis is comparable to that of ductal carcinoma.

Less common histologic subtypes of adenocarcinoma collectively comprise less than 25% of invasive breast cancers.

The diagnosis of tubular carcinoma requires the presence of tubular formation in at least 75% of the specimen. This pathology is associated with improved prognosis.
Mucinous (or colloid) carcinoma also has a favorable prognosis when compared with ductal carcinoma. These slow-growing lesions characteristically produce large amounts of mucin, thus are usually bulky. They, like tubular carcinoma, rarely metastasize.
Medullary carcinoma, despite being a poorly differentiated tumor, also carries an improved prognosis.

ER and PR are valuable as predictors of disease-free survival and response to hormonal therapy. Studies in patients with ER(+) tumors who did not receive chemotherapy suggest they have a higher rate of disease-free survival than patients with ER(-) tumors. The presence of these nuclear steroid receptors on tumor staining should be considered, along with other histologic features, in determining the need for hormonal and adjuvant chemotherapy.

Human epidermal growth factor receptor (Her)-2/neu protein expression is associated with increased incidence of recurrence and shortened overall survival. Her-2/neu is overexpressed in 20-30% of breast cancers. Her-2/neu–positive lesions have also been associated with comedo-type DCIS, another poor prognostic indicator. Patients with Her-2/neu–positive breast cancer are candidates for treatment with combination chemotherapy and monoclonal antibody therapy.

S-phase (proliferative) fraction can be determined by flow cytometry. This fraction represents cells in the synthetic or replication phase of the cell cycle. High S-phase fraction is an indicator of more aggressive disease regardless of nodal status. It has not been shown to predict response to chemotherapy.

Other histologic factors, such as lymphatic invasion, an extensive DCIS component (>25% of the tumor), and Ki-67 staining, continue to be investigated as potential prognostic factors for breast cancer.

Presentation

When evaluating a patient with possible breast cancer, direct questions toward both assessment of risk and narrowing the differential diagnosis. Patient factors associated with increased risk of breast cancer are discussed in Etiology. In addition, inquiry regarding nipple discharge, fever, pain, rapid growth, duration of the mass, and changes with menses may be helpful in directing the workup for breast cancer.

Physical examination should include inspection of the patient in the upright as well as supine positions. With the patient upright, assessment for symmetry and changes in the nipple and skin may be performed. Obvious size discrepancy, nipple inversion, skin dimpling, scaling, and edema (peau d'orange) are suggestive findings. Supraclavicular, infraclavicular, and axillary lymphadenopathy also can be best detected in this position.

Once the patient is in the supine position with the ipsilateral arm extended over the head, the breast parenchyma can be compressed against the chest wall, which allows for improved sensitivity for the examiner. The 2 most common techniques for supine examination are the clockwise radial pattern and the linear pattern. In the clockwise radial technique, examination begins at the 12-o'clock position near the clavicle and proceeds towards the nipple. This is repeated in a clockwise fashion around the entire breast.

The linear technique, when performed correctly, is arguably more sensitive, although time-consuming. Proponents of the linear technique recommend beginning in the axilla at the mid-axillary line, proceeding toward the inferior mammary fold, and then returning to the clavicle in a series of rows (12-15 rows, depending on the size of the breast). Using the pads of 3 fingertips, the examiner should palpate dime-sized circles in 3 different depths at each site before moving one finger width toward the inferior mammary fold and repeating the circular motion at the superficial, medium, and deep levels. Benign lesions are more frequently smaller, rubbery, well-circumscribed, and mobile. Characteristics suggestive of malignancy include skin involvement, fixation to the chest wall, irregular border, firmness, and enlargement.

Compression of the breast or nipple is no longer recommended to assess for discharge. However, visual inspection of the nipple/areola complex should be a routine part of the examination. Only spontaneous discharge should be considered clinically significant. Concerning characteristics include unilateral discharge, nonmilky fluid, and origin from a single duct. Intraductal papilloma, a benign finding, is the most common cause of unilateral bloody nipple discharge. Other benign pathology associated with nipple discharge includes subareolar duct ectasia and fibrocystic changes. Usually, malignant pathology presenting with nipple discharge is also associated with a palpable mass, suggestive mammographic findings, or both.

Breast self-examination, performed monthly, is still generally recommended for women beginning at age 18 years, although no strong statistical data exist to support its efficacy in the early detection of breast cancer. Physicians should examine patients aged 19-40 years approximately every 3 years. The American Cancer Society recommends annual evaluation by physician examination along with screening mammography for women aged 40 years and older, particularly if risk factors are present.

Relevant Anatomy

A thorough understanding of the relative anatomy of the breast and axilla is essential to successful and uncomplicated surgical treatment of breast cancer.

The breast is bounded by the clavicle superiorly, the sternum medially, the lateral border of the latissimus muscle laterally, and the inframammary fold inferiorly. The axillary tail of Spence extends into the deep fascia superior and lateral to the breast. The deep pectoral fascia defines the deep margin.

