Posts Tagged ‘Cancer Breast’

Breast cancer is a cancer that starts in the cells of the breast Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. Worldwide, breast cancer is by far the most common cancer amongst women, with an incidence rate more than twice that of colorectal cancer and cervical cancer and about three times that of lung cancer. However breast cancer mortality worldwide is just 25% greater than that of lung cancer in women. In 2005, breast cancer caused 502,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.

In most cases, it isn’t clear what causes normal breast cells to become cancerous. Doctors do know that only 5 percent to 10 percent of breast cancers are inherited. Families that do have genetic defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), have a much greater risk of developing both breast and ovarian cancer. Other inherited mutations — including the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene — also make it more likely that you’ll develop breast cancer. If one of these genes is present in your family, you have a 50 percent chance of having the gene.

Inflammatory breast cancer is a type of breast cancer that involves the skin of the breast. This type of cancer comprises less than 4% of all breast cancers diagnosed each year in the US. The physical symptoms of inflammatory breast cancer include redness of the skin of the breast and a general swelling of the breast. In some cases, a lump may be present.

Types of Breast Cancer

Tumor grade: If the cancer is an invasive type, the pathologist assigns it a grade. The grade is based on how closely cells in the sample tissue resemble normal breast tissue under the microscope. The grading information, along with the cell type, helps your doctor determine treatment options.

Tubular carcinoma: This rare type of breast cancer gets its name from the appearance of the cancer cells under a microscope. Though it’s an invasive breast cancer, the outlook is more favorable than it is for invasive ductal carcinoma or invasive lobular carcinoma.

Metaplastic carcinoma: Met plastic carcinoma represents less than 1 percent of all newly diagnosed breast cancers. This lesion tends to remain localized and contains several different types of cells that are not typically seen in other forms of breast cancer. Prognosis and treatment is the same as for invasive ductal carcinoma.

Lobular Carcinoma In Situ is NOT cancer. But it’s a sign that the woman who has it is 6 to 7 more times likely to develop cancer, over the course of her lifetime, than a woman who doesn’t have LCIS: the same risk you’d be at if your mother and sister both had cancer.

Most lumps turn out to be fibrocystic changes. The term “fibrocystic” refers to fibrosis and cysts. Fibrosis is the formation of fibrous (or scar-like) tissue, and cysts are fluid-filled sacs. Fibrocystic changes can cause breast swelling and pain. This often happens just before a period is about to begin. Your breasts may feel lumpy and, sometimes, you may notice a clear or slightly cloudy nipple discharge.

Breast cancer is the most common cancer in women affecting one in eight women during their lives. It may develop at any time but the risk of developing it increases as women get older. It is far more common in post-menopausal women and the risk continues to increase with rising age.

CAUSE

The cause of breast cancer is not known and while it can also occur in men, the much higher occurrence in women implicates estrogen.

Today, breast cancer, like other forms of cancer, is considered to be the final outcome of multiple environmental and hereditary factors.

Breathing secondhand smoke increases breast cancer risk by 70% in younger, primarily pre-menopausal women.

A newly released study indicates a correlation between the drop in breast cancer and the drop in women taking HRT.

SIGNS AND SYMPTOMS

Breast cancer elicits so many fears, including those relating to surgery, death, loss of body image and loss of sexuality, however it is more easily treated and often curable if it is found early, therefore regular self examination and screening is essential. Breast cancer usually shows as a lump or thickening in the breast tissue, although most breast lumps are not cancerous.

Certain predisposing factors are clear.

Women at high risk are those who:

Have a family history of breast cancer.

Have long menstrual cycles, began menses early or menopause late.

Have never been pregnant

Were first pregnant after age 31.

Have had unilateral breast cancer.

Have endometrial or Ovarian cancer.

Were exposed to low level ionizing radiation.

Many other possible factors are still under investigation including, obesity, alcohol and environmental factors.

Those with lower risk include women who:

Were pregnant before age 20.

Have had multiple pregnancies.

Are native American or Asian.

Breast cancer occurs more often in the left breast and in the upper quadrant.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge.

TYPES

When breast cancer cells invade the dermal lymphatics, small lymph vessels in the skin of the breast, its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange peel texture to the skin referred to as peau d’orange.

The most common pathologic types of breast cancer are invasive ductal carcinoma, malignant cancer in the breast’s ducts, and invasive lobular carcinoma, malignant cancer in the breast’s lobules.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms.

