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Breast

Breast cancer screening


Agnès Sorel, the « dame de Beauté », 15th century

According to last 2003 survey, breast cancer remains the most-feared disease among American women : 22.1 percent, versus 9.7 percent for heart diseases.

1) Epidemiology: Breast cancer is the most common cancer type among women, not only in the US (210 000 cases per year), but in all developed countries. Its incidence : 1 out of 8-9, means that one woman out of 8 or 9, depending on the country, will develop a breast cancer in her lifetime. This incidence keeps growing by 1 to 2% per year, but deaths have been stabilizing for the last ten years, and seem even to slowly decline. Breast cancer remains a social scourge in Western countries: the main ones are the US, Canada, Western Europe, Australia, New-Zealand. Currently, more than 1 million women in the US are living with Stage II, III, or IV breast cancer. Although medical science has not established a means of preventing this cancer, advances in diagnosis and therapy can arrest the disease in many patients.
Nevertheless, the risk has not to be overestimated, as it is too often : the actual risk is 13%, and a recent survey shown that 89% of the women overestimated their risk for this cancer : the average estimate is 46%, instead the real 13%. Don't worry too much !
Don't forget also that 1 000 males are affected per year in the US.

2) Risk factors: even if the causes of breast cancer are not precisely known, it's generally admitted that this cancer is the consequence of the accumulation of genetic alterations, most of them acquired after birth. Sometimes, they are inherited from one of the 2 parents: this may be called genetical predisposition to breast cancer.

To date, 2 genetic predispositions are identified (others, such as BRCA3, are under investigation): BRCA1 and BRCA2, that need to be searched for in some cases of familial cancers: there are "hereditary" cancers.

The main risk factors are:
- sex: 100 women for one man;
- age: the disease is uncommon in women under 30; most cases occur around age 50; high risk is over age 60;
- personal typical hyperplasia history: breast density, revealed by mammary biopsies;
- long gynaecological life: early puberty, late menopause;
- no pregnancy, or late childbearing.
Other causes have been identified, but with lower risks: - environment (way of life, social status, diet), - obesity during youth, - hormone treatments, - tobacco, - alcohol.

3) Development: even if the exact explanation of the cancerisation phenomenon of the normal mammary cell escapes us, the natural history is well known: the mammary cells that line the galactophoric ducts (that drive mother's milk) grow, fill the duct, cross the duct wall, enter the lymph or blood capillary vessels, giving metastases in nodes or in all other parts of the body. The growing tumor becomes perceptible to imaging (mammography, ultrasound, MRI), and axillary nodes can be found. If the tumor is not treated, it can become an open skin lesion, the nodes can thicken, and the metastases keep growing until the patient's death.

4) Symptoms: they are well described: appearance of a lump in the breast, with possible skin retraction (small wrinkle or small depression), irreversible nipple retraction, bleeding nipple, axillary nodes.

5) Screening of breast cancer: The best way towards a complete cure.
- breast self-examination.
- bilateral mammography, once a year or every 2 years after age 40 (or 50, depending on countries). Possible to detect tumors before becoming palpable, at an early stage, before spreading.
- ultrasound is advised.
- Sentinel Breast Scan, technique by InfraredSciences, NY.
- tumor markers are necessary.

6) Diagnosis of breast cancer: relies on
- mammography; Sentinel BreastScan;
- ultrasound; MRI;
- biopsies: either core-biopsy (fine-needle aspiration), or surgical biopsies. A new technique "lymphatic mapping and sentinel node biopsy" is used to determine the cancer's progression into nearby lymph nodes, and can help some patients avoid the pain and discomfort of full armpit node removal.
Well to be understood there are lot of false posive images from mammography : seven out of every 10 women suspected of having breast cancer and sent for biopsies turn out to have no malignancies.
- And the tumor markers: CEA, CA 15-3, and now the Cyfra 21-1.

7) Treatment: usually teamwork: associating surgery, radiotherapy and medical treatments. These treatments are tailor made for every patient.

- Surgery: total mastectomy (breast removal) is now necessary just for 30% of cases, partial mastectomy is the most often used: lumpectomy, segmental mastectomy. Axillary lymph node dissection remains essential for monitoring medical treatments: it can be minimally invasive for small tumors (smaller than 10 mm) found during screening.
The reconstruction can be offered at the time of the mastectomy, or later on; several are available, with acceptable results.
- Radiation: essential after breast-sparing surgery, sometimes used after total mastectomy. Today, the results are excellent, in cosmetic terms, as are the global survival rates.
Radiation is also used before surgery, alone or in conjunction with chemotherapy, to shrink the tumor.
- The medical adjuvant treatments: depend on the parameters of the tumor and of the nodes.
- Chemotherapy uses a combination of drugs. Breast cancer metastasizes very early, chemotherapy often has to be prescribed. Many different protocols are available, allowing significant results in healing.
- Hormonal therapy: reduces hormone cell growth.

8) Follow-up, after treatment: absolutely essential, has to be done for life, because of the risk of recurrence.

Must be performed at first every 3 months, then every 6 months, then once a year:
- clinical exam;
- mammography;
- the tumor marker assays: CEA, CA 15-3, and Cyfra 21-1. Please note that Cyfra 21-1, an exceptionally explicit marker, allows detecting recurrence 6 to 12 months before clinical signs. Unfortunately, this Cyfra 21-1 is NOT performed in the US : you, American women, take the opportunity to be tested with Cancersafe, sole of its kind.
Serial determinations of tumor markers are particularly sensitive for each detection of bone and liver metastases.
Should alarming readings occur, other exams would be realised: ultrasound, MRI.

9) Prevention: Many studies, many assays are running worldwide. To date, there is no consensus for a routine protocol. Teams worldwide use radical techniques (total mastectomy when genetic hereditary forms are detected) and different drugs (Tamoxiphen, Raloxyphen). Further research results are eagerly awaited.

WARNING : should you have any ANTI-AGING treatment, using in particular the DHEA, you should MAKE SURE there is no underlying breast cancer.


The above-mentioned tumor markers are part of the CancersafeŽ test ; performing this panel once a year is highly recommended.

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