Fibrous bands, known as the suspensory ligaments of Cooper, divide the breast parenchyma into 12-20 separate lobules of glandular tissue. Separate branching lactiferous ducts drain each lobule. These ducts converge just beneath the nipple into sinuses that empty into a single terminal duct. Drainage from individual ducts can be localized for surgical excision.

The lateral pectoral nerve passes medially around the medial pectoralis minor, and the medial pectoral nerve passes laterally around the pectoralis minor. The names are based on the origin of the nerves from the lateral and medial cords of the brachial plexus rather than their orientation to the muscle. Injuries to these nerves are rare.

Injury to the brachial plexus can be avoided by keeping the superior extent of the axillary dissection inferior to the lower border of the axillary vein.

The thoracodorsal nerve is identifiable medial to the thoracodorsal vein running along to enter the latissimus dorsi. Injury may result in slight, if any, clinically evident weakening of the latissimus.

The long thoracic nerve is located more medially in the axilla. It runs just beneath the investing fascia of the serratus anterior, medial to the thoracodorsal complex. Injury to this nerve results in winging of the scapula on arm extension.

The skin of the axilla and upper arm is supplied by the intercostobrachial nerve, which often is sacrificed in the dissection of axillary nodes. Transection may result in numbness in these areas.

Axillary lymph nodes receive most mammary lymphatic drainage. The internal mammary nodes also receive some drainage medially. Axillary nodes are referred to by levels, which are defined by the pectoralis minor muscle. Level I nodes are lateral, II behind, and III medial to the muscle.

The external mammary artery and perforators of the internal mammary artery supply blood to the breast. Venous drainage follows arterial anatomy.

Contraindications

Contraindications to surgical resection depend on the procedure in question. Breast conservation therapy is applicable in most patients with early stage invasive carcinoma. Relative contraindications include small breast size, large tumor size (>5 cm), and collagen vascular disease. Absolute contraindications include multi-focal disease, history of prior radiation to the area of treatment, first or second trimester of pregnancy, and persistent positive margins following attempts at conservation.

Factors that often are considered but should not be absolute deterrents include axillary node involvement and tumor location. Consideration of cosmesis, while important, should never outweigh the clinical priority of obtaining negative surgical margins. For example, lesions involving Paget's disease of the nipple may be treated with excision of the nipple-areolar complex and reconstruction. Larger lesions in patients with concerns regarding cosmesis may be better served by standard modified radical mastectomy and immediate reconstruction.

A relative contraindication to modified radical mastectomy is locally advanced cancer requiring neo-adjuvant therapy prior to surgical intervention.

via : http://emedicine.medscape.com

BREAST CANCER PICTURES

2009-02-01T10:27:00.000-08:00

	Pictures of Breast Self-Exam See diagrams of Breast Self-Examination.			Pictures of Diagnosis See pictures of MRIs, Mammograms, Ultrasounds, and PET Scans.
	Pictures of Types of Breast Cancer See pictures of Non–Invasive and Invasive tumors, and more.			Pictures of Breast Anatomy See diagrams of Breast Self Examination.
	Pictures of Treatment See pictures of Mastectomy, Radiation Therapy, Chemotherapy, and more.			Pictures of Breast Reconstruction See pictures of TRAM Flap, Tissue Expanders, Latissimus Dorsi Flap Reconstruction, and more.

Drug Rehab Programs

2009-02-01T10:24:00.000-08:00

Selecting a drug rehab center is one of the most important and difficult decisions you will make in your lifetime. Few of us know what to look for in a quality rehab program and not all drug rehabilitation centers are alike. Each drug rehab has its own program options, staff qualifications, credentials, cost, and effectiveness.

Asking appropriate questions when you call a drug rehab for information is important and you should expect to receive clear answers.

Before you make any decisions-ask questions and get the facts!

Does the drug rehab offer a variety of programs?

Alcohol and drug addiction are diseases that progress through predictable stages. It takes a trained health professional, often a doctor specializing in addiction medicine, to make an accurate diagnosis and prescribe the most appropriate treatment, whether it be outpatient counseling or an inpatient alchol and drug rehab.

A drug rehabilitation treatment center should offer a variety of treatment programs that meet individual needs. Programs may include inpatient, residential, outpatient, and/or short-stay options.

The difference between inpatient and a residential treatment center is that inpatient services are provided by a licensed hospital, while residential programs usually do not meet the same rigorous standards of medical care.

The length of stay depends on the severity and stage of the disease.

How much does a drug rehab center cost?

"How much does it cost?" is often one of the first questions asked when someone calls a drug rehab program.

The price tag for drug rehab treatment depends on the type of rehab you choose. You need to know what is included, what will be added to your bill as a fee-for-service program, and what services your health insurance will cover. This makes it extremely difficult to compare prices by simply asking the question - "What does rehab cost?" The best way to find out the range of costs for rehab is to talk to an intake advisor. You can discuss your insurance coverage or your financial concerns and they will help you narrow down your choices to what best meets your needs in the most affordable way.

