BACKGROUND

In breast cancer, some cells begin growing abnormally. The cells divide more rapidly than healthy cells and may spread through the breast tissue to the lymph nodes or other parts of the body (metastasize). The most common type of breast cancer begins in the milk-producing ducts, but cancer may also occur in the lobules or in other breast tissue.

According to the National Cancer Institute (NCI), breast cancer is the second leading cause of cancer death in American women.

In the United States, it is estimated that 12% of American women will develop the disease and 3.5% will die from it.

The incidence of breast cancer varies with age being very low in the twenties, gradually increasing and reaching a plateau at the age of 45 and then increasing dramatically after fifty. Breast cancer is diagnosed in women over 65 years 50% of the time, indicating the ongoing necessity for women to have yearly screenings.

Although rare, breast cancer may also occur in men. In men, breast cancer can occur at any age, but is most common between the ages of 60 to 70 years. For every 100 cases of breast cancer, less than 1 is found in men.

Breast cancer is considered a heterogeneous disease, meaning that it is a different disease in different women, a different disease in different age groups and has different cell populations within the tumor itself. Generally, breast cancer is a much more aggressive disease in younger women.

There are many different varieties of breast cancer. Some cancer cells are fast growing while others are slow. Some cancer cells are stimulated by the estrogen in the body while others result from an out-of-control oncogene (cancer gene). Treatment is based on the special characteristics of the breast cancer.

Stage 0: Stage 0 is when the cancer has not spread from the breast tissue. Stage 0 may also be known as noninvasive carcinoma or carcinoma in situ. Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule that seldom become invasive cancer. Their presence is a sign that a woman has an increased risk of developing breast cancer, and this risk of cancer is relevant for both breasts.

Ductal carcinoma in situ (DCIS): DCIS refers to abnormal cells in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread beyond the duct invading the surrounding breast tissue, but women with DCIS remain at an increased risk for invasive breast cancer. The most common type of breast cancer is ductal carcinoma. Both DCIS and LCIS are classified as Stage 0.

Stage I and II: Stage I and stage II are early stages of breast cancer in which the cancer has spread beyond the lobe or duct invading nearby tissue. Stage I means that the tumor is no more than one inch across, and has not spread beyond the breast. Stage II means that the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm, that the tumor is between 1 and 2 inches across with or without infiltration to lymph nodes under the arm (called Stage IIa), or that the tumor is larger than 2 inches across, but has not spread to the lymph nodes under the arm (called Stage IIb).

Stage III: Stage III is also known as locally advanced cancer. In this stage, the tumor in the breast is smaller or larger than 2 inches and has spread to the lymph nodes under the arm and is extensive in the underarm lymph nodes (called Stage IIIa), or the cancer has spread to lymph nodes near the breastbone, muscles, and other tissues near the breast (called Stage IIIb). In stage IIIc, the tumors have spread to lymph nodes beneath the collarbone, lymph nodes near the neck, lymph nodes within the breast or under the arm, and to tissues near the breast. This stage may be operable dependent upon its location.

Stage IV: Stage IV is metastatic cancer. The cancer has spread beyond the breast and underarm lymph nodes to other parts of the body. The five-year survival rate for cancer diagnosed at this stage is 5 to 10%.

Recurrent cancer: Recurrent cancer means the disease has come back in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease may return due to undetected cancer cells that remained in the body following treatment. Most recurrences appear within the first two or three years after treatment, but breast cancer can develop many years later.

Cancer appearing in the area of the original surgery is called a local recurrence. If the disease returns in another part of the body, the distant recurrence is called metastatic breast cancer. The patient may need a combination of treatments for recurrent cancer.

Infiltrating or invasive ductal: Infiltrating ductal is the most common type of breast cancer, representing 78% of all malignancies. These lesions can have a star-like appearance on mammography or be well rounded. The star-like lesions generally have a poorer prognosis.

Medullary carcinoma: Medullary carcinoma comprises 15% of breast cancers. These lesions are generally well circumscribed, but may be difficult to distinguish from fibroadenomas on mammography or sonography. Medullary carcinoma is estrogen and progesterone receptor (prognostic indicator) negative 90% of the time. Medullary carcinoma usually has a better prognosis than ordinary breast cancer.

Infiltrating or invasive lobular: Infiltrating lobular cancer represents 15% of breast cancers. The lesions are generally found in the upper outer quadrant of the breast as a slight thickening, and are difficult to diagnose by mammography. Infiltrating lobular cancer can occur bilaterally (involve both breasts).

Tubular carcinoma: Tubular carcinoma is categorized as an orderly or well-differentiated carcinoma of the breast. These lesions make up about 2% of breast cancer. They have a favorable prognosis with a ten-year survival rate of nearly 95%.

