Breast cancer
Overview
Breast cancer is cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 originating from breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

 tissue, most commonly from the inner lining of milk
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...

 ducts
Duct (anatomy)
In anatomy and physiology, a duct is a circumscribed channel leading from an exocrine gland or organ.-Types of ducts:Examples include:-Duct system:...

 or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinoma
Lobular carcinoma
Lobular carcinoma is a form of tumor which primarily affects the lobules of a gland.It is sometimes considered equivalent to "terminal duct carcinoma".If not otherwise specified, it generally refers to breast cancer. Examples include:...

s. Breast cancer is a disease of human
Human
Humans are the only living species in the Homo genus...

s and other mammal
Mammal
Mammals are members of a class of air-breathing vertebrate animals characterised by the possession of endothermy, hair, three middle ear bones, and mammary glands functional in mothers with young...

s; while the overwhelming majority of cases in humans are women, men can also develop breast cancer.
The size, stage, rate of growth, and other characteristics of the tumor determine the kinds of treatment.
Encyclopedia
Breast cancer is cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 originating from breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

 tissue, most commonly from the inner lining of milk
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...

 ducts
Duct (anatomy)
In anatomy and physiology, a duct is a circumscribed channel leading from an exocrine gland or organ.-Types of ducts:Examples include:-Duct system:...

 or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinoma
Lobular carcinoma
Lobular carcinoma is a form of tumor which primarily affects the lobules of a gland.It is sometimes considered equivalent to "terminal duct carcinoma".If not otherwise specified, it generally refers to breast cancer. Examples include:...

s. Breast cancer is a disease of human
Human
Humans are the only living species in the Homo genus...

s and other mammal
Mammal
Mammals are members of a class of air-breathing vertebrate animals characterised by the possession of endothermy, hair, three middle ear bones, and mammary glands functional in mothers with young...

s; while the overwhelming majority of cases in humans are women, men can also develop breast cancer.
The size, stage, rate of growth, and other characteristics of the tumor determine the kinds of treatment. Treatment may include surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

, drug
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...

s (hormonal therapy and chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

), radiation
Radiation
In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...

 and/or immunotherapy
Immunotherapy
Immunotherapy is a medical term defined as the "treatment of disease by inducing, enhancing, or suppressing an immune response". Immunotherapies designed to elicit or amplify an immune response are classified as activation immunotherapies. While immunotherapies that reduce or suppress are...

. Surgical removal of the tumor provides the single largest benefit, with surgery alone being capable of producing a cure in many cases. To somewhat increase the likelihood of long-term disease-free survival, several chemotherapy regimens are commonly given in addition to surgery. Most forms of chemotherapy kill cells that are dividing rapidly anywhere in the body, and as a result cause temporary hair loss and digestive disturbances. Radiation is indicated especially after breast conserving surgery and substantially improves local relapse rates and in many circumstances also overall survival. Some breast cancers are sensitive to hormones such as estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...

 and/or progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...

, which makes it possible to treat them by blocking the effects of these hormones.
Worldwide, breast cancer comprises 22.9% of all cancers (excluding non-melanoma
Melanoma
Melanoma is a malignant tumor of melanocytes. Melanocytes are cells that produce the dark pigment, melanin, which is responsible for the color of skin. They predominantly occur in skin, but are also found in other parts of the body, including the bowel and the eye...

 skin cancer
Skin cancer
Skin neoplasms are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises...

s) in women. In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women). Breast cancer is more than 100 times more common in women than breast cancer in men
Male breast cancer
Male breast cancer is a relatively rare cancer in men that originates from the breast. As it presents a similar pathology as female breast cancer, assessment and treatment relies on experiences and guidelines that have been developed in female patients. The optimal treatment is currently not...

, although males tend to have poorer outcomes due to delays in diagnosis.
Prognosis and survival rate varies greatly depending on cancer type, staging and treatment. However, survival rates across the world are generally good. Overall more than 8 out of 10 women (84%) in England that are diagnosed with the disease survive it for at least 5 years.

Signs and symptoms

The first noticeable symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

 of breast cancer is typically a lump
Breast lump
Breast lump is a localized swelling that feels different from the surrounding breast tissue. It is a symptom/sign for a variety of conditions. As approximately 10% of breast lumps ultimately lead to a diagnosis of breast cancer, it is important for women with a breast lump to receive appropriate...

 that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump. The earliest breast cancers are detected by a mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer.

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. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.

Inflammatory breast cancer
Inflammatory breast cancer
Inflammatory breast cancer is an especially aggressive type of breast cancer that can occur in women of any age .It is called inflammatory because it frequently presents with symptoms resembling an inflammation...

 is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange; the absence of a discernible lump delays detection dangerously.

Another reported symptom complex of breast cancer is Paget's disease of the breast
Paget's disease of the breast
Paget's disease of the breast is a malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast....

. This syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...

 presents as eczema
Eczema
Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...

toid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.

In rare cases, what initially appears as a fibroadenoma
Fibroadenoma
Fibroadenomas of the breast, are lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample to rule out cancer in older patients...

 (hard movable lump) could in fact be a phyllodes
Phyllodes tumor
Phyllodes tumors , also cystosarcoma phyllodes, cystosarcoma phylloides and phylloides tumor, are typically large, fast growing masses that form from the periductal stromal cells of the breast...

 tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are called non-specific, meaning they could be manifestations of many other illnesses.

Most symptoms of breast disorders, including most lumps, do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis
Mastitis
Mastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...

 and fibroadenoma
Fibroadenoma
Fibroadenomas of the breast, are lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample to rule out cancer in older patients...

 of the breast are more common causes of breast disorder symptoms. Nevertheless, the appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Risk factors

The primary risk factors for breast cancer are female sex, age, lack of childbearing or breastfeeding, higher hormone levels, race, economic status and dietary iodine deficiency.

Most cases of breast cancer cannot be prevented through any action on the part of the affected person. The World Cancer Research Fund
World Cancer Research Fund
World Cancer Research Fund International is a not-for-profit association, established by royal decree in Belgium, with headquarters in London, UK...

 estimated that 38% of breast cancer cases in the US are preventable through reducing alcohol intake, increasing physical activity levels and maintaining a healthy weight. It also estimated that 42% of breast cancer cases in the UK could be prevented in this way, as well as 28% in Brazil and 20% in China.

Smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...

 tobacco may increase the risk of breast cancer with the greater the amount of smoking and the earlier in life smoking begins the higher the risk.

In a study of attributable risk and epidemiological factors published in 1995, later age at first birth and not having children accounted for 29.5% of U.S. breast cancer cases, family history of breast cancer accounted for 9.1% and factors correlated with higher income contributed 18.9% of cases. Attempts to explain the increased incidence (but lower mortality) correlated with higher income include epidemiologic observations such as lower birth rates correlated with higher income and better education, possible overdiagnosis
Overdiagnosis
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Overdiagnosis is the least familiar side effect of testing for early forms of disease – and, arguably, the most important...

 and overtreatment because of better access to breast cancer screening, and the postulation of as yet unexplained lifestyle and dietary factors correlated with higher income. One such factor may be past hormone replacement therapy
Hormone replacement therapy (menopause)
Hormone replacement therapy is a system of medical treatment for surgically menopausal, perimenopausal and to a lesser extent postmenopausal women...

