Breast cancer is cancer that develops from breast tissue. Signs of
breast cancer may include a lump in the breast, a change in breast
shape, dimpling of the skin, fluid coming from the nipple, a newly
inverted nipple, or a red or scaly patch of skin. In those with
distant spread of the disease, there may be bone pain, swollen lymph
nodes, shortness of breath, or yellow skin.
Risk factors for developing breast cancer include being female,
obesity, lack of physical exercise, drinking alcohol, hormone
replacement therapy during menopause, ionizing radiation, early age at
first menstruation, having children late or not at all, older age,
prior history of breast cancer, and family history. About
5–10% of cases are due to genes inherited from a person's
BRCA2 among others.
most commonly develops in cells from the lining of milk ducts and the
lobules that supply the ducts with milk.
Cancers developing from
the ducts are known as ductal carcinomas, while those developing from
lobules are known as lobular carcinomas. In addition, there are
more than 18 other sub-types of breast cancer. Some cancers, such
as ductal carcinoma in situ, develop from pre-invasive lesions. The
diagnosis of breast cancer is confirmed by taking a biopsy of the
concerning lump. Once the diagnosis is made, further tests are done
to determine if the cancer has spread beyond the breast and which
treatments it may respond to.
The balance of benefits versus harms of breast cancer screening is
controversial. A 2013
Cochrane review stated that it is unclear if
mammographic screening does more good or harm. A 2009 review for
US Preventive Services Task Force found evidence of benefit in
those 40 to 70 years of age, and the organization recommends
screening every two years in women 50 to 74 years old. The
medications tamoxifen or raloxifene may be used in an effort to
prevent breast cancer in those who are at high risk of developing
it. Surgical removal of both breasts is another preventative
measure in some high risk women. In those who have been diagnosed
with cancer, a number of treatments may be used, including surgery,
radiation therapy, chemotherapy, hormonal therapy and targeted
therapy. Types of surgery vary from breast-conserving surgery to
Breast reconstruction may take place at the time
of surgery or at a later date. In those in whom the cancer has
spread to other parts of the body, treatments are mostly aimed at
improving quality of life and comfort.
Outcomes for breast cancer vary depending on the cancer type, extent
of disease, and person's age. Survival rates in the developed
world are high, with between 80% and 90% of those in England and
the United States alive for at least 5 years. In developing
countries survival rates are poorer. Worldwide, breast cancer is
the leading type of cancer in women, accounting for 25% of all
cases. In 2012 it resulted in 1.68 million new cases and 522,000
deaths. It is more common in developed countries and is more
than 100 times more common in women than in men.
1 Signs and symptoms
2 Risk factors
2.3 Medical conditions
5.2 Pre-emptive surgery
8.1 Prognostic factors
8.2 Psychological aspects
11 Society and culture
11.1 Pink ribbon
Breast cancer culture
13.1 Birth control
Menopausal hormone replacement
Breast cancer cell lines
14.3 Molecular markers
14.3.1 Transcription factors
14.3.2 Metabolic markers
15 Other animals
17 External links
Signs and symptoms
Breast cancer showing an inverted nipple, lump, and skin dimpling.
The first noticeable symptom of breast cancer is typically a lump 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
Indications of breast cancer other than a lump may include thickening
different from the other breast tissue, one breast becoming larger or
lower, a nipple changing position or shape or becoming inverted, skin
puckering or dimpling, a rash on or around a nipple, discharge from
nipple/s, constant pain in part of the breast or armpit, and swelling
beneath the armpit or around the collarbone. Pain ("mastodynia")
is an unreliable tool in determining the presence or absence of breast
cancer, but may be indicative of other breast health
Inflammatory breast cancer 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. As
inflammatory breast cancer does not present as a lump there can
sometimes be a delay in diagnosis.
Another reported symptom complex of breast cancer is Paget's disease
of the breast. This syndrome presents as skin changes resembling
eczema, such as redness, discoloration, or mild flaking of the nipple
Paget's disease of the breast
Paget's disease of the breast advances, symptoms may include
tingling, itching, increased sensitivity, burning, and pain. There may
also be discharge from the nipple. Approximately half of women
Paget's disease of the breast
Paget's disease of the breast also have a lump in the
In rare cases, what initially appears as a fibroadenoma (hard, movable
non-cancerous lump) could in fact be a phyllodes 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
Occasionally, breast cancer presents as metastatic disease—that is,
cancer that has spread beyond the original organ. The symptoms caused
by metastatic breast cancer will depend on the location of metastasis.
Common sites of metastasis include bone, liver, lung and brain.
