Breast cancer: Difference between revisions
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'''Breast cancer''' is a [[cancer]] that starts in the [[breast]], usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment is selected from surgery, drugs (chemotherapy), and radiation. |
'''Breast cancer''' is a [[cancer]] that starts in the [[breast]], usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment is selected from surgery, drugs (chemotherapy), and radiation. |
Revision as of 22:51, 13 August 2009
Breast cancer | |
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Specialty | Oncology ![]() |
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Breast cancer is a cancer that starts in the breast, usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment is selected from surgery, drugs (chemotherapy), and radiation. [1].
In the United States, there were 216,000 cases of invasive breast cancer and 40,000 deaths in 2004.[2] Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted)[3] and the fifth most common cause of cancer death.[4] In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).[4]
Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes.[5][6][7]
Classification
Breast cancers are described along four different classification schemes, or groups, each based on different criteria and serving a different purpose:
- Pathology - Each tumor is classified by its histological (microscopic anatomy) appearance and other criteria.[8]
- Grade of tumor - The histological grade of a tumor is determined by a pathologist under a microscope. A well-differentiated (low grade) tumor resembles normal tissue. A poorly differentiated (high grade) tumor is composed of disorganized cells and, therefore, does not look like normal tissue. Moderately differentiated (intermediate grade) tumors are somewhere in between.
- Protein & gene expression status - Currently, all breast cancers should be tested for expression, or detectable effect, of the estrogen receptor (ER), progesterone receptor (PR) and HER2/neu proteins. These tests are usually done by immunohistochemistry and are presented in a pathologist's report. The profile of expression of a given tumor helps predict its prognosis, or outlook, and helps an oncologist choose the most appropriate treatment. More genes and/or proteins may be tested in the future.
- Stage of a tumor - The currently accepted staging scheme for breast cancer is the TNM classification. This considers the Tumor itself, whether it has spread to lymph Nodes, and whether there are any Metastases to locations other than the breast and lymph nodes.
Breast cancer is usually, but not always, primarily classified by its histological appearance. Rare variants are defined on the basis of physical exam findings. For example, inflammatory breast cancer (IBC), a form of ductal carcinoma or malignant cancer in the ducts, is distinguished from other carcinomas by the inflamed appearance of the affected breast.[9] In the future, some pathologic classifications may be changed.
Signs and symptoms
The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the surrounding breast tissue. According to the The Merck Manual, more than 80% of breast cancer cases are discovered when the woman feels a lump.[10] According to the American Cancer Society, the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram.[11] Lumps found in lymph nodes located in the armpits[10] can also indicate breast cancer.
Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.[10][11][12]
When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.[10]
Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.[13]
Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.[14] Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses.[15]
Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.[16]
Causes
The primary risk factors that have been identified are sex,[17] age,[18] childbearing, hormones,[19] a high-fat diet,[20] alcohol intake,[21][22] obesity,[23] and environmental factors such as tobacco use, radiation[24] and shiftwork.[25] However, studies of environmental and lifestyle factors only attribute a small increase in breast cancer to each factor. Furthermore, these studies are not randomized, controlled trials, and so they may associate breast cancer with factors that don't actually cause breast cancer.[original research?]
No etiology is known for 95% of breast cancer cases, while approximately 5% of new breast cancers are attributable to hereditary syndromes.[26] In particular, carriers of the breast cancer susceptibility genes, BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs.[27]
- Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
- Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
- Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
- Race: Breast cancer is diagnosed more often in Caucasian women than Latina, Asian, or African American women.
- No physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help decrease risk.
- Tamoxifen may interact unfavorably with certain antidepressants when used for prevention of breast cancer recurrence.[28]
Pathophysiology
Breast cancer, like other forms of cancer, is the outcome of multiple environmental and hereditary factors. Some of these factors include:
- Lesions to DNA such as genetic mutations. Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.[29]
- Failure of immune surveillance, a theory in which the immune system removes malignant cells throughout one's life.[30]
- Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.
