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Health Term-Paper on Breast Cancer


In the United States in 1995 alone, 43,063 died from breast
cancer. It is the number two cancer killer and the number
one cancer in females ages 15 to 54. On average if a woman
gets this disease, their life expectancy drops nineteen and
a half years. This cancer is within the top three cancers
of all woman above the age of 15, and comprises 6% of all
health care costs in the U.S. totaling an astounding 35
billion dollars a year. An average woman is said to have a
one in thirty chance of getting the cancer, but if that
person had family history of the disease, their chances
have been measured up to a one in six chance. Sixty©nine
percent of African©American women survive from it, and
there are predicted to be nearly two million new cases
reported this year in the U.S. The disease is breast cancer.
Breast cancer is a group of rapidly reproducing,
undifferentiated cells in the area of the breast in women.
The earliest changes occur in the epithelial cells of the
terminal end buds (TEB) of the breast milk ductal system.
While the outlining steps of breast cancer are unknown, the
cells in the breast trigger a reaction of cell
reproduction. These new cancer cells form tumors. If cancer
cells are active or are considered malign, the tumor grows
at tremendous speeds, and may end up in metastasis.
Metastasis is a complex process in which cells break away
from their primary tumors, and via the blood supply or
through the lymph system relocate into other organs, thus
spreading cancer throughout the body if left untreated.
Generally, if a lump is smaller than one centimeter, it is
considered benign, although every woman should consult her
doctor about any unusual bumps or feeling in the chest. One
sign of breast cancer results from ductal cancer in the
breast. A once hollow open tube could be completely clogged
up with cancerous cells thus leaving an awkward feeling in
the chest area. Other complications that result from this
cancer and others is on top of the clogging and cramming of
the system, the body's need to not only supply for itself,
but for the large tumors.
Recently genes have been touted as a great cause of cancer.
It now is thought among the medical community that while
there are definite environmental contributors to cancer,
even those people who are exposed to few carcinogens may
suffer from disease that runs in their families. Among the
genes that is being heavily researched is the gene BRCA1.
In one of the preliminary detections of this particular
gene, over 250 Jewish women were discovered to have
mutations with this germ©line allele, accounting for
approximately 13% of all breast cancer patients observed.
Jewish women in specific were used, as early on their was a
definite pattern of breast cancer through the Jewish
community especially that which lived in the United States.
The specific mutation, 185delAG, was, "strongly associated
with the onset of breast cancer in Jewish women before the
age of 30." Scientists thrived upon this new information of
genealogical interplay, so the ÃÃNew England Journal of
MedicineÄÄ (NEJM) set out determined to study the overall
effects of these genes, not only along familial lines, but
also concerning the general population. In an article
printed on January 18, 1996, germ©line alterations in BRCA1
were discovered in six of the 80 women surveyed with breast
cancer but had no apparent familial history of it. Thus the
scientists concluded that mutation was not limited to women
with history of cancer. In an article printed in the
ÃÃDallas Morning NewsÄÄ, genes were sighted as a cause of
five to twenty percent of all breast cancer. In that
article, a gene known as p53 supposedly stalls
reproduction, and can even cause a cell to "commit
suicide". Other genes that seem to accelerate growth to
overtake and stick to proteins includes HER2, neu, and
erB2. "Ten years from now, you won't go for a BRCA1 test,"
said Dr. Shattuck©Eidens of Salt Lake city. "You'll go for
a breast cancer predisposition test." Ôrelation between
serum estrogen levels at a single time with links to breast
cancer, but no evidence links estrogen levels over an
extended time to the risk of breast cancer, until
researchers at the ÃÃNew England Journal of MedicineÄÄ
proposed a study. Bone mass is a cumulative effect of
estrogen on bones scientists say, and so the study focused
on the more easily observed density and mass of bone tissue
in women. Four levels were accounted for, and the research
was tallied. The risk for getting cancer in the lowest
stage of bone mass was about 2%, and then 2.6, 2.7, and 7.0
in the second, third, and fourth levels of higher mass
respectively. This research lended itself to the assumption
that cumulative exposure to estrogen may play part in
breast cancer. Other hormonal factors have been viewed as
potential breast©cancer©causing agents. Birth control pills
are thought by some to lead to breast cancer. Early birth
control pills used much more estrogen and progesterone than
today's pills, and therefore could cause cancer. Lots of
contradictory results were found in research of the pill
because women who have been taking it for ten or twenty
years have actually been taking several different types of
pills with different levels of cancer causing hormones.