Unexplained weight loss can occasionally signal 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. Fewer than 20% of lumps,
for example, are cancerous, and benign breast diseases such as
mastitis and fibroadenoma 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
Main article: Risk factors of breast cancer
Risk factors can be divided into two categories:
modifiable risk factors (things that people can change themselves,
such as consumption of alcoholic beverages), and
fixed risk factors (things that cannot be changed, such as age and
The primary risk factors for breast cancer are being female and older
age. Other potential risk factors include genetics, lack of
childbearing or lack of breastfeeding, higher levels of certain
hormones, certain dietary patterns, and obesity. One study
indicates that exposure to light pollution is a risk factor for the
development of breast cancer.
See also: List of breast carcinogenic substances
Smoking tobacco appears to increase the risk of breast cancer, with
the greater the amount smoked and the earlier in life that smoking
began, the higher the risk. In those who are long-term smokers,
the risk is increased 35% to 50%. A lack of physical activity has
been linked to about 10% of cases.
Sitting regularly for prolonged
periods is associated with higher mortality from breast cancer. The
risk is not negated by regular exercise, though it is lowered.
There is an association between use of hormonal birth control and the
development of premenopausal breast cancer, but whether oral
contraceptives use may actually cause premenopausal breast cancer is a
matter of debate. If there is indeed a link, the absolute effect
is small. Additionally, it is not clear if the association
exists with newer hormonal birth controls. In those with mutations
in the breast cancer susceptibility genes
BRCA1 or BRCA2, or who have
a family history of breast cancer, use of modern oral contraceptives
does not appear to affect the risk of breast cancer.
The association between breast feeding and breast cancer has not been
clearly determined; some studies have found support for an association
while others have not. In the 1980s, the abortion–breast cancer
hypothesis posited that induced abortion increased the risk of
developing breast cancer. This hypothesis was the subject of
extensive scientific inquiry, which concluded that neither
miscarriages nor abortions are associated with a heightened risk for
A number of dietary factors have been linked to the risk for breast
cancer. Dietary factors which may increase risk include a high fat
diet, high alcohol intake, and obesity-related high
cholesterol levels. Dietary iodine deficiency may also play a
role. Evidence for fiber is unclear. A 2015 review found that
studies trying to link fiber intake with breast cancer produced mixed
results. In 2016 a tentative association between low fiber intake
during adolescence and breast cancer was observed.
Other risk factors include radiation and shift-work. A number
of chemicals have also been linked, including polychlorinated
biphenyls, polycyclic aromatic hydrocarbons, and organic solvents
Although the radiation from mammography is a low dose, it is estimated
that yearly screening from 40 to 80 years of age will cause
approximately 225 cases of fatal breast cancer per million women
Some genetic susceptibility may play a minor role in most cases.
Overall, however, genetics is believed to be the primary cause of
5–10% of all cases. Women whose mother was diagnosed before 50
have an increased risk of 1.7 and those whose mother was diagnosed at
age 50 or after has an increased risk of 1.4. In those with zero,
one or two affected relatives, the risk of breast cancer before the
age of 80 is 7.8%, 13.3%, and 21.1% with a subsequent mortality from
the disease of 2.3%, 4.2%, and 7.6% respectively. In those with a
first degree relative with the disease the risk of breast cancer
between the age of 40 and 50 is double that of the general
In less than 5% of cases, genetics plays a more significant role by
causing a hereditary breast–ovarian cancer syndrome. This
includes those who carry the
BRCA2 gene mutation. These
mutations account for up to 90% of the total genetic influence with a
risk of breast cancer of 60–80% in those affected. Other
significant mutations include p53 (Li–Fraumeni syndrome), PTEN
(Cowden syndrome), and STK11 (Peutz–Jeghers syndrome), CHEK2, ATM,
BRIP1, and PALB2. In 2012, researchers said that there are four
genetically distinct types of the breast cancer and that in each type,
hallmark genetic changes lead to many cancers.
Breast changes like atypical ductal hyperplasia and lobular
carcinoma in situ, found in benign breast conditions such
as fibrocystic breast changes, are correlated with an increased breast
Diabetes mellitus might also increase the risk of breast
cancer. Autoimmune diseases such as lupus erythematosus seem also
to increase the risk for the acquisition of breast cancer.
Main article: Carcinogenesis
Overview of signal transduction pathways involved in programmed cell
death. Mutations leading to loss of this ability can lead to cancer
Breast cancer, like other cancers, occurs because of an interaction
between an environmental (external) factor and a genetically
susceptible host. 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 they lose their ability to stop dividing, to
attach to other cells, to stay where they belong, and to die at the
Normal cells will commit cell suicide (programmed cell death) 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 pathway; another is the
RAS/MEK/ERK 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 protein turns off
AKT pathway when the cell is ready for programmed cell death.
In some breast cancers, the gene for the PTEN protein is mutated, so
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.