- Inherited defects in DNA repair genes, such as BRCA1, BRCA2[24] and TP53.[31] People in less-developed countries report lower incidence rates than in developed countries.
Experts believe that 95 percent of inherited breast cancer can be traced to one of two genes, which they call Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2). Hereditary breast cancers can take the form of a site-specific hereditary breast cancer- cancers affecting the breast only- or breast- ovarian and other cancer syndromes. Breast cancer can be inherited both from female and male relatives. [32]
Diagnosis
While screening techniques discussed above are useful in determining the possibility of cancer, a further testing is necessary to confirm whether a lump detected on screening is cancer, as opposed to a benign alternative such as a simple cyst.
In a clinical setting, breast cancer is commonly diagnosed using a "triple test" of clinical breast examination (breast examination by a trained medical practitioner), mammography, and fine needle aspiration cytology. Both mammography and clinical breast exam, also used for screening, can indicate an approximate likelihood that a lump is cancer, and may also identify any other lesions. Fine Needle Aspiration and Cytology (FNAC), which may be done in a GP's office using local anaesthetic if required, involves attempting to extract a small portion of fluid from the lump. Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.
Other options for biopsy include core biopsy, where a section of the breast lump is removed, and an excisional biopsy, where the entire lump is removed.
Screening
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Mammo_breast_cancer.jpg/220px-Mammo_breast_cancer.jpg)
Breast cancer screening is an attempt to find cancer in otherwise healthy individuals. The most common screening method for women is a combination of x-ray mammography and clinical breast exam. In women at higher than normal risk, such as those with a strong family history of cancer, additional tools may include genetic testing or breast Magnetic Resonance Imaging.
Breast self-examination was a form of screening that was heavily advocated in the past, but has since fallen into disfavour since several large studies have shown that it does not have a survival benefit for women and often causes considerably anxiety. This is thought to be because cancers that could be detected tended to be at a relatively advanced stage already, whereas other methods push to identify the cancer at an earlier stage where curative treatment is more often possible.
X-ray mammography uses x-rays to examine the breast for any uncharacteristic masses or lumps. Regular mammograms is recommended in several countries in women over a certain age as a screening tool.
Genetic testing for breast cancer typically involves testing for mutations in the BRCA genes. This is not generally a recommended technique except for those at elevated risk for breast cancer.
Treatment
![](http://upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Mastectomie_02.jpg/220px-Mastectomie_02.jpg)
The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy. At present, the treatment recommendations after surgery (adjuvant therapy) follow a pattern. This pattern is subject to change, as every two years, a worldwide conference takes place in St. Gallen, Switzerland, to discuss the actual results of worldwide multi-center studies.[citation needed] Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases, with each risk category following different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy.
In planning treatment, doctors can also use PCR tests like Oncotype DX or microarray tests that predict breast cancer recurrence risk based on gene expression. In February 2007, the first breast cancer predictor test won formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated.[33]
Radiation therapy is also used to help destroy cancer cells that may linger after surgery. Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3rds reduction of risk) when delivered in the correct dose. [34]
Prognosis
A prognosis is the medical team's "best guess" in how cancer will affect a patient. There are many prognostic factors associated with breast cancer: staging, tumor size and location, grade, whether disease is systemic (has metastasized, or traveled to other parts of the body), recurrence of the disease, and age of patient.
Stage is the most important, as it takes into consideration size, local involvement, lymph node status and whether metastatic disease is present. The higher the stage at diagnosis, the worse the prognosis. The stage is raised by the invasiveness of disease to lymph nodes, chest wall, skin or beyond, and the aggressiveness of the cancer cells. The stage is lowered by the presence of cancer-free zones and close-to-normal cell behaviour (grading). Size is not a factor in staging unless the cancer is invasive. Ductal Carcinoma in situ throughout the entire breast is stage zero.
Grading is based on how biopsied, cultured cells behave. The closer to normal cancer cells are, the slower their growth and the better the prognosis. If cells are not well differentiated, they will appear immature, will divide more rapidly, and will tend to spread. Well differentiated is given a grade of 1, moderate is grade 2, while poor or undifferentiated is given a higher grade of 3 or 4 (depending upon the scale used).
