Talk:Breast cancer

Obesity

Why does it say gaining weight after menopause can increase a woman or man's risk of contracting breast cancer? Surely men don't go through menopause...

checked the study referenced and fixed this Sfmammamia 18:02, 17 April 2007 (UTC)

mentions of men

I would like to make a case for expanded consideration of breast cancer in men. It is not my intent to obscure the fact that breast cancer is primarily a women's health issue. In a nutshell, the problem comes from three facts. First, breast cancer is much more common in women. Secondly, breast cancer is still a significant issue in men. Finally, the disease is not distinguishable between men and women such that an interested person can simply add a "Breast Cancer in Men" article. The disease is the same; the gender differences lie in the epidemiology, social context, screening recommendations, etc.

The article is well-written with regards to the issue of breast cancer in men. With this issue, I think there are two important points. First, that breast cancer is much more common in women, and that hormonal influences over the person's life, as opposed to innate anatomic differences between males and females, likely plays the major role in this discrepancy. Secondly, breast cancer in men is still a serious issue. Although I don't object in general to the use of the term "rare" in reference to male breast cancer, especially in comparison to the female incidence, it should be noted that, by NIH criteria, breast cancer in men actually occurs too often to be considered a rare disease.

Although breast cancer is primarily a disease of women, and there are many women-specific issues (screening mammography, advocacy groups, etc.), the disease itself has no gender. This is in contrast to cancer of the cervix, prostate, etc. Breast cancer in men, although very uncommon in comparison to women, is not insignificant. It is certainly not some sort of bizarre medical anomaly, like a case from the TV show House; it is not even a rare disease by the epidemiological definition.

I don't want to get into an edit war over mentions of breast cancer in men. I removed the phrase "which can occur in both men and women" in the article's first sentence, and it was re-inserted. I have left it there, but changed the order to "women and men". There have been numerous additions to this article over time mentioning breast cancer in men--some of these have clearly been vandalism, others were likely well-meaning, but were removed because they appeared to over-emphasize or over-state the risk and prevalence in men. If anyone disagrees, could we please discuss it here before making wholesale changes? Sfmammamia 23:06, 28 April 2007 (UTC)

I agree that the main focus of the article should be female breast cancer.--Dr.michael.benjamin 06:13, 23 May 2007 (UTC)

Why? Is female breast cancer differant than male breast cancer? Is it necessary to focus primarily on one? What is really being said here? That all information pertaining to females should be included and that informaion about men should only be included sparingly? Does one subtract from the other? I can't help but wonder how this discussion would go if someone were trying to focus on men and was deleting referances to the fact that women can get a certain type of cancer. I think it's ridiculous that this is even being disscussed who cares if it says "men and women" or "women and men"? Is breast cancers womens turf now? If someone vandalises the page then delete it. But otherwise what is the problem with recognizing that both sexes can suffer from this cancer? How will women seeking information about breast cancer sufer more if information about men is included? I can't see how they would unless the concern is that they may have to sift through a few sections or sentances that mention scenarios unique to men suffering with breast cancer. But don't men have just as much a right to be able to find info about breast cancer and how it may affect them? really, what is going on here?--Matt D 16:12, 9 October 2007 (UTC)

Matt D, if you see a problem with the current version of the article and how it deals with breast cancer occurrence in men, please make suggestions here to improve it or a bold edit in the article. My concern is with the article's overall accuracy, lack of bias, and credibility. If the article were to over-state or over-emphasize the risk of breast cancer in men, that could introduce inaccuracy and bias and could jeopardize the entire article's credibility for all readers. -- Sfmammamia 16:52, 9 October 2007 (UTC)

As of Oct 21, 2007, there is absolutely no recognition or reference to the fact that men can also have breast cancer in the article at all. I see this as a major problem because people are often mislead to believe that breast cancer can only happen to women, which is no the case at all. The fact that men can also have breast cancer should at least be mentioned in the beginning of the article without going into the specifics or better yet, have a seperate section about it in the artcle. --Stoppedcode12 07:03, 21 October 2007 (UTC)

Several sections of this article which had grown too large were split out on there own recently, including Epidemiology and etiology. This detailed risk factors including but not limited to sex. While this is not addressed in detail at the moment,[1] it is mentioned in the line "The primary risk factors that have been identified are sex, age, childbearing, hormones, a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use and radiation.". Several sections of the article still need rewrites to include the data, while not being as lengthy and detailed as before. Feel free to make edits in Wikipedia mainspace and actually correct this yourself. - Optigan13 07:39, 21 October 2007 (UTC)

Stoppedcode12, did you miss the last sentence of the lead? It does exactly what you said and includes a reference: "Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, though it is less common." --Sfmammamia 20:42, 21 October 2007 (UTC)

NBR2

I excised this portion from the epidemiology:genetics section. It's too technical for this article.