Abnormal growth factor signaling in the interaction between stromal
cells 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 people with breast cancer
and people 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 mutations, 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. Some mutations associated
with cancer, such as p53,
BRCA1 and BRCA2, occur in mechanisms to
correct errors in DNA. These mutations are either inherited or
acquired after birth. Presumably, they allow further mutations, which
allow uncontrolled division, lack of attachment, and metastasis to
distant organs. However, there is strong evidence of residual
risk variation that goes well beyond hereditary BRCA gene mutations
between carrier families. This is caused by unobserved risk
factors. This implicates environmental and other causes as
triggers for breast cancers. The inherited mutation in
BRCA1 or BRCA2
genes can interfere with repair of DNA cross links and DNA double
strand breaks (known functions of the encoded protein). These
carcinogens cause DNA damage such as DNA cross links and double strand
breaks that often require repairs by pathways containing
BRCA2. However, mutations in BRCA genes account for only 2 to
3 percent of all breast cancers. Levin et al. say that cancer may
not be inevitable for all carriers of
About half of hereditary breast–ovarian cancer syndromes involve
GATA-3 directly controls the expression of estrogen receptor (ER) and
other genes associated with epithelial differentiation, and the loss
GATA-3 leads to loss of differentiation and poor prognosis due to
cancer cell invasion and metastasis.
Early signs of possible breast cancer
Most types of breast cancer are easy to diagnose by microscopic
analysis of a sample—or biopsy—of the affected area of the breast.
Also, there are types of breast cancer that require specialized lab
The two most commonly used screening methods, physical examination of
the breasts by a healthcare provider and mammography, can offer an
approximate likelihood that a lump is cancer, and may also detect some
other lesions, such as a simple cyst. When these examinations are
inconclusive, a healthcare provider can remove a sample of the fluid
in the lump for microscopic analysis (a procedure known as fine needle
aspiration, or fine needle aspiration and cytology—FNAC) to help
establish the diagnosis. The needle aspiration may be performed in a
healthcare provider's office or clinic using local anaesthetic if
required.[clarification needed] A finding of 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,
physical examination of the breasts, mammography, and FNAC can be used
to diagnose breast cancer with a good degree of accuracy.
Other options for biopsy include a core biopsy or vacuum-assisted
breast biopsy, which are procedures in which a section of the
breast lump is removed; or an excisional biopsy, in which the entire
lump is removed. Very often the results of physical examination by a
healthcare provider, mammography, and additional tests that may be
performed in special circumstances (such as imaging by ultrasound or
MRI) are sufficient to warrant excisional biopsy as the definitive
diagnostic and primary treatment method.
MRI showing breast cancer
Excised human breast tissue, showing an irregular, dense, white
stellate area of cancer 2 cm in diameter, within yellow fatty
High-grade invasive ductal carcinoma, with minimal tubule formation,
marked pleomorphism, and prominent mitoses, 40x field.
Micrograph showing a lymph node invaded by ductal breast carcinoma,
with an extension of the tumor beyond the lymph node.
Neuropilin-2 expression in normal breast and breast carcinoma tissue.
F-18 FDG PET/CT: A breast cancer metastasis to the right scapula
Needle breast biopsy.
Elastography shows stiff cancer tissue on ultrasound imaging.
Ultrasound image shows irregularly shaped mass of breast cancer.
Infiltrating (Invasive) breast carcinoma.
Breast cancer classification
Breast cancers are classified by several grading systems. Each of
these influences the prognosis and can affect treatment response.
Description of a breast cancer optimally includes all of these
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 (the ones whose tissue is least like normal
breast tissue) have a worse prognosis.
Breast cancer staging using the TNM system is based on the size
of the tumor (T), whether or not the tumor has spread to the lymph
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
The main stages are:
Stage 0 is a pre-cancerous or marker condition, either ductal
carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).
Stages 1–3 are within the breast or regional lymph nodes.
Stage 4 is 'metastatic' cancer that has a less favorable prognosis
since it has spread beyond the breast and regional lymph nodes.
Stage T1 breast cancer
Stage T2 breast cancer
Stage T3 breast cancer
Where available, imaging studies may be employed as part of the
staging process in select cases to look for signs of metastatic
cancer. However, in cases of breast cancer with low risk for
metastasis, the risks associated with PET scans, CT scans, or bone
scans outweigh the possible benefits, as these procedures expose the
patient to a substantial amount of potentially dangerous ionizing
Breast cancer cells have receptors on their surface
and in their cytoplasm and nucleus. Chemical messengers such as
hormones bind to receptors, and this causes changes in the cell.
Breast cancer cells may or may not have three important receptors:
estrogen receptor (ER), progesterone receptor (PR), and HER2.
