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Introduction
I chose the topic "Breast Cancer and Traditional Chinese Medicine (TCM)"
for my thesis because I am a breast cancer survivor. As a result of havinghad cancer, it became clear to me that my thoughts and emotions were the
starting point of my disease. When I first found out that I had cancer, I felt
that my life was over. The discovery of my disease came about just as the
U.S. Economic Recession was gaining speed. There was little work for
many people, housing and investment concerns abounded, stability was at an
all-time low....and then my cancer.
When I surrendered to my cancer treatment, both with Traditional Chinese
Medicine (TCM) and Western Medicine, I recovered. I accepted my disease,
regained my health, and learned that I could still enjoy life and move on. I
started to appreciate each day, happily communicating with my friends andfamily. I never took my recovery for granted.
It is my desire to outline the approaches of both TCM and Western Medicine
in the treatment of breast cancer, and in doing so, make others aware of the
benefits of both.
I hope my experiences with using both types of these treatments, and the
benefits I derived from them, will help other cancer patients to beat the
disease and go on to lead full, healthy, long lives!
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Acknowledgment
This paper is dedicated first and foremost to my beloved husband, Saeed
Mohammadi, and my dear sons, Ehsan, Ali, and Atta.
Many thanks are extended to my professors and the friendly staff at
American Liberty University, especially Doctors Kevin Sultani, Monica
Sultani, Shahbaz, Jahroomy and Kim. Above all, I must thank my
oncologist, Dr. Homayena Sanati, who gave me exemplary care.
Special thanks go to my fellow classmates who shared their time and talentswith me, and to Lili Adibi, who frequently helped and motivated me to
continue this work.
A final thank you to Sharon Girulat, a close family friend, who helped me to
finish.
To all those people around the world who are striving to overcome cancer, I
wish you the best success with your treatment, and a return to good health!
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Dedication to All Cancer Patients
I am a cancer survivor. I am alive for one reason - to share my life and my
knowledge to help others. There are many cancer patients....some will be
survivors, and some not. I do not have the power to know or help them all. I
do have the power to try and meet and help as many as I possibly can, and
that I plan to do!
Whether through my work with acupuncture and my knowledge of
Traditional Chinese Medicine (TCM), or through lectures, visits with
patients, or other methods, I plan to turn cancer victims into cancer
survivors.You may or may not ever know me personally, but I feel that someday I
shall make the world a better, more hopeful place for those patients who
battle cancer.
We all need to ACT to prevent and cure this dreaded disease.
Eat Right
Don't Smoke
Don't Drink
Avoid Toxins
I also strongly believe that my faith in a Higher Power, meditation, positive
attitude, and a heart full of love have done much to help me endure and
improve my life.
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TABLE OF CONTENTS
CHAPTER 1. Pathology Of Cancer
History of Cancer 6
History of Breast Cancer 7
Ancient Egypt and Greece: Breast Cancer as a Systemic Disease 8
William Halstead and the Radical Mastectomy Paradigm 11
The Eighteenth Century: Breast Cancer as a Localized Disease and the Rise of Surgery
12
A New Beginning: Moving Away from the Halstead Mastectomy 13
New Hope for the Twenty-first Century: Changing Public Perception 14
CHAPTER2. What Is Cancer
What Is Cancer?
Normal cells in the body
How cancer starts
How cancer spreads
How cancers differ
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Tumors that are not cancer
How common is cancer?
CHAPTER 3. What Causes Cancer?
What Causes Cancer?
Heredity and Cancer
DNA, genes, and chromosomes
Genes and cancer
When should I worry?
CHAPTER 4. Type Of Cancer
Breast cancer
Colon cancer
Childhood cancers
Cancer Types
CHAPTER 5. Breast Cancer In Western Medicine
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Breast Cancer
What is breast cancer?
The normal breast
The lymph (lymphatic) system of the breast
Benign breast lumps
Fibrocystic changes
Other benign breast lumps
General breast cancer terms
Types of breast cancers
Less common types of breast cancer
Special types of invasive breast carcinoma
What are the risk factors for breast cancer?
Risk factors you cannot change
Family history of breast cancer
Personal history of breast cancer
CHAPTER 6. Breast awareness and self exam
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Mammograms and Self-Exam
What the doctor looks for on your mammogram
Limitations of mammograms
Clinical breast exam
Breast awareness and self exam
How to examine your breasts
Magnetic resonance imaging (MRI)
CHAPTER 7. How is breast cancer treated in western medicine?
General types of treatment
Local versus systemic therapy
Adjuvant and neoadjuvant therapy
Oncoplastic surgery
Breast reconstruction surgery
Radiation therapy
New chemotherapy drugs
Targeted therapies
Drugs that target HER2:
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Anti-angiogenesis drugs:
Other targeted drugs:
Denosumab
Vitamin D
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CHAPTER 8. Breast Cancer Statistics
Breast cancer in the United States
Women
Men
Rates of breast cancer over time
Mammography and rates of early detection over time
Race/ethnicity and breast cancer rates over time
Male breast cancer rates over time
Worldwide variation
Variation within the United States
Race/ethnicity and breast cancer rates
Migration to the U.S. and breast cancer rates
African American women
Ashkenazi Jewish women
Asian American and Pacific Islander women
Primary prevention is the answer
Breast cancer: Europe
Breast Cancer in Europe 2006
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CHAPTER 9. Cancer And Breast Cancer According To Traditional Chinese
Medicine
The Chinese understanding of cancer
Acupuncture
Acupuncture points for cancer
Herbal medicine
The role of the spirit
Diet
Breast Cancer in traditional Chinese medicine
First is the concept of flow and how it relates to health.
The second missing concept is immunity.
Conclusion
CHAPTER 10 . Diagnosis According to Traditional Chinese Medicine (T.C.M.) A
Guide to Oriental Medicine
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1 - Looking Diagnosis
Tongue Diagnosis
2 - Listening Diagnosis
3 - Smelling and tasting Diagnosis
4 - Feeling the pulse (Touching Diagnosis).
Where is the pulse felt?
CHAPTER 11. Chinese Medicine & The Theory of Qi , Blood and the Theory of Yin
Yang
Qi and Blood According to Traditional Chinese Medicine
"Qi is the source of all movement and heat.
Blood is mother to the Qi."
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of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and
more sparing procedures were developed that proved equally effective.
History of Breast Cancer
Breast cancer is an ancient disease, and it has been mentioned in almost every period of
recorded history. Physicians have consistently noted that breast cancer is visible to even
the untrained eye, progressing from a small lump to large tumors. Unlike other fatal
diseases (heart conditions and most other cancers), breast cancer announces itself in a
tangible fashion (Leopold 1999). Yet, despite the visibility of the disease and the powerful
reverberations breast cancer has had, for women specifically and society in general, any
discussion of breast cancer was found only in medical journals before the 1970s.
Historically, the breast carries with it many cultural expectations for women, specifically
their nurturing and sexual obligations. Perhaps it is because the breast holds such cultural
power that the disease was considered by many to be a taboo subject and many of its
sufferers often felt ashamed or embarrassed to openly discuss the disease. This previous
void in literature outside medical journals stands in stark contrast to the extremely visible
presence the disease holds in contemporary culture. Today there is no public forum in
which breast cancer is not discussed (Leopold 1999). Since the success of breast cancer
activism in the 1990s, the symbol of breast cancer--the pink ribbon--is ubiquitous in
American culture, and politicians and healthcare officials are acknowledging the role that
political and cultural assumptions play in finding a cure.