But, in general, the report concluded that the pill doubled
to up to quadrupled the women's chance of having breast
cancer. Diethylstilbestrol (DES) was used to increase
fertility in 1940 through 1960 and also decrease the
chances of having a miscarriage. Studies show it to
increase the rate of breast cancer by 1.4. Exposure to
estrogen during periods of rapid growth in the breast
tissue during pregnancy may increase risk. In August of
1989, Swedish doctor Leif Bergkvist studied 23244 women
ages 35 and up and found that an estrogen supplement that
they were taking quadrupled chances for breast cancer.
Fats have been thought to increase the rate of breast
cancer occurrence. But, in a study also conducted by the
NEJM of 337,819 women no evidence was found to support the
association of breast cancer with the intake of saturated,
monosaturated, or polysaturated fats. Conversely, many
studies have drawn out a link between fats and cancers. In
the 1940's, Albert Tannenbaum gave rats high fat diets and
found that it increased their rates of breast cancer by
27%. The fat threshold for rats is reiterated by many in
the health field today©one needs a maximum of only 20% of
overall calories from fat sources. Epidemiology experiments
are hard to perform on humans because it is extremely hard
to control a human's whole life diet. Therefore, it is much
easier to compare cultures of peoples which tend to
determine the food intake of those people. In Iceland, the
diet tends to be derived from healthy foods of the ocean,
including low©fat fish and vegetables. But when researchers
increased the amount of fat in their diets, their rate of
breast cancer shot up, demonstrating its potential in the
Iceland people.
Breast cancer accounts for the highest number of new cases
in women each year, and the war cry for breast cancer is,
"1 in 8!" According to some statistics a woman's chance to
develop breast cancer in her lifetime is one out of eight.
The Dartmouth Medical School in Lebanon, New Hampshire
reported in the ÃÃJournal of the National Cancer
InstituteÄÄ in May of 1995 that women overestimated their
chances for dying from breast cancer by twenty times. While
that journal reported in 1995 that the chances of getting
breast cancer were only 1 in 17 before the age of 65, but
italso said that breast cancer moved up 30% in the last
twenty©five years. Although breast cancer is the most
common cancer in American women, over 80% of cancer occurs
in postmenopausal women. While epidemiologist know that
breast cancer often comes with age and genes, now
speculation is arising that the earlier a woman has her
menstrual periods, andÔInstitute's environmental studies
division says the problem is that one half of women have
environmental risk factors, and often the disease is
perceived as a white woman's disease. Such white culture
icons as Nancy Reagan, Shirley Temple Black, Linda
Ellerbee, Ann Jillian and Betty Ford have had breast
cancer. Cancer statistics show that the disease is
especially prevalent in uneducated blacks who don't bother
with or don't know about regular breast exams. Dr. Bill
Eley of Rollins School of Public Health at Emory University
says it's economic, and that blacks are unproportionately
poor. Japanese women have a one sixth mortality rate when
compared to American women. But, when Japanese women move
to the United States, their breast cancer rates gradually
move up as their bodies' respond to the new environment.
Even so, the myth of it being a white©only disease still
lives on as told by Susan Shinagawa. "I was told by all the
doctors and nurses and every health care provider that I
saw that, number one, I was too young to have breast
cancer, and number two, that Asian women do not get breast
A number of doctors simply take the common sense approach
to preventing against breast cancer©exercising and getting
your proper nutrients is the best precaution. The New York
Times reported in May of 1997 a study that was done on
25,000 women in Norway. Compared with sedentary women,
those who exercised at least four hours a week had a 37%
lower risk of developing breast cancer. One leading
hypothesis on how exercise fights cancer is brought by Dr.
Leslie Bernstein, a professor of preventative medicine at
the University of Southern California. Dr. Bernstein says
that exercising reduces a woman's exposure to estrogen,
reducing that possible oncogen. Also, vitamins and minerals
including A, C, and E help to fight cancer says F. de Ward,
a cancer researcher. He claims that the problem might not
just lie in fat, but overall nutrition.