A recent publication in the Journal of Nucleic Acids Research shows that the ’BRCA1 and ’NBR2’’’ genes are directly connected by a bi-directional promoter. The promoter is found in a CpG island that is constitutively methylated as a means to silence the gene(s). In addition to being methylated, these genes have specific methyl binding domain proteins that they are associated with - namely MBD2. Through Western blots, ChIP analyses, and siRNA knockdowns, it was determined that MBD2 binds specifically to the BRCA1-NBR2 locus. In addition, if MBD2 is removed and unable to bind to the BRCA1-NBR2 promoter, no other methyl binding domain proteins will bind to this locus. There is no "rescue" by other MBD proteins. The high fidelity of binding and the specificity of MBD proteins have important implications in understanding the mechanism of breast cancer, and subsequent treatment approaches.

--Dr.michael.benjamin 06:36, 23 May 2007 (UTC)

Prevention of environmental causes

I cut this section off the main page. It appears to have been written by this breastcancerfund.org, and is POV and unsubstantiated. It should live on the discussion page, if at all, or consider a separate page entirely.

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Fewer than 20 percent of breast cancers are genetic. When all known risk factors and characteristics are added together, including family history, genetics, smoking and obesity, more than 50 percent of breast cancer cases remain unexplained. According to State of the Evidence 2006 - What Is the Connection Between the Environment and Breast Cancer?”, a report which reviews and analyzes nearly 350 journal-published scientific studies on environmental links to breast cancer:

• Over 100,000 synthetic chemicals are registered for use today in the United States, with an additional 1,000 new chemicals added each year, yet less than 10 percent of these chemicals have been tested for their effects on human health. Large numbers of these chemicals are found in products we come into contact with every day and compelling scientific evidence points to these chemicals as contributing to the development of breast cancer, either by altering hormone function or gene expression
• Many toxic chemicals are now credibly linked to serious chronic diseases including breast cancer. Furthermore, new science demonstrates that even very small amounts of some chemicals can have adverse health effects, particularly in pregnant mothers, infants and small children. (See State of the Evidence)

The Breast Cancer Fund suggests the following environmental prevention methods:

• Practice Healthy Purchasing: Don’t bring toxic chemicals home from the store. Choose chlorine-free paper products to reduce dioxin, a carcinogen released when chlorinated products are incinerated. Read food labels, and choose pesticide-free, organic produce and hormone-free meats and dairy products. Replace harmful household cleaners that contain bleach with cheaper, nontoxic alternatives like baking soda, borax soap and vinegar. Look for alternatives to chemical weed and bug killers— many contain toxic chemicals that accumulate in our bodies.

• Use Caution with Plastics: Some plastics leach hormone-disrupting chemicals called phthalates into the substances they touch. Polyvinyl chloride (PVC) plastics release carcinogens into our air and water during the production process. PVC plastics are especially dangerous in toys that children put in their mouths, so keep an eye out for nontoxic toys. Further, never put plastic or plastic wrap in the microwave, as this can release phthalates into food and beverages.

• Advocate for Clean Air: The soot and fumes released by factories, automobiles, diesel trucks and tobacco products contain chemicals called polycyclic aromatic hydrocarbons (PAHs) that are linked to breast cancer. Indeed, breathing these compounds from secondhand tobacco smoke may increase your risk for breast cancer more than active smoking. Stay away from secondhand smoke, and advocate for stronger clean air protections.

• Avoid Unnecessary Radiation: Ionizing radiation is a known cause of breast cancer. Radiation damage to genes is cumulative over a lifetime—thus many low doses may have the same effect as a single high dose. Mammograms, other X-rays and CT scans expose you to radiation. While mammography screening may benefit postmenopausal women, mammography for women in their 30s and 40s remains controversial. Whenever you have an X-ray or scan, request a lead shield to protect the areas of your body not being X-rayed.

• Explore Alternatives to Artificial Estrogens: Women who have prolonged exposure to estrogens are at higher risk for breast cancer, and major studies continue to show an increased risk when postmenopausal women use hormone replacement therapy (HRT). Women who use both birth control pills and—later in life—HRT face an even greater risk of breast cancer than those who use neither. Explore your options with healthcare professionals.