TREATMENT

Much controversy still exists over treatment of breast cancer, options include; Surgery , chemotherapy, Radiotherapy,Hormonal therapies,Herceptin and complementary treatments.

The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy.

In February 2007, the MammaPrint test became the first breast cancer predictor to win formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated.

Interstitial laser thermotherapy (ILT) is an innovative method of treating breast cancer in a minimally invasive manner and without the need for surgical removal, and with the absence of any adverse effect on the health and survival of the patient during intermediate follow up.

PREVENTION

Routine (annual) mammography of women older than age 40 or 50 is recommended by numerous organizations as a screening method to diagnose early breast cancer and has demonstrated a protective effect in multiple clinical trials.

Women with one or more first-degree relatives (mother, sister, daughter) with premenopausal breast cancer should begin screening at an earlier age.

PROGNOSIS

There are many prognostic factors associated with breast cancer: staging, tumour size and location, grade, whether disease is systemic (has metastasized, or traveled to other parts of the body), recurrence of the disease, and age of patient.

With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined by about 20% over the past decade, and research is ongoing to develop even more effective screening and treatment programs.

Information about Cancer

Cancer is a group of more than 100 different diseases. Cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order, forming a growth or tumor. Benign tumors are NOT cancer; malignant tumors are cancer. Cancer stem cell content and the intrinsic radio sensitivity of cancer stem cells is thought to vary between tumors, thereby affecting their radio curability. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis.

Symptoms and treatment depend on the cancer type and how advanced it is. Treatment plans may include surgery, radiation and/or chemotherapy. Causes Of Cancer Cells are the building blocks of living things. Cancer grows out of normal cells in the body. Normal cells multiply when the body needs them, and die when the body doesn’t. Cancer appears to occur when the growth of cells in the body is out of control and cells divide too rapidly. It can also occur when cells “forget” how to die. There are many different kinds of cancers. Cancer can develop in almost any organ or tissue, such as the lung, colon, breast, skin, bones, or nerve tissue. The mutation in the DNA changes these instructions, so that the cells carry on growing. This causes the cells to reproduce in an uncontrollable manner producing a lump of tissue, known as a tumors.

Types Of Cancer Breast cancer,prostate cancer,lung cancercancer of colon, or rectum,bladder cancer, and ovarian cancer. Symptoms Of Cancer Symptoms of cancer depend on the type and location of the tumor. For example, lung cancer can cause coughing, shortness of breath, or chest pain, while colon cancer often causes diarrhea, constipation, and blood in the stool. Local symptoms – these occur when the cancer is contained in one part of your body. changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or any other part of the body, indigestion or difficulty swallowing, obvious change in a wart or mole, or nagging cough or hoarseness.

Treatment Of Cancer Treatment also varies based on the type of cancer and its stage. The stage of a cancer refers to how much it has grown and whether the tumor has spread from its original location If the cancer is confined to one location and has not spread, the goal for treatment would be surgery and cure. If the tumor has spread to local lymph nodes only, sometimes these can also be removed. Information about cancer treatment, including surgery, chemotherapy, radiation therapy, clinical trials, proton therapy, complementary medicine, cutting edge technologies, Surgical Oncology, Targeted Therapies and Vaccine Therapies. Complementary medicine techniques such as acupuncture, meditation, and yoga could be a helpful addition to your regular medical treatment. Includes research on complementary techniques and ways to find qualified practitioners. If all of the cancer cannot be removed with surgery, the options for treatment include radiation, chemotherapy, or both. Some cancers require a combination of surgery, radiation, and chemotherapy.

Famous breast cancer survivors in words and pictures.

Lung cancer is the leading cause of cancer deaths in both women and men in the United States and throughout the world. Lung cancer has surpassed breast cancer as the leading cause of cancer deaths in women.

In the United States in 2007, 160,390 people were projected to die from lung cancer, which is more than the number of deaths from colorectal, breast, and prostate cancer combined.

Only about 2% of those diagnosed with lung cancer that has spread to other areas of the body are alive five years after the diagnosis, although the survival rates for lung cancers diagnosed at a very early stage are higher, with approximately 49% surviving for five years or longer.

Some lung tumors are metastatic from cancers elsewhere in the body. The lungs are a common site for metastasis. If this is the case, the cancer is not considered to be lung cancer. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer (a secondary cancer) in the lung and is not called lung cancer.

Cancer occurs when normal cells undergo a transformation that causes them to grow and multiply without the normal controls. The cells form a mass or tumor that differs from the surrounding tissues from which it arises. Tumors are dangerous because they take oxygen, nutrients, and space from healthy cells.