Ancient Egypt and Greece: Breast Cancer as a Systemic Disease
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Ancient Egyptians were the first to note the disease more than 3,500 years ago. Both the
Edwin Smith and George Ebers papyri contain descriptions of conditions that are
consistent with modern descriptions of breast cancer. For example, one nameless ancient
Egyptian surgeon describes “bulging tumors” in the breast and states that “there is no
cure.” In 460 B.C., Hippocrates, the father of Western Medicine, described breast cancer
as a humoral disease. In other words, for Hippocrates, the body consisted of four “humors”
(blood, phlegm, yellow bile, and black bile), which mirrored the building blocks of nature
(air, fire, earth, and water)--and any imbalance of the system of humors caused sickness
or even death. For Hippocrates, cancer was caused by the excess of black bile, or
“melonchole.” This logic made sense to Hippocrates because the appearance of an
untreated breast tumor would be black and hard, eventually erupting through the skin with
black fluids. He named the cancer karkinos, a Greek word for “crab,” because the tumors
seemed to have tentacles, like the legs of a crab. Hippocrates considered surgery dangerous
because those who had the tumor excised “perish quickly; while those who are not excised
lived longer (Olsen 2002).
In A.D. 200, Galen, Hippocrates successor, also describes cancer as excessive “black bile”
but, unlike Hippocrates, Galen also realized that some tumors were more dangerous than
others. Galen also discusses a wide range of pharmaceutical agents to treat breast cancer,
such as opium, castor oil, licorice, sulpher, and a variety of salves, as well as incantations
to the gods. For humoral physicians, surgery to remove the tumor or entire breast was not
even considered to be an option for a cure since they assumed the cancer would just
reappear near the surgical site or somewhere else in the body. For Galen and physicians
succeeding him over the next 2,000 years, breast cancer was a systemic disease, which
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meant it was a disease of the entire body, not just one localized part. The dark bile was
believed to course throughout the entire body--so even if a tumor were removed, the bile
would still remain in the body, ready to create more tumors.
Until the seventeenth century, physicians assumed that Galen had the final word on breast
cancer and that there was nothing left to discover. However, in 1680, French physician
Francois de la Boe Sylvius began to challenge the humoral theory of cancer by arguing
that cancer did not come from an excess of black bile but from a chemical process that
transformed lymphatic fluids from acidic to acrid. In the 1730s, Paris physician Claude-
Deshais Gendron also rejected the humors theory and insisted that cancer developed when
nerve and glandular tissue mixed with lymph vessels (Olson 1999).
The Eighteenth Century: Breast Cancer as a Localized Disease and the Rise of
Surgery
By 1769, the humoral theory had lost much of its currency. To disprove the humoral
theorists, French physician Jean Astruc took a piece of breast cancer tissue along with a
slice of beef and burned them both in an oven and chewed them. Both tasted the same, and
he concluded the tumor tissue did not contain unusual amounts of bile or acid. With the
humoral theory disproved, physicians began to search for a new origin of breast cancer,
and many argued that its origin was sexual. Physicians knew of Bernardino Ramazzini's
1713 hypotheses that the high frequency of breast cancer in nuns was due to lack of sex;
according to Ramazzini, without regular sexual activity, reproductive organs, including
the breast, started to decay and cancer was the result. Friedrich Hoffman of Prussia posited
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that women who had regular sex but still developed cancer were practicing “vigorous” sex
that could result in lymphatic blockage.
But there were other, nonsexual theories also presented. Giovanni Morgagni blamed
curdled milk. Johanes de Gorter in the 1750s claimed that tumors came from pus-filled
inflammations in the breast that mixed with blood, lodged in the milk gland, and dried into
a tumor. Claude-Nicolas Le Cat from Rouen claimed that depression caused cancer by
constricting the blood vessels and trapping coagulated blood. Lorenz Heister placed
childless women at high risk, while others blamed a sedentary lifestyle which slackened
bodily fluids. Though there was no lack of theories, the cause of breast cancer was still as
mysterious to them as it was to the ancients. But unlike the ancients, eighteenth-century
physicians gradually became more certain that breast cancer was a localized disease. This
had enormous implications, because in contrast to humoral theories which considered
mastectomy a tangential treatment due to the systemic nature of cancer, doctors were
rapidly becoming skeptical of anything but surgery (Olson 1999).
In 1757, Henri Le Dran, a leading French physician, argued that surgery could actually
cure breast cancer as long as the infected axillia lymph nodes were removed. Similarly,
Claude-Nicolas Le Cat argued that the scalpel was the only way to cure cancer. Le Cat
would amputate the breast, cutting out the lymph nodes as well as the pectoralis major
muscle. These physicians were convinced that the presence of a tumor did not necessarily
imply a more serious problem, but was a single-site disease that could be surgically
removed locally before it spread. This theory lasted well into the twentieth century and led
to the creation of the radical mastectomy (Hellman 1993).
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William Halstead and the Radical Mastectomy Paradigm
By the mid-nineteenth century, most physicians held that because cancer was a localized
disease, surgery was the only hope. The development of antiseptic, anesthesia, blood
transfusion, and cellular biology--as well as increased public trust in the medical field--
made radical surgery possible. Gone were the days of pre-anesthesia which necessitated
speed and dexterity with an often resistant patient. Surgeons now had time for deliberate
precision, and William Halstead of New York made radical breast surgery the gold
standard for the next 100 years. Halstead wanted to reduce the recurrences of the disease
which often afflicted patients within a year of their initial surgery and to help even the
most advanced-inflicted patients. Whereas earlier surgeons would remove the breast,
axilla nodes, and pectoralis muscle, that was not enough for Halstead. He knew that cancer
was a cellular disease and worried about his own role in spreading it. He argued that lifting
away the excised breast with surgeon hands probably scattered tumor cells. This led him
to call for a radical mastectomy — removal of the breast, axillary nodes, and both chest
muscles in a single en bloc procedure. He would cut widely around the tumor, removing
all the tissue in one piece.
During the first four decades of the twentieth century, the radical mastectomy dominated
breast cancer treatment. Halstead himself performed hundreds of radical mastectomies and
urged that inflicted women should receive a radical mastectomy before the tumor spread
to regional lymph nodes. While the radical mastectomy may have extended life slightly
and eased the pain of diseased breasts, it was not an unmixed blessing. Some women
avoided the surgery because it would leave them wounded and disfigured for the rest of
their lives. Women had to deal with a deformed chest wall, hollow voids under the collar
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bone and the armpit, chronic pain, and lymphedema or swelling in the arm because the
removed underarm lymph nodes could no longer process circulatory fluids efficiently.
Halstead dismissed these effects as necessary evils; besides, the women’s average age was
“nearly fifty-five years [and t]hey are no longer active members of society” (Olson 1999).
Halstead also gave some thought to shoulder amputation. For Halstead and his followers,
cutting away more and more tissue was the only way to treat breast cancer. Jerome Urban,
the architect of the super-radical mastectomy in 1949, would remove the breast, the
axillary nodes, the chest muscles, and internal mammary nodes in a single procedure, often
on patients who had tumors less than one centimeter large.
Twentieth-Century Surgeries: Oophorectomy, Adrenalectomy, and
Hypophysectomy
In 1895, Scottish surgeon George Beatson discovered that removing the ovaries from one
of his patients shrank her breast tumor. This news spread and soon surgeons were
performing “prophylactic” oophorectomies, which involved removing both ovaries and
performing a radical mastectomy. The operations were debilitating and the results
unpredictable since the surgeons had no way of determining which tumors possessed
estrogen receptors. Because of this, by 1920 most surgeons employed an oopherectomy
only as a last resort. What modern oncologists now know is that some breast tumors have
estrogen receptors that feed on estrogen. Removing the ovaries in some cases starved the
tumor, at least temporarily. The tumor would always regrow because the body
compensated by secreting estrogen-like substances from the adrenal and pituitary glands.
In 1952, approximately the same time as Urban’s super -radical mastectomy, Charles
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Huggins began removing a woman’s adrenal gland (adrenalectomy) in an effort to starve
the tumor of estrogen. Rolf Lefft and Herbert Olivecrona began performing
hypophysectomies, or the removal of the pituitary gland. Side effects included impaired
vision, personality changes, and cognitive difficulties. Even with these extreme surgeries,
the tumors still returned to kill.