Younger women tend to have a poorer prognosis than post-menopausal women due to several factors. Their breasts are active with their cycles, they may be nursing infants, and may be unaware of changes in their breasts. Therefore, younger women are usually at a more advanced stage when diagnosed. There may also be biologic factors contributing to a higher risk of disease recurrence for younger women with breast cancer.[35]
The presence of estrogen and progesterone receptors in the cancer cell, while not prognostic, is important in guiding treatment. Those who do not test positive for these specific receptors will not respond to hormone therapy.
Likewise, HER2/neu status directs the course of treatment. Patients whose cancer cells are positive for HER2/neu have more aggressive disease and may be treated with trastuzumab, a monoclonal antibody that targets this protein.
Elevated CA15-3, in conjunction with alkaline phosphatase, was shown to increase chances of early recurrence in breast cancer.[36]
Psychological aspects
The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which provide a supportive environment to help patients cope and gain perspective from cancer survivors. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.
Not all breast cancer patients experience their illness in the same manner. Factors such as age can have a significant impact on the way a patient copes with a breast cancer diagnosis. Premenopausal women with estrogen-receptor positive breast cancer must confront the issues of early menopause induced by many of the chemotherapy regimens used to treat their breast cancer, especially those that use hormones to counteract ovarian function. [37]
On the other hand, a recent study conducted by researchers at the College of Public Health of the University of Georgia showed that older women may face a more difficult recovery from breast cancer than their younger counterparts.[38] As the incidence of breast cancer in women over 50 rises and survival rates increase, breast cancer is increasingly becoming a geriatric issue that warrants both further research and the expansion of specialized cancer support services tailored for specific age groups.[38]
Epidemiology
Epidemiological risk factors for a disease can provide important clues as to the etiology, or cause, of a disease. The first case-controlled study on breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.[39][verification needed][40]
Worldwide, breast cancer is by far the most common cancer amongst women, with an incidence rate more than twice that of colorectal cancer and cervical cancer and about three times that of lung cancer. However breast cancer mortality worldwide is just 25% greater than that of lung cancer in women.[3] In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).[4] The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.[41][42]
The incidence of breast cancer varies greatly around the world, being lower in less-developed countries and greatest in the more-developed countries. In the twelve world regions, the annual age-standardized incidence rates per 100,000 women are as follows: in Eastern Asia, 18; South Central Asia, 22; sub-Saharan Africa, 22; South-Eastern Asia, 26; North Africa and Western Asia, 28; South and Central America, 42; Eastern Europe, 49; Southern Europe, 56; Northern Europe, 73; Oceania, 74; Western Europe, 78; and in North America, 90.[43]
United States
Women in the United States have the highest incidence rates of breast cancer in the world; 141 among white women and 122 among African American women.[44][45] Among women in the US, breast cancer is the most common cancer and the second-most common cause of cancer death (after lung cancer).[45] Women in the US have a 1 in 8 (12.5%) lifetime chance of developing invasive breast cancer and a 1 in 35 (3%) chance of breast cancer causing their death.[45] In 2007, breast cancer was expected to cause 40,910 deaths in the US (7% of cancer deaths; almost 2% of all deaths).[11] This figure includes 450-500 men who die annually in the U.S. out of approximately 2000 who contract it.[46]
In the US, both incidence and death rates for breast cancer have been declining in the last few years in Native Americans and Alaskan Natives.[11][47] Nevertheless, a US study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease,[48] even though heart disease is a much more common cause of death among women.[49] Many doctors say that women exaggerate their risk of breast cancer.[50]
Racial disparities
Several studies have found that black women in the U.S. are more likely to die from breast cancer even though white women are more likely to be diagnosed with the disease. Even after diagnosis, black women are less likely to get treatment compared to white women.[51][52][53] Scholars have advanced several theories for the disparities, including inadequate access to screening, reduced availability of the most advanced surgical and medical techniques, or some biological characteristic of the disease in the African American population.[54] Some studies suggest that the racial disparity in breast cancer outcomes may reflect cultural biases more than biological disease differences.[55] Research is currently ongoing to define the contribution of both biological and cultural factors.[52][56]
UK
45,000 cases diagnosed and 12,500 deaths per annum. 60% of cases are treated with Tamoxifen, of these the drug becomes ineffective in 35%.[57]
History
Breast cancer may be one of the oldest known forms of cancerous tumors in humans. The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.The writing says about the disease, "There is no treatment."[58] For centuries, physicians described similar cases in their practises, with the same conclusion. It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit. The French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. The Halsted radical mastectomy often involved removing both breasts, associated lymph nodes, and the underlying pectoral muscles. This often led to long-term pain and disability, but was seen as necessary in order to prevent the cancer from recurring.[59] Radical mastectomies remained the standard until the 1970s, when a new understanding of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and more sparing procedures were developed that proved equally effective.