• Advocate for Safe Cosmetics: Chemicals linked to cancer and birth defects do not belong in cosmetics, period. However, some popular brands of shampoo, deodorant, face cream and other everyday products contain these dangerous chemicals. The Breast Cancer Fund demands safer products and smarter laws by letting cosmetics companies know they need a makeover. The public can join BCF in asking cosmetic companies to sign the Compact for Safe Cosmetics, a pledge to substitute chemicals linked to birth defects, infertility, cancer, brain damage and other serious health consequences with safer alternatives.

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--Dr.michael.benjamin 20:54, 25 May 2007 (UTC)

Molecular Diagnosis of Breast Cancer

I am also removing this section, since it doesn't report any existing information. Like Jimmy says, it may be reportable at some point, just not right now. Wikipedia is not a forum for news per se; it's a repository of knowledge. There are a lot of studies right now describing the genomic differences between cancer and no cancer, but there aren't a lot of products on the market for doctors and patients. We should focus on what's actually out there, rather than what a company says they might do at some point.--Dr.michael.benjamin 05:44, 26 May 2007 (UTC)

OncoDetect (www. oncodetect.com) is an early-stage biopharmaceutical company focused on the development of a diagnostic assay for cancer. Preliminary research has shown the potential to use a combination of markers as a breast cancer diagnostic tool. The company is seeking to develop a molecular diagnostic assay. This assay will identify the presence or likelihood of breast cancer through measurement of markers in blood that are also expressed in malignant tumors to identify individuals at high risk to develop breast cancer. OncoDetect will develop molecular technique based diagnostic assay kits to accurately diagnose the presence and/or likelihood of breast cancer by determining the unique pattern of expression using a variety of gene markers. Research by Dr. Khanna has demonstrated the following results significant to the development of breast cancer diagnostic assays: Application of standard PCR techniques to malignant and non-malignant tissues from 50 human breast tissue pairs has confirmed the statistically significant difference in expression of molecular and protein markers between diseased and non-diseased states. (Results for Mammaglobin B, PPAR-alpha, PPAR-gamma, MMP-9, Skp2, TNF-alpha and TIMP-2.) Correlation of Mammaglobin B in breast tissues and lymphocytes of patients known to have malignant breast cancer (based on 25 tissue/lymphocyte pairs) indicates that mammaglobin B levels can be detected in blood samples, not only tissue samples requiring biopsy. Low concentrations of Mammaglobin B in the lymphocytes can be amplified using 10 to 40 PCR cycles, greatly lowering the detection threshold. Correlation of multiple molecular markers with in tissue and lymphocytes demonstrates the feasibility of a non-invasive blood based molecular diagnostic test for breast cancer

Symptoms

I beefed up the symptoms section and took out the "expand-me" tag. The symptoms section is exhaustive now, but not all that relevant, since probably 90% of breast cancers are diagnosed by mammography at this point, not symptoms.--Dr.michael.benjamin 04:27, 29 May 2007 (UTC)

Linkspam

Please don't post linkspam in the links section. This article should be based on evidence based medicine, not quackery.--Dr.michael.benjamin 04:53, 3 June 2007 (UTC)

TOC and MEDMOS

The Table of Contents of this article is quite large and rambling, with some stubby sections; it may be instructive to review WP:MEDMOS and recent featured articles like Tuberculosis, Influenza, and Tourette syndrome. SandyGeorgia (Talk) 05:04, 27 June 2007 (UTC)

I tried to re-organize the article to be a little less difficult. See my diff for the changes. I tried to follow the both the medical and general manual of style as well as the Prostate cancer article for guidelines. I tagged of the more lengthy sections for splitting. Also for splitting I saw that there is a Breast cancer chemotherapy stub. Would someone please review where I moved the sections to make sure they fall under the corrected subheadings. Also the diet, soy intake, and folic acid intake are all spread across multiple sectiosn which causes some overlap. I didn't change that since I couldn't make up my mind on how to characterize them as either a risk or a preventative factor. I also did some citation and other more minor changes as part of this edit. Optigan13 02:49, 7 October 2007 (UTC)

I've split some major sections out and created a navigation template so they don't get lost. So the article may read disconnected now because large sections are out on their own. I've left the recently revised tag on and left this comment to make sure no one misses these edits. Optigan13 08:00, 13 October 2007 (UTC)

Review

The article is a strange one: it has 87 (!) references in the list, yet many paragraphs and sections don't have them at all. The lead doesn't provide a meaningful summary of the article, it only discusses cancer rates. The article is patchy and difficult to read. It should be focused on the main causes, treatments,etc. All other short subsections should be grouped in ones like "Other causes", "Other treatments". The authors shouldn't attempt to write something about everything and instead try to select the core knowledge about the breast cancer and write a well sourced shorter article. Ruslik 13:22, 29 June 2007 (UTC)