, which was typically more widespread in higher income groups.

The genes associated with hereditary breast-ovarian cancer syndromes usually increase the risk slightly or moderately; the exception is women and men who are carriers of BRCA mutation
BRCA mutation
A BRCA mutation is a mutation in either of the genes BRCA1 and BRCA2. Harmful mutations in these genes produce a hereditary breast-ovarian cancer syndrome in affected families...

s. These people have a very high lifetime risk for breast and ovarian cancer, depending on the portion of the proteins where the mutation occurs. Instead of a 12 percent lifetime risk of breast cancer, women with one of these genes have a risk of approximately 60 percent.

In more recent years, research has indicated the impact of diet and other behaviors on breast cancer. These additional risk factors include a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use, radiation, endocrine disruptor
Endocrine disruptor
Endocrine disruptors are chemicals that interfere with endocrine in animals, including humans. These disruptions can cause cancerous tumors, birth defects, and other developmental disorders...

s and shiftwork. Although the radiation from mammography is a low dose, the cumulative effect can cause cancer.
In addition to the risk factors specified above, demographic and medical risk factors include:
  • Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting a second breast cancer.
  • Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer, the risk becomes significant if at least two close relatives had breast or ovarian cancer. The risk is higher if her family member got breast cancer before age 40. An Australian study found that having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk of breast cancer and other forms of cancer, including brain and lung cancers.
  • Certain breast changes: Atypical hyperplasia and lobular carcinoma in situ
    Lobular carcinoma in situ
    Lobular carcinoma in situ is a condition caused by unusual cells in the lobules of the breast.It is usually not considered cancer, but it can indicate an increased risk of future cancer...

     found in benign breast conditions such as fibrocystic breast changes
    Fibrocystic breast changes
    Fibrocystic breast changes or fibrocystic breast disease is a condition of breast tissue affecting an estimated 30-60% of women. It is characterized by noncancerous breast lumps in the breast which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual...

     are correlated with an increased breast cancer risk.


Those with a normal body mass index at age 20 who gained weight as they aged had nearly double the risk of developing breast cancer after menopause in comparison to women who maintained their weight. The average 60-year-old woman's risk of developing breast cancer by age 65 is about 2 percent; her lifetime risk is 13 percent.

Pathophysiology

Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues. Cells become cancerous when mutations destroy their ability to stop dividing, to attach to other cells and to stay where they belong. When cells divide, their DNA is normally copied with many mistakes. Error-correcting proteins fix those mistakes. The mutations known to cause cancer, such as p53
P53
p53 , is a tumor suppressor protein that in humans is encoded by the TP53 gene. p53 is crucial in multicellular organisms, where it regulates the cell cycle and, thus, functions as a tumor suppressor that is involved in preventing cancer...

, BRCA1
BRCA1
BRCA1 is a human caretaker gene that produces a protein called breast cancer type 1 susceptibility protein, responsible for repairing DNA. The first evidence for the existence of the gene was provided by the King laboratory at UC Berkeley in 1990...

and BRCA2
BRCA2
BRCA2 is a protein that in humans is encoded by the BRCA2 gene.BRCA2 orthologs have been identified in most mammals for which complete genome data are available....

, occur in the error-correcting mechanisms. These mutations are either inherited or acquired after birth. Presumably, they allow the other mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs.

Normal cells will commit cell suicide (apoptosis
Apoptosis
Apoptosis is the process of programmed cell death that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation...

) when they are no longer needed. Until then, they are protected from cell suicide by several protein clusters and pathways. One of the protective pathways is the PI3K/AKT
AKT
Akt, also known as Protein Kinase B , is a serine/threonine protein kinase that plays a key role in multiple cellular processes such as glucose metabolism, cell proliferation, apoptosis, transcription and cell migration.-Family members:...

 pathway; another is the RAS/MEK/ERK
Extracellular signal-regulated kinases
In molecular biology, extracellular-signal-regulated kinases or classical MAP kinases are widely expressed protein kinase intracellular signalling molecules that are involved in functions including the regulation of meiosis, mitosis, and postmitotic functions in differentiated cells...

 pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently "on", rendering the cell incapable of committing suicide when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations. Normally, the PTEN
PTEN (gene)
Phosphatase and tensin homolog is a protein that, in humans, is encoded by the PTEN gene. Mutations of this gene are a step in the development of many cancers....

 protein turns off the PI3K/AKT pathway when the cell is ready for cell suicide. In some breast cancers, the gene for the PTEN protein is mutated, so the PI3K/AKT pathway is stuck in the "on" position, and the cancer cell does not commit suicide.

Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.

Failure of immune surveillance, the removal of malignant cells throughout one's life by the immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...

.

Abnormal growth factor
Growth factor
A growth factor is a naturally occurring substance capable of stimulating cellular growth, proliferation and cellular differentiation. Usually it is a protein or a steroid hormone. Growth factors are important for regulating a variety of cellular processes....

 signaling in the interaction between stromal cell
Stromal cell
In cell biology, stromal cells are connective tissue cells of any organ, for example in the uterine mucosa , prostate, bone marrow, and the ovary. They are cells that support the function of the parenchymal cells of that organ...

s and epithelial cells can facilitate malignant cell growth. In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer.

In the United States, 10 to 20 percent of patients with breast cancer and patients with ovarian cancer have a first- or second-degree relative with one of these diseases. The familial tendency to develop these cancers is called hereditary breast—ovarian cancer syndrome. The best known of these, the BRCA mutation
BRCA mutation
A BRCA mutation is a mutation in either of the genes BRCA1 and BRCA2. Harmful mutations in these genes produce a hereditary breast-ovarian cancer syndrome in affected families...

s, confer a lifetime risk of breast cancer of between 60 and 85 percent and a lifetime risk of ovarian cancer of between 15 and 40 percent. However, mutations in these genes account for only 2 to 3 percent of all breast cancers. About half of hereditary breast–ovarian cancer syndromes involve unknown genes.

Diagnosis

Most types of breast cancer are easy to diagnose by microscopic analysis of the biopsy. There are however, rarer types of breast cancer that require specialized lab exams. Talk to the doctor and find out what steps should be taken for correct diagnosis.

The precise diagnosis leads to targeted treatment for the exact type of breast cancer in question. The doctor needs to tailor treatment to thus fit individual diagnosis and the patient's individuality. The various options of cancer treatment need to be discussed together in order to come up with the best course of action. All the pros and cons ought to be analyzed and presented to the patient, so that the woman knows what to expect and to be aware of what it's normal to the stage of treatment that she's going through.

While screening techniques (which are further discussed below) are useful in determining the possibility of cancer, a further testing is necessary to confirm whether a lump detected on screening is cancer, as opposed to a benign alternative such as a simple cyst.

Very often the results of noninvasive examination, mammography and additional tests that are performed in special circumstances such as ultrasound or MR imaging are sufficient to warrant excisional biopsy as the definitive diagnostic and curative method.

Both mammography and clinical breast exam, also used for screening, can indicate an approximate likelihood that a lump is cancer, and may also detect some other lesions. When the tests are inconclusive Fine Needle Aspiration and Cytology (FNAC) may be used. FNAC may be done in a GP's office using local anaesthetic if required, involves attempting to extract a small portion of fluid from the lump. Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.