Prominent women who died of breast cancer include Empress Theodora, wife of Justinian; Anne of Austria, mother of Louis XIV of France; Mary Washington, mother of George, and Rachel Carson, the environmentalist.[60]
Prevention
Regular exercise, weight loss, avoidance of alcohol, stressors, toxic chemicals and environmental pollutants are all helpful measures in the prevention of breast cancer. Dietary inclusion of dried beans, cruciferous vegetables, and whole grains have also proven beneficial. Brazil nuts, rich in the mineral selenium, when combined with natural vitamin E as found in almonds and walnuts are also highly effective in reducing cancer risk. [61][62]
Some researchers have hypothesized that regular exposure to semen reduces breast cancer.[63][64] This effect is attributed to its DHA, glycoprotein and selenium content.[65]
Cultural references
![](http://upload.wikimedia.org/wikipedia/commons/thumb/b/b5/Pink_ribbon.svg/80px-Pink_ribbon.svg.png)
In the month of October, breast cancer is recognized by survivors, family and friends of survivors and/or victims of the disease.[66] A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer.[67]
Pink for October is an initiative started by Matthew Oliphant, which asks that any sites willing to help make people aware of breast cancer, change their template or layout to include the color pink, so that when visitors view the site, they see that the majority of the site is pink. Then after reading a short amount of information about breast cancer, or being redirected to another site, they are aware of the disease itself.[68]
The patron saint of breast cancer is Saint Agatha of Sicily.[69]
The pink and blue ribbon was designed in 1996 by Nancy Nick, President and Founder of the John W. Nick Foundation to bring awareness that "Men Get Breast Cancer Too!"[70]
See also
- List of notable breast cancer patients according to occupation
- List of notable breast cancer patients according to survival status
- List of breast carcinogenic substances
- Mammary tumor for breast cancer in other animals
- Breast reconstruction
- Alcohol and cancer
- Mammography Quality Standards Act
- National Breast Cancer Coalition
- National Comprehensive Cancer Network
- Breast Cancer Action
- Breakthrough Breast Cancer
- Living Beyond Breast Cancer
- International Agency for Research on Cancer
- Susan G. Komen for the Cure
- Breast Cancer Network of Strength
- Your Disease Risk
References
- ^ Merck Manual Online, Breast Cancer
- ^ Harrison's Principles of Internal Medicine, 16th ed., Ch. 76, "Breast Cancer," by Marc E. Lippman
- ^ a b World Health Organization International Agency for Research on Cancer (2003). "World Cancer Report". Retrieved 2009-03-26.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ a b c World Health Organization (2006). "Fact sheet No. 297: Cancer". Retrieved 2009-03-26.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ "Male Breast Cancer Treatment - National Cancer Institute". National Cancer Institute. 2006. Retrieved 2006-10-16.
{{cite web}}
: External link in
(help)|work=
- ^ "Breast Cancer in Men: Cancer Research UK". Cancer Research UK. 2007. Retrieved 2007-11-06.