If you are seeking the best value for your treatment dollar, remember: Price can be meaningful only in the context of quality and performance.

Also remember that the cost of drug addiction and alcoholism, if not treated, can far exceed the cost of treatment.

Is the drug rehab treatment program medically based?

There is an advantage to including on-site medical care in a Drug Rehab. Physicians and nurses provide 24-hour hospital services to monitor and ensure a safe withdrawal from alcohol and other drugs. In addition, a medical staff specializing in addiction medicine can oversee the progress of each individual and make necessary adjustments to the treatment plan.

Medical credentials and accreditation can also be important. For example, a chemical dependency Drug Rehab that earns JCAHO accreditation (Joint Commission on Accreditation of Healthcare Organizations) meets national standards for providing quality medical care. Appropriate state licensing is also an important consideration.

Be sure to ask which medical costs are included in the price of treatment at the drug rehab.

What is the degree of family involvement in a drug rehab program?

Drug abuse and alcoholism affects the entire family, not just the alcoholic/addict. Quite often family members do not realize how deeply they have been affected by chemical dependency. Family involvement is an important component of recovery.

Drug Rehabs vary in the degree and quality of family involvement opportunities. Some offer just a few lectures and others offer family therapy. Ask if there is any time devoted to family programs and if group therapy is included.

Does drug rehabilitation include a quality continuing care program?

There are no quick fixes for the diseases of drug abuse and alcoholism. Recovery is an ongoing process. The skills one learns during intensive rehabilitation treatment must be integrated into everyday life and this takes time.

Some drug addiction treatment programs will offer a follow-up program but only in one location which may make it difficult to use.

Drug rehabilitation treatment programs should include a quality, continuing care program that supports and monitors recovery.

The decision to enter a drug rehab program can be a very difficult and painstaking process. If you are confused by the many choices offered on this drug rehab site, please call one of our our treament center specialist at (877) 729-0766.

Our treatment center helpline is answered by a professional staff who understands what you are going through. They will listen to your questions and concerns, and provide you with free drug rehab referrals.

via : http://www.drug-rehabs.com/

Staggering gap in support for advanced breast cancer patients

2008-11-23T06:06:00.000-08:00

Thousands of people with advanced breast cancer are suffering appalling gaps in essential support and care which is routinely offered to patients with primary breast cancer.

Research released today (1) by leading support charity Breast Cancer Care shows that nearly half of all patients with advanced, or secondary (2), breast cancer do not have access to a named health care professional who can provide vital medical and emotional care.

This is in stark contrast to those with a primary diagnosis, where 98 per cent of patients say they have access to a named breast care nurse.

Breast Cancer Care is calling for all secondary breast cancer patients to have access to a clinical nurse specialist with the skills and knowledge to help them manage their many and complex needs.

The demand is made in a report to be launched by Breast Cancer Care’s Secondary Breast Cancer Taskforce (3) at a national conference4 for health care professionals, which is to be opened by National Cancer Director, Mike Richards.

The detailed report, the culmination of a two-year inquiry by leading experts and patients into the needs of secondary breast cancer patients, shows that a lack of dedicated support can have a devastating impact on this patient group.

Patients reported feeling left alone without professional help to cope with a range of challenging and complex decisions around treatment options, emotional and psychosocial support and end of life issues.

Carol Core, 53, from Peterborough was diagnosed with primary breast cancer in 1995. Nine-and-a-half years later she was told that the cancer had spread to her spine and liver. While she received substantial help and support from a breast care nurse when she received her primary diagnosis, Carol said this was not the case with her secondary diagnosis.

“I think that one of the problems is that maybe the people who speak to you think that someone else is giving you the information you need, it’s all very ad hoc. Some people may get information from other health care professionals, but I don’t think there is as yet a uniformed approach across the board. I think that a key worker would alleviate some of the stress and anxiety that you have through living with secondary breast cancer,” she said.

“I had to give up work because of my secondary diagnosis, but nobody ever had the conversation with me as to whether I was coping financially. I was also deeply concerned about practical issues, such as if I fell ill on a Friday night or over the weekend, who could I turn to?

“I had to look for information myself, but the real difficulty was knowing where to start, as you don’t always know what the information is that you’re looking for, or what help and benefits are available to you.”

nurse specialists in The Secondary Breast Cancer Taskforce was only able to find evidence of five dedicated clinicalsecondary breast cancer across the UK.

This is despite a range of government and NICE guidance on the importance of the provision of such support to patients.

Care may be given by wider nursing staff, but there is little evidence to show that they have the specialist skills needed to provide the care and support needed by secondary breast cancer patients.

Joint research between Breast Cancer Care and the Royal College of Nursing (5) has shown that breast care nurses lack the time and knowledge to be able to provide adequate care to those with secondary breast cancer.

The majority of nurses surveyed also indicated that they would like additional training on managing the needs of this patient group.