I agree, the reference section is a too large; heck it is large enough to be it's own article. There are several statements that have more than one reference, is this really necessary? I also think that Ruslik's comment about grouping the shorter subsections is a good idea. Markco1 20:31, 12 October 2007 (UTC)

Actually this article is still light on references. The main problem is that it is unevenly referenced. Medical articles need to be heavy with references, or "dense". See the Medical Manual of Style section on citing sources. Medical articles need to be careful especially since people may come to this for personal medical questions, even though they shouldn't. It also provides verifiability and protects against copyright violations. - Optigan13 23:42, 14 October 2007 (UTC)

Diet in secondary prevention

While it is recognised that a healthy diet may prevent breast cancer, this study finds that once cancer has developed, adopting such a diet does not alter prognosis. JFW | T@lk 21:51, 17 July 2007 (UTC)

Technical sections

I addded the technical tag to this article because, a couple of sections in particular are quite dense. Selective Estrogen receptors under prevention is quite bad, and shows that it was pulled from very technical sources, and doesn't give context for a broad audience. Treatment also has several sections that become quite dense. For example, under indications for radiation the lines Patients with <4 LN involved, but extension out of the substance of a LN and Inadequate numbers of axillary LN sampled are quite difficult. Optigan13 02:49, 7 October 2007 (UTC)

Interesting interview

I read an interesting interview with an artist who had a mastectomy in an online magazine. Her way of dealing with this was to not have reconstructive surgery but to have a tattoo where the breast was removed. It is an extremely touching story. lovely magazine I thought about posting this to external links but did not want to do so without the ok from the group. The issue has other breast cancer stories in it as well. Markco1 —Preceding signed but undated comment was added at 22:12, 7 October 2007 (UTC)

I wouldn't include that in external links, instead you should check out that and other articles about the psychological and social impacts of mastectomy, then rewrite the Prognosis section including that as well as other information about breast prosthesis and other responses to Breast cancer. - Optigan13 23:42, 14 October 2007 (UTC)

Leading cause of death

In my area, there's a common belief that breast cancer is the leading illness affecting and/or the leading illness killing women. Some reading I did on the issue indicated that it's heart disease, not breast cancer, that both affects and kills the most women. Is the above-mentioned belief common? Am I right that such a belief would be mistaken? And is this worth noting in the article? — NRen2k5 13:47, 12 October 2007 (UTC)

I added a study that quantifies breast cancer as the most feared disease among women in the U.S. as well as a reference with comparative statistics to other frequent causes of death, indeed heart disease is a much more frequent killer -- I suspect this would be true in other industrialized countries as well but I don't have a source yet for this. Death rates from breast cancer in the U.S. have been declining in the last decade; I suspect this would also be true in other industrialized countries but lack a source for global trend data. I think it would strengthen the lead if such trend data could be added. --Sfmammamia 22:52, 15 October 2007 (UTC)

Does anybody else think that it's confusing to have the lead discussing whether breast cancer is the fifth, third, or second most common cause of cancer death among different population groups? Is it really that important? That discussion belongs further down. I would simply say in the lead that breast cancer is the most common cause of cancer death among women worldwide, that it's increasing, and use the lead to summarize a few other important points from the body. Nbauman 17:55, 16 October 2007 (UTC)

I agree that perhaps some of the details could be simplified in the lead, but I think I disagree that it could be simplified as much as you say. Here's what I see as the problem with that approach: It is true that breast cancer is the leading cause of cancer death among women worldwide. However, both the incidence and death rates from breast cancer are declining in the U.S., not increasing, according to study results published just yesterday [2]. I suspect the same may be true in other industrialized countries. Some of the currently provided detail helps to correct common misperceptions, such as the belief that breast cancer is a greater killer than it actually is. If we generalize too broadly or make the lead too short, I'm concerned we will feed fears and misperceptions rather than correct them. Do you have access to international trend data that could help us refine the current approach? --Sfmammamia 18:49, 16 October 2007 (UTC)

You’re missing the point. That breast cancer is a leading cause of death and a leading disease affecting women are myths, and apparently common ones at that. And this isn’t addressed in the article. I recommend creation an entire “controversy” section to address this and some other issues. One other such issue off the top of my head is “pinkwashing.” — NRen2k5 19:08, 23 October 2007 (UTC)