{{cite web}}
: External link in
(help)|work=
- ^ American Cancer Society (2007). "What Are the Key Statistics About Breast Cancer in Men?". Retrieved 2008-02-03.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ Peter Devilee; Fattaneh A. Tavassoli (2003). World Health Organization: Tumours of the Breast and Female Genital Organs. Oxford [Oxfordshire]: Oxford University Press. ISBN 92-832-2412-4.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ^ Giordano SH, Hortobagyi GN (2003). "Inflammatory breast cancer: clinical progress and the main problems that must be addressed". Breast Cancer Research. 5 (6): 284–8. doi:10.1186/bcr608. PMC 314400. PMID 14580242.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - ^ a b c d Merck Manual of Diagnosis and Therapy (2003). "Breast Disorders: Cancer". Retrieved 2008-02-05.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ a b c d American Cancer Society (2007). "Cancer Facts & Figures 2007" (PDF). Retrieved 2007-04-26.
- ^ eMedicine (2006). "Breast Cancer Evaluation". Retrieved 2008-02-05.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ National Cancer Institute (2005). "Paget's Disease of the Nipple: Questions and Answers". Retrieved 2008-02-06.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ Lacroix M (2006). "Significance, detection and markers of disseminated breast cancer cells". Endocrine-related Cancer. 13 (4): 1033–67. doi:10.1677/ERC-06-0001. PMID 17158753.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ National Cancer Institute (2004). "Metastatic Cancer: Questions and Answers". Retrieved 2008-02-06.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ Merck Manual of Diagnosis and Therapy (2003). "Breast Disorders: Introduction". Retrieved 2008-02-05.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN (2004). "Breast carcinoma in men: a population-based study". Cancer. 101 (1): 51–7. doi:10.1002/cncr.20312. PMID 15221988.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ "Individual Risk Factors". BreastCancer.org. Retrieved 2007-03-11.
- ^ Yager JD (2006). "Estrogen carcinogenesis in breast cancer". New Engl J Med. 354 (3): 270–82. doi:10.1056/NEJMra050776. PMID 16421368.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Chlebowski RT, Blackburn GL, Thomson CA; et al. (2006). "Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study". Journal of the National Cancer Institute. 98 (24): 1767–76. doi:10.1093/jnci/djj494. PMID 17179478.
{{cite journal}}
: Explicit use of et al. in:|author=
(help); Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Boffetta P, Hashibe M, La Vecchia C, Zatonski W, Rehm J (2006). "The burden of cancer attributable to alcohol drinking". International Journal of Cancer. 119 (4): 884–7. doi:10.1002/ijc.21903. PMID 16557583.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ [1]
- ^ BBC report Weight link to breast cancer risk
- ^ a b American Cancer Society (2005). "Breast Cancer Facts & Figures 2005-2006" (PDF). Retrieved 2007-04-26.
- ^ WHO international Agency for Research on Cancer Press Release No. 180, December 2007.
- ^ Madigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN (1995). "Proportion of breast cancer cases in the United States explained by well-established risk factors". Journal of the National Cancer Institute. 87 (22): 1681–5. doi:10.1093/jnci/87.22.1681. PMID 7473816.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Venkitaraman AR (2002). "Cancer susceptibility and the functions of BRCA1 and BRCA2". Cell. 108 (2): 171–82. doi:10.1016/S0092-8674(02)00615-3. PMID 11832208.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ http://www.cbsnews.com/stories/2009/05/30/health/main5050992.shtml?tag=main_home_storiesBySection
- ^ Cavalieri E, Chakravarti D, Guttenplan J; et al. (2006). "Catechol estrogen quinones as initiators of breast and other human cancers: implications for biomarkers of susceptibility and cancer prevention". Biochimica et Biophysica Acta. 1766 (1): 63–78. doi:10.1016/j.bbcan.2006.03.001. PMID 16675129.