Dr Peter Harvey, Chair of the Secondary Breast Cancer Taskforce, commented:

“It is very disappointing that half of all patients are not given the lifeline of a dedicated nurse who can help coordinate their care and support.

“While the creation of a new post to meet this role would be the ideal scenario, it is not the only option. We know that clinical nurse specialists already posses many of the skills and knowledge needed, and cancer networks need to work with individual trusts and breast care teams to see how they can best provide this specialised support.”

Samia al Qadhi, Chief Executive at Breast Cancer Care, said:

“During the course of its two year investigation, six Taskforce patient members have sadly passed away. So while we know that people can live long, full lives following a diagnosis, we are more than aware that this is not the case for many individuals.

“It is essential that people receive support as soon as they need it, for as long as they need it. Today’s call for a key worker marks the start of the charity’s campaigning work to ensure that the Taskforce’s recommendations become a reality, and that people living with secondary breast cancer can come to expect the same high level of support and care that’s available to those with a primary diagnosis.”

source : breastcancercare.org.uk

Chemotherapy

2008-10-06T01:08:00.000-07:00

Chemotherapy is a systemic therapy; this means it affects the whole body by going through the bloodstream. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells that may have spread from where the cancer started to another part of the body.

Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. The side effects of chemotherapy come about because cancer cells aren't the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.

Still, chemotherapy is much easier to tolerate today than even a few years ago. And for many women it's an important "insurance policy" against cancer recurrence. It's also important to remember that organs in which the cells do not divide rapidly, such as the liver and kidneys, are rarely affected by chemotherapy. And doctors and nurses will keep close track of side effects and can treat most of them to improve the way you feel.

In this section, you'll learn more about how chemotherapy works and the best ways to manage nausea, hair loss, and other chemotherapy side effects.

You'll also read about the different chemotherapy regimens and about deciding together with your medical oncologist which regimen would be best suited to you.

It's important to remember that every woman's ideal treatment plan is different. Be aware that your "chemo" regimen may be different from someone else's, based on very individual—and sometimes subtle—breast cancer factors. These include: lymph node involvement, tumor size, hormone receptor status, grade, and oncogene expression. Be prepared for your doctor to recommend a combination of chemotherapies—together or in a series.

The medical experts for Chemotherapy are:

Francene M. Fleegler, M.D., medical oncologist/hematologist, University of Pennsylvania Health System, Philadelphia, PA
Jennifer Griggs, M.D., MPH, medical oncologist and breast cancer specialist, University of Rochester Cancer Center, Rochester, NY
Blanche Reiner, RN, OCN, University of Pennsylvania Health System, Philadelphia, PA
Barbara Reville, M.S., CRNP, oncology nurse practitioner, University of Pennsylvania Health System, Philadelphia, PA
Sandra F. Schnall, M.D., medical oncologist/hematologist, Thomas Jefferson University Health System, Philadelphia, PA
Marisa C. Weiss, M.D., breast radiation oncologist, Thomas Jefferson University Health System, Philadelphia, PA
Lisa Weissmann, M.D., medical oncologist, Mount Auburn Hospital, Cambridge, MA.

These experts are members of the Breastcancer.org Professional Advisory Board, including more than 60 medical experts in breast cancer-related fields.

Vitamin D may benefit breast cancer patients

2008-09-23T12:03:00.000-07:00

Breast cancer patients with low levels of vitamin D were much more likely to die of the disease or have it spread than patients getting enough of the nutrient, a study found — adding to evidence the "sunshine vitamin'' has anti-cancer benefits.

The results are sure to renew arguments about whether a little more sunshine is a good thing.

The skin makes vitamin D from ultraviolet light. Too much sunlight can raise the risk of skin cancer, but small amounts — 15 minutes or so a few times a week without sunscreen — may be beneficial, many doctors believe.

While the vitamin is found in certain foods and supplements, most don't contain the best form, D-3, and have only a modest on blood levels of the nutrient. That's what matters, the Canadian study found.

Only 24 percent of women in the study had sufficient blood levels of D at the time they were first diagnosed with breast cancer. Those who were deficient were nearly twice as likely to have their cancer recur or spread over the next 10 years, and 73 percent more likely to die of the disease.

"These are pretty big differences,'' said study leader Dr. Pamela Goodwin of Mount Sinai Hospital in Toronto. "It's the first time that vitamin D has been linked to breast cancer progression.''

Hesitation from experts
But people shouldn't start downing supplements, she warned. Experts don't agree on how much vitamin D people need or the best way to get it, and too much can be harmful. They also don't know whether getting more vitamin D can help when someone already has cancer.

"We have no idea whether correcting a vitamin D deficiency will in any way alter these outcomes,'' said Dr. Julie Gralow, a cancer specialist at the University of Washington in Seattle.

The study was released Thursday by the American Society of Clinical Oncology and will be presented at the group's annual meeting later this month.