Several "miracle foods" have been tried and marketed as
cancer fighting agents. One such food is the green tea
leaf. Hasan Muktar of Case Western University in Cleveland
added green tea to cultured cells of human lymphoma,
prostate, breast and skin cancers. Amazingly, the tea
killed every cancer cell, but did not harm a single normal
functioning cell. Gianluca Lazzaro at the University of
Illinois made a synthetic form of vitamin D©5 that killed
cancer cells in a lab culture. The University of Western
Ontario found limonoids more effective than flavanoids in
halting growth of cancer cells. Limonoids, true to the
name, are responsible for the bitterness of lemons, limes,
oranges, and grapefruit. Walt Willet of the Harvard School
of Public Health conducted a study of 89,538 nurses between
the ages of 34©59. He found for those that consume hard
liquor, beer or wine experience 1.3 times the relative risk
of breast cancer. Those who had more than nine drinks a
week had an increase of two and a half times the rate of
breast cancer for a nonªdrinking person. In 1987, the
National Cancer Institute published a report comparing 1524
women with breast cancer against a control group of 1896
without the disease. Again, alcohol proved to promote
breast cancer.
Several medical procedures or side effects of them have
been thought to promote breast cancer. It was hypothesized
by staff at the NEJM that self©induced abortions could
greatly increase the chances of getting cancer as during
pregnancy the cells in the breast quickly divide and
reproduce. By having an abortion and thus suddenly halting
cell division, a number of cells would become greatly
unprotected by their not being any differentiation, and
thus would be vulnerable to cancer. To test this
hypothesis, the NEJM studied a cohort of 1.5 million women
with an identified 370,715Ôit was concluded that abortions
were not contributing to breast cancer. In another report
done by the NEJM, breast implants were analyzed as a
possible risk factor for breast cancer. After many
experiments, the NEJM concluded that the incidence of
breast cancer among women who had breast augmentation could
not be said to be higher or lower than the rate amongst the
general population. Radiation has also been thought of, and
for all intensive purposes in my opinion proven to be a
cause of breast cancer. There have been three major studies
that have been done concerning radiation. The first was
constructed around the bombing of Hiroshima and Nagasaki.
It was quickly ascertained that within a ten mile radius of
the bombing there was a definite cancer zone. More
importantly, younger people got much more cancer than did
older ones, especially with regards to breast cancer. This
forces more weight on the theory that the changing years of
the breasts in women are their most vulnerable and possibly
cancer causing ones. The second story is a Canadian study
that had looked at women who had been treated for TB in the
twenties and thirties with radiation. They, too, were found
to have the greatest risk for breast defects and
developments of cancer. The third study involves 606 women
in Rochester, New York who had inflamed breasts and were
treated with 50 to 450 rads for both breasts to alleviate
pain. Over half developed cancer.
Prevention is one point of the puzzle to cure breast
cancer, but it is extremely important to get breast
examinations often to make sure of no lumps or early
tumors. The simplest forms of breast exam is a self©exam,
one with a doctor, or a mammography. A mammogram is simply
an X©ray of the breast. Mammography can pick up small
legions of under one half a centimeter, whereas one can not
feel a lump until it is a full centimeter in diameter. But,
if breasts are small or dense, a mammogram might not pick
it up. Another procedure could be a wire localization. A
thin wire is used to show where the legion is after the
wire is inserted, and local anesthetic is administered.
Thermography is based on the idea that cancer gives off
more heat than regular cells. Transillumination is founded
in the concept that light shines through breast tissue, but
us blocked by lumps. An ultrasound is when high frequency
sound waves are sent off in a radar fashion, and reflect
off objects that they hit. A CAT scan is the process of
visually cutting the body into cross©sections. But, another
controversy runs deep in the issue of using CAT scans to
find cancer tissue. The radiation required to examine a
five milliliter lump is often considered simply too high
for safety, and has a possibility of just simply spreading
the cancer to other body parts. A MRI takes advantage of
the electromagnetic qualities of the hydrogen nucleus to
produce an electric chart or visual. While the most common
form of breast exam is mammography, there are many critics
of that procedure. Printed in ÃÃCA©A Cancer Journal for
CliniciansÄÄ, scientists claim that, "mammograms missed
10% of cancers in women younger than 50, and 5% in women
older than 50." Cancer patients have said that the
mammogram is often uncomfortable and takes too much time.