Other options for biopsy include core biopsy, where a section of the breast lump is removed, and an excisional biopsy, where the entire lump is removed.

In addition vacuum-assisted breast biopsy
Vacuum-assisted breast biopsy
Vacuum-assisted breast biopsy is a minimally invasive procedure to help in the diagnosis of breast cancer. VAB is characterized by single insertion, acquisition of contiguous and larger tissue samples, and directional sample capability. It also offers 10x the tissue of core needle biopsy....

 (VAB) may help diagnose breast cancer among patients with a mammographically detected breast in women.

Classification

Breast cancers are classified by several grading systems. Each of these influences the prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...

 and can affect treatment response. Description of a breast cancer optimally includes all of these factors.
  • Histopathology. Breast cancer is usually classified primarily by its histological appearance. Most breast cancers are derived from the epithelium lining the ducts or lobules, and these cancers are classified as ductal or lobular carcinoma. Carcinoma in situ is growth of low grade cancerous or precancerous cells within a particular tissue compartment such as the mammary duct without invasion of the surrounding tissue. In contrast, invasive carcinoma does not confine itself to the initial tissue compartment.

  • Grade. Grading compares the appearance of the breast cancer cells to the appearance of normal breast tissue. Normal cells in an organ like the breast become differentiated, meaning that they take on specific shapes and forms that reflect their function as part of that organ. Cancerous cells lose that differentiation. In cancer, the cells that would normally line up in an orderly way to make up the milk ducts become disorganized. Cell division becomes uncontrolled. Cell nuclei become less uniform. Pathologists describe cells as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade) as the cells progressively lose the features seen in normal breast cells. Poorly differentiated cancers have a worse prognosis.

  • Stage. Breast cancer staging using the TNM system is based on the size of thetumor (T), whether or not the tumor has spread to the lymph
    Lymph node
    A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...

     nodes (N) in the armpits, and whether the tumor has metastasized (M) (i.e. spread to a more distant part of the body). Larger size, nodal spread, and metastasis have a larger stage number and a worse prognosis.
    The main stages are:
    • Stage 0 is a pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ
      Lobular carcinoma in situ
      Lobular carcinoma in situ is a condition caused by unusual cells in the lobules of the breast.It is usually not considered cancer, but it can indicate an increased risk of future cancer...

       (LCIS).
    • Stages 1–3 are within the breast or regional lymph nodes.
    • Stage 4 is 'metastatic' cancer that has a less favorable prognosis.

  • Receptor status. Breast cancer cells have receptors on their surface and in their cytoplasm
    Cytoplasm
    The cytoplasm is a small gel-like substance residing between the cell membrane holding all the cell's internal sub-structures , except for the nucleus. All the contents of the cells of prokaryote organisms are contained within the cytoplasm...

     and nucleus
    Cell nucleus
    In cell biology, the nucleus is a membrane-enclosed organelle found in eukaryotic cells. It contains most of the cell's genetic material, organized as multiple long linear DNA molecules in complex with a large variety of proteins, such as histones, to form chromosomes. The genes within these...

    . Chemical messengers such as hormone
    Hormone
    A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...

    s bind to receptors
    Receptor (biochemistry)
    In biochemistry, a receptor is a molecule found on the surface of a cell, which receives specific chemical signals from neighbouring cells or the wider environment within an organism...

    , and this causes changes in the cell. Breast cancer cells may or may not have three important receptors: estrogen receptor
    Estrogen receptor
    Estrogen receptor refers to a group of receptors that are activated by the hormone 17β-estradiol . Two types of estrogen receptor exist: ER, which is a member of the nuclear hormone family of intracellular receptors, and the estrogen G protein-coupled receptor GPR30 , which is a G protein-coupled...

     (ER), progesterone receptor
    Progesterone receptor
    The progesterone receptor also known as NR3C3 , is an intracellular steroid receptor that specifically binds progesterone...

     (PR), and HER2/neu
    HER2/neu
    HER-2 also known as proto-oncogene Neu, receptor tyrosine-protein kinase erbB-2, CD340 or p185 is an enzyme that in humans is encoded by the ERBB2 gene. Over expression of this gene is correlated with higher aggressiveness in breast cancers...

    .
    ER+ cancer cells depend on estrogen for their growth, so they can be treated with drugs to block estrogen effects (e.g. tamoxifen
    Tamoxifen
    Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as an agonist, hence tamoxifen may be characterized as a mixed agonist/antagonist...

    ), and generally have a better prognosis. HER2+ breast cancer had a worse prognosis, but HER2+ cancer cells respond to drugs such as the monoclonal antibody trastuzumab
    Trastuzumab
    Trastuzumab is a monoclonal antibody that interferes with the HER2/neu receptor.The HER receptors are proteins that are embedded in the cell membrane and communicate molecular signals from outside the cell to inside the cell, and turn genes on and off...

     (in combination with conventional chemotherapy), and this has improved the prognosis significantly. Cells with none of these receptors are called basal-like or triple negative
    Triple Negative Breast Cancer
    Triple-negative breast cancer refers to any breast cancer that does not express the genes for estrogen receptor , progesterone receptor or Her2/neu. Triple negative is sometimes used as a surrogate term for basal-like, however more detailed classification is possible providing better guidance for...

    .

  • DNA assays. DNA testing of various types including DNA microarrays have compared normal cells to breast cancer cells. The specific changes in a particular breast cancer can be used to classify the cancer in several ways, and may assist in choosing the most effective treatment for that DNA type.

Screening

Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening test have been employed including: clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.

A clinical or self breast exam involves feeling the breast for lumps
Breast lump
Breast lump is a localized swelling that feels different from the surrounding breast tissue. It is a symptom/sign for a variety of conditions. As approximately 10% of breast lumps ultimately lead to a diagnosis of breast cancer, it is important for women with a breast lump to receive appropriate...

 or other abnormalities. Research evidence does not support the effectiveness of either type of breast exam, because by the time a lump is large enough to be found it is likely to have been growing for several years and will soon be large enough to be found without an exam. Mammographic screening
Mammography
Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....

 for breast cancer uses x-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...

s to examine the breast for any uncharacteristic masses or lumps. The Cochrane collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...

 in 2009 concluded that mammograms reduce mortality from breast cancer by 15 percent but also result in unnecessary surgery and anxiety, resulting in their view that it is not clear whether mammography screening does more good or harm. Many national organizations recommend regular mammography, nevertheless. For the average woman, the U.S. Preventive Services Task Force recommends mammography every two years in women between the ages of 50 and 74. The Task Force points out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation.

In women at high risk, such as those with a strong family history of cancer, mammography screening is recommended at an earlier age and additional testing may include genetic screening that tests for the BRCA genes and / or magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

.
Molecular breast imaging is currently under study and may also be an alternative.

Prevention

Exercise may decrease breast cancer risk. Also avoiding alcohol and obesity. Prophylactic bilateral mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...

 may be considered in patients with BRCA1 and BRCA2 mutations. A 2007 report concluded that women can somewhat reduce their risk by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children.