Lots of earlier research suggests vitamin D may help prevent prostate, breast and especially colon cancer. In lab and animal tests, vitamin D stifles abnormal cell growth, curbs formation of blood vessels that feed tumors and has many other anti-cancer effects.

Other evidence: People who live in northern regions of the world have higher cancer rates than those living closer to the equator, possibly because of less sunshine and vitamin D.

The Canadian researchers wanted to see whether it made a difference in survival. They took blood from 512 women at three University of Toronto hospitals between 1989 and 1995, when the women were first diagnosed with early-stage breast cancer.

A decade later, 83 percent of those who had had adequate vitamin D blood levels were alive without extensive spread of their cancer, versus 79 percent of those whose vitamin D levels were insufficient and 69 percent of those who were deficient, as defined by widely used medical standards for measuring intake.

Too much of a good thing?
One red flag: The few women with the very highest levels of vitamin D seemed to have worse survival.

Though the study was too small and those results were not conclusive, "there may be an optimal level of vitamin D in women with breast cancer and it may be possible to take too much,'' Goodwin said.

The federal government says up to 2,000 international units of vitamin D a day seems OK. Taking 800 units per day will, on average, raise blood levels to the middle of the range that seems best for bone and general health, Goodwin said.

Vitamin D is in salmon and other oily fish, and milk is routinely fortified with it, but dietary sources account for little of the amount of D circulating in the blood, experts say.

"It's very hard to make a recommendation'' because how much difference a supplement makes depends on someone's baseline level, which also can be affected by sunlight, skin type and time of year, she explained.

Doctors do suggest breast cancer patients get their vitamin D levels checked to see whether they are deficient. The simple blood test is available in many hospitals and labs for about $25, Goodwin said.

Dr. Nancy Davidson, a Johns Hopkins University cancer specialist who is president of the oncology society, said those tests are growing in popularity, even in ordinary medical care.

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"Rightly or wrongly, I'm increasingly seeing physicians who are measuring this,'' she said.

The Canadian study was paid for by the Breast Cancer Research Foundation in New York, established by cosmetics magnate Evelyn Lauder.

"It's a very provocative paper. It's confirmatory of a tremendous amount of evidence that vitamin D is an important component of health,'' said Dr. Larry Norton, chief of breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York and a medical adviser to the foundation.

Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.

Warning Signs of Breast Cancer

2008-09-03T10:51:00.000-07:00

While there are no "classic" warning signs of breast cancer, nipple discharge, changes in breast tissue, or nipple tenderness may signal the presence of the disease. This lack of warning signs of breast cancer makes screening for the disease an important concern.

Warning Signs of Breast Cancer: An Overview

There are no classic warning signs of breast cancer. That is why breast cancer screening is so important. Screening prior to the appearance of breast cancer signs can help doctors find and treat cancer early. Also, breast cancer treatment is more likely to work well when cancer is found early.

Symptoms of Breast Cancer

When signs of breast cancer are present, they may include:

A change in how the breast or nipple feels
A lump or thickening in or near the breast or in the underarm area
Nipple tenderness
A change in how the breast or nipple looks
A change in the size or shape of the breast
A nipple turned inward into the breast
Nipple discharge (fluid).

Is Pain a Warning Sign of Breast Cancer?

Early breast cancer usually does not cause pain. Still, a woman should see her healthcare provider about breast pain or any possible breast cancer symptoms as early as possible so that problems can be diagnosed and treated. Keep in mind that most often problems in the breast are not actually due to cancer but to other, less serious, health problems.

Warning Signs for Breast Cancer: A Summary

There are no early warning signs for breast cancer; however, there are things that people can do to decrease their risk of developing the disease. By knowing breast cancer risk factors and breast cancer protective measures, a person can decrease his or her chance of developing breast cancer (see Breast Cancer Prevention).

Breast Cancer Risk Factors

2008-09-03T10:49:00.000-07:00

In the case of breast cancer, risk factors for the disease include such things as being over 60, having a family history of the disease, and experiencing certain changes in breast tissue. Other risk factors for breast cancer include being overweight or obese after menopause, a lack of physical activity, and excessive consumption of alcohol. It's important to remember that women with breast cancer risk factors will not necessarily get the disease. And women who have no risk factors for breast cancer can still get the disease.

Breast Cancer Risk Factors: An Introduction

In most cases, doctors do not know the exact cause or causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not.

They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Breast cancer research has shown that women with certain breast cancer risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease. Anything that decreases a person's chance of developing a disease is called a protective factor. Breast cancer prevention involves avoiding the risk factors and increasing the protective factors that can be controlled so that the chances of developing cancer decrease.

Specific Breast Cancer Risk Factors

Studies have identified the following breast cancer risk factors:

Age (most cases of breast cancer occur in women over 60)
Personal history of breast cancer
Family history
Certain breast changes
Gene changes
Reproductive and menstrual history
Race (Caucasian women are at greater risk than women of other races)
Radiation to the chest
Breast density
Taking DES (diethylstilbestrol -- a synthetic estrogen)
Being overweight or obese (see BMI Calculator to check your weight status)
Lack of physical activity
Excessive consumption of alcohol.

