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Information about Breast Cancer, and links

"Courage is not the towering oak that sees storms come and go; it is the fragile blossom that opens in the snow." 
Alice M. Swai

The Breast Clinic Holland presents a new concept with a medical specialist as a breast disease expert, giving women direct results from check up and diagnostic clinics in Amsterdam.
The principle behind the breast unit is that women with breast problems or women at risk for breast cancer are seen by a specialist for check up after appointment.
Initial assessment follows the principles of the "triple approach" combining clinical examination, imaging and cytology by the same specialist and at the same time. All necessary investigations are permormed at the initial clinic visit.
In the majority of patients breast assessment is carried out to exclude the presence of malignant disease. The aim is to carry out assessment both quickly and efficiently while ensuring that significant disease is not overlooked. This can be achieved by careful attention with the most important principle being breastspecialist working to clearly defined protocols.
A significant proportion of women having no recognizable breast disease have sufficient irregularity of the "normal" breast tissue to cause concern and to necessitate further evaluation. An overall perspective of the frequency of various breast problems can be gained from a recent analysis. Most women, seen at the breast center, have after careful evaluation no breast disease. Fibrocystic changes are the dominant breast problem in 40% of cases. About 10% of the women are suffering from various lesions. Most of these diseases of the breast in women under 50 years are fortunately benign and only a few percent are cancer. However, cancer of the breast is the. second most commen cause of cancer deaths.

In recent years, ultrasound techniques have improved to the extent that they have become a routine examination of the breast in premenopausal women both to clarify an uncertain diagnosis and to detect an occult carcinoma in an asymptomatic breast. It happens rather often that small suspicious nodules, which are not detected by mammography and physical examination, are discovered by ultrasound, wether the tumors are palpable or nonpalpable. This situation usually occurs in patients with dense breasts, breast with extensive postsurgical or postradiation changes or breast with implants. Ultrasound has become the first-line modality with which to evaluate the dens breasts of adolescents and young adults, and pregnant and lactating women. Ultrasound can also image the contents of cysts and detect intracystic tumors.
Both conditions can be differentiated easily by cytology (FNA). Mammography is the gold standard for the detection of carcinomas and isolated microcalcifications, used for cancer screening in elderly women. However, (in young women) Ultrasound can visualize masses as small as 0.5 cm in diameter in vertually every type of breast.

New therapeutic concepts should be based on the biology of breast cancer, factors that influence the course of the disease and appreciation of the striking interindividual variation in biology. It is time to return to strategies that reflect the heterogeneity in the biology of the breast cancer. Therapy is therefore likely to have to be tailored for the individual woman, whose tolerance of therapy and whose preferences should be taken into account. Women can, will and should influence diagnosis and management of breast disease. Comprehensive information about the value of diagnostic methods and possible treatments should be given. Their decision will not necessarily be worse than the doctors opinion.

  • Controversy about the value of mammography for women once again erupted with the publication of a meta-analysis of past clinical trials. According to the Danish authors is screening for breast cancer with mammography unjustified. There is no reliable evidence that screening decreases breast cancer mortality.
    The Lancet 2000:355;129-134.
  • There is a high rate of discomfort associated wih mammography, according to an article in Radiology; 52% of women reported moderate to extreme discomfort at mammography. This discomfort may be important to mammography facilities with respect to consumer satisfaction.
    Radiology 2000:214;547-552.
  • Very small invasive breast cancers of 14 mm or smaller generally have good outcomes. After 20 years 94% of these women are still alive. Only 1 type of breast cancer has a bad outcome, which led to 20-year survival of about 55% only. It represent a small subgroup invasive carcinoma (high grade or poorly differentiated, comedo-type) with the presence of surrounding DCIS(=Ductal Carcinoma In Situ), showing casting-type calcifications.
    The Lancet 2000:355;429-33.