Treatment

Breast cancer is usually treated with surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 and then possibly with chemotherapy or radiation, or both. A multidisciplinary approach is preferable. Hormone positive cancers are treated with long term hormone blocking therapy. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence.
  • Stage 1 cancers (and DCIS) have an excellent prognosis and are generally treated with lumpectomy and sometimes radiation. HER2+ cancers should be treated with the trastuzumab
    Trastuzumab
    Trastuzumab is a monoclonal antibody that interferes with the HER2/neu receptor.The HER receptors are proteins that are embedded in the cell membrane and communicate molecular signals from outside the cell to inside the cell, and turn genes on and off...

     (Herceptin) regime. Chemotherapy is uncommon for other types of stage 1 cancers.
  • Stage 2 and 3 cancers with a progressively poorer prognosis and greater risk of recurrence are generally treated with surgery (lumpectomy or mastectomy with or without lymph node removal), chemotherapy (plus trastuzumab
    Trastuzumab
    Trastuzumab is a monoclonal antibody that interferes with the HER2/neu receptor.The HER receptors are proteins that are embedded in the cell membrane and communicate molecular signals from outside the cell to inside the cell, and turn genes on and off...

     for HER2+ cancers) and sometimes radiation (particularly following large cancers, multiple positive nodes or lumpectomy).
  • Stage 4, metastatic cancer, (i.e. spread to distant sites) has poor prognosis and is managed by various combination of all treatments from surgery, radiation, chemotherapy and targeted therapies. 10 year survival rate is 5% without treatment and 10% with optimal treatment.

Surgery

Surgery involves the physical removal of the tumor, typically along with some of the surrounding tissue and frequently sentinel node
Sentinel node
A sentinel node is a specifically designated node used with linked lists and trees as a traversal path terminator. A sentinel node does not hold or reference any data managed by the data structure...

 biopsy.

Standard surgeries include:
  • Mastectomy
    Mastectomy
    Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...

    : Removal of the whole breast.
  • Quadrantectomy
    Quadrantectomy
    Quadrantectomy is a surgical procedure in breast cancer surgery in which entire segment of the involved breast is removed along with axillary dissection and radiotherapy....

    : Removal of one quarter of the breast.
  • Lumpectomy
    Lumpectomy
    Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...

    : Removal of a small part of the breast.


If the patient desires, then breast reconstruction surgery, a type of cosmetic surgery, may be performed to create an aesthetic appearance.

In other cases, women use breast prostheses to simulate a breast under clothing, or choose a flat chest.

Medication

Drugs used after and in addition to surgery are called adjuvant therapy. Not all of these are appropriate for every person with breast cancer. 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
Hormonal therapy (oncology)
Hormonal therapy is one of the major modalities of medical treatment for cancer, others being cytotoxic chemotherapy and targeted therapy . It involves the manipulation of the endocrine system through exogenous administration of specific hormones, particularly steroid hormones, or drugs which...

: 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
Tamoxifen
Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as an agonist, hence tamoxifen may be characterized as a mixed agonist/antagonist...

 (Nolvadex), or alternatively block the production of estrogen with an aromatase inhibitor
Aromatase inhibitor
Aromatase inhibitors are a class of drugs used in the treatment of breast cancer and ovarian cancer in postmenopausal women. AIs may also be used off-label to treat or prevent gynaecomastia in men....

, e.g. anastrozole
Anastrozole
Anastrozole is an aromatase-inhibiting drug approved for treatment of breast cancer after surgery, as well as for metastasis in both pre and post-menopausal women. The severity of breast cancer is increased by estrogen, as sex hormones cause hyperplasia, and differentiation at estrogen receptor...

 (Arimidex) or letrozole
Letrozole
Letrozole is an oral non-steroidal aromatase inhibitor for the treatment of hormonally-responsive breast cancer after surgery.Estrogens are produced by the conversion of androgens through the activity of the aromatase enzyme...

 (Femara). Aromatase inhibitors, however, are only suitable for post-menopausal patients.

Chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

: Predominately used for stage 2-4 disease, being particularly beneficial in estrogen receptor-negative (ER-) disease. They are given in combinations, usually for 3–6 months. One of the most common treatments is cyclophosphamide plus doxorubicin (Adriamycin), known as AC. Most chemotherapy medications work by destroying fast-growing 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.)

Monoclonal antibodies
Monoclonal antibodies
Monoclonal antibodies are monospecific antibodies that are the same because they are made by identical immune cells that are all clones of a unique parent cell....

: A relatively recent development in HER2+
HER2/neu
HER-2 also known as proto-oncogene Neu, receptor tyrosine-protein kinase erbB-2, CD340 or p185 is an enzyme that in humans is encoded by the ERBB2 gene. Over expression of this gene is correlated with higher aggressiveness in breast cancers...

 breast cancer treatment. Approximately 15-20 percent of breast cancers have an amplification of the HER2/neu gene or overexpression of its protein product. This receptor is normally stimulated by a growth factor which causes the cell to divide; in the absence of the growth factor, the cell will normally stop growing. Overexpression of this receptor in breast cancer is associated with increased disease recurrence and worse prognosis. Trastuzumab
Trastuzumab
Trastuzumab is a monoclonal antibody that interferes with the HER2/neu receptor.The HER receptors are proteins that are embedded in the cell membrane and communicate molecular signals from outside the cell to inside the cell, and turn genes on and off...

 (Herceptin), a monoclonal antibody to HER2, has improved the 5 year disease free survival of stage 1–3 HER2+ breast cancers to about 87% (overall survival 95%). Trastuzumab
Trastuzumab
Trastuzumab is a monoclonal antibody that interferes with the HER2/neu receptor.The HER receptors are proteins that are embedded in the cell membrane and communicate molecular signals from outside the cell to inside the cell, and turn genes on and off...

, however, is expensive, and approx 2% of patients suffer significant heart damage; it is otherwise well tolerated, with far milder side effects than conventional chemotherapy. Other monoclonal antibodies are also undergoing clinical trials.

A recent analysis of a subset of the Nurses' Health Study data indicated that Aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...

 may reduce mortality from breast cancer.

Radiation

Radiotherapy 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. Radiation therapy can be delivered as external beam radiotherapy
External beam radiotherapy
External beam radiotherapy or teletherapy is the most common form of radiotherapy. The patient sits or lies on a couch and an external source of radiation is pointed at a particular part of the body...

 or as brachytherapy
Brachytherapy
Brachytherapy , also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment...

 (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 cancer- intraoperatively. The largest randomised trial to test this approach was the TAR-GIT-A Trial 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 50-66% (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).

Prognosis

A prognosis is a prediction of outcome and the probability of progression-free survival (PFS) or disease-free survival (DFS). These predictions are based on experience with breast cancer patients with similar classification. A prognosis is an estimate, as patients with the same classification will survive a different amount of time, and classifications are not always precise. Survival is usually calculated as an average number of months (or years) that 50% of patients survive, or the percentage of patients that are alive after 1, 5, 15, and 20 years. Prognosis is important for treatment decisions because patients with a good prognosis are usually offered less invasive treatments, such as lumpectomy and radiation or hormone therapy, while patients with poor prognosis are usually offered more aggressive treatment, such as more extensive mastectomy and one or more chemotherapy drugs.

