COMPARATIVE STUDY ON BREAST CANCER

Osuntokun O.T and 2Ojo R.O

Faculty of Science ,Adekunle Ajasin

Department

of

Microbiology,

University,Akungba Akoko,Ondo State, Nigeria.

2

Department of Biological Science(Microbiology),College of Natural and Applied

Science, Achievers University, Owo ,Ondo state, Nigeria Tel No-08063813636, 08056096672,08062484836 E-mail-osuntokun4m@yahoo.com, osuntokun4m@gmail.com,ojorufus2011@yahoo.com ABSTRACT This article presents a comprehensive review of the Breast Cancer literature examining epidemiology, diagnosis, pathology, benignbreast disease, breast carcinoma in situ syndromes, staging, and post-treatment surveillance among many topics. Breast cancer remains the most commonly occurring cancer in women in Ondo state using Owo local government as a case study.. Breast cancer detection, treatment, and prevention are prominent issues in public health and medical practice. Background information on developments in these arenas is provided so that Medical Microbiologist And Economics alike can continue to update their approach to the assessment of breast cancer risk to enhance productivity in the local government and Nigeria as whole.

Introduction

Breast cancer was the form of cancer most often described in ancient documents. Because autopsies were rare, cancers of the internal organs were essentially invisible to ancient medicine. Breast cancer, however, could be felt through the skin, and in its advanced state often developed into fungating lesions: the tumor would become necrotic (die from the inside, causing the tumor to appear to break up) and ulcerate through the skin, weeping fetid, dark fluid.19 The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. For centuries, physicians described similar cases in their practices, with the same conclusion. Ancient medicine, from the time of the Greeks through the 17th century, was based on humoralism, and thus believed that breast cancer was generally caused by imbalances in the fundamental fluids that controlled the body, especially an excess of black bile 18 Alternatively, patients often saw it as divine punishment, in the 18th century, a wide variety of medical explanations were proposed, including a lack of sexual activity, too much sexual activity, physical injuries to the breast, curdled breast milk, and various forms of lymphatic blockages, either internal or due to restrictive clothing. In the 19th century, the Scottish surgeon John Rodman said that fear of cancer caused cancer, and that this anxiety, learned by example from the mother, accounted for breast cancer's tendency to run in families.17 Although breast cancer was known in ancient times, it was uncommon until the 19th century, when improvements in sanitation and control of deadly infectious diseases resulted in dramatic increases in lifespan. Previously, most women had died too young to have developed breast cancer. Additionally, early and frequent childbearing and breastfeeding probably reduced the rate of breast cancer development in those women who did survive to middle age

Mastectomy for breast cancer was performed at least as early as AD 548, when it was proposed by the court physician Aetios of Amida to Theodora. It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could link breast cancer's spread to the lymph nodes in the armpit. The French surgeon Jean Louis Petit(16741750) and later the Scottish surgeon Benjamin Bell (17491806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle.44

What is breast cancer?

Cells in the body normally divide (reproduce) only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign (not cancerous). If, however, the cells that are growing out of control are abnormal and don't function like the body's normal cells, the tumor is called malignant (cancerous). Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.

Types of breast cancers

There are many types of breast cancer, but some of them are very rare. Sometimes a breast tumor can be a mix of these types or a mixture of invasive and in situ cancer. 1.Ductal carcinoma in situ (DCIS): This is a type of non-invasive breast cancer. DCIS means that the cancer cells are only in the ducts. They have not grown through the walls of the ducts into the tissue of the breast and so cannot spread to lymph nodes or other