Breast Cancer Causes

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In most cases of the disease, breast cancer causes are not known. Research scientists believe that heredity plays a role in approximately 5 to 10 percent of cases. While not breast cancer causes, there are certain risk factors that increase a person's chance of developing breast cancer. Examples of these risk factors include a family history of the disease, dense breast tissue, and early menstruation; however, most women who develop breast cancer do not have any of the known risk factors.

Breast Cancer Causes: An Overview

Scientists are not sure of the breast cancer causes in most cases of the disease. In 5 to 10 percent of breast cancer cases, there is a genetic reason for the breast cancer.

Genetics as Breast Cancer Causes

The genes in cells carry the hereditary information that is received from a person's parents. As mentioned, hereditary breast cancer makes up approximately 5 to 10 percent of all breast cancer patients. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease.

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer.

Breast Cancer Research

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Scientists conducting breast cancer research are actively looking for new ways to prevent, diagnose, detect, and treat breast cancer. This breast cancer research has led to new advances in surgery, new medications, and possible new early-detection methods. Breast cancer research is also focused on lessening the side effects from current treatments for breast cancer.

Breast Cancer Research: An Overview

Doctors and scientists are hard at work conducting breast cancer research. They are studying new ways to prevent, detect, diagnose, and treat breast cancer. Some researchers are also studying therapies that may improve the quality of life for women during or after cancer treatment.

Breast cancer research is designed to answer important questions and to determine whether new approaches are safe and effective. Breast cancer research already has led to advances, and researchers continue to search for more effective methods for dealing with cancer.

Breast Cancer Research on Prevention Methods

Scientists are looking for drugs that may prevent breast cancer. For example, in certain breast cancer research studies, they are testing several different drugs that lower hormone levels or prevent a hormone's effect on breast cells.

In one breast cancer research study, the drug tamoxifen reduced the number of new cases of breast cancer among women who were at an increased risk of the disease. Doctors are studying whether the drug raloxifene is as effective as tamoxifen.

Types of Breast Cancer

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Types of breast cancer include invasive and non-invasive. Invasive breast cancers make up the majority of breast cancer cases. Within those two categories are other types of breast cancer, including infiltrating ductal carcinoma, Paget's disease of the nipple, intraductal carcinoma, and lobular carcinoma in situ (LCIS).

Types of Breast Cancer: An Overview
A doctor performs a biopsy to look at breast tissue under a microscope. This allows the doctor to look at the breast tissue cells for breast cancer and, if found, the type of breast cancer present.

Types of breast cancer can be invasive (moves into the surrounding tissue) or non-invasive (stays in the ducts or lobes). Healthcare providers will often use the term "infiltrating" instead of invasive. Some types of breast cancer can also be named based on where the cancer begins. For example, ductal carcinoma begins in the lining of the milk ducts while another type, lobular carcinoma, begins in the lobules where breast milk is produced.

Invasive Types of Breast Cancer
Invasive breast cancers make up 70 to 80 percent of all breast cancer cases. The most common type of invasive breast cancer is infiltrating ductal carcinoma (also called invasive ductal carcinoma). This type of breast cancer is found in approximately 60 percent of breast cancer cases. The second most common type of breast cancer is infiltrating lobular carcinoma (also called invasive lobular caricoma), found in approximately 6 percent of breast cancer cases.

Other, less common, invasive types of breast cancer include:

* Infiltrating ductal and lobular carcinoma
* Inflammatory breast cancer
* Medullary carcinoma
* Mucinous carcinoma
* Paget's disease of the nipple
* Papillary carcinoma
* Tubular carcinoma.

Non-Invasive Types of Breast Cancer
Non-invasive types of breast cancer have not moved into the surrounding breast tissue. Therefore, the prognosis is good for these types of breast cancer.

Common non-invasive types of breast cancer include:

* Intraductal carcinoma, also known as ductal carcinoma in situ (DCIS)
* Lobular carcinoma in situ (LCIS).

Breast Cancer Stages (Cont.)

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Stage III Breast Cancer

Stage III breast cancer may be a large tumor, but the cancer has not spread beyond the breast and into nearby lymph nodes. It is locally advanced cancer. There are three types of stage III breast cancer:

Stage IIIA
Stage IIIB
Stage IIIC.

Stage IIIA Breast Cancer

Stage IIIA breast cancer is one of the following:

The tumor in the breast is smaller than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures.
The tumor is more than 5 centimeters across. The cancer has spread to the underarm lymph nodes.

Stage IIIB Breast Cancer

Stage IIIB breast cancer is one of the following:

The tumor has grown into the chest wall or the skin of the breast
The cancer has spread to lymph nodes behind the breastbone.

Stage IIIC Breast Cancer

Stage IIIC breast cancer is a tumor of any size. It has spread in one of the following ways:

The cancer has spread to the lymph nodes behind the breastbone and under the arm
The cancer has spread to the lymph nodes under or above the collarbone.