Prognostic factors are reflected in the classification scheme for breast cancer
Breast cancer classification
Breast cancer classification divides breast cancer into several categories according to multiple different schemes, each based on different criteria and serving a different purpose. A typical description usually considers each of these aspects in turn: the histolopathological type, the grade of the...

 including stage, (i.e., tumor size, location, whether disease has spread to lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...

s and other parts of the body), grade, recurrence of the disease, and the age and health of the patient.

The stage of the breast cancer is the most important component of traditional classification methods of breast cancer, because it has a greater effect on the prognosis than the other considerations. Staging takes into consideration size, local involvement, lymph node status and whether metastatic disease is present. The higher the stage at diagnosis, the poorer the prognosis. The stage is raised by the invasiveness of disease to lymph nodes, chest wall, skin or beyond, and the aggressiveness of the cancer cells. The stage is lowered by the presence of cancer-free zones and close-to-normal cell behaviour (grading). Size is not a factor in staging unless the cancer is invasive. For example, Ductal Carcinoma In Situ (DCIS) involving the entire breast will still be stage zero and consequently an excellent prognosis with a 10yr disease free survival of about 98%.

The breast cancer grade is assessed by comparison of the breast cancer cells to normal breast cells. The closer to normal the cancer cells are, the slower their growth and the better the prognosis. If cells are not well differentiated, they will appear immature, will divide more rapidly, and will tend to spread. Well differentiated is given a grade of 1, moderate is grade 2, while poor or undifferentiated is given a higher grade of 3 or 4 (depending upon the scale used). The most widely used grading system is the Nottingham scheme; details are provided in the discussion of breast cancer grade.

The presence of estrogen and progesterone receptors in the cancer cell is important in guiding treatment. Those who do not test positive for these specific receptors will not be able to respond to hormone therapy
Hormone therapy
Hormone therapy, or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone antagonists may also referred to as hormonal therapy...

, and this can affect their chance of survival depending upon what treatment options remain, the exact type of the cancer, and how advanced the disease is.

In addition to hormone receptors, there are other cell surface proteins that may affect prognosis and treatment. HER2 status directs the course of treatment. Patients whose cancer cells are positive for HER2 have more aggressive disease and may be treated with the 'targeted therapy', trastuzumab (Herceptin), a monoclonal antibody that targets this protein and improves the prognosis significantly.

Younger women tend to have a poorer prognosis than post-menopausal women due to several factors. Their breasts are active with their cycles, they may be nursing infants, and may be unaware of changes in their breasts. Therefore, younger women are usually at a more advanced stage when diagnosed. There may also be biologic factors contributing to a higher risk of disease recurrence for younger women with breast cancer.

Psychological aspects

The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support group
Cancer support group
Cancer support groups provide a setting in which cancer patients can talk about living with cancer with others who may be having similar experiences...

s which provide a supportive environment to help patients cope and gain perspective from cancer survivors. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.

Not all breast cancer patients experience their illness in the same manner. Factors such as age can have a significant impact on the way a patient copes with a breast cancer diagnosis. Premenopausal women with estrogen-receptor positive breast cancer must confront the issues of early menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...

 induced by many of the chemotherapy regimens used to treat their breast cancer, especially those that use hormones to counteract ovarian function.

On the other hand, a recent study conducted by researchers at the College of Public Health of the University of Georgia showed that older women may face a more difficult recovery from breast cancer than their younger counterparts. As the incidence of breast cancer in women over 50 rises and survival rates increase, breast cancer is increasingly becoming a geriatric issue that warrants both further research and the expansion of specialized cancer support services tailored for specific age groups.

Epidemiology

Worldwide, breast cancer is the most common invasive cancer in women. (The most common form of cancer is non-invasive non-melanoma skin cancer; non-invasive cancers are generally easily cured, cause very few deaths, and are routinely excluded from cancer statistics.) Breast cancer comprises 22.9% of invasive cancers in women and 16% of all female cancers.

In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women and 6.0% of all cancer deaths for men and women together). Lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...

, the second most common cause of cancer-related death in women, caused 12.8% of cancer deaths in women (18.2% of all cancer deaths for men and women together).

The incidence of breast cancer varies greatly around the world: it is lowest in less-developed countries and greatest in the more-developed countries. In the twelve world regions, the annual age-standardized incidence rates per 100,000 women are as follows: in Eastern Asia, 18; South Central Asia, 22; sub-Saharan Africa, 22; South-Eastern Asia, 26; North Africa and Western Asia, 28; South and Central America, 42; Eastern Europe, 49; Southern Europe, 56; Northern Europe, 73; Oceania, 74; Western Europe, 78; and in North America, 90.

The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly attributed to the modern lifestyles.

Breast cancer is strongly related to age with only 5% of all breast cancers occurring in women under 40 years old.

United States

The lifetime risk for breast cancer in the United States is usually given as about 1 in 8 (12%) of women by age 95, with a 1 in 35 (3%) chance of dying from breast cancer. This calculation assumes that all women live to at least age 95, except for those who die from breast cancer before age 95. Recent work, using real-world numbers, indicate that the actual risk is probably less than half the theoretical risk.

The United States has the highest annual incidence rates of breast cancer in the world; 128.6 per 100,000 in whites and 112.6 per 100,000 among African Americans. It is the second-most common cancer (after skin cancer) and the second-most common cause of cancer death (after lung cancer) in women. In 2007, breast cancer was expected to cause 40,910 deaths in the US (7% of cancer deaths; almost 2% of all deaths). This figure includes 450-500 annual deaths among men out of 2000 cancer cases.

In the US, both incidence and death rates for breast cancer have been declining in the last few years in Native Americans and Alaskan Natives. Nevertheless, a US study conducted in 2005 indicated that breast cancer remains the most feared disease, even though heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

 is a much more common cause of death among women. Many doctors say that women exaggerate their risk of breast cancer.

UK

45,000 cases diagnosed and 12,500 deaths per annum.

Developing countries

As developing countries grow and adopt Western culture they also accumulate more disease that has arisen from Western culture and its habits (fat/alcohol intake, smoking, exposure to oral contraceptives, the changing patterns of childbearing and breastfeeding, low parity). For instance, as South America has developed so has the amount of breast cancer.
"Breast cancer in less developed countries, such as those in South America, is a major public health issue. It is a leading cause of cancer-related deaths in women in countries such as Argentina, Uruguay, and Brazil. The expected numbers of new cases and deaths due to breast cancer in South America for the year 2001 are approximately 70,000 and 30,000, respectively."
However, because of a lack of funding and resources, treatment is not always available to those suffering with breast cancer.

History

Because of its visibility, 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 lesion
Fungating lesion
A fungating lesion is a type of skin lesion that is marked by ulcerations and necrosis and that usually has a bad smell. This kind of lesion may occur in many types of cancer, including breast cancer, melanoma, and squamous cell carcinoma, and especially in advanced disease...

s: the tumor would become necrotic (die from the inside, causing the tumor to appear to break up) and ulcerate
Ulcerate
Ulcerate is a death metal band from Auckland, New Zealand. The band formed in 2000 under the name Bloodwreath with Michael Hoggard on guitar, Jamie Saint Merat on drums and Mark Seeney on vocals...

 through the skin, weeping fetid, dark fluid.