organs. Nearly all women with cancer at this stage can be cured. Mammograms find many cases of DCIS. 2.Invasive (or infiltrating) ductal carcinoma (IDC): This is the most common breast cancer. It starts in a milk passage (a duct), breaks through the wall of the duct, and invades the tissue of the breast. From there it may be able to spread (metastasize) to other parts of the body. It accounts for about 8 out of 10 invasive breast cancers. 3.Invasive (infiltrating) lobular carcinoma (ILC): This cancer starts in the milk glands (the lobules) and then spreads through the wall of the lobules. It can then spread(metastasize) to other parts of the body. About 1 in 10 invasive breast cancers are of this type. 4.Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, IBC makes the skin of the breast look red and feel warm. It also may make the skin look thick and pitted, something like an orange peel. The breast may get bigger, hard, tender, or itchy. [12] PATHOLOGY OF BREAST CANCER Ninety-five percent of breast cancers are carcinomas, ie, they arise from breast epithelial elements. Breast cancers are divided into 2 major types, in situ carcinomas and invasive (or infiltrating) carcinomas. The in situ carcinomas may arise in either ductal or lobular epithelium, but remain confined there, with no invasion of the underlying basement membrane that would constitute extension beyond epithelial boundaries. As would be expected with such localized and confined malignancy, there is negligible potential for metastases. When there is extension of the ductal or lobular malignancy beyond the basement membrane that constitutes the epithelial border, then the malignancy is considered invasive (or infiltrating) ductal or lobular carcinoma. The potential for metastases and ultimately death occurs in invasive disease.

Who gets breast cancer?

Breast cancer is the most common cancer among women other than skin cancer. Breast cancer is the second-leading cause of cancer death in women after lung cancer, and it's the leading cause of cancer death among women ages 35 to 54. Only 5% to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are "sporadic," meaning there is no direct family history of the disease. Increasing age is another risk factor for developing breast cancer.

What are the warning signs of breast cancer?

1.A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle 30 2. A mass or lump, which may feel as small as a pea 2 3. A change in the size, shape, or contour of the breast25 4. A blood-stained or clear fluid discharge from the nipple3 5. A change in the look or feel of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed) .33 6 .Redness of the skin on the breast or nipple1 7. An area that is distinctly different from any other area on either breast

8.A marble-like hardened area under the skin12 These changes may be found when performing monthly breast self-exams. By performing breast self-exams, you can become familiar with the normal monthly changes in your breasts. Breast self-examination should be performed at the same time each month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.

What are the stages of breast cancer?

Stage 0 breast cancer is when the disease is localized to the milk ducts (carcinoma in situ). Stage I breast cancer: The cancer is smaller than 1-inch across and hasn't spread anywhere. Stage II breast cancer is one of the following:

The tumor is less than an inch across but has spread to the underarm lymph nodes (IIA); or

The tumor is between 1 and 2 inches (with or without spread to the lymph nodes); or

The tumor is larger than 2 inches and has not spread to the lymph nodes under the arm (both IIB).

Advanced breast cancer (metastatic) results after cancer cells spread to the lymph nodes and to other parts of the body.

Stage III breast cancer is also called "locally advanced breast cancer." The tumor is larger than 2 inches and has spread to the lymph nodes under the arm, or a tumor that is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue (IIIA). Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes (located beneath the breast and inside the chest). Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, or liver.

Conditions with increased risk of malignancy

1.Ductal hyperplasia without atypia. This is the most commonly encountered breast biopsy result that is definitely associated with increased risk of future development of breast cancer and confers a 2-fold increased risk. The number, size and shape of epithelial cells lining the basement membrane of ducts are increased, but the histology does not fulfill criteria for malignancy. The loss of expression of transforming growth factor-b receptor II in the affected epithelial cells is associated with an increased risk of invasive breast cancer.10 A number of other benign lesions also confer a roughly 2-fold increased risk for development of breast cancer. These include sclerosing adenosis, where lobular tissue undergoes hyperplastic change with increased fibrous tissue and interspaced glandular cells, diffuse papillomatosis which is the formation of multiple papillomas, and fibroadenomas with proliferative disease, which are tumors that contain cysts greater than 3 mm in diameter, with sclerosing adenosis, epithelial calcification, or papillary apocrine change.