Myths according to whom? My main concern with your characterization is that it be attributed to reliable sources and not original research. With regard to "pinkwashing" it seems to me more relevant in articles about those accused of its practice, not necessarily here. This article has recently undergone effort to reduce its size, with major subtopics split out, so any new sections should be highly relevant and appropriately condensed. I added mention of pinkwashing months ago to the article on Susan G. Komen for the Cure, where it seems more relevant to me. --Sfmammamia 23:44, 23 October 2007 (UTC)

Myths according to the facts. If reading the data (not collecting it) is original research, then I have to confess, I don't know what isn't. — NRen2k5 12:15, 2 November 2007 (UTC)

What you are suggesting sounds exactly like synthesis of published material serving to advance a position to me. Find a reliable source. --Sfmammamia 17:28, 2 November 2007 (UTC)

More women die of lung cancer than breast cancer in the U.S. According to Harrison's Internal Medicine, there are 40,000 deaths from breast cancer every year, and 80,000 cases of lung cancer among women (Which I think they mean to be interpreted as eventual deaths). It would be difficult to get worldwide statistics, because it's hard to collect accurate statistics in third-world countries. In fact, the most accurate cancer statistics in the U.S. are from a few states in the SEER reporting system, and deaths from non-SEER states aren't as reliable. One of the big problems is that most elderly people have many diseases, such as cancer, lung disease and heart disease. The problem is figuring out which one caused the death. Nbauman 18:46, 2 November 2007 (UTC)

The stat you mention for deaths in the U.S. is already in the article lead, although the cited source, the American Cancer Society, predicts slightly different numbers of deaths for women in 2007 -- roughly 71,000 for lung cancer and 40,500 for breast cancer. The lead also already states that breast cancer is the leading worldwide cause of cancer death among women, using the World Health Organization's statistics, but places the disease as a killer within the wider context by stating that breast cancer causes roughly 1% of all deaths worldwide. The only addition to context that I have been able to find is this one [3], also from WHO, that ranks the top 10 worldwide causes of death by income groups. Breast cancer is ranked 8th, but only for high income countries. This analysis groups men and women together, so I'm uncertain whether adds much to what's already in the lead. So again, my question is, what is missing from what's already stated? --Sfmammamia 19:58, 2 November 2007 (UTC)

That WHO fact sheet No. 297 says that breast cancer is the most frequent cancer among women in order of deaths, but it doesn't give the numbers. Neither does it give the source of that claim, so you can't look it up and drill down, and the lack of a source makes it not reliable. I wonder how accurate it is, and I wonder if it's just a rough estimate. How do you get accurate numbers on breast cancer from China and India?

The 10 leading causes of death document also gives more deaths from lung cancer than breast cancer in high-income and middle-income countries, and doesn't list lung or breast cancer at all for the low-income countries. So how do they get breast cancer as a more frequent death than lung cancer among women? Nbauman 05:02, 3 November 2007 (UTC)

The feminist POV slant here is astounding. I don’t even know where to start editing. On the other hand, I wouldn’t trust them not to try to drag my name through the mud once I get started. — NRen2k5, 20:03, 11 February 2008 (UTC)

Current article status and splits

Optigan13 has done some very good work bringing this article down to a manageable length. I'm starting a discussion session to encourage further comment on the article's current state. My own comments: Regarding further splits, I don't think it's necessary to split the Classification section, as it's fairly short. Ditto the Staging section -- this is pretty basic information for a cancer article and is pretty compact. I think the Screening section, now that the split has been done, could benefit from further summarizing and condensing in this overview article. Other comments? -- Sfmammamia 18:20, 13 October 2007 (UTC)

Most of the splits were either going from size or what sub-pages Prostate cancer has. After the split it is noticeable how many sections need a full rewrite, because they are both unreferenced and very technical. The page still needs some restructuring to make it more manageable, so take a look at the medical manual of style for that. I haven't been able to properly rephrase treatment so it is still a duplicate of the subpage, so that and its subpage should be first up. Also with respect to the words sex vs gender, the article should use sex since their is a technical difference between the two. I understand what you were trying to accomplish by changing it, but I think we should just stick to reverting, and possibly having the sites blacklisted if the same articles are added. Also some of the language this article uses will inevitably attracts vandals, but it is still more important to be direct then to tiptoe around. - Optigan13 23:42, 14 October 2007 (UTC)

I think there should be more detail in the staging section. People are interested in learning more about the staging, and it has a place in a reference piece.--Dr.michael.benjamin 16:05, 22 October 2007 (UTC)

Accuracy - diet and prevention

The National Breast Cancer Coalition seems to think the idea that eating fruits and vegetables will prevent breast cancer is a popular myth not supported by scientific evidence.[4] The sources in the Folate section are not strong; they are journal articles describing individual studies, which are not necessarily a good indication of whether or not there is scientific consensus to support the results of the studies. Can anyone reconcile these competing claims? -- Beland 02:13, 28 October 2007 (UTC)

Hi Beland- I think you're correct that the evidence is clearly very mixed and contradictory with regard to whether or not folic acid reduces breast cancer in general. There does appear to be, however, good evidence that folic acid can reduce the effects of alcohol on raising the risk of this type of cancer.