About 90% of lung cancers arise due to tobacco use. Cigarette smoking is the most important cause of lung cancer. Research as far back as the 1950s clearly established this relationship. Cigarette smoke contains more than 4,000 chemicals, many of which have been identified as causing cancer. A person who smokes more than one pack of cigarettes per day has a risk of developing lung cancer 20-25 times greater than someone who has never smoked.

However, Once a person quits smoking, his or her risk for lung cancer gradually decreases. About 15 years after quitting, the risk for lung cancer decreases to the level of someone who never smoked. Cigar and pipe smoking also increases the risk of lung cancer but not as much as smoking cigarettes.

Most lung tumors are malignant. This means that they invade and destroy the healthy tissues around them and can spread throughout the body.

The tumors can also spread to nearby lymph nodes or through the bloodstream to other organs. This process is called metastasis. When lung cancer metastasizes, the tumor in the lung is called the primary tumor, and the tumors in other parts of the body are called secondary tumors or metastatic tumors.

Adenocarcinoma (an NSCLC) is the most common type of lung cancer, making up 30%-40% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonia-like appearance on chest x-rays. Squamous cell carcinoma (an NSCLC) is the second most common type of lung cancer, making up about 30% of all lung cancers. Large cell cancer (another NSCLC) makes up 10% of all cases. SCLC makes up 20% of all cases. And finally, Carcinoid tumors account for only 1% of all cases.

Lung cancers are usually divided into two main groups that account for about 95% of all cases. These division into groups is based on the type of cells that make up the cancer. About 5% of lung cancers are of rare cell types, including carcinoid tumor, lymphoma, and others.

The two main types of lung cancer are characterized by the cell size of the tumor when viewed under the microscope. They are called small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC includes several subtypes of tumors. SCLCs are less common, but they grow more quickly and are more likely to metastasize than NSCLCs. Often, SCLCs have already spread to other parts of the body when the cancer is diagnosed.

Up to one-fourth of all people with lung cancer may have no symptoms when the cancer is diagnosed. These cancers usually are identified incidentally when a chest x-ray is performed for another reason. The majority of people, however, develop symptoms. The symptoms are due to direct effects of the primary tumor, to effects of metastatic tumors in other parts of the body, or to disturbances of hormones, blood, or other systems caused by the cancer.

Symptoms of primary lung cancers include cough, coughing up blood, chest pain, and shortness of breath. Symptoms of metastatic lung tumors depend on the location and size. About 30%-40% of people with lung cancer have some symptoms or signs of metastatic disease.

A cough that does not go away or gets worse over time should be evaluated by a health-care provider. Also, Coughing up blood (hemoptysis) occurs in a significant number of people who have lung cancer. Any amount of coughed-up blood is cause for concern. Chest pain is a symptom in about one-fourth of people with lung cancer. The pain is dull, aching, and persistent and may involve other structures surrounding the lung.

Additionally, shortness of breath usually results from a blockage to the flow of air in part of the lung, collection of fluid around the lung (pleural effusion), or the spread of tumor throughout the lungs. Wheezing or hoarseness may signal blockage or inflammation in the lungs that may go along with cancer. Finally, Repeated respiratory infections, such as bronchitis or pneumonia, can be a sign of lung cancer.

Breast Cancer Early Detection

Breast cancer can be detected in an early stage if women are taught to self-examine their breast. In case of detection of any breast lump or of any slightest suspicion, mammography should be done to rule out any tumor. Mammography is a good tool to diagnose this type of cancer.

Symptoms Male Breast Abnormalities

- The most male breast changes are due to benign (non-cancerous) abnormalities, such as gynecomastia (non-cancerous tissue growth)
– So, the men should report any persistent breast changes to their physicians for clinical evaluation.
-The Symptoms of male breast cancer may include:
-a breast lump,
-swelling,
-skin dimpling or puckering,
-nipple retraction (the nipple turns inward),
-redness or scaling of the nipple or breast skin,
-and nipple discharge

Cause

Although the cause is not fully understood but it is hypothesized that there are various factors such as genetic and environmental. The environmental factors are increased age, obesity, smoking and having the first child at late age.

Cancer is one of the biggest killers around the world. In America alone, 25% of all deaths are related to cancer.