A New Beginning: Moving Away from the Halstead Mastectomy
The Halstead mastectomy was based on the premise that breast cancer was a localized
disease that could be treated by surgically removing the diseased part of the body. George
Crile in 1955 began to argue that cancer was not localized but rather is spread throughout
the body. Bernard Fisher also revolutionized cancer treatment by revising metastasis
theory which, like Hippocrates, argued that cancer cells traveled throughout both the
circulatory and lymphatic systems and that surgery could not cure cancer because cancer
cells were floating throughout the body in the circularity system. In 1976, Fisher published
results indicating that simpler breast-conserving surgery followed by radiation or
chemotherapy were just as effective as the radical mastectomy, and usually more so
(Hellman 1993). By advocating a more systemic approach to breast cancer, Fisher and
Crile directly challenged the surgeon’s role as the primary source of breast cancer
treatment. Yet physicians were reluctant to abandon the Halstead mastectomy until the
sexual revolution and modern feminism.
With the decline of the Halstead radical mastectomy and a revised theory of metastasis,
physicians hypothesized about the origins of breast cancer and, during the 1990s,
everything ranging from diet, chemical pollution, race, delay in having children, and
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breastfeeding was up for debate. Despite this uncertainty, there were still advances. After
an in initial increase in breast cancer rates, the number of deaths plateaued in 1995 and
then started to decline. By 1995, less than 10 percent of breast cancer-inflicted women had
a mastectomy. Improvements in chemotherapy, radiation, hormone treatments
(particularly Tamoxifen), mammography, and surgery helped move breast cancer from an
urgent disease to a chronic condition. Significantly, scientists isolated the genes that cause
breast cancer: BRCA2 and ATM. Today, advances in molecular and genetic sciences are
creating novel therapeutic strategies that give both women and men not only hope but also
more choices about their bodies.
New Hope for the Twenty-first Century: Changing Public Perception
The ultimate cure for breast cancer remains elusive. The disease is so complex, diverse,
and so subtly connected to genetic and environmental variables that finding a cure can
often seem remote if not impossible. While a cure has not yet been found, public
perception surrounding breast cancer has changed dramatically. Once a disease that
women felt ashamed to discuss, breast cancer now has lost much of its stigma, providing
the opportunity for politicians and health care officials to acknowledge that economic and
political considerations bear on the success of breast cancer treatment as much as advances
in medical science.
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CHAPTER2. What Is Cancer
What Is Cancer?
Cancer is the general name for a group of more than 100 diseases. Although there
are many kinds of cancer, all cancers start because abnormal cells grow out of
control. Untreated cancers can cause serious illness and death.
Normal cells in the body
The body is made up of trillions of living cells. Normal body cells grow, divide, and die in
an orderly fashion. During the early years of a person’s life, normal cells divide faster to
allow the person to grow. After the person becomes an adult, most cells divide only to
replace worn-out or dying cells or to repair injuries.
How cancer starts
Cancer starts when cells in a part of the body start to grow out of control. Cancer cell
growth is different from normal cell growth. Instead of dying, cancer cells continue to grow
and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues,
something that normal cells cannot do. Growing out of control and invading other tissues
are what makes a cell a cancer cell.
Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in
every cell and it directs all the cell’s actions. In a normal cell, when DNA gets damaged
the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not
repaired, and the cell doesn’t die like it should. Instead, the cell goes on making new cells
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that the body doesn’t need. These new cells all have the same abnormal DNA as the first
cell does.
People can inherit abnormal DNA, but most DNA damage is caused by mistakes that
happen while the normal cell is reproducing or by something in the environment.
Sometimes the cause of the DNA damage may be something obvious like cigarette
smoking or sun exposure. But it’s rare to know exactly what caused any one person’s
cancer.
In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form
tumors. Instead, these cancer cells involve the blood and blood-forming organs and
circulate through other tissues where they grow.
How cancer spreads
Cancer cells often travel to other parts of the body where they begin to grow and form new
tumors. This happens when the cancer cells get into the body’s bloodstream or lymph
vessels. Over time, the tumors replace normal tissue. The process of cancer spreading is
called metastasis.
How cancers differ
No matter where a cancer may spread, it’s always named for the place where it started. For
example, breast cancer that has spread to the liver is called metastatic breast cancer, not
liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic
prostate cancer, not bone cancer.
Different types of cancer can behave very differently. For instance, lung cancer and skin
cancer are very different diseases. They grow at different rates and respond to different
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treatments. This is why people with cancer need treatment that is aimed at their kind of
cancer.
Tumors that are not cancer
Not all tumors are cancer . Tumors that aren’t cancer are called benign. Benign tumors can
cause problems – they can grow very large and press on healthy organs and tissues. But
they cannot grow into (invade) other tissues. Because they can’t invade, they also can’t
spread to other parts of the body (metastasize). These tumors are almost never life
threatening.
How common is cancer?
Half of all men and one-third of all women in the US will develop cancer during their
lifetimes.
Today, millions of people are living with cancer or have had cancer. The risk of developing
many types of cancer can be reduced by changes in a person’s lifestyle, for example, by
staying away from tobacco, limiting time in the sun, being physically active and healthy
eating.
There are also screening tests that can be done for some types of cancers so they can be
found as early as possible – while they are small and before they have spread. In general,
the earlier a cancer is found and treated, the better the chances are for living for many years.
CHAPTER 3. What Cause Cancer?
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What Causes Cancer?
Cancer is a complex group of diseases with many possible causes. In this section you can
learn more about the known causes of cancer, including genetic factors; lifestyle factors
such as tobacco use, diet, and physical activity; certain types of infections; and
environmental exposures to different types of chemicals and radiation.
Heredity and Cancer
Cancer is such a common disease that it is no surprise that many families have at least a
few members who have had cancer. Sometimes, certain types of cancer seem to run in
some families. This can be caused by a number of factors. Often, family members have
certain risk factors in common, such as smoking, which can cause many types of cancer.
But in some cases the cancer is caused by an abnormal gene that is being passed along from
generation to generation. Although this is often referred to as inherited cancer, what is
inherited is the abnormal gene that can lead to cancer, not the cancer itself. Only about 5%
to 10% of all cancers are inherited. This document focuses on those cancers.
DNA, genes, and chromosomes
Cancer is a disease of abnormal gene function. Genes are pieces of DNA (deoxyribonucleic
acid). They contain the instructions on how to make the proteins the body needs to function,
when to destroy damaged cells, and how to keep the cells in balance. Your genes control
things such as hair color, eye color, and height. They also can affect your chance of getting
certain diseases, such as cancer.
An abnormal change in a gene is called a mutation. The 2 types of mutations are inherited
and acquired (somatic).
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Inherited gene mutations are passed from parent to child through the egg or sperm. These
mutations are in every cell in the body.
Acquired (somatic) mutations are not present in the egg or sperm. These mutations are
acquired at some point in the person's life, and are more common than inherited
mutations. This type of mutation occurs in one cell, and then is passed on to any new
cells that are the offspring of that cell.
Genes are found on long strands of DNA called chromosomes. Humans have 23 pairs of
chromosomes in each cell. We inherit one set of chromosomes from each parent. Each
chromosome can contain hundreds or thousands of genes that are passed from the parents
to the child. Every cell in your body has all of the genes you were born with. Although all
cells have the same genes and chromosomes, different cells (or types of cells) may use
different genes. For example, muscle cells use a different set of genes than skin cells use.
The genes that the cell doesn't need are turned off and not used. The genes that the cell is
using are activated or turned on.
Genes and cancer
Genes seem to have 2 major roles in cancer: Some called oncogenes, can cause cancer;
others known as tumor suppressor genes, stop cancer from developing or growing. More
information about oncogenes and tumor suppressor genes can be found in our
document, Oncogenes, Tumor Suppressor Genes, and Cancer .