Examination at The Breast Clinic:

  • Case history; reason for the examination and possible complaints.
  • Physical examination; the physician will inspect and palpate (feel) the breasts and will provide instructions for self-examination.
  • Ultrasound scanning of the breasts; the structure of the tissue of the breast becomes visible via the use of sonic waves and can show possible defects in an early stage before they can be felt as lumps on the breast. This painless method may show defects that are smaller than one centimetre and may therefore prevent the necessity of a major operation.
  • Cytological examination; if defects are detected then cellular tissue form the breast will be removed using a tiny needle. There will be no anaesthetics because the puncture only needs to be done once and is similar to getting an injection to allow blood to be taken. The cells of the lump will be examined under a microscope and the results wil be given immediately afterwards by the specialist (pathologist).

Results of the examination

The results of the ultrasound examination will be given by the physician to the client immediately after the examination and the client will therefore not have to wait for the results to be delivered by post. Microscopic examination is also carried out straight away and results given immediately afterwards. Findings of possible further cytological examination by the pathologist will be given in writing. After consultation with the client and depending on risk factor and results, an appointment for a follow-up examination will be made (annual ultrasound examination or mammographical screening).


Help Groups for Breast Cancer
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Genetics of Breast and Ovarian Cancer (PDQ)

General Information Among women, breast cancer is the most commonly diagnosed cancer after nonmelanoma skin cancer, and is the second leading cause of cancer deaths after lung cancer. In 2004, an estimated 217,440 new cases will be diagnosed, and 40,580 deaths from breast cancer will occur.[1] (Refer to the PDQ summary on Breast Cancer Treatment for more information on breast cancer rates, diagnosis, and management.)

A possible genetic contribution to breast cancer risk is indicated by the increased incidence of breast cancer among women with a family history of breast cancer, and by the observation of rare families in which multiple family members are affected with breast cancer, in a pattern compatible with autosomal dominant inheritance of cancer susceptibility.

Formal studies of families (linkage analysis) have subsequently proven the existence of an autosomal dominant form of breast cancer, and have led to the identification of several highly penetrant genes of major effect as the cause of inherited cancer risk in many cancer-prone families. (Refer to the PDQ summary Cancer Genetics Overview for more information on linkage analysis.) These mutations are rare and are estimated to account for no more than 5% to 10% of breast cancer cases overall. It is likely that other background genetic factors contribute to the etiology of breast cancer.

Family History as a Risk Factor for Breast Cancer In cross-sectional studies of adult populations, 5% to 10% of women have a mother or sister with breast cancer, and about twice as many have either a first-degree or a second-degree relative with breast cancer.[2-5] The risk conferred by a family history of breast cancer has been assessed in both case-control and cohort studies, using volunteer and population-based samples, with generally consistent results.[6] In a pooled analysis of 38 studies, the relative risk of breast cancer conferred by a first-degree relative with breast cancer was 2.1 (95% confidence interval (CI) 2.0-2.2).[6]

Risk varies with the age at which the affected relative was diagnosed: the younger the affected relative, the greater the risk posed to relatives.[2-4,6-8] This effect was strongest for women younger than 50 years who had a first-degree relative affected before age 50 years.[6]

The number of affected relatives and the closeness of their biologic relationship are also important factors.[3,4,6] In general, the larger the number of affected relatives and the closer the biologic relationship, the greater the risk.[3,4,6] The number of female relatives in the family influences both utility and significance of the family history. In families with few women, it may be difficult to identify a genetic susceptibility to cancer. If a family has many female members, the proportion of affected relatives may be a more important indicator of risk than the number of affected relatives.