Radial scars are benign breast lesions of uncertain pathogenesis, which are usually discovered incidentally when a breast mass is removed for other reasons. Radial scars are characterized by a fibroelastic core from which ducts and lobules radiate.11 Atypical hyperplasia of either ductal or lobular cells, where the cells are uniform but have lost their apical-basal cellular orientation, confers a 4-fold increased risk unless there is also a family history of 1 or more first-degree relatives with breast cancer, where the risk increases to 6-foldsine kinase activity. Women with atypical hyperplasia with over-expression of HER-2/neu have a greater than 7-fold increased risk of developing invasive breast carcinoma, as compared with women with non-proliferative benign breast lesions and no evidence of HER-2/neu amplification,13 Nipple discharge is often of concern to women and their physicians as a sign of malignancy, but the reality is that non-bloody nipple discharge and bilateral nipple discharge are usually of benign causation. Women with papillomas often have bloody discharge. Nipple discharge is uncommon in invasive breast cancer and if present is invariably unilateral and is usually associated with a palpable mass.8 Breast pain is an uncommon presentation of breast cancer. In a study of 987 women referred for breast imaging because of breast pain alone, only 4 women (0.4%) were found to have invasive breast cancer, a number that was not different from a control asymptomatic group.9

RELATIONSHIP OF BENIGN BREAST DISEASE WITH BREAST CANCER

Breast biopsies -conferring no significantly increased risk for malignancy include any lesion with non-proliferative change5.20 These include duct ectasia and simple fibroadenomas, benign solid tumors containing glandular as well as fibrous tissue. The latter is usually single but may be multiple.

Solitary papillomas are also benign lesions conferring no increased risk of future malignancy, despite the fact that they are often7with sanguineous or serosanguineous nipple discharge. Fibrocystic-change (cysts and/or fibrous tissue without symptoms) or fibrocystic disease (fibrocystic changes occurring in conjunction with pain, nipple discharge, or a degree of lumpiness sufficient to cause suspicion of cancer) does not carry increased risk for cancer (other than the potential for missing a malignant mass). Some clinicians differentiate fibrocystic change or disease into those of hyperplasia, adenosis, and cystic change because of their differentiation into age distributions. Hyperplasia characteristically occurs in women in their 20s, often with upper outer quadrant breast pain and an indurated axillary tail, as a result of stromal proliferation. Women in their 30s present with solitary or multiple breast nodules 210 mm in size, as a result of proliferation of glandular cells. Women in their 30s and 40s present with solitary or multiple cysts. Acute enlargement of cysts may cause pain, and because breast ducts are usually patent, nipple discharge is common with the discharge varying in color from pale green to brown.28

How is breast cancer diagnosed?

During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following: 1.Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different (in size, texture, and movement) than benign lumps.

2.Mammography: An X-ray test of the breast can give important information about a breast lump. 3.Digital mammography: A technique in which an X-ray image of the breast is digitally recorded into a computer rather than on a film. This may be better for women with dense breasts. 4.Ultrasonography: This test uses sound waves to detect the character of a breast lump -- whether it is a fluid-filled cyst (not cancerous) or a solid mass (which may or may not be cancerous). This may be performed along with the mammogram. 15 Based on the results of these tests, your doctor may or may not request a biopsy test to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles. 1.After the sample is removed, it is sent to a lab for testing. A pathologist -- a doctor who specializes in diagnosing abnormal tissue changes -- views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is (ductal or lobular carcinoma) and whether it has spread beyond the ducts or lobules (invasive). 2.Laboratory tests, such as hormone receptor tests (estrogen and progesterone) and human epidermal growth factor receptor (HER2/neu), can show whether hormones or growth factors are helping the cancer grow. If the test results show that they are (a positive test), the cancer is likely to respond to hormonal treatment or antibody treatment.10 These therapies deprive the cancer of the estrogen hormone or use a monoclonal antibody known as herceptin to treat the cancer.