The National Breast Cancer Coalition may have been referring to breast cancer in general rather than that associated with drinking. In addition, it was apparently referring to folates from fruits and vegetables in the diet rather than from supplements. I don't think any responsible organization or researcher would ever claim that folates or anything else in a diet can prevent breast cancer, but only reduce the risk. So the Coalition's position is not necessarily inconsistent with the fact that folate can reduce the risk of breast cancer associated with drinking, especially if taken as a supplement.

The following studies have found folate to reduce or eliminate the effects of alcohol on breast cancer:

Ulrika Ericson, Emily Sonestedt, Bo Gullberg, Håkan Olsson and Elisabet Wirfält. High folate intake is associated with lower breast cancer incidence in postmenopausal women in the Malmö Diet and Cancer cohort. American Journal of Clinical Nutrition, Vol. 86, No. 2, 434-443, August 2007

A Tjønneland1, J Christensen1, A Olsen1, C Stripp1, S B Nissen1, K Overvad2and B L Thomsen. Folate intake, alcohol and risk of breast cancer among postmenopausal women in Denmark. European Journal of Clinical Nutrition (2006) 60, 280–286.

Laura Baglietto, Dallas R English, Dorota M Gertig, John L Hopper, Graham G Giles. Does dietary folate intake modify effect of alcohol consumption on breast cancer risk? Prospective cohort study. British Medical Journal, 2005;331:807.

Sellers TA, Grabrick DM, Vierkant RA, Harnack L, Olson JE, Vachon CM, et al. Does folate intake decrease risk of postmenopausal breast cancer among women with a family history? Cancer Causes Control 2004;15: 113-20.

Shrubsole MJ, Jin F, Dai Q, Shu XO, Potter JD, Hebert JR, et al. Dietary folate intake and breast cancer risk: results from the Shanghai breast cancer study. Cancer Res 2001;61: 7136-41.

Sellers TA, Kushi LH, Cerhan JR, Vierkant RA, Gapstur SM, Vachon CM, et al. Dietary folate intake, alcohol, and risk of breast cancer in a prospective study of postmenopausal women. Epidemiology 2001;12: 420-8.

Negri E, La Vecchia C, Franceschi S. Re: dietary folate consumption and breast cancer risk. J Natl Cancer Inst 2000;92: 1270-1.

Rohan TE, Jain MG, Howe GR, Miller AB. Dietary folate consumption and breast cancer risk. J Natl Cancer Inst 2000;92: 266-9.

Zhang S, Hunter DJ, Hankinson SE, Giovannucci EL, Rosner BA, Colditz GA, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281: 1632-7.

Ronco A, De Stefani E, Boffetta P, Deneo-Pellegrini H, Mendilaharsu M, Leborgne F. Vegetables, fruits, and related nutrients and risk of breast cancer: a case-control study in Uruguay. Nutr Cancer 1999;35: 111-9.

Freudenheim JL, Marshall JR, Vena JE, Laughlin R, Brasure JR, Swanson MK, et al. Premenopausal breast cancer risk and intake of vegetables, fruits, and related nutrients. J Natl Cancer Inst 1996;88: 340-8.

Graham S, Hellmann R, Marshall J, Freudenheim J, Vena J, Swanson M, et al. Nutritional epidemiology of postmenopausal breast cancer in western New York. Am J Epidemiol 1991;134: 552-66.