Smoking: The most prevalent and easily avoidable type of cancer is the one caused by the use of tobacco. This includes the use of cigarettes, cigars and pipes. Even though smokers are addicted to nicotine, the fact that 200,000 people die every year due to smoking caused cancer should be enough motivation to quit. Some experts say that cessation of smoking can increase lifespan by up to 20 years.

Although nothing has been proven, studies indicate that stress may also be a contributing factor to cancer. Many cancer patients are also employed in stressful jobs. Some theologians believe that stress lowers the bodies immunity to cancer.

Exercise and Healthy Eating: Healthy eating and exercise is universally known to be beneficial in many aspects. But, many people don’t know that food full of nutrition can reduce the risk of cancer. Specific foods such as fruit and veg can help prevent cancer whilst fatty foods such as meat can increase the likelihood of cancer.

Treat Cancer or Prevent Cancer

Many people think of cancer as a single problem but in fact, it is a number of problems spread throughout the body. Generally speaking, if cancer is caught in the early stages of development, it can be treated and cured.

Although there are several different types of cancer, the most common ones are Lung, Prostate, Breast, Testicular, Skin and Colon cancers.

Genes control the multiplication and growth of cells. If these genes are defective in the first place, then the cells will not be able to grow or divide properly. As a result of this abnormality, cancerous cells are born.

There are a number of factors which cause cancer. Factors which are controllable by humans are smoking, toxic elements and radiation. These can be controlled to some degree and therefore it would be wise to avoid them by changing lifestyle habits. However, there are certain elements which are outside our control.
These include mutation and inherited DNA.

As a result of studies conducted by the American Cancer Society, more than 180,000 people have died as a direct result of smoking. Another 200,000 people have died due to lack of changing lifestyle habits. Obesity, laziness and malnutrition can have an effect on the growth of cancer. Needless to say, cancer has risen by more than 50% since 1995.

Let’s take a look at some of these cancer causes in more detail.

Skin cancer can easily be avoided by simply listening to good advice. Wear sunglasses, hats, sun cream and other sensible items of clothing to avoid the onset of this type of cancer. Although this may seem like common sense, more than one million people have been diagnosed with skin cancer in a single year.

In summary, some cancers can be avoided. New research and studies are being conducted all the time. So, rather than concentrating on how to treat cancer patients, maybe we should all be looking for more ways to prevent the cancer in the first place.

Latest research

Latest research is being done on both the surgery and the medicine. For the surgery, surgeons are trying to find out the best way of surgery so that post surgery the patients have minimal disabilities. Similar medicines with lesser side effects are being researched.

For more info related to this subject and others please visit Breast Cancer Info

Breast cancer symptoms can be experienced by men as well as women but breast cancer is very rare in men compared to women. More than 1 in 10 women are likely to suffer from breast cancer symptoms, and be diagnosed with breast cancer, in a lifetime. Breast cancer symptoms can be detected when a lump, tumor, or cyst grows large enough to either be felt or seen on a mammogram. Sometimes a tumor isn’t found for many years. Breast cancer symptoms don’t often manifest themselves until the cancer is already in its later stages of growth, and may have already metastasized to other more vital areas of the body. That is why it is so important for women to regularly get checked.

Breast cancer symptoms are often subtle, and self discovery can be elusive. Due to the high incidence of breast cancer among older women, screening is now recommended in many countries.

Lumps or masses in the breast are not unusual, and most of them are not cancerous. Some breast masses can be felt during a breast exam.

Lump may form in the breast, chest or under the arm if the cancer is in the breast or near the chest wall. You will also notice a change in the size, shape and skin of the breast.

Earlier the diagnosis of breast cancer always involved the removal of the breast and the surrounding skin, muscles underneath the breast and the lymph nodes underneath the arm. Today’s method of diagnosis is well advanced without the above mentioned procedure radical mastectomy.

Among young women, a lump that moves may be a sign of fibrocystic breast disease. But simply asking questions is not enough; a combination of tests is used to make a final diagnosis.

Generally, breast cancer is a much more aggressive disease in younger women. Generally a lump that is cancerous will not be tender to the touch, it will be hard, non-movable, and not change rapidly in size (within several days or weeks). If a lump is tender, it could be a cyst or a swollen lymph node. Genetic counseling and genetic testing should be considered for families who may carry a heritidary form of cancer.

Inflammatory breast cancer is an uncommon type of breast cancer, which includes the breast being warm, red, and swollen.The inflammation occurs because the cancer cells block the lymphatic vessels in the skin of the breast . It doesn’t always involve a lump.