3.Breast cancer diagnosis and treatment are best accomplished by a team of experts working together with the patient. Each patient needs to evaluate the advantages and limitations of each type of treatment and work with her team of physicians to develop the best approach.

Other diagnostic tests

Other methods being investigated include: 1.Scintimammography: A technique in which radioactive contrast agents are injected into a vein in the arm. An image of the breast is taken with a special camera, which detects the radiation (gamma rays) emitted by the dye. Tumor cells, which contain more blood vessels than benign tissue, collect more of the dye and project a brighter image. 2.Positron emission tomography (PET) scanning: A technique that measures a signal from injected radioactive tracers that migrate to the rapidly dividing cancer cells. The PET scanner picks up the signal and creates an image. 3.Magnetic resonance imaging (MRI): A test that produces very clear pictures, or images, of the human body without the use of X-rays. MRI uses a large magnet, radio waves, and a computer to produce these images. 4.Scientists are also exploring ways to detect breast cancer or markers of cancer in the blood, urine, and in fluid taken from the nipple.5

How is breast cancer treated?

If the tests find cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to

reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis. The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells, and the stage, or extent, of the disease. Your doctor will usually consider your age and general health as well as your feelings about the treatment options. Breast cancer treatments are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments. Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy are systemic treatments. A patient may have just one form of treatment or a combination, depending on her needs. Surgery: Breast conservation surgery involves removing the cancerous portion of the breast and an area of normal tissue surrounding the cancer, while striving to preserve the normal appearance of the breast. This procedure has often been called a lumpectomy, which is a partial mastectomy. Some of the lymph nodes under the arm are also removed. Usually, six weeks of radiation therapy is then used to treat the remaining breast tissue. Most women who have a small, early-stage tumor are excellent candidates for this approach.16

What happens after treatment?

Following local breast cancer treatment, the treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of the drugs like tamoxifen

or anastrozole (ARIMIDEX) or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.19

How can I protect myself from breast cancer?

Follow these three steps for early detection: 1.Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force (USPTF) came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40. 2.Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes. 3.Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram. 20

Survival rates for breast cancer

Some people with cancer may want to know the survival rates for their type of cancer. Others may not find the numbers helpful, or may even not want to know them. Whether

or not you want to read about survival rates is up to you. If you decide that you do not want to read about them, skip to the next section. The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is found. Of course, many people live much longer than 5 years. Also, people with cancer can die from other things, and these numbers do not take into account the fact that some of the deaths are from causes other than breast cancer. These numbers are based on women treated a number of years ago. Because we now find more cancers early and use newer, better treatments, the survival rates are getting better all the time. Risk factors for breast cancer 1. Lifestyle 1.Smoking- tobacco appears to increase the risk of breast cancer with the greater the amount of smoked and the earlier in life smoking began the higher the risk. [23] In those who are long term smokers the risk is increased 35% to 50%. 14 A lack of physical activity has been linked to ~10% of cases.22 2.Breast feeding. -The association between breast feeding and breast cancer has not been clearly determined with some studies finding support for an association and others not. 3.Abortion-breast cancer hypothesis -In the 1980s the abortionbreast cancer hypothesis posited that induced abortion increased the risk of developing breast cancer.[26 4.Miscarriages nor abortions- This hypothesis has been the subject of extensive scientific inquiry which has concluded that neither miscarriages nor abortions are associated.[6] 5Oral contraceptives .-There may be an association between oral contraceptives and the development of premenopausal breast cancer.26 6.Not breastfeeding: Some studies have shown that breastfeeding slightly lowers breast

cancer risk, especially if the breastfeeding lasts 1 to 2 years. This could be because breastfeeding lowers a womans total number of menstrual periods, as does pregnancy. But this has been hard to study because, in countries such as the United States, breastfeeding for this long is uncommon.29 7.Being overweight or obese: Being overweight or obese after menopause (or because of weight gain that took place as an adult) is linked to a higher risk of breast cancer. But the link between weight and breast cancer risk is complex. The risk seems to be higher if theextra fat is around the waist.