Mucinous carcinoma: Mucinous carcinoma has well rounded lesions, a favorable prognosis, and represents 1 to 2% of breast cancers.

Inflammatory breast cancer (IBC): IBC is a particularly aggressive type of breast cancer. It is usually found due to skin changes of the breast including redness (erythema), thickening of the skin, and prominence of the hair follicles resembling an orange peel. The diagnosis is made by a skin biopsy, which 50% of the time reveals tumors in the lymphatic and vascular channels. The five-year median survival rate for inflammatory breast cancer is approximately 40%.

Breast cancer is generally treated with surgery, irradiation, and chemotherapy.

RISK FACTORS

Age: The chances of developing breast cancer increases with age. The disease rarely affects women younger than 25 years of age, whereas close to 80% of breast cancers occur in women older than age 50. At age 40, there is a one in 252 chance of developing breast cancer. By age 85, the chances are one in eight.

A personal history of breast cancer: If an individual has had breast cancer in one breast, there is an increased risk of developing cancer in the other breast.

Family history: If the individual's mother, sister, daughter or male relative has had breast cancer, ovarian cancer, or both, the risk of developing breast cancer is doubled. In general, the more relatives one has with breast cancer that were premenopausal at the time of diagnosis, the higher the risk.

Genetic predisposition: Between 5 and 10% of breast cancers are inherited. Defects in one of several genes, especially BRCA1 or BRCA2, put the individual at a greater risk for developing breast, ovarian and colon cancers. Usually these genes help prevent cancer by making proteins that keep cells from growing abnormally, but if they are mutated, then the genes aren't effective at protecting the individual from cancer.

Radiation exposure: Radiation treatments to the chest experienced as a child or young adult may increase in the risk of developing breast cancer later in life. The younger the individual was when they received the treatments the greater the risk.

Excess weight: The relationship between excess weight and breast cancer is complex. In general, weighing more than what is normal for the patient's age and height increases the risk of breast cancer, especially if the patient has gained the weight as an adult or in postmenopause. The risk is even greater if the excess fat is in the upper part of the body. Although women usually have more fat in their thighs and buttocks, they tend to gain weight in their abdomens in their 30s, which can increase their risk of developing breast cancer.

Exposure to estrogen: The longer an individual is exposed to estrogen, the greater the risk of breast cancer. In general, if an individual has a late menopause (after age 55) or early menses (before age 12), there is a slightly higher risk of developing breast cancer. Women who never had children or whose first pregnancy occurred when they were age 35 or older also have an increased risk of developing breast cancer.

Race: Caucasian women are more likely to develop breast cancer than African-American or Hispanic women. However, African-American women are more likely to die of the disease because their cancers are found at a more advanced stage. Although some studies show that African-American women may have more aggressive tumors, socioeconomic factors may enter the picture also. Women of all races with incomes below the poverty level are often diagnosed with late-stage breast cancer, and are more likely to die of the disease than women with higher incomes. Low-income women don't usually receive the routine medical care that would allow breast cancer to be discovered earlier.

Hormone therapy: A study sponsored by the National Institutes of Health (NIH) in June 2002 was halted as researchers reported that hormone therapy, once considered standard treatment for menopausal symptoms, actually posed more health risks than benefits. Along with an increase in cardiovascular disease and uterine cancer, there was a slightly higher risk of breast cancer for women taking the particular combination of hormone therapy (estrogen plus progestin) used in the study. In addition, combination hormone therapy can make malignant tumors harder to detect on mammograms, leading to cancers that are diagnosed at more advanced stages when they're more difficult to treat.

Birth control pills: The hormone therapy studies have raised questions about the relationship between birth control pills and breast cancer. Studies have reported that women who are currently using birth control or have used them in the past 10 years are at a slightly increased risk for having breast cancer in the next 10 years. These cancers tend to be localized to the breast and are less clinically advanced than the cancers diagnosed in women who never used birth control pills.

Smoking: Studies have found that smoking does increase the incidence of breast cancer in those with the genetic predisposition. More than 30 carcinogenic chemicals are present in tobacco smoke; many of which are fat-soluble, resistant to metabolism and can be stored in breast adipose tissue. A study published in 2001 found that smoking significantly increases the risk of breast cancer in women with a family history of breast and ovarian cancers. A more recent study found that exposure to secondhand smoke also increases the risk of breast cancer in premenopausal women. Researchers hypothesize that higher estrogen levels combined with the cancer-causing agents in tobacco spark the development of breast tumors.

