Importance of Early Detection

Although the incidence of breast cancer is increasing, its death rate has been steady since 1990 and may even be dropping. Much of this increased survival can be attributed to increased awareness leading to early detection of the disease, and treating it before it has had a chance to spread. The importance of early detection cannot be stressed enough, whether or not a woman has a family history of the disease. Early detection can be achieved by monthly breast self-examination. The American...

Role of Diet in Preventing Breast Cancer

We are often bombarded with media reports of dangers in our food supply. There is increased awareness that the ingestion of highly saturated fats and trans-fatty acids is correlated with heart disease if not with cancer. Prepared foods often contain additives that some believe are potentially carcinogenic. There is increased concern about genetically modified corn and other products. Animal feed is often supplemented with antibiotics and hormones that can later be found in meat and milk. Fish...

The Role of Crosstalk Between Malignant Cells and Their Surroundings

A focus of current research is to understand how a malignant cell's environment modifies its behavior. This approach is called epi-genetic, because the target is not the gene itself but rather factors that regulate the expression of the gene. A gene may be damaged, but its expression may be controlled so that its altered product may not be produced. In other words, cancer may be preventable if we can change the environment the gene acts on rather than changing the genetically altered cell. For...

The Role of Sex Age Hormonal Status and Ethnicity on the Biology of Breast Cancer

As noted in chapter 1, men are also susceptible to breast cancer, and it can be just as deadly. The disease follows a similar course, but since men are often unaware that they can get breast cancer they may delay seeing a doctor when they find a suspicious lump, and therefore may be diagnosed too late for effective treatment. Age is the greatest risk factor for developing breast cancer, but tumors in post-menopausal women are sometimes less aggressive than in those who are pre-menopausal. A...

Considerations for Alternative Medicine

Some patients choose to obtain care from practitioners of alternative medicine. They may consult naturopaths, homeopaths, or herbologists, and are treated with assorted diets and herbal therapies. None of these, however, has ever been tested on breast cancer in a clinical trial, nor is there any credible evidence of their effectiveness. Furthermore, some unproven treatments can interfere with standard medical treatments or may cause serious side effects. Nevertheless, alternative medicine is...

Modification of Genetic Risk Caused by Environmental Factors

The question arises whether a woman can modify her risk of breast cancer by altering environmental factors that may induce its development. This thinking can apply equally to those who have inherited a faulty gene or to those who are at average risk, since, in either case, environmental factors most likely provide the necessary genetic damage to initiate the onset of disease. Many potential environmental triggers are still being investigated, and no single culprit has been identified. Different...

Diagnostics

Diagnostic imaging techniques are intended to identify tumors at the earliest possible stages. Ultimately, the goal is to distinguish between dense tissue, benign lumps, and cancer. To date, mammo-grams still offer the best imaging available for early diagnosis of breast cancer. However, they are not foolproof, and miss perhaps 10 percent of cancers. In younger women with dense breast tissue, mammograms may not distinguish a small tumor from surrounding tissue, although digital enhancing may...

Cancers Related to Specific Mutations eg Retinoblastoma Ataxia Telangiectasia

Some cancers are associated with specific gene mutations. I have already mentioned retinoblastoma, which occurs when the tumor suppressing the RB gene is lost or altered. Another disease, ataxia telangiectasia (AT), is caused by a recessive gene. AT patients have increased sensitivity to ionizing radiation and often develop leukemia or lymphoma. Their heterozygous relatives have an increased incidence of breast cancer. There are other cancers associated with inherited defects of specific genes,...

How Does Breast Cancer Kill

Once a cancer has spread, it is difficult to control. Treatments such as surgery, chemotherapy, or radiation may reduce the mass of the tumor, but metastatic cells may remain in lymph nodes or elsewhere and eventually resume their rampage. Some cells develop resistance to chemotherapy or radiation. Those cells have a selective advantage and will continue to grow. Eventually, vital organs are destroyed and the patient dies of organ failure or hemorrhage. Cancer patients often develop fatal...

The Anatomy of the Human Breast Where Breast Cancers Begin

Milk Duct Armpit

In order to understand the nature of different cancers, it is helpful to understand the structures of the organs and tissues in which they arise. As seen in fig. 2.3, the human breast tissue consists of special glands called lobules that surround branches of ducts like leaves on a tree. Each breast contains six to nine independent ductal systems that run from the nipple back to the underlying pectoral muscle. The amount of breast tissue is genetically determined, and may extend from the...

Treatment of Breast Cancer

Depending upon the nature of the particular tumor, a surgeon may elect to do a lumpectomy in which the tumor and a wide margin of normal surrounding tissue is removed, or to do a total mastectomy in which the entire breast is removed. The disfiguring Halstead radical mastectomy, in which the muscle of the chest wall is also removed, is rarely done today. The patient is usually involved in the decision-making process. Most surgeons attempt to spare as much breast tissue as possible (breast...

Acknowledgments

This book could not have been written without the help and support of many people. I am deeply indebted to my editor, Miriam Bloom, Ph.D. for her advice and understanding. I am especially grateful to Catherine Klein, M.D. (Hereditary Cancer Clinic, VA Medical Center, and Division of Medical Oncology, University of Colorado Health Sciences Center, Denver, CO) for critically reviewing the first draft of the manuscript and for her valuable suggestions. Several breast cancer specialists took time...

Biology of Sporadic vs Hereditary Breast Cancer

Recent studies have demonstrated that hereditary breast cancers often present different histological characteristics from those that occur sporadically. However, the biological behavior of tumors is often the same. In fact, younger women with hereditary breast cancer often do better than those whose tumors arise sporadically. Women who have two or more first degree relatives (mother, sister) with breast cancer have a greatly increased chance of developing the disease at a younger age, but the...

Introduction

Although an American woman is more likely to die of heart disease or of lung cancer, a diagnosis of breast cancer is the medical pronouncement she is most likely to fear. A woman often equates the breast with her femininity, sexuality, and psyche, and may fear possible disfigurement even more than death. This very fear may cause her to avoid simple screening procedures such as mammograms or self-examinations. She may delay seeking medical advice even after finding a lump. Consequences of this...