{{cite journal}}
: Explicit use of et al. in:|author=
(help); Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Farlex (2005). ">immunological surveillance "The Free Dictionary: Immunological Surveilliance". Retrieved 2008-02-10.
{{cite web}}
: Check|url=
value (help) - ^ Dunning AM, Healey CS, Pharoah PD, Teare MD, Ponder BA, Easton DF (1999). "A systematic review of genetic polymorphisms and breast cancer risk". Cancer Epidemiology, Biomarkers & Prevention. 8 (10): 843–54. PMID 10548311.
{{cite journal}}
: Unknown parameter|day=
ignored (help); Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Braddock, Suzanne W., Jane M. Kercher, John J. Edney, and Melanie M. Clark. Straight talk about breast cancer from diagnosis to recovery : a guide for the whole family. Omaha, Neb: Addicus Books, 1994.[page needed]
- ^ "FDA Approves New Breast Cancer Test". Associated Press, February 6, 2007.
- ^ Breastcancer.org Treatment Options
- ^ Peppercorn J (2009). "Breast Cancer in Women Under 40". Oncology. 23 (6).
- ^ Keshaviah A, Dellapasqua S, Rotmensz N; et al. (2007). "CA15-3 and alkaline phosphatase as predictors for breast cancer recurrence: a combined analysis of seven International Breast Cancer Study Group trials". Annals of Oncology. 18 (4): 701–8. doi:10.1093/annonc/mdl492. PMID 17237474.
{{cite journal}}
: Explicit use of et al. in:|author=
(help); Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Pritchard KI (2009). "Ovarian Suppression/Ablation in Premenopausal ER-Positive Breast Cancer Patients". Oncology. 23 (1).
- ^ a b Robb C, Haley WE, Balducci L; et al. (2007). "Impact of breast cancer survivorship on quality of life in older women". Critical Reviews in Oncology/hematology. 62 (1): 84–91. doi:10.1016/j.critrevonc.2006.11.003. PMID 17188505.
{{cite journal}}
: Explicit use of et al. in:|author=
(help); Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Lane-Claypon, Janet Elizabeth (1926). A further report on cancer of the breast, with special reference to its associated antecedent conditions. London, Greater London: Her Majesty’s Stationery Office (HMSO). OCLC 14713036.
{{cite book}}
: Cite has empty unknown parameter:|coauthors=
(help) - ^ Alfredo Morabia (2004). A History of Epidemiologic Methods and Concepts. Boston: Birkhauser. pp. 301–302. ISBN 3-7643-6818-7. Retrieved 2007-12-31.
- ^ Laurance, Jeremy (2006-09-29). "Breast cancer cases rise 80% since Seventies". The Independent. Retrieved 2006-10-09.
- ^ "Breast Cancer: Statistics on Incidence, Survival, and Screening". Imaginis Corporation. 2006. Retrieved 2006-10-09.
{{cite web}}
: External link in
(help)|work=
- ^ Stewart B. W. and Kleihues P. (Eds): World Cancer Report. IARCPress. Lyon 2003
- ^ Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Institute, 2003.
- ^ a b c American Cancer Society (2007). "What Are the Key Statistics for Breast Cancer?". Retrieved 2008-02-03.
{{cite web}}
: Unknown parameter|month=
ignored (help) - ^ http://www.medicinenet.com/male_breast_cancer/article.htm
- ^ Espey DK, Wu XC, Swan J; et al. (2007). "Annual report to the nation on the status of cancer, 1975-2004, featuring cancer in American Indians and Alaska Natives". Cancer. 110 (10): 2119–52. doi:10.1002/cncr.23044. PMID 17939129.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ^ "Women's Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared Disease" (Press release). Society for Women's Health Research. 2005-07-07. Retrieved 2007-10-15.
- ^ "Leading Causes of Death for American Women 2004" (PDF). National Heart Lung and Blood Institute. Retrieved 2007-10-15.
- ^ In Breast Cancer Data, Hope, Fear and Confusion, By DENISE GRADY, New York Times, January 26, 1999.