ER+ cancer cells (that is, cancer cells that have estrogen receptors)
depend on estrogen for their growth, so they can be treated with drugs
to block estrogen effects (e.g. tamoxifen), and generally have a
better prognosis. Untreated, HER2+ breast cancers are generally more
aggressive than HER2- breast cancers, but HER2+ cancer cells
respond to drugs such as the monoclonal antibody trastuzumab (in
combination with conventional chemotherapy), and this has improved the
prognosis significantly. Cells that do not have any of these three
receptor types (estrogen receptors, progesterone receptors, or HER2)
are called triple-negative, although they frequently do express
receptors for other hormones, such as androgen receptor and prolactin
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.
Stage 1A breast cancer
Stage 1B breast cancer
Stage 2A breast cancer
Stage 2A breast cancer
Stage 2B breast cancer
Stage 2B breast cancer
Stage 2B breast cancer
Stage 3A breast cancer
Stage 3A breast cancer
Stage 3A breast cancer
Stage 3B breast cancer
Stage 3B breast cancer
Stage 4 breast cancer
Women may reduce their risk of breast cancer by maintaining a healthy
weight, drinking less alcohol, being physically active and
breastfeeding their children. These modifications might prevent
38% of breast cancers in the US, 42% in the UK, 28% in Brazil and 20%
in China. The benefits with moderate exercise such as brisk
walking are seen at all age groups including postmenopausal
women. High levels of physical activity reduce the risk of
breast cancer by about 14%. Strategies that encourage regular
physical activity and reduce obesity could also have other benefits,
such as reduced risks of cardiovascular disease and diabetes.
High intake of citrus fruit has been associated with a 10% reduction
in the risk of breast cancer.
Marine omega-3 polyunsaturated fatty acids appear to reduce the
risk. High consumption of soy-based foods may reduce risk.
Removal of both breasts before any cancer has been diagnosed or any
suspicious lump or other lesion has appeared (a procedure known as
prophylactic bilateral mastectomy) may be considered in people with
BRCA2 mutations, which are associated with a substantially
heightened risk for an eventual diagnosis of breast cancer.
Evidence is not strong enough to support this procedure in anyone but
those at the highest risk. BRCA testing is recommended in those
with a high family risk after genetic counseling. It is not
recommended routinely. This is because there are many forms of
changes in BRCA genes, ranging from harmless polymorphisms to
obviously dangerous frameshift mutations. The effect of most of the
identifiable changes in the genes is uncertain. Testing in an
average-risk person is particularly likely to return one of these
indeterminate, useless results. It is unclear if removing the second
breast in those who have breast cancer in one is beneficial.
The selective estrogen receptor modulators (such as tamoxifen) reduce
the risk of breast cancer but increase the risk of thromboembolism and
endometrial cancer. There is no overall change in the risk
of death. They are thus not recommended for the prevention
of breast cancer in women at average risk but may be offered for those
at high risk. The benefit of breast cancer reduction continues
for at least five years after stopping a course of treatment with
Breast cancer screening
A mobile breast cancer screening unit in New Zealand
Breast cancer screening refers to testing otherwise-healthy women for
breast cancer in an attempt to achieve an earlier diagnosis under the
assumption that early detection will improve outcomes. A number of
screening tests have been employed including clinical and self breast
exams, mammography, genetic screening, ultrasound, and magnetic
A clinical or self breast exam involves feeling the breast for lumps
or other abnormalities. Clinical breast exams are performed by health
care providers, while self-breast exams are performed by the person
themselves. Evidence does not support the effectiveness of either
type of breast exam, as by the time a lump is large enough to be found
it is likely to have been growing for several years and thus soon be
large enough to be found without an exam. Mammographic
screening for breast cancer uses X-rays to examine the breast for any
uncharacteristic masses or lumps. During a screening, the breast is
compressed and a technician takes photos from multiple angles. A
general mammogram takes photos of the entire breast, while a
diagnostic mammogram focuses on a specific lump or area of
A number of national bodies recommend breast cancer screening. For the
average woman, the
U.S. Preventive Services Task Force recommends
mammography every two years in women between the ages of 50 and
Council of Europe
Council of Europe recommends mammography between 50 and 69
with most programs using a 2-year frequency, and in Canada
screening is recommended between the ages of 50 and 74 at a frequency
of 2 to 3 years. These task force reports point 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.
Cochrane collaboration (2013) states that the best quality
evidence neither demonstrates a reduction in cancer specific, nor a
reduction in all cause mortality from screening mammography. When
less rigorous trials are added to the analysis there is a reduction in
mortality due to breast cancer of 0.05% (a decrease of 1 in 2000
deaths from breast cancer over 10 years or a relative decrease of 15%
from breast cancer). Screening over 10 years results in a 30%
increase in rates of over-diagnosis and over-treatment (3 to 14 per
1000) and more than half will have at least one falsely positive
test. This has resulted in the view that it is not clear
whether mammography screening does more good or harm. Cochrane
states that, due to recent improvements in breast cancer treatment,
and the risks of false positives from breast cancer screening leading
to unnecessary treatment, "it therefore no longer seems beneficial to
attend for breast cancer screening" at any age. Whether
MRI as a
screening method has greater harms or benefits when compared to
standard mammography is not known.