Breast cancer is a common disease. Each year, approximately 200,000 women in the United States are diagnosed with breast cancer, and one in nine American women will develop breast cancer in her lifetime. Breast cancer occurs much more commonly in women and fewer than 1 in 100 of breast cancers occur in men. In the UK, approximately 250 men are diagnosed with breast cancer each year. Breast cancer starts in the cells of the breast. The breast tissue covers an area larger than just the breast.

Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life. Women who attend Infinite Boundaries retreats are in all stages of breast cancer. Some are newly diagnosed while others may have been treated for breast cancer years ago. Women who drink alcohol have a modestly increased risk. The more you drink, the greater your risk

Women had limited knowledge of their relative risk of developing breast cancer, of associated risk factors and of the diversity of potential breast cancer-related symptoms. Older women were particularly poor at identifying symptoms of breast cancer, risk factors associated with breast cancer and their personal risk of developing the disease. Women, sometimes, have lumps in their breasts which have been there for a lifetime. They’re usually harmless fibroids, and never conclusively mean you’ve developed breast cancer. Women are very conscious about their breast care. Beautiful and healthy breast are one of the most cherished dream of women.

An Ebook That Covers Nearly Everything You Need To Know About How To Reduce Breast Cancer Risk And It’s Symptoms, Diagnoses, Prognoses, Treatment Options Along With Courageous Stories About Breast Cancer Survivors.
How To Reduce Breast Cancer Risk 2nd Ed.

Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer. Breast cancer is a cancer of the breast tissue, which can occur in both women and men. Breast cancer may be one of the oldest known forms of cancer tumors in humans.Worldwide, breast cancer is the fifth most common cause of cancer death (after lung cancer, stomach cancer, liver cancer, and colon cancer). Breast cancer kills more women in the United States than any cancer except lung cancer. Today, breast cancer, like other forms of cancer, is considered to be a result of damage to DNA. How this mechanism may occur comes from several known or hypothesized factors (such as exposure to ionizing radiation, or viral mutagenesis). Some factors lead to an increased rate of mutation (exposure to estrogens) and decreased repair (the BRCA1, BRCA2 and p53) genes. Alcohol generally appears to increase the risk of breast cancer.

Breast cancer can also occur in men, although it rarely does. Experts predict 178,000 women and 2,000 men will develop breast cancer in the United States. There are several different types of breast cancer. First is Ductal carcinoma begins in the cells lining the ducts that bring milk to the nipple and accounts for more than 75% of breast cancers. Second is Lobular carcinoma begins in the milk-secreting glands of the breast but is otherwise fairly similar in its behavior to ductal carcinoma. Other varieties of breast cancer can arise from the skin, fat, connective tissues, and other cells present in the breast. Some women have what is known as HER2-positive breast cancer. HER2, short for human epidermal growth factor receptor-2, is a gene that helps control cell growth, division, and repair. When cells have too many copies of this gene, cell growth speeds up.

Causes of Breast Cancer

Simply being a woman is the main risk for breast cancer. While men can also get the disease, it is about 100 times more common in women than in men. The chance of getting breast cancer goes up as a woman gets older. Nearly 8 out of 10 breast cancers are found in women age 50 or older. About 5% to 10% of breast cancers are linked to changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother’s or father’s side of the family. Woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from the first cancer coming back Many experts now believe that the main reason for this is because they have faster growing tumors. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer. Certain types of abnormal biopsy results can be linked to a slightly higher risk of breast cancer.Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer

Some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby. Recent studies have shown that these women (and their daughters who were exposed to DES while in the uterus), have a slightly increased risk of getting breast cancer. Use of alcohol is clearly linked to a slightly increased risk of getting breast cancer. Women who have 1 drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink.Being overweight is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is in the waist area. Breast-feeding and pregnancy: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman’s total number of menstrual periods, as does pregnancy. Women who began having periods early (before 12 years of age) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.

Symptoms of Breast Cancer

1.Lumps.

2.Rash.

3.Breast Pain.

4.Cysts.

5.Nipple Discharge.

6.Inverted Nipple.

Treatment of Breast Cancer

1.Hormonal therapy (with tamoxifen).

2.Chemotherapy.

3.Radiotherapy.

4.Surgery.

Breast cancer is the most common cancer and the second leading cause of cancer deaths in women in the United States.  In 2008, approximately 184,450 patients were estimated to be diagnosed with invasive breast cancer, and an estimated 40,930 were estimated to die of this disease.   Furthermore, over 50,000 female carcinoma in situ breast cases would have been diagnosed.  The etiology of breast cancer is poorly understood with multiple genetic and environmental factors involved in the initiation and progression of cancer. 

