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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.
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