Breast cancer management
The management of breast cancer depends on various factors, including
the stage of the cancer and the age of the patient. Increasingly
aggressive treatments are employed in accordance with the poorer the
patient's prognosis and the higher the risk of recurrence of the
cancer following treatment.
Breast cancer is usually treated with surgery, which may be followed
by chemotherapy or radiation therapy, or both. A multidisciplinary
approach is preferable.
Hormone receptor-positive cancers are
often treated with hormone-blocking therapy over courses of several
years. Monoclonal antibodies, or other immune-modulating treatments,
may be administered in certain cases of metastatic and other advanced
stages of breast cancer.
Chest after right breast mastectomy
Surgery involves the physical removal of the tumor, typically along
with some of the surrounding tissue. One or more lymph nodes may be
biopsied during the surgery; increasingly the lymph node sampling is
performed by a sentinel lymph node biopsy.
Standard surgeries include:
Mastectomy: Removal of the whole breast.
Quadrantectomy: Removal of one-quarter of the breast.
Lumpectomy: Removal of a small part of the breast.
Once the tumor has been removed, if the patient desires, breast
reconstruction surgery, a type of plastic surgery, may then be
performed to improve the aesthetic appearance of the treated site.
Alternatively, women use breast prostheses to simulate a breast under
clothing, or choose a flat chest.
Nipple prosthesis can be used at any
time following the mastectomy.
Drugs used after and in addition to surgery are called adjuvant
Chemotherapy or other types of therapy prior to surgery are
called neoadjuvant therapy.
Aspirin may reduce mortality from breast
There are currently three main groups of medications used for adjuvant
breast cancer treatment: hormone-blocking agents, chemotherapy, and
Hormone blocking therapy
Some breast cancers require estrogen to continue growing. They can be
identified by the presence of estrogen receptors (ER+) and
progesterone receptors (PR+) on their surface (sometimes referred to
together as hormone receptors). These ER+ cancers can be treated with
drugs that either block the receptors, e.g. tamoxifen, or
alternatively block the production of estrogen with an aromatase
inhibitor, e.g. anastrozole or letrozole. The use of tamoxifen is
recommended for 10 years.
Letrozole is recommended for 5 years.
Aromatase inhibitors are only suitable for women after menopause;
however, in this group, they appear better than tamoxifen. This
is because the active aromatase in postmenopausal women is different
from the prevalent form in premenopausal women, and therefore these
agents are ineffective in inhibiting the predominant aromatase of
premenopausal women. Aromatase inhibitors should not be given to
premenopausal women with intact ovarian function (unless they are also
on treatment to stop their ovaries from working).
Chemotherapy is predominantly used for cases of breast cancer in
stages 2–4, and is particularly beneficial in estrogen
receptor-negative (ER-) disease. The chemotherapy medications are
administered in combinations, usually for periods of 3–6 months. One
of the most common regimens, known as "AC", combines cyclophosphamide
with doxorubicin. Sometimes a taxane drug, such as docetaxel, is
added, and the regime is then known as "CAT". Another common treatment
is cyclophosphamide, methotrexate, and fluorouracil (or "CMF"). Most
chemotherapy medications work by destroying fast-growing and/or
fast-replicating cancer cells, either by causing DNA damage upon
replication or by other mechanisms. However, the medications also
damage fast-growing normal cells, which may cause serious side
effects. Damage to the heart muscle is the most dangerous complication
of doxorubicin, for example.
Trastuzumab, a monoclonal antibody to HER2 (a cell receptor that is
especially active in some breast cancer cells), has improved the
5-year disease free survival of stage 1–3 HER2-positive breast
cancers to about 87% (overall survival 95%). When stimulated by
certain growth factors, HER2 causes cellular growth and division; in
the absence of stimulation by the growth factor, the cell will
normally stop growing. Between 25% and 30% of breast cancers
overexpress the HER2 gene or its protein product, and
overexpression of HER2 in breast cancer is associated with increased
disease recurrence and worse prognosis. When trastuzumab binds to the
HER2 in breast cancer cells that overexpress the receptor, trastuzumab
prevents growth factors from being able to bind to and stimulate the
receptors, effectively blocking the growth of the cancer cells.
Trastuzumab, however, is very expensive, and its use may cause serious
side effects (approximately 2% of patients who receive it suffer
significant heart damage). Further, trastuzumab is only effective
in patients with HER2 amplification/overexpression.