Oncogenes are mutated forms of certain normal genes of the cell called proto-
oncogenes. Proto-oncogenes are often genes that normally control what kind of cell it is
and how often it grows and divides. When a proto-oncogene mutates (changes) into an
http://www.cancer.org/Cancer/CancerCauses/GeneticsandCancer/heredity-and-cancerhttp://www.cancer.org/Cancer/CancerCauses/GeneticsandCancer/heredity-and-cancerhttp://www.cancer.org/Cancer/CancerCauses/GeneticsandCancer/heredity-and-cancerhttp://www.cancer.org/ssLINK/oncogenes-and-tumor-suppressor-genes-tochttp://www.cancer.org/ssLINK/oncogenes-and-tumor-suppressor-genes-tochttp://www.cancer.org/ssLINK/oncogenes-and-tumor-suppressor-genes-tochttp://www.cancer.org/ssLINK/oncogenes-and-tumor-suppressor-genes-tochttp://www.cancer.org/Cancer/CancerCauses/GeneticsandCancer/heredity-and-cancer
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oncogene, it turns on or activates when it is not supposed to be. When this occurs, the cell
can grow out of control, leading to cancer.
Tumor suppressor genes are normal genes that slow down cell division, repair DNA
mistakes, or tell cells when to die (a process known as apoptosis or programmed cell
death). When tumor suppressor genes don’t work properly, cells can grow out of control,
which can lead to cancer.
A tumor suppressor gene is like the brake pedal on a car. It normally keeps the cell from
dividing too quickly just as a brake keeps a car from going too fast. When something goes
wrong with the gene, such as a mutation, cell division can get out of control.
An important difference between oncogenes and tumor suppressor genes is that oncogenes
result from the activation (turning on) of proto-oncogenes, but tumor suppressor genes
cause cancer when they are inactivated (turned off).
Even if you were born with healthy genes, some of them can become changed (mutated)
over the course of your life. These mutations are known as sporadic or somatic, meaning
they are not inherited. Sporadic mutations cause most cases of cancer. These mutations
may be caused by things that we are exposed to in our environment, including cigarette
smoke, radiation, hormones, and diet (although in many cases there is no obvious cause).
More gene mutations build up as we get older, leading to a higher risk of cancer.
When someone has inherited an abnormal copy of a gene, their cells already start out with
one mutation. This makes it all the easier (and quicker) for enough mutations to build up
for a cell to become cancer. That is why cancers that are inherited tend to occur earlier in
life than cancers of the same type that are not inherited.
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When should I worry?
When many cases of cancer occur in a family, it is most often due to chance or because
family members have been exposed to a common toxin, such as cigarette smoking. Less
often, these cancers may be caused by an inherited gene mutation. (These are called family
cancer syndromes.) Certain things make it more likely that an abnormal gene is causing
cancers in a family, such as
Many cases of an uncommon or rare type of cancer (like kidney cancer)
Cancers occurring at younger ages than usual (like colon cancer in a 20 year old)
More than one type of cancer in a single person (like a woman with both breast and
ovarian cancer)
Cancers occurring in both of a pair of organs (both eyes, both kidneys, both breasts)
More than one childhood cancer in a set of siblings (like sarcoma in both a brother and a
sister)
Before you decide that cancer runs in your family, first gather some information. For each
case of cancer, look at:
Who is affected? How are we related?
What type of cancer is it? Is it rare?
How old was this relative when they were diagnosed?
Did this person get more than one type of cancer?
Did they smoke or have other known risk factors?
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Cancer in a close relative, like a parent or sibling (brother or sister), is more cause for
concern than cancer in a more distant relative. Even if the cancer was from a gene mutation,
the chance of it passing on to you gets lower with more distant relatives.
It is also important to look at each side of the family separately. Having 2 relatives with
cancer is more concerning if the people are related to each other (meaning that they are
both on the same side of the family). For example, if both relatives are your mother's
brothers it means more than if one was your father's brother and the other was your mother's
brother.
The type of cancer matters, too. More than one case of the same rare cancer is more
worrisome than cases of a more common cancer. And having the same type of cancer in
many relatives is more concerning than if it is several different kinds of cancer. Still, in
some family cancer syndromes, a few types of cancer seem to go together. For example,
breast cancer and ovarian cancer run together in families with hereditary breast and ovarian
cancer syndrome (HBOC). Colon and endometrial cancers tend to go together in a
syndrome called hereditary non-polyposis colorectal cancer (HNPCC), also known as
Lynch syndrome.
The age of the person when the cancer was diagnosed is also important. For example, colon
cancer is rare in people under 30. Having 2 or more cases in close relatives under 30 could
be a sign of an inherited cancer syndrome. On the other hand, prostate cancer is very
common in elderly men, so if both your father and his brother were found to have prostate
cancer when they were in their 80s, it is less likely to be due to an inherited gene change.
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When many relatives have the same type of cancer it is important to notice if the cancer
could be related to smoking. For example, lung cancer is commonly caused by smoking,
so many cases of lung cancer in a family of heavy smokers is more likely to be due to
smoking than to an inherited gene change.
CHAPTER 4. Type of Cancer
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Types of cancer
Cancer Types
Adrenal Cortical Cancer
Advanced Cancer
Anal Cancer
Aplastic Anemia
Bile Duct Cancer
Bladder Cancer
Bone Cancer
Bone Metastasis
Brain/CNS Tumors In Adults
Brain/CNS Tumors In Children
Breast Cancer
Breast Cancer In Men
Cancer in Children
Cancer of Unknown Primary
Castleman Disease
Cervical Cancer
Colon/Rectum Cancer
Endometrial Cancer
Esophagus Cancer
Ewing Family Of Tumors