The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus
Edwin Smith papyrus
The Edwin Smith Papyrus is an Ancient Egyptian medical text and the oldest known surgical treatise on trauma. It dates to Dynasties 16-17 of the Second Intermediate Period in Ancient Egypt, ca. 1500 BCE. The Edwin Smith papyrus is unique among the four principal medical papyri in existencethat...

 describes 8 cases of tumors or ulcers of the breast that were treated by cauterization
Cauterization
The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities...

. The writing says about the disease, "There is no treatment." For centuries, physicians described similar cases in their practises, 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. 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.

Although breast cancer was known in ancient times, it was uncommon until the 19th century, when improvements in sanitation and control of deadly infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...

s 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.

Because ancient medicine believed that the cause was systemic, rather than local, and because surgery carried a high mortality rate, the preferred treatments tended to be pharmacological rather than surgical. Herbal and mineral preparations, especially involving the poisons hemlock
Hemlock
The word hemlock may refer to:*Hemlock, several poisonous plants in the Apiaceae family :**Hemlock , two species, one formerly used as a method of execution**Water Hemlock...

or arsenic
Arsenic
Arsenic is a chemical element with the symbol As, atomic number 33 and relative atomic mass 74.92. Arsenic occurs in many minerals, usually in conjunction with sulfur and metals, and also as a pure elemental crystal. It was first documented by Albertus Magnus in 1250.Arsenic is a metalloid...

, were relatively common.

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
Jean Louis Petit
Jean-Louis Petit was a French surgeon, and the inventor of the tourniquet. He was first enthusiastic about anatomy, received a master's certificate in surgery in Paris in 1700. He became a member of the French Royal Academy of Sciences in 1715, and was named director of the French Royal Academy of...

 (1674–1750) and later the Scottish surgeon Benjamin Bell
Benjamin Bell
Benjamin Bell of Hunthill FRSE FRCSE is considered by many to be the first Scottish scientific surgeon. He is commonly described as the 'father of the Edinburgh school of surgery', or the first of the Edinburgh scientific surgeons,,...

 (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle.

Their successful work was carried on by William Stewart Halsted
William Stewart Halsted
William Stewart Halsted was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer...

 who started performing radical mastectomies in 1882, helped greatly by advances in general surgical technology, such as aseptic technique
Aseptic technique
Aseptic technique refers to a procedure that is performed under sterile conditions. This includes medical and laboratory techniques, such as with microbiological cultures. It includes techniques like flame sterilization...

 and anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

. The Halsted radical mastectomy often involved removing both breasts, associated lymph nodes, and the underlying chest muscles. This often led to long-term pain and disability, but was seen as necessary in order to prevent the cancer from recurring. Before the advent of the Halsted radical mastectomy, 20-year survival rates were only 10%; Halsted's surgery raised that rate to 50%. Extending Halsted's work, Jerome Urban
Jerome Urban
Jerome Urban was an American surgical oncologist who promoted superradical mastectomies until 1963, when the lack of difference in ten-year survival rates convinced him that it worked no better than the less-mutilating radical mastectomy.-Education:...

 promoted superradical mastectomies, taking even more tissue, until 1963, when the ten-year survival rates proved equal to the less-damaging radical mastectomy.

Radical mastectomies remained the standard of care in America until the 1970s, but in Europe, breast-sparing procedures, often followed radiation therapy, were generally adopted in the 1950s. One reason for this striking difference in approach may be the structure of the medical professions: European surgeons, descended from the barber surgeon
Barber surgeon
The barber surgeon was one of the most common medical practitioners of medieval Europe - generally charged with looking after soldiers during or after a battle...

, were held in less esteem than physicians; in America, the surgeon was the king of the medical profession. Additionally, there were far more European women surgeons: Less than one percent of American surgical oncologists were female, but some European breast cancer wards boasted a medical staff that was half female. American health insurance companies also paid surgeons more to perform radical mastectomies than they did to perform more intricate breast-sparing surgeries.

Breast cancer staging systems were developed in the 1920s and 1930s.

During the 1970s, a new understanding of metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...

 led to perceiving cancer as a systemic illness as well as a localized one, and more sparing procedures were developed that proved equally effective. Modern chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

 developed after World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

.

The French surgeon Bernard Peyrilhe
Bernard Peyrilhe
Bernard Peyrilhe was a French surgeon known as one of the founders of experimental cancer research. He injected some extracts of breast cancer to study the transmission of the disease....

 (1737–1804) realized the first experimental transmission of cancer by injecting extracts of breast cancer into an animal.

Prominent women who died of breast cancer include Anne of Austria
Anne of Austria
Anne of Austria was Queen consort of France and Navarre, regent for her son, Louis XIV of France, and a Spanish Infanta by birth...

, the mother of Louis XIV of France; Mary Washington
Mary Ball Washington
Mary Ball Washington was the second wife to Augustine Washington, and was the mother of George Washington.-Life:...

, mother of George, and Rachel Carson
Rachel Carson
Rachel Louise Carson was an American marine biologist and conservationist whose writings are credited with advancing the global environmental movement....

, the environmentalist.

The first case-control
Case-control
A case-control study is a type of study design in epidemiology. Case-control studies are used to identify factors that may contribute to a medical condition by comparing subjects who have that condition with patients who do not have the condition but are otherwise similar .Case-control studies are...

led study on breast cancer epidemiology was done by Janet Lane-Claypon
Janet Lane-Claypon
Janet Elizabeth Lane-Claypon was an English physician. She was one of the founders of the science of epidemiology, pioneering the use of so-called cohort studies and case-control studies....

, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.

In the 1980s and 1990s, thousands of women who had successfully completed standard treatment then demanded and received high-dose bone marrow transplant
Bone marrow transplant
Hematopoietic stem cell transplantation is the transplantation of multipotent hematopoietic stem cell or blood, usually derived from bone marrow, peripheral blood stem cells, or umbilical cord blood...

s, thinking this would lead to better long-term survival. However, it proved completely ineffective, and 15–20% of women died because of the brutal treatment.

The 1995 reports from the Nurses' Health Study
Nurses' Health Study
The Nurses Health Study, established in 1976 by Dr. Frank Speizer, and the Nurses' Health Study II, established in 1989 by Dr. Walter Willett, are the most definitive long-term epidemiological studies conducted to date on older women's health. The study has followed 121,700 female registered...

 and the 2002 conclusions of the Women's Health Initiative
Women's Health Initiative
The Women's Health Initiative was initiated by the U.S. National Institutes of Health in 1991. The objective of this women's health research initiative was to conduct medical research into some of the major health problems of older women...

 trial conclusively proved that hormone replacement therapy
Hormone replacement therapy (menopause)
Hormone replacement therapy is a system of medical treatment for surgically menopausal, perimenopausal and to a lesser extent postmenopausal women...

 significantly increased the incidence of breast cancer.

Society and culture

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
Raising awareness
"Raising awareness" is a phrase that advocacy groups commonly use when promoting a particular issue, organization or event. Raising awareness refers to alerting the general public that a certain issue exists and should be approached the way the group desires...

 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
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...

) 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, in-hospital visits from women who had survived breast cancer.

The breast cancer movement of the 1980s and 1990s developed out of the larger feminist movement
Feminist movement
The feminist movement refers to a series of campaigns for reforms on issues such as reproductive rights, domestic violence, maternity leave, equal pay, women's suffrage, sexual harassment and sexual violence...

s 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
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

 awareness campaigns, resulted in the widespread acceptance of second opinions before surgery, less invasive surgical procedures, support groups, and other advances in patient care.