Internal radiotherapy for breast cancer
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
Radiation therapy can be delivered as
external beam radiotherapy or as brachytherapy (internal
radiotherapy). Conventionally radiotherapy is given after the
operation for breast cancer.
Radiation can also be given at the time
of operation on the breast cancer.
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
Breasts after double mastectomy followed by nipple-sparing
reconstruction with implants
An example of an advanced recurrent breast cancer with an ulcerating
Prognosis is usually given for 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
Prognostic factors are reflected in the classification scheme for
breast cancer including stage, (i.e., tumor size, location, whether
disease has spread to lymph nodes and other parts of the body), grade,
recurrence of the disease, and the age and health of the patient. The
Nottingham Prognostic Index is a commonly used prognostic tool.
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 10-year disease free survival of about 98%.
There are many different types of evaluations that can be preformed to
determine the stage of breast cancer in a patient. Patients may not
have to undergo all of the following tests listed, but at least one
will need to be preformed by a medical doctor to determine the stage
of a patients breast cancer. The known was to determine the stage of
breast cancer are blood tests, such as a complete blood count,
mammogram of the other breast to look for signs of cancer, breast MRI,
bone scan, computerized tomography (CT) scan, and a positron emission
tomography (PET) scan. 
Stage 1 cancers (and DCIS, LCIS) have an excellent prognosis and are
generally treated with lumpectomy and sometimes radiation. HER2+
cancers should be treated with the trastuzumab (Herceptin)
Chemotherapy is uncommon for other types of stage 1
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 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. Ten-year
survival rate is 5% without treatment and 10% with optimal
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, and this can affect their chance of survival depending upon
what treatment options remain, the exact type of 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 a 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 with an age of less than 40 years or women over 80 years
tend to have a poorer prognosis than post-menopausal women due to
several factors. Their breasts may change with their menstrual cycles,
they may be nursing infants, and they 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
High mammographic breast density, which is a marker of increased risk
of developing breast cancer, may not mean an increased risk of death
among breast cancer patients, according to a 2012 report of a study
involving 9232 women by the National
Cancer Institute (NCI). On
the other hand, more recent research has shown that women with
extremely low mammographic densities (<10%) hold a significantly
worse prognosis compared to women with other densities, irrespective
of all possible confounding factors.
Since breast cancer in males is usually detected at later stages,
outcomes are typically worse.
The emotional impact of cancer diagnosis, symptoms, treatment, and
related issues can be severe. Most larger hospitals are associated
with cancer support groups which provide a supportive environment to
help patients cope and gain perspective from cancer survivors. Not
only is there emotional strain on patients and suvivors of breast
cancer, but there is also an impact on close friends, family memebers,
and caregivers. Specific support groups have also been created to help
those that surround individuals effected by breast cancer to provide
hope and a stress-relieving environment.
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 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 small 2007 study conducted by researchers at the
College of Public Health of the University of Georgia suggested a need
for greater attention to promoting functioning and psychological
well-being among older cancer survivors, even when they may not have
obvious cancer-related medical complications. The study found
that older breast cancer survivors showed multiple indications of
decrements in their health-related quality of life, and lower
psychosocial well-being than a comparison group. Survivors reported no
more depressive symptoms or anxious mood than the comparison group,
however, they did score lower on measures of positive psychosocial
well-being and reported more depressed mood and days affected by
fatigue. 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
Main article: Epidemiology of breast cancer
Age-standardized death from breast cancer per 100,000 inhabitants
Worldwide, breast cancer is the most common invasive cancer in
women. It affects about 12% of women worldwide. (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 2012, it comprised 25.2% of cancers
diagnosed in women, making it the most common female cancer.
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, 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
Breast cancer is strongly related to age with
only 5% of all breast cancers occurring in women under 40 years
old. There were more than 41,000 newly diagnosed cases of breast
cancer registered in England in 2011, around 80% of these cases were
in women age 50 or older  Based on U.S. statistics in 2015 there
were 2.8 million women affected by breast cancer. In the United
States, the age-adjusted incidence of breast cancer per 100,000 women
rose from around 102 cases per year in the 1970s to around 141 in the
late 1990s, and has since fallen, holding steady around 125 since
2003. However age-adjusted deaths from breast cancer per 100,000 women
only rose slightly from 31.4 in 1975 to 33.2 in 1989 and have since
declined steadily to 20.5 in 2014.
It has been suggested that this section be split out into another
article titled History of breast cancer. (Discuss) (December 2015)
Breast cancer surgery in 18th century
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
Breast cancer, however, could be felt through the
skin, and in its advanced state often developed into fungating
lesions: the tumor would become necrotic (die from the inside, causing
the tumor to appear to break up) and ulcerate through the skin,
weeping fetid, dark fluid.