http://www.cancer.org/cancer/adrenalcorticalcancer/indexhttp://www.cancer.org/cancer/adrenalcorticalcancer/indexhttp://www.cancer.org/cancer/advancedcancer/indexhttp://www.cancer.org/cancer/advancedcancer/indexhttp://www.cancer.org/cancer/analcancer/indexhttp://www.cancer.org/cancer/analcancer/indexhttp://www.cancer.org/cancer/aplasticanemia/indexhttp://www.cancer.org/cancer/aplasticanemia/indexhttp://www.cancer.org/cancer/bileductcancer/indexhttp://www.cancer.org/cancer/bileductcancer/indexhttp://www.cancer.org/cancer/bladdercancer/indexhttp://www.cancer.org/cancer/bladdercancer/indexhttp://www.cancer.org/cancer/bonecancer/indexhttp://www.cancer.org/cancer/bonecancer/indexhttp://www.cancer.org/cancer/bonemetastasis/indexhttp://www.cancer.org/cancer/bonemetastasis/indexhttp://www.cancer.org/cancer/braincnstumorsinadults/indexhttp://www.cancer.org/cancer/braincnstumorsinadults/indexhttp://www.cancer.org/cancer/braincnstumorsinchildren/indexhttp://www.cancer.org/cancer/braincnstumorsinchildren/indexhttp://www.cancer.org/cancer/breastcancer/indexhttp://www.cancer.org/cancer/breastcancer/indexhttp://www.cancer.org/cancer/breastcancerinmen/indexhttp://www.cancer.org/cancer/breastcancerinmen/indexhttp://www.cancer.org/cancer/cancerinchildren/indexhttp://www.cancer.org/cancer/cancerinchildren/indexhttp://www.cancer.org/cancer/cancerofunknownprimary/indexhttp://www.cancer.org/cancer/cancerofunknownprimary/indexhttp://www.cancer.org/cancer/castlemandisease/indexhttp://www.cancer.org/cancer/castlemandisease/indexhttp://www.cancer.org/cancer/cervicalcancer/indexhttp://www.cancer.org/cancer/cervicalcancer/indexhttp://www.cancer.org/cancer/colonandrectumcancer/indexhttp://www.cancer.org/cancer/colonandrectumcancer/indexhttp://www.cancer.org/cancer/endometrialcancer/indexhttp://www.cancer.org/cancer/endometrialcancer/indexhttp://www.cancer.org/cancer/esophaguscancer/indexhttp://www.cancer.org/cancer/esophaguscancer/indexhttp://www.cancer.org/cancer/ewingfamilyoftumors/indexhttp://www.cancer.org/cancer/ewingfamilyoftumors/indexhttp://www.cancer.org/cancer/ewingfamilyoftumors/indexhttp://www.cancer.org/cancer/esophaguscancer/indexhttp://www.cancer.org/cancer/endometrialcancer/indexhttp://www.cancer.org/cancer/colonandrectumcancer/indexhttp://www.cancer.org/cancer/cervicalcancer/indexhttp://www.cancer.org/cancer/castlemandisease/indexhttp://www.cancer.org/cancer/cancerofunknownprimary/indexhttp://www.cancer.org/cancer/cancerinchildren/indexhttp://www.cancer.org/cancer/breastcancerinmen/indexhttp://www.cancer.org/cancer/breastcancer/indexhttp://www.cancer.org/cancer/braincnstumorsinchildren/indexhttp://www.cancer.org/cancer/braincnstumorsinadults/indexhttp://www.cancer.org/cancer/bonemetastasis/indexhttp://www.cancer.org/cancer/bonecancer/indexhttp://www.cancer.org/cancer/bladdercancer/indexhttp://www.cancer.org/cancer/bileductcancer/indexhttp://www.cancer.org/cancer/aplasticanemia/indexhttp://www.cancer.org/cancer/analcancer/indexhttp://www.cancer.org/cancer/advancedcancer/indexhttp://www.cancer.org/cancer/adrenalcorticalcancer/index
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Eye Cancer
Gallbladder Cancer
Gastrointestinal Carcinoid Tumors
Gastrointestinal Stromal Tumor (GIST)
Gestational Trophoblastic Disease
Hodgkin Disease
Kaposi Sarcoma
Kidney Cancer
Laryngeal and Hypopharyngeal Cancer
Leukemia - Acute Lymphocytic (ALL) in Adults
Leukemia - Acute Myeloid (AML)
Leukemia - Chronic Lymphocytic (CLL)
Leukemia - Chronic Myeloid (CML)
Leukemia - Chronic Myelomonocytic (CMML)
Leukemia in Children
Liver Cancer
Lung Cancer - Non-Small Cell
Lung Cancer - Small Cell
Lung Carcinoid Tumor
Lymphoma of the Skin
Malignant Mesothelioma
Multiple Myeloma
Myelodysplastic Syndrome
http://www.cancer.org/cancer/eyecancer/indexhttp://www.cancer.org/cancer/eyecancer/indexhttp://www.cancer.org/cancer/gallbladdercancer/indexhttp://www.cancer.org/cancer/gallbladdercancer/indexhttp://www.cancer.org/cancer/gastrointestinalcarcinoidtumor/indexhttp://www.cancer.org/cancer/gastrointestinalcarcinoidtumor/indexhttp://www.cancer.org/cancer/gastrointestinalstromaltumorgist/indexhttp://www.cancer.org/cancer/gastrointestinalstromaltumorgist/indexhttp://www.cancer.org/cancer/gestationaltrophoblasticdisease/indexhttp://www.cancer.org/cancer/gestationaltrophoblasticdisease/indexhttp://www.cancer.org/cancer/hodgkindisease/indexhttp://www.cancer.org/cancer/hodgkindisease/indexhttp://www.cancer.org/cancer/kaposisarcoma/indexhttp://www.cancer.org/cancer/kaposisarcoma/indexhttp://www.cancer.org/cancer/kidneycancer/indexhttp://www.cancer.org/cancer/kidneycancer/indexhttp://www.cancer.org/cancer/laryngealandhypopharyngealcancer/indexhttp://www.cancer.org/cancer/laryngealandhypopharyngealcancer/indexhttp://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/indexhttp://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/indexhttp://www.cancer.org/cancer/leukemia-acutemyeloidaml/indexhttp://www.cancer.org/cancer/leukemia-acutemyeloidaml/indexhttp://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/indexhttp://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/indexhttp://www.cancer.org/cancer/leukemia-chronicmyeloidcml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyeloidcml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyelomonocyticcmml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyelomonocyticcmml/indexhttp://www.cancer.org/cancer/leukemiainchildren/indexhttp://www.cancer.org/cancer/leukemiainchildren/indexhttp://www.cancer.org/cancer/livercancer/indexhttp://www.cancer.org/cancer/livercancer/indexhttp://www.cancer.org/cancer/lungcancer-non-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-non-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-smallcell/indexhttp://www.cancer.org/cancer/lungcarcinoidtumor/indexhttp://www.cancer.org/cancer/lungcarcinoidtumor/indexhttp://www.cancer.org/cancer/lymphomaoftheskin/indexhttp://www.cancer.org/cancer/lymphomaoftheskin/indexhttp://www.cancer.org/cancer/malignantmesothelioma/indexhttp://www.cancer.org/cancer/malignantmesothelioma/indexhttp://www.cancer.org/cancer/multiplemyeloma/indexhttp://www.cancer.org/cancer/multiplemyeloma/indexhttp://www.cancer.org/cancer/myelodysplasticsyndrome/indexhttp://www.cancer.org/cancer/myelodysplasticsyndrome/indexhttp://www.cancer.org/cancer/myelodysplasticsyndrome/indexhttp://www.cancer.org/cancer/multiplemyeloma/indexhttp://www.cancer.org/cancer/malignantmesothelioma/indexhttp://www.cancer.org/cancer/lymphomaoftheskin/indexhttp://www.cancer.org/cancer/lungcarcinoidtumor/indexhttp://www.cancer.org/cancer/lungcancer-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-non-smallcell/indexhttp://www.cancer.org/cancer/livercancer/indexhttp://www.cancer.org/cancer/leukemiainchildren/indexhttp://www.cancer.org/cancer/leukemia-chronicmyelomonocyticcmml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyeloidcml/indexhttp://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/indexhttp://www.cancer.org/cancer/leukemia-acutemyeloidaml/indexhttp://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/indexhttp://www.cancer.org/cancer/laryngealandhypopharyngealcancer/indexhttp://www.cancer.org/cancer/kidneycancer/indexhttp://www.cancer.org/cancer/kaposisarcoma/indexhttp://www.cancer.org/cancer/hodgkindisease/indexhttp://www.cancer.org/cancer/gestationaltrophoblasticdisease/indexhttp://www.cancer.org/cancer/gastrointestinalstromaltumorgist/indexhttp://www.cancer.org/cancer/gastrointestinalcarcinoidtumor/indexhttp://www.cancer.org/cancer/gallbladdercancer/indexhttp://www.cancer.org/cancer/eyecancer/index
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Nasal Cavity and Paranasal Sinus Cancer
Nasopharyngeal Cancer
Neuroblastoma
Non-Hodgkin Lymphoma
Non-Hodgkin Lymphoma In Children
Oral Cavity and Oropharyngeal Cancer
Osteosarcoma
Ovarian Cancer
Pancreatic Cancer
Penile Cancer
Pituitary Tumors
Prostate Cancer
Retinoblastoma
Rhabdomyosarcoma
Salivary Gland Cancer
Sarcoma - Adult Soft Tissue Cancer
Skin Cancer - Basal and Squamous Cell
Skin Cancer - Melanoma
Small Intestine Cancer
Stomach Cancer
Testicular Cancer
Thymus Cancer
Thyroid Cancer
