PART I

a. Aging

A. On average, women over 60 are more likely to be diagnosed with breast cancer. Only about
10 percent to 15 percent of breast cancers occur in women younger than 45. However, this may
vary for different races or ethnicities. List the possible risk factors that can contribute to LJ’s
breast malignancy

Possible Risk factors that were identified on LJ’s case were as follows:

b. Genetics
Family history: Having a family history of breast cancer, particularly women with a
mother, sister or daughter who has or had breast cancer, may double the risk. Some
inherited genetic mutations may increase your breast cancer risks. Mutations in the BRCA1
and BRCA2 genes are the most common inherited causes. Other rare mutations may also
make some women more susceptible to developing breast cancer. Genetic testing reveals
the presence of potential genetic problems, particularly in families that have a history of
breast cancer.

c. Gender.
Being a woman is the most significant risk factor for developing breast cancer. Although
men can get breast cancer, too, women’s breast cells are constantly changing and growing,
mainly due to the activity of the female hormones estrogen and progesterone. This activity
puts them at much greater risk for breast cancer.
d. Hyperuricemia, DM, Hypertension (obesity)
Although the increased cancer burden associated with hyperuricemia in obesity, T2DM,
and MetS has suggested the relevance of modulating XOR activity in cancer therapy,
presently available strategies may be inappropriate for many types of cancer. Decreased or
absent tumor cell XOR has been observed in the most aggressive human breast cancer. the
elevated levels of leptin found in obesity, T2DM, and MetS may collaborate with UA and
contribute to tumorigenesis and metastasis by down regulation of tumor cell XOR. Taken
together these data suggest a mechanism by which diminished tumor cell XOR in
conjunction with hyperuricemia and elevated leptin promote cancer cell proliferation,
migration, and survival
e. Obesity:
After menopause, fat tissue may contribute to increases in estrogen levels, and high levels
of estrogen may increase the risk of breast cancer. Weight gain during adulthood and excess
body fat around the waist may also play a role.
f. Pregnancy and breastfeeding.
 Pregnancy and breastfeeding reduce the overall number of menstrual cycles in a woman’s
lifetime, and this appears to reduce future breast cancer risk. Women who have never had
a full-term pregnancy, or had their first full-term pregnancy after age 30, have an increased
risk of breast cancer. For women who do have children, breastfeeding may slightly lower
their breast cancer risk, especially if they continue breastfeeding for 1 1/2 to 2 years. For
many women, however, breastfeeding for this long is neither possible nor practical.
g. High breast density:
Women with less fatty tissue and more glandular and fibrous tissue may be at higher risk
for developing breast cancer than women with less dense breasts.
h. Certain breast changes:
Certain benign (noncancerous) breast conditions may increase breast cancer risk.
i. Menstrual history:
Women who start menstruation at an early age (before age 12) and/or menopause at an
older age (after age 55) have a slightly higher risk of breast cancer. The increase in risk
may be due to a longer lifetime exposure to the hormones estrogen and progesterone.
j. DES exposure.
Women who took a medication called diethylstilbestrol (DES), used to prevent miscarriage
from the 1940s through the 1960s, have a slightly increased risk of breast cancer. Women
whose mothers took DES during pregnancy may have a higher risk of breast cancer as well.
k. Race.
White women are slightly more likely to develop breast cancer than are African American
women. Asian, Hispanic, and Native American women have a lower risk of developing
and dying from breast cancer.
l. Radiation therapy to the chest.
Having radiation therapy to the chest area as a child or young adult as treatment for another
cancer significantly increases breast cancer risk. The increase in risk seems to be highest if
the radiation was given while the breasts were still developing (during the teen years).
m. Exposure to estrogen.
Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen
over long periods of time, without any breaks, can increase the risk of breast cancer. Some
of these risk factors are not under your control, such as:
starting menstruation (monthly periods) at a young age (before age 12)

going through menopause (end of monthly cycles) at a late age (after 55)

exposure to estrogens in the environment (such as hormones in meat or pesticides such as

DDT, which produce estrogen-like substances when broken down by the body)
n. Exercise.
Evidence is growing that exercise can reduce breast cancer risk. The American Cancer
Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a
week.
 o. Alcohol consumption.
Studies have shown that breast cancer risk increases with the amount of alcohol a woman
drinks. Alcohol can limit your liver’s ability to control blood levels of the hormone
estrogen, which in turn can increase risk.
p. Smoking.
Smoking is associated with a small increase in breast cancer risk.

q. Diet.
Studies are looking at the relationship between diet and breast cancer risk and the risk of
recurrence. The Women's Health Initiative Trial suggested that a diet very low in fat may
reduce the risk of breast cancer. More research is needed in this important area for women
who are interested in eating well to reduce their risk of ever getting breast cancer.
In the meantime, here's what dietitians suggest:

Keep your body weight in a healthy range for your height and frame. Body mass index,
though not a perfect measurement, can help you estimate your healthy weight.

Eat plenty of vegetables and fruit (more than 5 cups a day).

Try to limit your saturated fat intake to less than 10% of your total calories per day and
limit your fat intake to about 30 grams per day.

Eat foods high in omega-3 fatty acids.

Avoid trans fats, processed meats, and charred or smoked foods.

B. Give the rationale of the different diagnostic exams

Complete Blood Count

A complete blood count (CBC) is a common blood test that your doctor may recommend for
the following reasons:
 To help diagnose some blood cancers, such as leukemia and lymphoma
 Find out if cancer has spread to the bone marrow
 Determine how a person’s body is handling cancer treatment
 To diagnose other, noncancerous conditions
Blood Chemistry

Blood chemistry tests are common blood tests. They are often done as part of a routine checkup,
but can be done at any time.
 Blood chemistry tests can be done to:
 learn information about your general health
 check how certain organs are working, such as the kidneys, liver and thyroid
 check the body’s electrolyte balance
 help diagnose diseases and conditions
 provide the levels of chemicals (a baseline) to compare with future blood chemistry tests
 check how a treatment is affecting certain organs
 monitor cancer or another condition (as a part of follow-up)

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a test that shows and records the electrical activity of the heart
during a period of time. It checks how fast your heart is beating (your heart rate), if the heart is
beating normally (the rhythm) and how well the heart muscle is working. An e lectrocardiogram
may also be called an EKG. An ECG may be done to:

 check for heart problems and heart disease

 measure any heart damage
 check the health of your heart before surgery or other treatments
 monitor the effects of cancer treatments on your heart
 provide a baseline to compare with future ECGs

Glycosylated Hemoglobin and CBG

Blood glucose monitoring is a way of testing the concentration of glucose in the blood
(glycemia). The glycosylated hemoglobin test (A1c, also called hemoglobin A1c or the
glycosylated hemoglobin test) is an important blood test to diagnose diabetes or determine
control of your diabetes. It provides an average blood glucose measurement over the past 3
months and is used in conjunction with home glucose monitoring to make treatment
adjustments.
This is done because, glycosylated hemoglobin may capture the glucose exposure most relevant
to cancer risk.

Chest X-ray

 An x-ray is an imaging test that uses small doses of radiation to produce pictures of
internal organs and structures of the body.
 follow up suspicious findings from a physical examination or laboratory test
 find out the size, shape and location of tumours
 see how far cancer has spread and if it is in other organs and tissues (staging)
 find out if cancer treatment is working by comparing the size of the tumour before,
during and after treatment
 screen for some types of cancer