The oldest discovered evidence of breast cancer is from Egypt and
dates back 4200 years, to the Sixth Dynasty. The study of a
woman's remains from the necropolis of
Qubbet el-Hawa showed the
typical destructive damage due to metastatic spread. The Edwin
Smith Papyrus describes 8 cases of tumors or ulcers of the breast that
were treated by cauterization. The writing says about the disease,
"There is no treatment." For centuries, physicians described
similar cases in their practices, with the same conclusion. Ancient
medicine, from the time of the Greeks through the 17th century, was
based on humoralism, and thus believed that breast cancer was
generally caused by imbalances in the fundamental fluids that
controlled the body, especially an excess of black bile.
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 diseases resulted in dramatic increases in lifespan.
Previously, most women had died too young to have developed breast
cancer. Additionally, early and frequent childbearing and
breastfeeding probably reduced the rate of breast cancer development
in those women who did survive to middle age.
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
poison arsenic, 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
Jean Louis Petit
Jean Louis Petit (1674–1750) performed total mastectomies
which included removing the axillary lymph nodes, as he recognized
that this reduced recurrence. Petit's work was built on by
another French surgeon,
Bernard Peyrilhe (1737–1804), who
additionally removed the pectoral muscle underlying the breast, as he
judged that this greatly improved the prognosis. The Scottish
Benjamin Bell (1749–1806) advocated removal of the entire
breast, even when only a portion was affected.
Their successful work was carried on by
William Stewart Halsted
William Stewart Halsted who
started performing radical mastectomies in 1882, helped greatly by
advances in general surgical technology, such as aseptic technique and
anesthesia. 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 promoted superradical
mastectomies, taking even more tissue, until 1963, when the ten-year
survival rates proved equal to the less-damaging radical
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, 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 cancer staging systems were developed in the 1920s and
During the 1970s, a new understanding 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.
Modern chemotherapy developed after World War II.
Prominent women who died of breast cancer include Anne of Austria, the
mother of Louis XIV of France; Mary Washington, mother of George, and
Rachel Carson, the environmentalist.
The first case-controlled study on breast cancer epidemiology was done
by Janet Lane-Claypon, 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 transplants, 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 and the 2002
conclusions of the
Women's Health Initiative
Women's Health Initiative trial conclusively proved
that hormone replacement therapy significantly increased the incidence
of breast cancer.
Society and culture
Breast cancer awareness and List of people with breast
Before the 20th century, breast cancer was feared and discussed in
hushed tones, as if it were shameful. As little could be safely done
with primitive surgical techniques, women tended to suffer silently
rather than seeking care. When surgery advanced, and long-term
survival rates improved, women began raising awareness of the disease
and the possibility of successful treatment. The "Women's Field Army",
run by the American Society for the Control of
Cancer (later the
Cancer Society) during the 1930s and 1940s was one of the
first organized campaigns. In 1952, the first peer-to-peer support
group, called "Reach to Recovery", began providing post-mastectomy,
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 movements and women's health movement of the 20th
century. This series of political and educational campaigns,
partly inspired by the politically and socially effective AIDS
awareness campaigns, resulted in the widespread acceptance of second
opinions before surgery, less invasive surgical procedures, support
groups, and other advances in patient care.
Main article: Pink ribbon
The pink ribbon is a symbol to show support for breast cancer
A pink ribbon 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.
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.
Wearing or displaying a pink ribbon has been criticized by the
opponents of this practice as a kind of slacktivism, because it has no
practical positive effect. It has also been criticized as hypocrisy,
because some people 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.
Cancer Action launched the "Think Before You Pink" campaign,
and said that businesses have co-opted the pink campaign to promote
products that cause breast cancer, such as alcoholic beverages.
Breast cancer culture
This section is written like a personal reflection or opinion essay
that states a editor's personal feelings about a topic.
Please help improve it by rewriting it in an encyclopedic style.
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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 therapy becomes a rite of passage 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 survivors. 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 bears given to adult
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.
Compared to other diseases or other cancers, breast cancer receives a
proportionately greater share of resources and attention. In 2001 MP
Ian Gibson, chairman of the
House of Commons of the United Kingdom
House of Commons of the United Kingdom all
party group on cancer stated "The treatment has been skewed by the
lobbying, there is no doubt about that.
Breast cancer sufferers get
better treatment in terms of bed spaces, facilities and doctors and
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. Ultimately there is a concern
that favoring 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, have been studied little
except in women with breast cancer.
One result of breast cancer's high visibility is that statistical
results can sometimes be misinterpreted, such as the claim that one in
eight women will be diagnosed with breast cancer during their
lives—a claim that depends on the unrealistic assumption that no
woman will die of any other disease before the age of 95. This
obscures the reality, which is that about ten times as many women will
die from heart disease or stroke 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.
Breast cancers occur during pregnancy at the same rate as breast
cancers in non-pregnant women of the same age.