http://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/indexhttp://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/indexhttp://www.cancer.org/cancer/nasopharyngealcancer/indexhttp://www.cancer.org/cancer/nasopharyngealcancer/indexhttp://www.cancer.org/cancer/neuroblastoma/indexhttp://www.cancer.org/cancer/neuroblastoma/indexhttp://www.cancer.org/cancer/non-hodgkinlymphoma/indexhttp://www.cancer.org/cancer/non-hodgkinlymphoma/indexhttp://www.cancer.org/cancer/non-hodgkinlymphomainchildren/indexhttp://www.cancer.org/cancer/non-hodgkinlymphomainchildren/indexhttp://www.cancer.org/cancer/oralcavityandoropharyngealcancer/indexhttp://www.cancer.org/cancer/oralcavityandoropharyngealcancer/indexhttp://www.cancer.org/cancer/osteosarcoma/indexhttp://www.cancer.org/cancer/osteosarcoma/indexhttp://www.cancer.org/cancer/ovariancancer/indexhttp://www.cancer.org/cancer/ovariancancer/indexhttp://www.cancer.org/cancer/pancreaticcancer/indexhttp://www.cancer.org/cancer/pancreaticcancer/indexhttp://www.cancer.org/cancer/penilecancer/indexhttp://www.cancer.org/cancer/penilecancer/indexhttp://www.cancer.org/cancer/pituitarytumors/indexhttp://www.cancer.org/cancer/pituitarytumors/indexhttp://www.cancer.org/cancer/prostatecancer/indexhttp://www.cancer.org/cancer/prostatecancer/indexhttp://www.cancer.org/cancer/retinoblastoma/indexhttp://www.cancer.org/cancer/retinoblastoma/indexhttp://www.cancer.org/cancer/rhabdomyosarcoma/indexhttp://www.cancer.org/cancer/rhabdomyosarcoma/indexhttp://www.cancer.org/cancer/salivaryglandcancer/indexhttp://www.cancer.org/cancer/salivaryglandcancer/indexhttp://www.cancer.org/cancer/sarcoma-adultsofttissuecancer/indexhttp://www.cancer.org/cancer/sarcoma-adultsofttissuecancer/indexhttp://www.cancer.org/cancer/skincancer-basalandsquamouscell/indexhttp://www.cancer.org/cancer/skincancer-basalandsquamouscell/indexhttp://www.cancer.org/cancer/skincancer-melanoma/indexhttp://www.cancer.org/cancer/skincancer-melanoma/indexhttp://www.cancer.org/cancer/smallintestinecancer/indexhttp://www.cancer.org/cancer/smallintestinecancer/indexhttp://www.cancer.org/cancer/stomachcancer/indexhttp://www.cancer.org/cancer/stomachcancer/indexhttp://www.cancer.org/cancer/testicularcancer/indexhttp://www.cancer.org/cancer/testicularcancer/indexhttp://www.cancer.org/cancer/thymuscancer/indexhttp://www.cancer.org/cancer/thymuscancer/indexhttp://www.cancer.org/cancer/thyroidcancer/indexhttp://www.cancer.org/cancer/thyroidcancer/indexhttp://www.cancer.org/cancer/thyroidcancer/indexhttp://www.cancer.org/cancer/thymuscancer/indexhttp://www.cancer.org/cancer/testicularcancer/indexhttp://www.cancer.org/cancer/stomachcancer/indexhttp://www.cancer.org/cancer/smallintestinecancer/indexhttp://www.cancer.org/cancer/skincancer-melanoma/indexhttp://www.cancer.org/cancer/skincancer-basalandsquamouscell/indexhttp://www.cancer.org/cancer/sarcoma-adultsofttissuecancer/indexhttp://www.cancer.org/cancer/salivaryglandcancer/indexhttp://www.cancer.org/cancer/rhabdomyosarcoma/indexhttp://www.cancer.org/cancer/retinoblastoma/indexhttp://www.cancer.org/cancer/prostatecancer/indexhttp://www.cancer.org/cancer/pituitarytumors/indexhttp://www.cancer.org/cancer/penilecancer/indexhttp://www.cancer.org/cancer/pancreaticcancer/indexhttp://www.cancer.org/cancer/ovariancancer/indexhttp://www.cancer.org/cancer/osteosarcoma/indexhttp://www.cancer.org/cancer/oralcavityandoropharyngealcancer/indexhttp://www.cancer.org/cancer/non-hodgkinlymphomainchildren/indexhttp://www.cancer.org/cancer/non-hodgkinlymphoma/indexhttp://www.cancer.org/cancer/neuroblastoma/indexhttp://www.cancer.org/cancer/nasopharyngealcancer/indexhttp://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/index
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Uterine Sarcoma
Vaginal Cancer
Vulvar Cancer
Waldenstrom Macroglobulinemia
Wilms Tumor
http://www.cancer.org/cancer/uterinesarcoma/indexhttp://www.cancer.org/cancer/uterinesarcoma/indexhttp://www.cancer.org/cancer/vaginalcancer/indexhttp://www.cancer.org/cancer/vaginalcancer/indexhttp://www.cancer.org/cancer/vulvarcancer/indexhttp://www.cancer.org/cancer/vulvarcancer/indexhttp://www.cancer.org/cancer/waldenstrommacroglobulinemia/indexhttp://www.cancer.org/cancer/waldenstrommacroglobulinemia/indexhttp://www.cancer.org/cancer/wilmstumor/indexhttp://www.cancer.org/cancer/wilmstumor/indexhttp://www.cancer.org/cancer/wilmstumor/indexhttp://www.cancer.org/cancer/waldenstrommacroglobulinemia/indexhttp://www.cancer.org/cancer/vulvarcancer/indexhttp://www.cancer.org/cancer/vaginalcancer/indexhttp://www.cancer.org/cancer/uterinesarcoma/index
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CHAPTER 5.Breast Cancer in Western Medicine
Breast cancer
Many women are concerned that breast cancer seems to run in their family. A woman who
has a first-degree relative (a mother, sister, or daughter) with breast cancer is about twice
as likely to develop breast cancer as a woman without a family history of this cancer. Still,
most cases of breast cancer, even those in close relatives, are not part of a family cancer
syndrome caused by an inherited gene mutation.
The chance that someone has an inherited form of breast cancer is higher the younger they
are when they get the cancer and the more relatives they have with the disease. Inherited
breast cancer can be caused by several different genes, but the most common
are BRCA1 and BRCA2. Inherited mutations in these genes cause hereditary breast and
ovarian cancer syndrome (HBOC). Along with breast and ovarian cancer, this syndrome
can also lead to male breast cancer, pancreatic cancer, prostate cancer, as well as some
others. This syndrome is more common in women of Ashkenazi Jewish descent than it is
in the general US population.
Women with a strong family history of breast cancer may choose to undergo genetic
counseling to estimate their risk for inherited breast cancer. They then can choose to be
tested to find out if they have a breast cancer gene mutation. If a mutation is present, the
woman has a high risk of developing breast cancer. She may start getting mammograms at
an age younger than 40, have special breast cancer screening tests, or take other measures
to try to reduce her risk of getting breast cancer.
What is breast cancer in western medicine?
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Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor
is a group of cancer cells that can grow into (invade) surrounding tissues or spread
(metastasize) to distant areas of the body. The disease occurs almost entirely in women,
but men can get it, too.
To understand breast cancer, it helps to have some basic knowledge about the normal
structure of the breasts, shown in the diagram below.
The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes
that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective
tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).
Most breast cancers begin in the cells that line the ducts (ductal cancers). Some begin in
the cells that line the lobules (lobular cancers), while a small number start in other tissues.
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The lymph (lymphatic) system of the breast
The lymph system is important to understand because it is one way breast cancers can
spread. This system has several parts.
Lymph nodes are small, bean-shaped collections of immune system cells (cells that are
important in fighting infections) that are connected by lymphatic vessels. Lymphatic
vessels are like small veins, except that they carry a clear fluid called lymph (instead of
blood) away from the breast. Lymph contains tissue fluid and waste products, as well as
immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in
lymph nodes.
Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary
nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal
mammary nodes) and those either above or below the collarbone
( supraclavicular or infraclavicular nodes).
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If the cancer cells have spread to lymph nodes, there is a higher chance that the cells could
have also gotten into the bloodstream and spread (metastasized) to other sites in the body.
The more lymph nodes that have breast cancer, the more likely it is that the cancer may be
found in other organs as well. Because of this, finding cancer in one or more lymph nodes
often affects the treatment plan. Still, not all women with cancer cells in their lymph nodes
develop metastases, and some women can have no cancer cells in their lymph nodes and
later develop metastases.
Benign breast lumps
Most breast lumps are not cancerous (benign). Still, some may need to be sampled and
viewed under a microscope to prove they are not cancer.
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Fibrocystic changes
Most lumps turn out to be fibrocystic changes. The term fibrocystic refers to fibrosis and
cysts. Fibrosis is the formation of scar-like (fibrous) tissue, and cysts are fluid-filled sacs.
Fibrocystic changes can cause breast swelling and pain. This often happens just before a
woman's menstrual period is about to begin. Her breasts may feel lumpy and, sometimes,
she may notice a clear or slightly cloudy nipple discharge.
Other benign breast lumps
Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal
growths, but they are not cancerous and do not spread outside the breast to other organs.
They are not life threatening. Still, some benign breast conditions are important because
women with these conditions have a higher risk of developing breast cancer.
General breast cancer terms
Here are some of the key words used to describe breast cancer.
Carcinoma
This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of
organs like the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas
or lobular carcinomas).
Adenocarcinoma
An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes
and secretes a substance). The ducts and lobules of the breast are glandular tissue (they
make breast milk), so cancers starting in these areas are often called adenocarcinomas.
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Carcinoma in situ
This term is used for an early stage of cancer, when it is confined to the layer of cells where
it began. In breast cancer, in situ means that the cancer cells remain confined to ducts
(ductal carcinoma in situ). The cells have not grown into (invaded ) deeper tissues in the
breast or spread to other organs in the body. Carcinoma in situ of the breast is sometimes
referred to as non-invasive or pre-invasive breast cancer because it may develop into an
invasive breast cancer if left untreated.
When cancer cells are confined to the lobules it is called lobular carcinoma in situ. This is
not actually a true cancer or pre-cancer.
Invasive (infiltrating) carcinoma
An invasive cancer is one that has already grown beyond the layer of cells where it started
(as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas — either
invasive ductal carcinoma or invasive lobular carcinoma.
Sarcoma
Sarcomas are cancers that start in connective tissues such as muscle tissue, fat tissue, or
blood vessels. Sarcomas of the breast are rare.
Types of breast cancers
There are several types of breast cancer, but some of them are quite rare. In some cases a
single breast tumor can be a combination of these types or be a mixture of invasive and in
situ cancer.
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Ductal carcinoma in situ
Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common
type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts
but have not spread through the walls of the ducts into the surrounding breast tissue.
About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this
early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS
early.
When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from
tissue samples) will look for areas of dead or dying cancer cells, called tumor necrosis,
within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive.
The term comedocarcinoma is often used to describe DCIS with necrosis.
Invasive (or infiltrating) ductal carcinoma
This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma
(IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and
grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize)
to other parts of the body through the lymphatic system and bloodstream. About 8 of 10
invasive breast cancers are infiltrating ductal carcinomas.
Invasive (or infiltrating) lobular carcinoma
Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC,
it can spread (metastasize) to other parts of the body. About 1 in 10 invasive breast cancers
is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than
invasive ductal carcinoma.
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Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads
to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare,
accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola
often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may
notice burning or itching.
Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue)
of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names
for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are
usually benign but on rare occasions may be malignant.
Benign phyllodes tumors are treated by removing the tumor along with a margin of normal
breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider
margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but these
cancers may not respond as well to the other treatments used for more common breast
cancers. When a malignant phyllodes tumor has spread, it can be treated with the
chemotherapy given for soft-tissue sarcomas.
Angiosarcoma: This is a form of cancer that starts in cells that line blood vessels or lymph
vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication
of previous radiation treatments. This is an extremely rare complication of breast radiation
therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur
in the arms of women who develop lymphedema as a result of lymph node surgery or
radiation therapy to treat breast cancer.
What are the risk factors for breast cancer?
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A risk factor is anything that affects your chance of getting a disease, such as cancer.
Different cancers have different risk factors. For example, exposing skin to strong sunlight
is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth,
larynx (voice box), bladder, kidney, and several other organs.
But risk factors don't tell us everything. Having a risk factor, or even several, does not
mean that you will get the disease. Most women who have one or more breast cancer risk
factors never develop the disease, while many women with breast cancer have no apparent
risk factors (other than being a woman and growing older). Even when a woman with risk
factors develops breast cancer, it is hard to know just how much these factors may have
contributed to her cancer.
There are different kinds of risk factors. Some factors, like a person's age or race, can't be
changed. Others are linked to cancer-causing factors in the environment. Still others are
related personal behaviors, such as smoking, drinking, and diet. Some factors influence
risk more than others, and your risk for breast cancer can change over time, due to factors
such as aging or lifestyle.
Risk factors you cannot change
Gender
Simply being a woman is the main risk factor for developing breast cancer. Men can
develop breast cancer, but this disease is about 100 times more common among women
than men. This is likely because men have less of the female hormones estrogen and
progesterone, which can promote breast cancer cell growth
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Aging
Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive
breast cancers are found in women younger than 45, while about 2 of 3 invasive breast
cancers are found in women age 55 or older.
Genetic risk factors
About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly
from gene defects (called mutations) inherited from a parent.
BRCA1 and BRCA2 : The most common cause of hereditary breast cancer is an inherited
mutation in the BRCA1 and BRCA2genes. In normal cells, these genes help prevent cancer
by making proteins that keep the cells from growing abnormally. If you have inherited a
mutated copy of either gene from a parent, you have a high risk of developing breast cancer
during your lifetime. The risk may be as high as 80% for members of some families
with BRCA mutations. These cancers tend to occur in younger women and more often
affect both breasts than cancers in women who are not born with one of these gene
mutations. Women with these inherited mutations also have an increased risk for
developing other cancers, particularly ovarian cancer.
In the United States BRCA mutations are found most often in Jewish women of Ashkenazi
(Eastern Europe) origin, but they can occur in any racial or ethnic group.
Changes in other genes: Other gene mutations can also lead to inherited breast cancers.
These gene mutations are much rarer and often do not increase the risk of breast cancer as
much as the BRCA genes. They are not frequent causes of inherited breast cancer.
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were still developing. Radiation treatment after age 40 does not seem to increase breast
cancer risk.
Diethylstilbestrol exposure
From the 1940s through the 1960s some pregnant women were given the drug
diethylstilbestrol (DES) because it was thought to lower their chances of miscarriage
(losing the baby). These women have a slightly increased risk of developing breast cancer.
Women whose mothers took DES during pregnancy may also have a slightly higher risk
of breast cancer.
Lif estyle-related factors and breast cancer r isk
Having children
Women who have had no children or who had their first child after age 30 have a slightly
higher breast cancer risk. Having many pregnancies and becoming pregnant at a young age
reduce breast cancer risk. Pregnancy reduces a woman's total number of lifetime menstrual
cycles, which may be the reason for this effect.
Recent oral contraceptive use
Studies have found that women using oral contraceptives (birth control pills) have a slightly
greater risk of breast cancer than women who have never used them. This risk seems to go
back to normal over time once the pills are stopped. Women who stopped using oral
contraceptives more than 10 years ago do not appear to have any increased breast cancer
risk. When thinking about using oral contraceptives, women should discuss their other risk
factors for breast cancer with their health care team.
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especially in countries such as the United States, where breast-feeding for this long is
uncommon.