Awareness Month

In most countries, October is recognized as National Breast Cancer Awareness Month
National Breast Cancer Awareness Month
Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure...

 (NBCAM). The primary purpose is to promote screening mammography as the most effective way to save lives by detecting breast cancer at early stages.

The month features many events, especially fundraiser
Fundraiser
A fundraiser is an event or campaign whose primary purpose is to raise money for a cause. See also: fundraising. A fundraiser can also be an individual or company whose primary job is to raise money for a specific charity or non-profit organization...

s. Cosmetics company Estée Lauder
Estée Lauder Companies
Estée Lauder Companies, Inc. is a manufacturer and marketer of prestige skincare, makeup, fragrance and hair care products. The company has its headquarters in Midtown Manhattan, New York City.-History:...

 has sponsored the illumination of landmark
Landmark
This is a list of landmarks around the world.Landmarks may be split into two categories - natural phenomena and man-made features, like buildings, bridges, statues, public squares and so forth...

s with pink lights. Lee National Denim Day
Lee National Denim Day
Lee National Denim Day is a fundraiser created by Lee Jeans to support the Women's cancer programs of the Entertainment Industry Foundation. Every year, people are asked to donate the money they'd spend on a pair of jeans to support breast cancer research and wellness programs...

 encourages employers to offer a relaxed dress code in return for a small donation to a breast cancer charity. Susan G. Komen for the Cure
Susan G. Komen for the Cure
Susan G. Komen for the Cure, formerly known as The Susan G. Komen Breast Cancer Foundation, often referred to as simply Komen, is the most widely known, largest and best-funded breast cancer organization in the US....

 and other breast cancer organizations hold walkathons and other sponsored athletic events. The ubiquitous presence of pink ribbon
Pink ribbon
The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer....

s and other pink objects has prompted the title "Pinktober". Typically, relatively little money from pink ribbons and tie-in
Tie-in
A tie-in is an authorized product based on a media property a company is releasing, such as a movie or video/DVD, computer game, video game, television program/television series, board game, web site, role-playing game or literary property...

 merchandise is donated to the cause.

Some critics call NBCAM the "National Breast Cancer Industry Month" to highlight the conflict of interest
Conflict of interest
A conflict of interest occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other....

 between corporations promoting breast cancer awareness while profiting from the resulting increased diagnoses and treatments. Breast Cancer Action
Breast Cancer Action
Breast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...

 says that October is a slick public relations
Public relations
Public relations is the actions of a corporation, store, government, individual, etc., in promoting goodwill between itself and the public, the community, employees, customers, etc....

 campaign that distracts people from discovering the causes and means of preventing breast cancer and instead focuses on raising awareness as a way to sell mammography equipment and chemotherapy drugs. The term pinkwashing describes the actions of companies that manufacture and use chemicals which may cause breast cancer while simultaneously and hypocritically giving money to breast cancer organizations.

Pink ribbon

A pink ribbon
Pink ribbon
The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer....

 is the most prominent symbol of breast cancer awareness. Pink ribbons, which can be made inexpensively, are sometimes sold as fundraisers, much like poppies on Remembrance Day. They may be worn to honor those who have been diagnosed with breast cancer, or to identify products that the manufacturer would like to sell to consumers that are interested in breast cancer—usually white, middle-aged, middle-class and upper-class, educated women.

The pink ribbon is associated with individual generosity, faith in scientific progress, and a "can-do" attitude. It encourages consumers to focus on the emotionally appealing ultimate vision of a cure for breast cancer, rather than on the fraught path between current knowledge and any future cures.

Promotion of the pink ribbon as a symbol for breast cancer has not been credited with saving any lives. Wearing or displaying a pink ribbon has been denounced as a kind of slacktivism
Slacktivism
Slacktivism is a portmanteau formed out of the words slacker and activism. The word is usually considered a pejorative term that describes "feel-good" measures, in support of an issue or social cause, that have little or no practical effect other than to make the person doing it feel satisfaction...

, because it has no practical positive effect and as hypocrisy
Hypocrisy
Hypocrisy is the state of pretending to have virtues, moral or religious beliefs, principles, etc., that one does not actually have. Hypocrisy involves the deception of others and is thus a kind of lie....

 among those who wear the pink ribbon to show good will towards women with breast cancer, but then oppose these women's practical goals, like patient rights and anti-pollution legislation. Critics say that the feel-good nature of pink ribbons and pink consumption distracts society from the lack of progress on preventing and curing breast cancer. It is also criticized for reinforcing gender stereotypes and objectifying women and their breasts. Breast Cancer Action
Breast Cancer Action
Breast Cancer Action is a national grassroots education and advocacy organization dedicated to supporting people living with breast cancer and creating system-wide change that will end the breast cancer epidemic. It was founded in 1990 by Elenore Pred, Susan Claymon, and Linda Reyes...

 launched the "Think Before You Pink" campaign, and charged that companies have co-opted the pink campaign to promote products that encourage breast cancer, such as high-fat Kentucky Fried Chicken and alcohol.

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
Rite of passage
A rite of passage is a ritual event that marks a person's progress from one status to another. It is a universal phenomenon which can show anthropologists what social hierarchies, values and beliefs are important in specific cultures....

 rather than a disease. 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.

As with most cultural models, people who conform to the model are given social status, in this case as cancer survivor
Cancer survivor
A cancer survivor is an individual with cancer of any type, current or past, who is still living. About 11 million Americans alive today—one in 30 people–are either currently undergoing treatment for cancer or have done so in the past." Currently nearly 65% of adults diagnosed with cancer in the...

s. Women who reject the model are shunned, punished and shamed.

The culture is criticized for treating adult women like little girls, as evidenced by "baby" toys such as pink teddy bear
Teddy bear
The teddy bear is a stuffed toy bear. They are usually stuffed with soft, white cotton and have smooth and soft fur. It is an enduring form of a stuffed animal in many countries, often serving the purpose of entertaining children. In recent times, some teddy bears have become collector's items...

s given to adult women.

The primary purposes or goals of breast cancer culture are to maintain breast cancer's dominance as the preëminent 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.

Overemphasis

Compared to other diseases or other cancers, breast cancer receives a disproportionate share of resources and attention. In 2001 MP Ian Gibson
Ian Gibson (politician)
Ian Gibson is a British Labour Party politician, who was the Member of Parliament for Norwich North from 1997 to 2009...

, chairman of the House of Commons of the United Kingdom all party group on cancer stated "The treatment has been skewed by the lobbying
Lobbying
Lobbying is the act of attempting to influence decisions made by officials in the government, most often legislators or members of regulatory agencies. Lobbying is done by various people or groups, from private-sector individuals or corporations, fellow legislators or government officials, or...

, there is no doubt about that. Breast cancer sufferers get better treatment in terms of bed spaces, facilities and doctors and nurses." Breast cancer also receives significantly more media coverage than other, equally prevalent cancers, with a study by Prostate Coalition showing 2.6 breast cancer stories for each one covering cancer of the prostate
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...