- ^ Wisconsin Cancer Incidence and Mortality, 2000-2004 Wisconsin Department of Health and Family Services
- ^ a b Tammemagi CM (2007). "Racial/ethnic disparities in breast and gynecologic cancer treatment and outcomes". Curr. Opin. Obstet. Gynecol. 19 (1): 31–6. doi:10.1097/GCO.0b013e3280117cf8. PMID 17218849.
- ^ Hirschman J, Whitman S, Ansell D (2007). "The black:white disparity in breast cancer mortality: the example of Chicago". Cancer Causes Control. 18 (3): 323–33. doi:10.1007/s10552-006-0102-y. PMID 17285262.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Breast cancer rates differ in races by Amanda Villa Wednesday, October 24, 2007. Badger Herald
- ^ Benjamin M, Reddy S, Brawley OW (2003). "Myeloma and race: a review of the literature". Cancer Metastasis Rev. 22 (1): 87–93. doi:10.1023/A:1022268103136. PMID 12716040.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Demicheli R, Retsky MW, Hrushesky WJ, Baum M, Gukas ID, Jatoi I (2007). "Racial disparities in breast cancer outcome: insights into host-tumor interactions". Cancer. 110 (9): 1880–8. doi:10.1002/cncr.22998. PMID 17876835.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Daily Mail (UK) 13 Nov 2008
- ^ "The History of Cancer". American Cancer Society. 2002-03-25. Retrieved 2006-10-09.
- ^ [2]
- ^ James S. Olson. Bathsheba's Breast: Women, Cancer, and History, 1st edition, The Johns Hopkins University Press, 2005 [ISBN 0801880645. ISBN 978-0801880643]
- ^ http://womenshealth.about.com/od/cancerprevention/a/10stepsprevbcan.htm
- ^ http://www.breastcancerchoices.org/selenium.html
- ^ http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T84-4BRKM0D-4T&_coverDate=12/31/1989&_alid=459778230&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5076&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e80bcbf5baa4f3a9ba95d6bb197659a2
- ^ http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN2-4C0CYXX-S7&_user=10&_coverDate=04/30/1978&_alid=459739520&_rdoc=228&_fmt=summary&_orig=search&_cdi=6950&_sort=d&_st=13&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8ccc92fa1c1ceb0fd5057380d50e2fba
- ^ http://www.pacifichealthonline.com/?p=33
- ^ "Breast Cancer Awareness Month". Retrieved 2008-01-04.
- ^ "Pink Ribbon". Retrieved 2008-01-04.
- ^ "Pink for October". Retrieved 2008-01-04.
- ^ "Index of Saints". Catholic Forum. Retrieved 2008-01-04.
- ^ "About Our Ribbon". Retrieved 2008-09-17.</
- "Breast Cancer Risk Assessment". DukeHealth.org. Retrieved 2008-07-08.
- Arthur, Joyce (2002-03). "Abortion and Breast Cancer — A Forged Link". The Humanist. Retrieved 2007-11-03.
{{cite web}}
: Check date values in:|date=
(help) - Ressler, Kelly-Anne (2002-08). "Information for GPs – Alcohol and cancer risk" (PDF). Cancer Control Program. South Eastern Sydney and Illawarra Area Health Service. Retrieved 2007-11-03.
{{cite web}}
: Check date values in:|date=
(help) - "Surgery choices for women with early-stage Breast cancer" (PDF). National Cancer Institute. United States Department of Health and Human Services. Retrieved 2007-11-03.
- Napieralski, Julie A. (1988-03). "Alcohol and the Risk of Breast Cancer". Program on Breast Cancer and Environmental Risk Factors in New York State. Cornell University. Retrieved 2007-11-03.
{{cite web}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
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suggested) (help) - "Radiology Info - Breast Cancer". Radiological Society of North America. Radiological Society of North America. Retrieved 2007-11-03.
External links
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- Breast cancer at Curlie
- Template:Yahoo directory
- Mastectomy v. Lumpectomy: Who Decides?, from the National Research Center for Women and Families