One explanation for this possible effect may be that breast-feeding reduces a woman's total
number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or
going through early menopause).
Alcohol
The use of alcohol is clearly linked to an increased risk of developing breast cancer. The
risk increases with the amount of alcohol consumed. Compared with non-drinkers, women
who consume 1 alcoholic drink a day have a very small increase in risk. Those who have
2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. Excessive
alcohol use is also known to increase the risk of developing several other types of cancer.
Being overweight or obese
Being overweight or obese has been found to increase breast cancer risk, especially for
women after menopause. Before menopause your ovaries produce most of your estrogen,
and fat tissue produces a small amount of estrogen. After menopause (when the ovaries
stop making estrogen), most of a woman's estrogen comes from fat tissue. Having more fat
tissue after menopause can increase your chance of getting breast cancer by raising
estrogen levels. Also, women who are overweight tend to have higher blood insulin levels.
Higher insulin levels have also been linked to some cancers, including breast cancer.
But the connection between weight and breast cancer risk is complex. For example, the
risk appears to be increased for women who gained weight as an adult but may not be
increased among those who have been overweight since childhood. Also, excess fat in the
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waist area may affect risk more than the same amount of fat in the hips and thighs.
Researchers believe that fat cells in various parts of the body have subtle differences that
may explain this.
Physical activity
Evidence is growing that physical activity in the form of exercise reduces breast cancer
risk. The main question is how much exercise is needed. In one study from the Women's
Health Initiative (WHI) as little as 1.25 to 2.5 hours per week of brisk walking reduced a
woman's risk by 18%. Walking 10 hours a week reduced the risk a little more.
Factors with uncertain, contr oversial , or unproven effect on breast cancer r isk
Diet and vitamin intake
Many studies have looked for a link between what women eat and breast cancer risk, but
so far the results have been conflicting. Some studies have indicated that diet may play a
role, while others found no evidence that diet influences breast cancer risk. Studies have
looked at the amount of fat in the diet, intake of fruits and vegetables, and intake of meat.
No clear link to breast cancer risk was found.
Studies have also looked at vitamin levels, again with inconsistent results. Some studies
actually found an increased risk of breast cancer in women with higher levels of certain
nutrients. So far, no study has shown that taking vitamins reduces breast cancer risk. This
is not to say that there is no point in eating a healthy diet. A diet low in fat, low in red meat
and processed meat, and high in fruits and vegetables may have other health benefits.
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Breast implants
Several studies have found that breast implants do not increase breast cancer risk, although
silicone breast implants can cause scar tissue to form in the breast. Implants make it harder
to see breast tissue on standard mammograms, but additional x-ray pictures called implant
displacement views can be used to examine the breast tissue more completely.
Chemicals in the environment
A great deal of research has been reported and more is being done to understand possible
environmental influences on breast cancer risk.
Of special interest are compounds in the environment that studies in lab animals have found
to have estrogen-like properties. These could in theory affect breast cancer risk. For
example, substances found in some plastics, certain cosmetics and personal care products,
pesticides (such as DDE), and PCBs (polychlorinated biphenyls) seem to have such
properties.
Tobacco smoke
For a long time, studies found no link between cigarette smoking and breast cancer. In
recent years though, some studies have found that smoking may increase the risk of breast
cancer. The increased risk seems to affect certain groups, such as women who started
smoking when they were young. In 2009, the International Agency for Research on Cancer
concluded that there is limited evidence that tobacco smoking causes breast cancer.
An active focus of research is whether secondhand smoke increases the risk of breast
cancer. Both mainstream and secondhand smoke contain chemicals that, in high
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concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast
tissue and are found in breast milk.
The evidence on secondhand smoke and breast cancer risk in human studies is
controversial, at least in part because smokers have not been shown to be at increased risk.
One possible explanation for this is that tobacco smoke may have different effects on breast
cancer risk in smokers and in those who are just exposed to smoke.
Night work
Several studies have suggested that women who work at night — for example, nurses on a
night shift — may have an increased risk of developing breast cancer. This is a fairly recent
finding, and more studies are looking at this issue. Some researchers think the effect may
be due to changes in levels of melatonin, a hormone whose production is affected by the
body's exposure to light, but other hormones are also being studied.
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CHAPTER 6. Mammograms and Self-Exam
Mammograms and Self-Exam
A mammogram is an x-ray of the breast. A diagnostic mammogram is used to diagnose
breast disease in women who have breast symptoms or an abnormal result on a screening
mammogram. Screening mammograms are used to look for breast disease in women who
are asymptomatic; that is, they appear to have no breast problems. Screening mammograms
usually take 2 views (x-ray pictures taken from different angles) of each breast. For some
patients, such as women with breast implants, more pictures may be needed to include as
much breast tissue as possible. Women who are breast-feeding can still get mammograms,
but these are probably not quite as accurate because the breast tissue tends to be dense.
What the doctor looks for on your mammogram
The doctor reading the mammogram will look for several types of changes:
Calcifications are tiny mineral deposits within the breast tissue, which look like small white
spots on the films. They may or may not be caused by cancer. There are 2 types of
calcifications:
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Macrocalcifications are coarse (larger) calcium deposits that are most likely changes in
the breasts caused by aging of the breast arteries, old injuries, or inflammation. These
deposits are related to non-cancerous conditions and do not require a biopsy.
Macrocalcifications are found in about half the women over 50, and in about 1 of 10
women under 50.
Microcalcifications are tiny specks of calcium in the breast. They may appear alone or in
clusters. Microcalcifications seen on a mammogram are of more concern, but still usually
do not mean that cancer is present. The shape and layout of microcalcifications help the
radiologist judge how likely it is that cancer is present. If the calcifications look
suspicious for cancer, a biopsy will be done.
A mass, which may occur with or without calcifications, is another important change seen
on a mammogram. Masses can be many things, including cysts (non-cancerous, fluid-filled
sacs) and non-cancerous solid tumors (such as fibroadenomas), but they could also be
cancer.
Cysts can be simple fluid-filled sacs (known as simple cysts) or can be partially solid
(known as complex cysts). Simple cysts are benign and don’t need to be biopsied. Any
other type of mass (such as a complex cyst or a solid tumor) might need to be biopsied to
be sure it isn’t cancer.
A cyst and a tumor can feel alike on a physical exam. They can also look the same on a
mammogram. To confirm that a mass is really a cyst, a breast ultrasound is often done.
Another option is to remove (aspirate) the fluid from the cyst with a thin, hollow needle.
If a mass is not a simple cyst (that is, if it is at least partly solid), then you may need to
have more imaging tests. Some masses can be watched with periodic mammograms,
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while others may need a biopsy. The size, shape, and margins (edges) of the mass help
the radiologist determine if cancer is present.
Limitations of mammograms
A mammogram cannot prove that an abnormal area is cancer. To confirm whether cancer
is present, a small amount of tissue must be removed and looked at under a microscope.
This procedure, called a biopsy.
Clinical breast exam
A clinical breast exam (CBE) is an exam of your breasts by a health care professional, such
as a doctor, nurse practitioner, nurse, or doctor's assistant. For this exam, you undress from
the waist up. The health care professional will first look at your breasts for abnormalities
in size or shape, or changes in the skin of the breasts or nipple. Then, using the pads of the
fingers, the examiner will gently feel (palpate) your breasts.
Special attention will be given to the shape and texture of the breasts, location of any lumps,
and whether such lumps are attached to the skin or to deeper tissues. The area under both
arms will also be examined.
The CBE is a good time for women who don't know how to examine their breasts to learn
the proper technique from their health care professionals. Ask your doctor or nurse to teach
you and watch your technique.
Breast awareness and self exam
Beginning in their 20s, women should be told about the benefits and limitations of breast
self-exam (BSE). Women should know how their breasts normally look and feel and report
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any new breast changes to a health professional as soon as they are found. Finding a breast
change does not necessari