Breast cancer then
becomes more common in the 5 or 10 years following pregnancy but then
becomes less common than among the general population. These
cancers are known as postpartum breast cancer and have worse outcomes
including an increased risk of distant spread of disease and
mortality. Other cancers found during or shortly after pregnancy
appear at approximately the same rate as other cancers in women of a
Diagnosing new cancer in a pregnant woman is difficult, in part
because any symptoms are commonly assumed to be a normal discomfort
associated with pregnancy. As a result, cancer is typically
discovered at a somewhat later stage than average in many pregnant or
recently pregnant women. Some imaging procedures, such as MRIs
(magnetic resonance imaging), CT scans, ultrasounds, and mammograms
with fetal shielding are considered safe during pregnancy; some
others, such as PET scans are not.
Treatment is generally the same as for non-pregnant women.
However, radiation is normally avoided during pregnancy, especially if
the fetal dose might exceed 100 cGy. In some cases, some or all
treatments are postponed until after birth if the cancer is diagnosed
late in the pregnancy. Early deliveries to speed the start of
treatment are not uncommon.
Surgery is generally considered safe
during pregnancy, but some other treatments, especially certain
chemotherapy drugs given during the first trimester, increase the risk
of birth defects and pregnancy loss (spontaneous abortions and
stillbirths). Elective abortions are not required and do not
improve the likelihood of the mother surviving or being cured.
Radiation treatments may interfere with the mother's ability to
breastfeed her baby because it reduces the ability of that breast to
produce milk and increases the risk of mastitis. Also, when
chemotherapy is being given after birth, many of the drugs pass
through breast milk to the baby, which could harm the baby.
Regarding future pregnancy among breast cancer survivors, there is
often fear of cancer recurrence. On the other hand, many still
regard pregnancy and parenthood to represent normalcy, happiness and
In breast cancer survivors, non-hormonal birth control methods should
be used as first-line options. Progestogen-based methods such as depot
IUD with progestogen
IUD with progestogen or progestogen only
pills have a poorly investigated but possible increased risk of cancer
recurrence, but may be used if positive effects outweigh this possible
Menopausal hormone replacement
In breast cancer survivors, it is recommended to first consider
non-hormonal options for menopausal effects, such as bisphosphonates
or selective estrogen receptor modulators (SERMs) for osteoporosis,
and vaginal estrogen for local symptoms. Observational studies of
systemic hormone replacement therapy after breast cancer are generally
reassuring. If hormone replacement is necessary after breast cancer,
estrogen-only therapy or estrogen therapy with an intrauterine device
with progestogen may be safer options than combined systemic
Treatments are being evaluated in trials. This includes individual
drugs, combinations of drugs, and surgical and radiation techniques
Investigations include new types of targeted therapy, cancer
vaccines, oncolytic virotherapy, and immunotherapy.
The latest research is reported annually at scientific meetings such
as that of the American Society of Clinical Oncology, San Antonio
Cancer Symposium, and the St. Gallen
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.
Fenretinide, a retinoid, is also being studied as a way to reduce the
risk of breast cancer (retinoids are drugs related to vitamin
As of 2014 cryoablation is being studied to see if it could be a
substitute for a lumpectomy in small cancers. There is tentative
evidence in those with tumors less than 2 centimeters. It may
also be used in those in who surgery is not possible. Another
review states that cryoablation looks promising for early breast
cancer of small size.
Breast cancer cell lines
See also: List of breast cancer cell lines
A considerable part of the current knowledge on breast carcinomas is
based on in vivo and in vitro studies performed with cell lines
derived from breast cancers. 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
breast cancer cell 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 breast cancer cell lines 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 breast
cancer cell lines issued from metastatic tumors, mainly from pleural
effusions. 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 breast cancer cell lines, as
concluded from a Medline-based survey.
NFAT transcription factors are implicated in breast cancer, more
specifically in the process of cell motility at the basis of
metastasis formation. Indeed, NFAT1 (NFATC2) and NFAT5 are
pro-invasive and pro-migratory in breast carcinoma and NFAT3
(NFATc4) is an inhibitor of cell motility. NFAT1 regulates the
expression of the TWEAKR and its ligand TWEAK with the Lipocalin 2 to
increase breast cancer cell invasion and NFAT3 inhibits Lipocalin
2 expression to blunt the cell invasion.
Clinically, the most useful metabolic markers in breast cancer are the
estrogen and progesterone receptors that are used to predict response
to hormone therapy. New or potentially new markers for breast cancer
BRCA1 and BRCA2 to identify patients at high risk of
developing breast cancer, HER-2 and SCD1 for predicting
response to therapeutic regimens, and urokinase plasminogen activator,
PA1-1 and SCD1 for assessing prognosis.
Mammary tumor for breast cancer in other animals
Mouse models of breast cancer metastasis
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