Studies of family history of ovarian cancer suggest an association with breast cancer risk. A first-degree relative with ovarian cancer confers a modest risk of breast cancer, e.g., the odds ratio (OR) derived from a case-control study based on the Utah Cancer Registry was 1.27 (95% CI 0.91-1.77),[9] and other studies have found no evidence of increased risk.[7,10] When the Utah data were analyzed according to a family history score (based on characteristics that included number of relatives with ovarian cancer, their age of diagnosis, and biologic relatedness), however, the OR for women with a score of 5 or higher (3% of the population) was 1.60 (95% CI 1.03-2.43); for women with scores of 2.0 to 4.9 (12% of the population), the OR was 1.15 (95% CI 1.01-1.36).[9] The presence of both breast and ovarian cancer in a family increases the likelihood that a cancer-predisposing mutation is present.[11,12]

Source: http://cancer.gov/cancerinfo/pdq/genetics/breast-and-ovarian

The Breast

The female breasts are modified sweat glands composed of lobes and lobules interspersed with adipose tissue and connective tissue. Ducts drain from each lobule. These converge to form a lactiferous duct that drains from each lobe. The lactiferous ducts merge just beneath the nipple to form a lactiferous sinus.
The functional secretory unit in lactation is the terminal duct lobular unit. Here, each duct has a lining epithelium surrounded by a thin myoepithelial cell layer responsive to oxytocin, the hormone that stimulates lactation.
Neoplasms may arise in either the ductular epithelium, lobules, or the stroma. However, the majority of cancers arise in the ducts.
    1. Normal breast, high power microscopic.
    2. Normal breast, duct with myoepithelial cells identified by immunoperoxidase staining for actin, high power microscopic.

Incidence of Breast Cancer

Breast cancer is very rare before age 20 and is rarely diagnosed in women younger than age 25. Past that age, the incidence rises steadily to reach a peak around the age of menopause. The rate of increase is lessened after menopause, but older women are still at increasing risk over time.
About 1 in 8 women in the United States and Canada will develop breast cancer. This incidence is similar for many European countries. However, breast cancer is much less common in Asia.
The incidence rate for breast cancer rose 24% in the U.S. between 1973 and 1991, while mortality from breast cancer did not increase. In addition, more localized cancers were diagnosed over time. These statistics indicate that screening for breast cancer, including mammography, probably played a role in detecting more cancers at an earlier stage.

Risk Factors for Breast Cancer

Although a specific cause for breast cancer has not been identified, there are risk factors that increase the likelihood that a woman will develop a breast cancer. These risks include:
    • Maternal relative with breast cancer. Women whose mother or sister or aunt had breast cancer, particularly at a younger age, have a greater risk.
    • BRCA1 and BRCA2 genes. The incidence of the BRCA1 gene on chromosome 17 may be 1 in 800 women. The BRCA2 gene on chromosome 13 is less frequent but associated with early onset breast carcinomas. The presence of these genes may explain some of the familial cases, and may be the etiology for about 1% of breast cancers overall.
    • Longer reproductive span. Women who have an earlier menarche and/or a later menopause, increasing the length of reproductive years, are at greater risk.
    • Obesity. Women who are overweight are at increased risk. In addition, increased dietary fat intake is a risk.
    • Nulliparity. Women who have never borne children are at greater risk, while women who have been pregnant are at a lower risk.
    • Later age at first pregnancy. Women who had their first child over age 30 are at greater risk.
    • Atypical epithelial hyperplasia. Although fibrocystic changes that produce benign breast "lumps" are not premalignant, the presence of atypical changes in ductular epithelium does increase the risk.
    • Previous breast cancer. Women who have had breast cancer in the opposite breast are at increased risk for cancer in the remaining breast.
    • Previous endometrial carcinoma. Women who have had adenocarcinoma of the endometrium are at increased risk for breast cancer.
Aside from the genetic predisposition, the common factor in many of these risks is increased endogenous estrogen exposure over a long time.

Classification of Breast Cancer

Breast cancers can be classifed histologically based upon the types and patterns of cells that compose them. Carcinomas can be invasive (extending into the surrounding stroma) or non-invasive (confined just to the ducts or lobules). The tables below identify the major histologic types of invasive and non-invasive breast cancers, along with their frequency of all breast cancer types, and overall relative 5-year survival (% of patients with that histologic type surviving for 5 years following diagnosis). The "NOS" categories contain carcinomas not easily classified into other histologic types or carcinomas for which minimal tissue was available for diagnosis.