However, this study did not:

R. Stolzenberg-Solomon, S. Chang, M. Leitzmann, et al. Folate intake, alcohol use, and postmenopausal breast cancer risk in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Am J Clin Nutr; 83:895-904 (April, 2006)

David Justin 00:29, 29 October 2007 (UTC)

A quick note concerning folate & cancer risk - it has been suggested by studies examining the relationship between folate supplement consumption and colon cancer that perhaps folate only reduces the risk up to a certain level of folate use; since we now supplement so many foods with folate, as long as you're not overwhelming your system with alcohol, additional folate might not make a difference. I'm off to look for the citations both from the colon cancer study, and for any I find on breast cancer. I'll post them here when I find them.~~Ruth Feb 12 2008

Merge: Racism in diagnosis and treatment section

I think this would fit better in the Epidemiology and etiology of Breast cancer article, but could we at least keep one sentence in this main article? futurebird 19:35, 28 October 2007 (UTC)

It does deserve a mention in the article in both risk factors in treatment epidemiological risk factors and in treatment, since race does play a factor in treatment in a addition to being a risk factor. So yeah please refactor the section to go into the sub-articles, and to get a mention in the main one (this article). The other problem is that it isn't only race, but also culture, socio-economic status, and a myriad of other factors that create health disparities. Check out the National Cancer Institute's articles on women of color. That one has several studies across multiple populations cited. The other problem is that this is still focusing on an American audience. So we need some way to expand on race as a factor, while still keeping it global. - Optigan13 21:32, 28 October 2007 (UTC)

The section isn't about "risk factors" it's about racism in the way people are screened and diagnosed. Take a look at Race and health, there may be some info there on race being a risk factor... although that article is also US focused. futurebird 21:39, 28 October 2007 (UTC)

Sorry, I meant to say it deserves a mention in both risk factors and in treatment. When I say risk factors, I'm talking about epidemiological risk factors, and referring to the epidemiology and etiology section. The race and health article does covers this in general. But that article also mentions what I'm talking about in that direct racism isn't the only factor affecting treatment. The section right now just mentions direct racism towards African-American women in treatment. It needs to include how the other factors mentioned in the race and health articles 3rd line that begins with Many explanations for such differences affect risk (epidemiology), screening, and treatment. I'm favoring a line in those three sections and a section in each one's article. Saying that direct racism is the only factor is too narrow a focus. It also doesn't give examples of how race affects treatment (such as higher rates of full mastectomy). It doesn't mention any other women of color. I'm not arguing against including race in treatment, it just needs to be part of a broader look at race and how it relates to breast cancer. - Optigan13 22:52, 28 October 2007 (UTC)

I think the section is relevant to a general article on breast cancer. I also thought the section was very poorly worded and documented, so I fixed a few things and added some references. There was a lot of POV, and I corrected that. The disparity issue is either related to cultural or biological factors, or both. There is active research (i.e., over 200 PubMed citations) on both of these factors.--Dr.michael.benjamin 06:43, 29 October 2007 (UTC)

I am continuing to remove the POV quote in the section by the scholar in Wisconsin, as I think it's too inflammatory, and not really supported by the substantial literature suggesting that there is a possible biological reason why breast cancer disproportionately affects the African American community, not just racism.--Dr.michael.benjamin 01:05, 30 October 2007 (UTC)

I agree with you about the quote, but in the process of getting rid of it, you removed other changes that had made the section clearer and more neutral. I'm restoring those changes. --Sfmammamia 01:26, 30 October 2007 (UTC)

The issue of racism is raised in a number of papers published in peer reviewed journals. Of course, it is still an open question, but there's nothing inflammatory about discussing exactly what is meant by "racism," as the quote does.

There are good data supporting the concept that inherent or genetic differences are not the reasons that blacks have higher breast cancer mortality rates than whites. The most obvious evidence is the fact that there was no disparity in mortality between blacks and whites in the United States before 1980. It is distressing that Bradley and colleagues (2) found that, after adjusting for age, socioeconomic status, and insurance coverage, black women diagnosed with breast cancer were less likely to receive surgical removal of their tumors than white women.... It is a sad statement that race influences one's chances of obtaining adequate medical care. In the United States, it is bad to have cancer; it is worse to be poor and have cancer; and it is even worse to be poor, black, and have cancer....Results of several breast cancer clinical trials demonstrate that equal treatment yields equal outcomes among equal patients (14–16). Other institution-specific treatment series demonstrate that outcomes are similar among the races when there is equal treatment (17–19). These findings, taken together with the fact that the racial disparity in mortality began in 1981, are consistent with the hypothesis that as we have learned how to treat breast cancer, a larger proportion of one segment of the population (the middle and upper class, which is primarily white) is receiving better (or more effective) treatment than are other segments of the population. Disaggregating the Effects of Race and Poverty on Breast Cancer Outcomes by Otis W. Brawley. ( JNCI Journal of the National Cancer Institute 2002 94(7):471-473; doi:10.1093/jnci/94.7.471 )

Others:

• The Personal Is Scientific, the Scientific Is Political: The Public Paradigm of the Environmental Breast Cancer Movement
• Racing for the Cure, Walking Women, and Toxic Touring: Mapping Cultures of Action within the Bay Area Terrain of Breast Cancer futurebird 01:53, 30 October 2007 (UTC)

I don't disagree with Dr. Brawley; while I was at Emory he and I wrote a paper about the racial disparity issue in multiple myeloma, which I reference in the breast cancer disparity section. I think the problem has a largely social explanation, but there are researchers who, even now, are trying to discover a biological explanation for the disparity issue. The fact that it is being studied at all is worthy of mention. I think the Brawley citation should be included as a standard reference.--Dr.michael.benjamin 04:34, 30 October 2007 (UTC)

JCI

Targeted review on the origins and evolution of breast cancer: doi:10.1172/JCI33295 JFW | T@lk 00:29, 4 November 2007 (UTC)

Breast Cancer in men

Can I ask why the segment about breast cancer in men was deleted, it should remain in the article because it is a fact. --88.108.100.139 (talk) 02:12, 19 December 2007 (UTC)

As I explained in the edit summary, the addition was completely uncited. Also, this degree of detail needs to be added to the main article, Epidemiology and etiology of Breast cancer, not here. We need to keep this article a summary level, because it is already too long. This article already mentions men further down in the lead and in a couple other places. There's no consensus for increasing the emphasis. --Sfmammamia (talk) 02:42, 19 December 2007 (UTC)

death numbers

it is known by all with some form of intelligence that prostate cancer kills more men a year than breast cancer kills women..so why does the page state that it is the fifth most common cause of cancer death .. breast cancer is not exclusive to women so we simply cant make this page exclusive no matter what the statistics. —Preceding unsigned comment added by PotentiallyMensa (talk • contribs) 16:06, 27 December 2007 (UTC)

According to the cited source, the World Health Organization, breast cancer ranks fifth globally in total cancer deaths, inclusive of both men and women. Do you have a reliable source that states otherwise? --Sfmammamia (talk) 17:33, 27 December 2007 (UTC)

Ultrasound, gamma imaging

Breast ultrasound and gamma imaging aren't screening techniques, they're used for surgical guidance. They've been marked as not having sources since October 2007. Isn't it time to delete them (unless someone can supply sources)? And Miraluma has even weaker justification. Nbauman (talk) 15:32, 10 January 2008 (UTC)

Nbauman, here is a grand idea: search Medline for sources and improve the article yourself. Emmanuelm (talk) 15:56, 10 January 2008 (UTC)

Emmanuelm, (1) Wikipedia doesn't work that way. The person who added the sections on ultrasound and gamma imaging should have provided a WP:RS when they first added it.

(2) I don't have to search Medline. I have a bookshelf of oncology books and I read the medical journals, so I already know what Medline will say.

The American Cancer Society's textbook Clinical Oncology, for example, says that ultrasound is used after a mammogram to tell whether lesions are solid tumors or cysts. US is not a screening test.

Unless anyone has a good reason to the contrary, that section should be removed, because it's inaccurate, misleading, confusing, and unsourced. The best way to improve the article is to remove it. Nbauman (talk) 06:47, 11 January 2008 (UTC)

Nbauman, one of the five pillars of Wikipedia is to be bold!. You seem far more educated than the average editor. Go ahead, edit the article. Emmanuelm (talk) 14:39, 11 January 2008 (UTC)

Psychological aspects

I think this section should be pruned. Some of it isn’t relevant or specific to breast cancer. — NRen2k5, 20:22, 11 February 2008 (UTC)

Copyright problems with Image:BCtimeline.jpg (Sources for new pic please)

Image:BCtimeline.jpg, has been listed at Wikipedia:Copyright problems because it is a suspected copyright violation. The source listed is http://carcin.oxfordjournals.org/, but no specific journal is listed. I tagged it as possibly needing to be converted to an SVG, which is why someone noticed the licensing issue. In order to create a new image without it being a pure reproduction of that image. Can anyone provide similar images or references so if someone creates a new image that isn't derivative of that specific work alone. I've done a quick try on google, but haven't done an exhaustive search myself.

Also, reliable overview references for some sections of this article would probably help for citations and to trim more language back out into the sub-topic articles. I had initially planned to do a proper lit review for overview sources to help reduce the screening article into something of an abstract of the sub-article, and also to better source the treatment section and its article, but I've yet to follow through with that. I think the longer these two spend without the short sections here the higher the chance of differing data/information. -Optigan13 (talk) 18:42, 28 February 2008 (UTC)