8.Lack of exercise: Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2 hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more.

Risk factors you cannot change

1.Gender: Being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men. 2.Age: The chance of getting breast cancer goes up as a woman gets older. About 2 of 3 women with invasive breast cancer are 55 or older when the cancer is found. 3.Genetic risk factors: About 5% to 10% of breast cancers are thought to be linked to inherited changes (mutations) in certain genes. The most common changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80%chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk, too. 4.Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mothers or fathers side of the family. Having a mother, sister, or daughter with breast cancer about doubles a

womans risk. Its important to note that most (over 85%) women who get breast cancer do not have a family history of this disease, so not having a relative with breast cancer doesnt mean you wont get it. 5.Personal history of breast cancer: A 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 a return of the first cancer (called a recurrence). 6.Race: Overall, white women are slightly more likely to get breast cancer than AfricanAmerican women. African American women, though, are more likely to die of breast cancer. And in women under 45 years of age, breast cancer is more common in African American women. Asian, Hispanic, and Native-American women have a lower risk of getting and dying from breast cancer. 7.Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms. 8.Certain benign (not cancer) breast problems: Women who have certain benign breast changes may have an increased risk of breast cancer. Some of these are more closely linked to breast cancer risk than others. For more details about these, see our document, 9.Non-cancerous Breast Conditions. Lobular carcinoma in situ: In this condition, cells that look like cancer cells are in the milk-making glands (lobules), but they do not grow through the wall of the lobules and cannot spread to other parts of the body. It is not a true cancer or pre-cancer, but having LCIS increases a woman's risk of getting cancer in either breast later. For this reason, it's important that women with LCIS make sure they have regular mammograms and doctor visits. Women with lobular carcinoma in situ (LCIS) have a 7 to 11 times greater risk of developing cancer in either breast.

10.Menstrual periods: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone. 11.Breast radiation early in life: 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. The risk varies with the patients age when she had radiation. The risk from chest radiation is highest if the radiation were given during the teens, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk. 12.Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby (miscarriage). Studies have shown that these women have a slightly increased risk of getting breast cancer. The effect on the children exposed in the womb is less clear, but they may also have a slightly higher risk of breast cancer

Management and Medication of Breast Cancer

Drugs used after and in addition to surgery are called adjuvant therapy. Chemotherapy or other types of therapy prior to surgery are called neoadjuvant therapy. There are currently three main groups of medications used for adjuvant breast cancer treatment: hormone blocking therapy, chemotherapy, and monoclonal antibodies. Hormone blocking therapy Some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progesterone receptors (PR+) on their surface (sometimes referred to together as hormone receptors). These ER+ cancers can be

treated with drugs that either block the receptors, e.g. tamoxifen (Nolvadex), or alternatively block the production of estrogen with an aromatase inhibitor, e.g. anastrozole (Arimidex)34 or letrozole(Femara). Aromatase inhibitors, however, are only suitable for post-menopausal patients. This is because the active aromatase in postmenopausal women is different from the prevalent form in premenopausal women, and therefore these agents are ineffective in inhibiting the predominant aromatase of premenopausal women Chemotherapy Predominately used for stage 24 disease, being particularly beneficial in estrogen receptor-negative (ER-) disease. They are given in combinations, usually for 36 months. One of the most common treatments is cyclophosphamide plus doxorubicin (Adriamycin), known as AC. Most chemotherapy medications work by destroying fastgrowing and/or fast-replicating cancer cells either by causing DNA damage upon replication or other mechanisms; these drugs also damage fast-growing normal cells where they cause serious side effects. Damage to the heart muscle is the most dangerous complication of doxorubicin. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. Another common treatment, which produces equivalent results, is cyclophosphamide, methotrexate, and fluorouracil (CMF). (Chemotherapy can literally refer to any drug, but it is usually used to refer to traditional non-hormone treatments for cancer.15