Stage IV Breast Cancer

Stage IV breast cancer is distant metastatic cancer. The cancer has spread to other parts of the body.

Recurrent Breast Cancer

Recurrent cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bones, liver, or lungs.

Inflammatory Breast Cancer Stages

In inflammatory breast cancer, the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the pitted appearance called peau d'orange (like the skin of an orange). Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.

Breast Cancer Stages (Cont.)

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Ductal Carcinoma in Situ (DCIS)

In this breast cancer type, abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.

Stage I Breast Cancer

Stage I breast cancer is an early stage of invasive breast cancer. In stage I breast cancer:

The tumor is no more than 2 centimeters (three-quarters of an inch) across
Cancer cells have not spread beyond the breast.

Stage II Breast Cancer

There are two types of stage II breast cancer:

Stage IIA
Stage IIB.

Stage IIA Breast Cancer

In stage IIA breast cancer:

No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm)
The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes
The tumor is larger than 2 centimeters but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB Breast Cancer

In stage IIB breast cancer, the tumor is either:

Larger than 2 centimeters but no larger than 5 centimeters and has spread to the axillary lymph nodes
Larger than 5 centimeters but has not spread to the axillary lymph nodes.

Breast Cancer Stages

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In cases of breast cancer, stages are used to express the progression of the disease based on such factors as the size of the tumor and whether it has spread. It is important to determine the stage of the breast cancer in order to plan treatment. Breast cancer stages include stages 0 through IV and recurrent breast cancer. In many instances of breast cancer, the stage of the disease cannot be accurately determined until after surgery has been performed to remove the tumor.

Breast Cancer Stages: An Overview

To plan your treatment, your doctor needs to know the extent of the disease. This is called the breast cancer stage. The breast cancer stage is based on such factors as the size of the tumor and whether the cancer has spread.

To accurately diagnose the breast cancer stage, x-rays and lab tests may be used. These tests can show whether the cancer has spread and, if so, to what parts of your body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). The breast cancer stage often is not known until after surgery is performed to remove the tumor in your breast and the lymph nodes under your arm.

The different breast cancer stages include:

Stage 0 (including lobular carcinoma in situ and ductal carcinoma in situ)
Stage I
Stage II (including IIA and IIB)
Stage III (including IIIA, IIIB, and IIIC)
Stage IV
Recurrent.

Stage 0 Breast Cancer

Stage 0 is carcinoma in situ. (In situ means "in place.") There are two types of stage 0 breast cancer:

Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS).

Lobular Carcinoma in Situ (LCIS)

In this type of breast cancer, abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer in both breasts.

Male Breast Cancer

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Although rare, male breast cancer does occur -- usually in men between the ages of 60 and 70. Risk factors for male breast cancer include exposure to radiation, having a disease related to high levels of estrogen in the body (such as cirrhosis), and a family history of breast cancer in female relatives. Male breast cancer is staged the same as it is in women. Unfortunately, most cases of male breast cancer are diagnosed at a later stage than most cases of breast cancer in women.

Male Breast Cancer: An Overview

Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

Men at any age may develop breast cancer, but it is usually found in men between 60 and 70 years of age.

Male breast cancer makes up less than 1 percent of all cases of breast cancer. There were an estimated 1,690 new cases and 460 deaths from male breast cancer in the United States in 2005.

Risk Factors for Male Breast Cancer

Risk factors for male breast cancer include the following:

Exposure to radiation
Having a disease related to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder)
Having several female relatives who have had breast cancer, especially relatives who have an alteration of the BRCA2 gene.

Causes of Male Breast Cancer

Male breast cancer is sometimes caused by inherited gene mutations. Most often, however, the cause of male breast cancer is not known.

Diagnosing Male Breast Cancer

A doctor should be seen if changes in the breasts are noticed. Typically, men with breast cancer have lumps that can be felt.

A biopsy can be done to check for male breast cancer. The following are different types of biopsies:

Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid using a thin needle. This procedure is also called a fine-needle aspiration biopsy.
Core biopsy: The removal of part of a lump or suspicious tissue using a wider needle.
Excisional biopsy: The removal of an entire lump or suspicious tissue.

After the tissue or fluid has been removed, a pathologist (someone who studies diseases) views it under a microscope to check for cancer cells.

Inflammatory Breast Cancer

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Inflammatory Breast Cancer

Inflammatory breast cancer is rare, and is characterized by cancer cells that block lymph vessels in the skin of the breast. Common symptoms of inflammatory breast cancer include pink or purple skin that is swollen and warm to the touch. The skin may also appear pitted. Treatment for inflammatory breast cancer usually consists of chemotherapy and surgery.

Inflammatory Breast Cancer: An Overview

Inflammatory breast cancer is an uncommon type of breast cancer in which breast cancer cells block the lymph vessels in the skin of the breast.