. Warren Farrell
Warren Farrell
Warren Farrell is an American author of seven books on men's and women's issues. His books cover twelve fields: history, law, sociology and politics ; couples’ communication ; economic and career issues ; child psychology and child custody ; and...

 highlighted the 660% higher funding given to breast cancer research compared to prostate cancer
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...

 despite similar incidence and death rates. Ultimately there is a concern that favouring sufferers of breast cancer with disproportionate funding and research on their behalf may well be costing lives elsewhere. Partly because of its relatively high prevalence and long-term survival rates, research is biased towards breast cancer. Some subjects, such as cancer-related fatigue
Cancer-related fatigue
Cancer-related fatigue is a subjective symptom of fatigue that is experienced by nearly all cancer patients.Among patients receiving cancer treatment other than surgery, it is essentially universal. Fatigue is a normal and expected side effect from most forms of chemotherapy, radiation therapy,...

, have been studied in little except women with breast cancer.

One result of breast cancer's high visibility is that most women significantly overestimate their personal risk of dying from it. Misleading statistics, such as the claim that one in eight women will be diagnosed with breast cancer during their lives—a claim that depends on the patently unrealistic assumption that no woman will die of any other disease before the age of 95—obscure the reality, which is that about ten times as many women will die from heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

 or stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

 than from breast cancer.

The emphasis on breast cancer screening may be harming women by subjecting them to unnecessary radiation, biopsies, and surgery. One-third of diagnosed breast cancers might recede on their own. Screening mammography efficiently finds non-life-threatening, asymptomatic breast cancers and pre-cancers, even while overlooking serious cancers. According to H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, research on screening mammography has taken the "brain-dead approach that says the best test is the one that finds the most cancers" rather than the one that finds dangerous cancers.

Art

Several historical paintings show anomalies that have been interpreted as visible evidence of breast cancer; retrospective diagnoses are discussed in the medical literature. Possible signs of breast cancer such as a typical lump, differences in breast size or shape and the peau d'orange skin texture can be found for example in works by Raphael
Raphael
Raffaello Sanzio da Urbino , better known simply as Raphael, was an Italian painter and architect of the High Renaissance. His work is admired for its clarity of form and ease of composition and for its visual achievement of the Neoplatonic ideal of human grandeur...

, Rembrandt and Rubens.

The paintings and the historical context do not give enough information to conclude whether or not the visible changes are really signs of breast cancer and alternative explanations such as tuberculous mastitis or a chronic lactational breast abscess need to be considered.

Research

A considerable part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with breast cancer cell (BCC) lines. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first line described, BT-20, was established
in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low (about 100). Indeed, attempts to culture BCC from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available BCC lines issued from metastatic tumors, mainly from pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

s. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.
Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, and MDA-MB-231, account for more than two-thirds of all abstracts reporting studies on mentioned BCC lines, as concluded from a Medline
MEDLINE
MEDLINE is a bibliographic database of life sciences and biomedical information. It includes bibliographic information for articles from academic journals covering medicine, nursing, pharmacy, dentistry, veterinary medicine, and health care...

-based survey.

Treatments are constantly evaluated in randomized, controlled trials, to evaluate and compare individual drugs, combinations of drugs, and surgical and radiation techniques. The latest research is reported annually at scientific meetings such as that of the American Society of Clinical Oncology
American Society of Clinical Oncology
The American Society of Clinical Oncology is the world's leading professional organization representing physicians of all oncology subspecialties who care for people with cancer. Founded in 1964 by Drs...

, San Antonio Breast Cancer Symposium, and the St. Gallen Oncology Conference in St. Gallen, Switzerland. These studies are reviewed by professional societies and other organizations, and formulated into guidelines for specific treatment groups and risk category.

List of cell lines
Mainly based on Lacroix and Leclercq (2004). For more data on the nature of TP53 mutations in breast cancer cell lines, see Lacroix et al. (2006).
Cell line Primary tumor Origin of cells Estrogen receptor
Estrogen receptor
Estrogen receptor refers to a group of receptors that are activated by the hormone 17β-estradiol . Two types of estrogen receptor exist: ER, which is a member of the nuclear hormone family of intracellular receptors, and the estrogen G protein-coupled receptor GPR30 , which is a G protein-coupled...

s
Progesterone receptor
Progesterone receptor
The progesterone receptor also known as NR3C3 , is an intracellular steroid receptor that specifically binds progesterone...

s
ERBB2 amplification Mutated TP53  Tumorigenic in mice Reference
600MPE Invasive ductal carcinoma + - -
AU565 Adenocarcinoma - - + -
BT-20 Invasive ductal carcinoma Primary
Primary tumor
A primary tumor is a tumor growing at the anatomical site where tumor progression began and proceeded to yield a cancerous mass....

 
No No No Yes Yes
BT-474 Invasive ductal carcinoma Primary
Primary tumor
A primary tumor is a tumor growing at the anatomical site where tumor progression began and proceeded to yield a cancerous mass....

 
Yes Yes Yes Yes Yes
BT-483 Invasive ductal carcinoma + + -
BT-549 Invasive ductal carcinoma - - +
Evsa-T Invasive ductal carcinoma, mucin-producing, signet-ring type Metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...

 (ascites
Ascites
Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...

)
No Yes ? Yes ?
Hs578T Carcinosarcoma Primary
Primary tumor
A primary tumor is a tumor growing at the anatomical site where tumor progression began and proceeded to yield a cancerous mass....

 
No No No Yes No
MCF-7  Invasive ductal carcinoma Metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...

 (pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

)
Yes Yes No No (wild-type) Yes (with estrogen supplementation)
MDA-MB-231 Invasive ductal carcinoma Metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...

 (pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

)
No No No Yes Yes
SK-BR-3 Invasive ductal carcinoma Metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...

 (pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

)
No No Yes Yes No
T-47D Invasive ductal carcinoma Metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...

 (pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

)
Yes Yes No Yes Yes (with estrogen supplementation)

External links

  • Clinically reviewed breast cancer information for patients, from Cancer Research UK
    Cancer Research UK
    Cancer Research UK is a cancer research and awareness charity in the United Kingdom, formed on 4 February 2002 by the merger of The Cancer Research Campaign and the Imperial Cancer Research Fund. Its aim is to reduce the number of deaths from cancer. As the world's largest independent cancer...

  • UK breast cancer statistics from Cancer Research UK
    Cancer Research UK
    Cancer Research UK is a cancer research and awareness charity in the United Kingdom, formed on 4 February 2002 by the merger of The Cancer Research Campaign and the Imperial Cancer Research Fund. Its aim is to reduce the number of deaths from cancer. As the world's largest independent cancer...

  • Female Breast Cancer from NHS Choices
  • Alcohol and cancer risk from the Cancer Control Program of South Eastern Sydney and Illawarra Area Health Service
  • Alcohol and the Risk of Breast Cancer from Cornell University
    Cornell University
    Cornell University is an Ivy League university located in Ithaca, New York, United States. It is a private land-grant university, receiving annual funding from the State of New York for certain educational missions...

  • CancerMath.net Calculates survival with breast cancer based on prognostic factors and treatment. From Massachusetts General Hospital
    Massachusetts General Hospital
    Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...

    .
  • Radiology Information from the Radiological Society of North America
    Radiological Society of North America
    The Radiological Society of North America, Inc. is a professional membership society committed to excellence in patient care through education and research...

  • Touched by Breast Cancer - slideshow by Life magazine
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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