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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 ÌÌNew England Journal of Medicine€€ (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 ÌÌDallas Morning News€€, 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." ïrelation 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 ÌÌNew England Journal of Medicine€€ 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 ÌÌJournal of the National Cancer Institute€€ 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, andïInstitute'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 cancer." 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 non»drinking 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 370,715ïit 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 ÌÌCA©A Cancer Journal for Clinicians€€, 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.ïwhich 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 worksïcent per stamp that would go in the support of breast cancer. 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.