Scandinavian Twin Study:  For years, there has been a hot debate as to whether the cause of breast cancer is genetic or environmental.  Then in 2000, Lichtenstein and his colleagues at the Karolinska Institute in Sweden published their study of 44,788 pairs of twins from the Swedish, Danish, and Finnish twin registries.  In this study, they looked at cancer risk with 28 different types of cancers and did statistical modeling of genetic and hereditary contributions in eleven different cancer types.  For breast cancer, they clearly showed that only 27% of breast cancers were due to genetic factors.  This was an even lower hereditary component than other common cancers such as prostate and colorectal.  This study and others have confirmed the fact that over 70% of breast cancers are influenced by environmental factors.

BRCA genes:  Although much attention has been made about hereditary breast cancer, only two genes are commonly tested for breast cancer risk assessment.  These two genes are tumor suppressor genes named “BRCA1″ and “BRCA2″ that are involved with DNA repair.  These two genes only account for about 5% of all breast cancers.  Because of the Scandinavian twin study, most experts believed that there are other yet to be discovered genes involved with breast cancer.  Because the chance of having a BRCA mutation in the general population is so low, genetic testing is not indicated in most patients.  However, if a patient has a family history of breast cancer, then a mathematical model can be used to determine if BRCA testing is indicated.  The likelihood of being a BRCA carrier increases with the number of relatives who had cancer and if the cancers occurred earlier in life.  For example, in families with four or more cases of breast or ovarian cancer under the age of 60, over 80% are found to have a damaged version of BRCA1 or BRCA2.  If a patient is a carrier of one or both of the BRCA1 and BRCA2 genes, her risk of breast cancer dramatically increases.  According to estimates of lifetime risk, about 13.2% (132 out of 1,000 individuals) of women in the general population will develop breast cancer, compared with estimates of 36-85% (360-850 out of 1,000) of women with an altered BRCA1 or BRCA2 gene.  In other words, women with an altered BRCA1 and/or BRCA2 gene are up to eight times more likely to develop breast cancer than women without alterations in those genes.  The BRCA1 mutation confers a higher risk than a BRCA2 mutation.  Women who inherit a damaged BRCA1 gene have a 60-85% chance of developing breast cancer at some stage in their lives and a 20-40% chance of developing ovarian cancer.  For BRCA2, the risks are 40-60% and 10-20%, respectively.  

Family History and Breast Cancer:  Although the spotlight in hereditary breast cancer has been directed on the BRCA genes, the majority of patients with a family history of breast cancer are BRCA1 and BRCA2 negative.  Even in these BRCA negative patients, however, there is an increased risk of developing cancer with a family history of breast cancer.   Six factors (unrelated to BRCA genes) have been studied in patients with a family history of breast cancer.  They are as follows:

1.  Degree of relationship:  If the family member with a history of cancer is a first degree relative, the increased risk is much greater than for second degree relatives. 

2.  Number of relatives who have had breast cancer:  People with two or more family members who have had breast cancer are at higher risk than those with only one affected relative.

3.  Age of onset of cancer:  If the relative developed breast cancer at an early age (pre-menopausal), the risk is higher than if the relative developed post menopausal breast cancer.

4.  Bilateral breast cancer:  If the relative has a history of bilateral breast cancer, the risk is greater than having a relative with unilateral breast cancer.

5.  Gender of the relative:  If the family member with breast cancer is a man, the risk is higher.

6.  Other related early onset tumors:  If there is a family history of early onset ovarian cancer, this incurs an increased risk for a person.

How to decide whether you need the BRCA gene test

The following is an excerpt from the American Society of Breast Surgeons:

1.  Early onset breast cancer (diagnosed before age 50)

2.  Two primary breast cancers, either bilateral or ipsilateral
3.  A family history of early onset breast cancer
4.  Male breast cancer
5.  A personal or family history of ovarian cancer
6.  Ashkenazi (Eastern European) Jewish heritage
7.  A previously identified BRCA1 or BRCA2 mutation in the family

Any one of these features alone indicates a risk for harboring a BRCA1 or BRCA2 mutation.  The presence of more than one of these features raises that risk to greater than 10%, the traditional cutoff for recommending a BRCA test. Such patients should have access to BRCA testing.  A simple risk-calculation model based on the prevalence of mutations seen among women tested for BRCA mutations is available at http://www.brcacalculator.com.