Invasive Carcinomas of the Breast

Histologic Type

Frequency (%)

5-year Survival (%)

Infiltrating Ductal Carcinoma

63.6

79

Infiltrating Lobular Carcinoma

5.9

84

Infiltrating Ductal & Lobular Carcinoma

1.6

85

Medullary Carcinoma

2.8

82

Mucinous (colloid) Carcinoma

2.1

95

Comedocarcinoma

1.4

87

Paget's Disease

1.0

79

Papillary Carcinoma

0.8

96

Tubular Carcinoma

0.6

96

Adenocarcinoma, NOS

7.5

65

Carcinoma, NOS

3.5

62


Non-invasive Carcinomas of the Breast

Histologic Type

Frequency (%)

5-year Survival (%)

Intraductal Carcinoma

3.6

>99

Lobular Carcinoma in situ (LCIS)

1.6

>99

Intraductal & LCIS

0.2

>99

Papillary Carcinoma

0.4

>99

Comedocarcinoma

0.3

>99

Source: http://www-medlib.med.utah.edu/WebPath/TUTORIAL/BREAST/BREAST.html

Breast cancerFrom MayoClinic.com
Special to CNN.com

Overview

In breast cancer, cells in your breast begin growing abnormally often for unknown reasons. These cells divide more rapidly than healthy cells and may spread through your breast or into other parts of your body. The most common type of breast cancer begins in the ducts designed to carry milk after childbirth, but cancer may also occur in the small sacs that produce milk (lobules) or in other breast tissue.

Breast cancer is the disease many women fear most, though they're far more likely to die of cardiovascular disease than they are of all forms of cancer combined. Still, breast cancer is second only to lung cancer as a cause of cancer deaths in American women. More than 200,000 American women are diagnosed annually with breast cancer. And nearly 40,000 American women die annually of breast cancer. Although rare, breast cancer can also occur in men.

Yet there's more reason for optimism with regard to breast cancer than ever before. Great strides have been made in diagnosis and treatment in the last 25 years. In 1975 a diagnosis of breast cancer usually meant radical mastectomy removal of the entire breast along with underarm lymph nodes and skin and muscles underneath the breast. Today, radical mastectomy is rarely performed. Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations, such as lumpectomy.

Emphasis is also being placed on early detection, lifestyle changes and therapies such as tamoxifen that may reduce the risk of breast cancer. In addition, a growing network of agencies and resources exist to help those who have just received a diagnosis, are facing treatment decisions or are living with breast cancer.

Cancer

Women's top health threats: A surprising list

Breast cancer in men

Source: http://cnn.nl/HEALTH/library/DS/00328.html

* Breast cancer now affects one woman in 9 during her lifetime in the United Kingdom.
*
Breast cancer is the commonest cancer in minority ethnic groups in the UK.
*
Breast cancer claims more years of life from women under 65 than coronary heart disease.
*
Every week 730 new breast cancers are diagnosed and 250 women die from breast cancer.
*
Each year 38,000 women are newly diagnosed and 13,100 women die from breast cancer.
* Survival rates are improving, on average 74 per cent of women are still alive five years later

Information provided by Breast Cancer Campaign

Breast Cancer Support and Information - UK Contacts
Putting Breast Cancer on the Map - A Project by WEN
With the recently added
project review and exhibition of the maps
Jo Spence - An on-line exhibition
Be Breast Aware
Feedback - Archive 1995 - 2000
Diary - Archive 1996 - 2000
Book Reviews
Patients' Rights

This site started in 1995 to fill, what was then, a real gap on the web for UK based support and information for women affected by breast cancer. Almost all the organisations we originally provided information about now have their own websites, which you can find on the Support and Information page. The other pages on this site mainly form an archive or record of the work we did on the site during its early years - much of which is still of interest or relevance today.

Source: http://hosted.aware.easynet.co.uk/

The following link is of a very special Web Site about Chemo Hats. It is worth to visit the site, especially when you are facing getting bald or being bald due to the Chemo Therapy: www.cjhats.com

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