But, one of the largest studies in this subject in medical
history disagrees. In a cancer study conducted by the
American Cancer Society due to be released to the public in
June, the organization does a twenty year follow up on an
experiment started in the early 70's. Based on a 96% follow
up from 1993 to 1995, 4051 women had breast cancer. Out of
those cancer patients, 2658 were alive (66%), and 1393
(34%) were dead. At the end of the twenty year period,
those who were forced into examination were 20 times less
likely to get cancer. One startling conclusion enforces a
hypothesis dating back to the days of Darwin. Younger women
are at increased risk for biologically more aggressive
carcinoma, meaning that the future battle for curing cancer
is not getting any easier.Ôwhich cancer growths are
dependant upon the growth of blood vessels to nurture the
cancer cells. New drugs are being developed to stop the
growth of cancer cells by preventing nourishment of the
cancers by new blood vessels. By cutting off the blood
supply to the cells, they die, and thus are eliminated from
the system.
There are various treatments aimed at killing the cancerous
cells© from surgically removing that area of the body to
killing it off by use of chemicals. A very common operation
is chemotherapy. Chemotherapy is a drug designed to kill
rapidly dividing cells. Monoclonal antibodies are
antibodies that can be engineered to carry drugs or
radiation directly to the tumor, and is an efficient way of
delivering chemotherapy to the body. Another adaptation
that has been added to chemotherapy is the use of genes
that are chemo©resistant. Doctors at the University of
Texas Anderson Cancer Center use these special genes to
stimulate the regular body tissue to live through high
doses of chemotherapy, and therefore, the disease can be
cured a lot more quickly. One treatment involves stem cell
transplantation. Stem cells are often referred to as master
cells, and they seem to carry a proliferation of antibodies
which fight malignancies, and may be able to fight cancer.
One solution to cancer may be hormone therapy. The hormone,
usually tamoxifen, slows growth of cancer cells by blocking
some growth enhancing properties of estrogen. "Tamoxifen is
the most commonly used breast cancer drug in the world. It
works, works well, and does it with relatively few side
effects," said Dr. Wickerman of a Dallas clinic. The
controversy over Tamoxifen is that it might cause other
types of cancer. In 1981, the National Cancer Institute ran
a test in which women took a placebo or Tamoxifen. Women
with the drug were less likely to develop cancer of the
breast, but they were more likely to develop blood clots,
ovarian cancer, or breast cancer. Chemotherapy involving
tamoxifen has proved useful in delaying breast recurrence,
but the majority of patients treated with Tamoxifen
eventually go into relapse. There are several physical
operations. Traditionally, there are three types of cancer
treatments: radiation, mastectomy, cytotoxic chemotherapy.
The type of surgery really has its basis on the size of the
tumor. A lumpectomy removes the tumor and surrounding
tissues. A simple mastectomy removes the breast, nearby
lymph nodes, and portions of the chest and arms. Doctors
can perform preventative mastectomies. Some surgeons feel
that if the breast is fairly lumpy, and the patient appears
to be in very high risk of breast cancer, the surgery may
be beneficial. The whole surgery is highly controversial. A
total bilateral mastectomy and reconstruction is preferred.
This removal takes out all of the breast including the
nipple and duct system so that there can be little chance
of relapse.
One complication that can result in cancer is Ductal
Carcinoma insitu. This area houses the lobules and ducts
and is the area in which milk is produced. Similar to rust
clogging up pipes, often extra cells or cancerous cells
will clog up the tubes providing for some discomfort and
other risks. Studies show that 20©25% of women with
untreated DCIS will get invasive cancer within 10 years.
Also dealing with the lactating in women is breast cancer
during pregnancy. Breast cancer during pregnancy is usually
not harmful except for minor complications. Breast cancer
during that period could also be hard to detect because of
the rapidly expanding breasts, and other new growth. On a
final note, men can also get breast cancer, but it is often
more evident as there tends to be less flesh in a man's
chest than in a female's.
How can you get involved? All contributions of time, money,
or services to any of the national cancer organizations
would help the cause greatly. One minor way to show support
is buy buying a new type of stamp possibly in the
worksÔcent per stamp that would go in the support of breast
Until individuals commit themselves to a healthy diet,
watch for signs of cancer, or even volunteer time, we will
always have the problem. While there are many factors from
weight to factors that one can't even control, taking a
look at the whole picture and evaluating your opinions into
your own choice, and consulting other references will end
in the best decision for yourself.



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