Signs and Symptoms of Inflammatory Breast Cancer

The blockage of lymph vessels in inflammatory breast cancer may cause the breast to become red, swollen, and warm. The skin of the breast may also appear pink, purple, or bruised, and it may have ridges or appear pitted, like the skin of an orange (called peau d'orange). These changes often occur quickly over a period of weeks.

Another possible sign of inflammatory breast cancer is swollen lymph nodes under the arm, above the collarbone, or in both places. Often, a tumor cannot be felt, and may not be seen on a mammogram.

Diagnosing Inflammatory Breast Cancer

The diagnosis of inflammatory breast cancer is based on the results of the biopsy and the doctor's clinical judgment.

Treatment for Inflammatory Breast Cancer

Inflammatory breast cancer generally grows rapidly, and the cancer cells often spread to other parts of the body. Therefore, a woman with inflammatory breast cancer usually has local treatment to remove or destroy the cancer in the breast and systemic treatment to control or kill cancer cells that may have spread to other parts of the body.

Local treatment for inflammatory breast cancer affects only cells in the tumor and the area close to it; systemic treatment affects cells throughout the body.

The local treatment for inflammatory breast cancer may involve surgery and/or radiation therapy to the breast and underarm area.

The systemic treatment for inflammatory breast cancer may be chemotherapy (anticancer drugs), hormonal therapy (drugs that interfere with the effects of the female hormone estrogen), or both. Systemic treatment for inflammatory breast cancer is generally given before surgery and/or radiation therapy.

In some cases of inflammatory breast cancer, local treatment may be followed by additional systemic treatment with hormonal therapy, chemotherapy, or both. Some women with inflammatory breast cancer also may have biological therapy (which stimulates the immune system to fight the cancer).

BREAST CANCER

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An Introduction to Breast Cancer

Women in the United States get breast cancer more than any other type of cancer, except for skin cancer. Each year, more than 200,000 American women learn they have the disease and over 40,000 women die from it.

Breast cancer is second only to lung cancer as a cause of cancer death in women. It occurs in men also, but the number of cases is smaller (see Male Breast Cancer).

What Is Cancer?

Cancer is a group of more than 100 different diseases. It occurs when, for unknown reasons, cells become abnormal and divide without control or order. All parts of the body are made up of cells that normally divide to produce more cells, but only when the body needs them. With cancer, cells keep dividing, even when new cells are not needed.

The change from normal to cancerous cells requires several separate, different gene alterations. Eventually, altered genes and uncontrolled growth may produce a tumor that can be benign (not cancerous) or malignant (cancerous). Malignant tumors can invade, damage, and destroy nearby tissues and spread to other parts of the body. A benign tumor won't spread to other parts of the body, but local tissue may be damaged and the growth may need to be removed.

Cancer cells can also break away from a malignant tumor and enter the bloodstream or the lymphatic system. This is how the condition spreads within the body. When breast cancer spreads outside the breast, cancer cells often are found in the lymph nodes under the arm. They can also spread to other lymph nodes, the bones, liver, or lungs. Although it is not common, some people whose underarm lymph nodes are clear of breast cancer may still have cancer cells that have spread to other parts of the body.

Cancer that spreads to other parts of the body is the same disease and has the same name as the original cancer. For example, breast cancer that has spread to the bones is called metastatic breast cancer, not bone cancer.

Breast Cancer Treatment

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Different types of treatment are available for people with breast cancer. Treatment options vary based on:

The stage of the cancer (see Breast Cancer Stages)
The breast cancer type
Estrogen-receptor and progesterone-receptor levels in the tumor tissue
A person's age, general health, and menopausal status (whether a woman is still having menstrual periods)
Whether the cancer has just been diagnosed or has recurred (come back).

In general, treatment options for breast cancer can include:

Surgery
Chemotherapy
Radiation therapy
Hormone therapy
Biological therapy.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values. Choosing the most appropriate treatment is a decision that ideally involves the patient, family, and healthcare team.

from : http://breast-cancer.emedtv.com

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Breast Enhancement Gel is an all natural herbal breast enhancement solution., Breast Enhancement is an all natural herbal breast enhancement solution that uses your body internal mechanisms to naturally induce new breast growth. Two state lawmakers say they have a plan to reduce the number of abortions in Florida. The proposal would require women to have an ultrasound before they could have an abortion in Florida

Breast Cancer Drug Your Choice of Breast Implants

2008-08-22T05:26:00.000-07:00

Your Choice of Breast Implants The most important choice a woman makes in breast augmentation is the choice of filler material of the breast implant. As of 2006, silicone gel implants became available Your Choice of Breast Implants Big Breasted Models Natural breast enlargement, also known as natural breast enhancement, is a method of breast augmentation without surgery. It is designed to help women increase both the size and firmness of their breasts, as well as increasing their Your Choice of Breast Implants Why Laser eye surgery can be an excellent choice for those who suffer from deformities or problems in eyes. Perhaps we have been all too aware of the flaws or difficulties in our eyes, and are really tired of feeling odd about them.