Radiation
Radiation is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on tumor microenvironment.38

Radiation therapy can be delivered as external beam radiotherapyor as brachytherapy (internal radiotherapy). Conventionally radiotherapy is given after the operation for breast cancer. Radiation can also be given at the time of operation on the breast cancerintra operatively. The largest randomized trial to test this approach was the TAR-GIT-A Trial.21 Radiation which found that targeted intraoperative radiotherapy was equally effective at 4-years as the usual several weeks' of whole breast external beam radiotherapy. Radiation can reduce the risk of recurrence by 5066% (1/2 2/3 reduction of risk) when delivered in the correct dose and is considered essential when breast cancer is treated by removing only the lump (Lumpectomy or Wide local excision). Can breast cancer be prevented? There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage. Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that are under your control. Body weight, physical activity, and diet have all been linked to breast cancer, so these might be areas where you can take action. At this time, the best advice about diet and activity to possibly reduce the risk of breast cancer is to: 1.Get regular physical activity. 2.Reduce your lifetime weight gain by eating fewer calories and getting regular exercise. 3.Avoid or limit your alcohol intake. To find out more, see our document, American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. Women who choose to breastfeed for at least several months may also reduce their breast cancer risk. Not using hormone therapy after menopause can also help you avoid

raising your risk. It's not clear at this time whether chemicals that have estrogen-like properties (like those found in some plastic bottles or certain cosmetics and personal care products) increase breast cancer risk. If there is an increased risk, it is likely to be very small. Still, women who are concerned may choose to avoid products that contain these substances when they can3. Finding breast cancer early: It is also important for women to follow the American Cancer Societys guidelines for finding breast cancer early. Society and culture belief/Effect of breast cancer Before the 20th century, breast cancer was feared and discussed in hushed tones, as if it were shameful. As little could be safely done with primitive surgical techniques, women tended to suffer silently rather than seeking care. When surgery advanced, and long-term survival rates improved, women began raising awareness of the disease and the possibility of successful treatment. The "Women's Field Army", run by the American Society for the Control of Cancer (later the American Cancer Society) during the 1930s and 1940s was one of the first organized campaigns. In 1952, the first peer-to-peer support group, called "Reach to Recovery", began providing post-mastectomy, inhospital visits from women who had survived breast cancer.43 The breast cancer movement of the 1980s and 1990s developed out of the larger feminist movements and women's health movement of the 20th century. This series of political and educational campaigns, partly inspired by the politically and socially effective AIDS awareness campaigns, resulted in the widespread acceptance of second opinions before surgery, less invasive surgical procedures, support groups, and other advances in patient care

Breast cancer culture

Breast cancer culture, or pink ribbon culture, is the set of activities, attitudes, and values that surround and shape breast cancer in public. The dominant values are selflessness, cheerfulness, unity, and optimism. Appearing to have suffered bravely is the passport into the culture. The woman with breast cancer is given a cultural template that constrains her emotional and social responses into a socially acceptable discourse: She is to use the emotional trauma of being diagnosed with breast cancer and the suffering of extended treatment to transform herself into a stronger, happier and more sensitive person who is grateful for the opportunity to become a better person. Breast cancer thereby becomes a rite of passage rather than a disease.4 To fit into this mold, the woman with breast cancer needs to normalize and feminize her appearance, and minimize the disruption that her health issues cause anyone else. Anger, sadness and negativity must be silenced. he primary purposes or goals of breast cancer culture are to maintain breast cancer's dominance as the preminent women's health issue, to promote the appearance that society is "doing something" effective about breast cancer, and to sustain and expand the social, political, and financial power of breast cancer activists.43

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epidemiologic findings induced rat mammary [...] Abortion would

undifferentiated structures

like those observed

mammary

gland, which could render the gland again susceptible to

carcinogenesis."

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