Other carcinogens: Polycyclic aromatic hydrocarbons are chemicals found mainly in cigarette smoke and charred red meat. Studies have shown that exposure to these chemicals can significantly increases the chances of developing breast cancer. Exposure to certain pesticides may also increase the risk.

Excessive use of alcohol: Women who consume more than one alcoholic drink a day have about a 20% greater risk of breast cancer than women who don't drink. The National Cancer Institute recommends limiting alcohol intake to no more than one drink per day.

Precancerous breast changes (atypical hyperplasia, carcinoma in situ): These changes are often discovered only after a breast biopsy is performed, and they can double the risk of developing breast cancer.

CAUSES

The precise cause of breast cancer is unknown. Most cases of breast cancer occur in women who are not classified as high risk. More research must be done in order to uncover other possible causes.

Genetics: In most cases, it isn't clear what triggers abnormal cell growth in breast tissue, but it is estimated that between 5 and 10% of breast cancers are inherited. Having a mother and/or a sister with the disease increases the risk. About a quarter of breast cancer cases occur in women who have the disease in the family. Defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), put an individual at a greater risk of developing both breast and ovarian cancer. Inherited mutations in the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene also make it more likely that an individual will develop breast cancer.

Genetic mutations may result from radiation exposure. Women treated with chest radiation therapy in childhood, for instance, have a significantly higher incidence of breast cancer than women not exposed to radiation. Mutations may also develop as a result of exposure to cancer-causing chemicals, such as the polycyclic aromatic hydrocarbons found in tobacco and charred red meats.

Estrogen: The female hormone estrogen is linked to breast cancer. The role of estrogen and its relation to breast cancer is not yet completely understood. If the individual has never given birth, they are at greater risk for breast cancer because of more exposure to estrogen than women who have had a baby. This is because the body produces less estrogen when one is pregnant. Taking estrogen after menopause (hormone replacement therapy: HRT) also increases the risk. It is important to remember that taking estrogen after menopause also increases the long-term risk of heart disease, uterine cancer, and stroke.

Diet: Some studies suggest that a diet high in animal fat and protein may cause breast cancer, although the results of these studies are not definite.

Others: Other research has focused on certain preservatives (parabens) that are used in deodorants and antiperspirants, as well as many cosmetics, foods, and pharmaceutical products. A study did not show any increased risk for breast cancer in women who reported using an underarm antiperspirant or deodorant. Some chemicals in the environment may mimic estrogen in the body which that may lead to breast cancer.

SIGNS AND SYMPTOMS

Common signs and symptoms of breast cancer include a lump in the breast that feels distinctly different from other breast tissue or that does not go away, swelling of the breast that does not go away, thickening of breast tissue, dimpling or pulling of the skin on the breast which may then resemble the skin of an orange, any change in the breast shape or contour, nipple discharge, retraction of the nipple, scaliness of the nipple, pain or tenderness of the breast, and swollen bumps or puss-filled sores.

Fibrocystic changes: This condition can cause the breasts to feel ropy or granular. Fibrocystic changes are extremely common, occurring in at least half of all women. In most cases the changes are harmless. If the breasts are very lumpy, then performing a breast self-exam is more challenging.

Cysts: These are fluid-filled sacs that frequently occur in the breasts of women ages 35 to 50. Cysts can range from very tiny to about the size of an egg. They can increase in size or become more tender just prior to menstruation, and may disappear completely after. Cysts are less common in postmenopausal women.

Fibroadenomas: These are solid, noncancerous tumors that often occur in women during their reproductive years. A fibroadenoma is a firm, smooth, rubbery lump with a well-defined shape. It will move under the skin when touched, and is usually painless. Over time, fibroadenomas may grow larger, smaller or even disappear completely.

Infections: Breast infections (mastitis) are common in women who are breastfeeding or who have recently stopped breastfeeding, but mastitis may develop when women are not nursing. The breast will likely be red, warm, tender and lumpy, and the lymph nodes under the arm may swell. The individual may also feel slightly ill and present with a low-grade fever.

Trauma: Sometimes a blow to the breast or a bruise also can cause a lump, but this doesn't mean the individual is more likely to get breast cancer.

Calcium deposits (microcalcifications): These tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram. Most women have one or more areas of microcalcifications of various sizes. They may be caused by secretions from cells, cellular debris, inflammation, trauma or prior radiation. Calcium deposits are not the result of taking calcium supplements. The majority of calcium deposits are harmless, but a small percentage may be precancerous or cancer.

Inflammatory breast cancer (IBC): Symptoms of IBC can include one breast larger than the other, red or pink skin, swelling, rash (entire breast or small patches), orange-like texture (peau d' orange), skin hot to the touch, pain and/or itchiness, ridges or thickened areas of breast, nipple discharge, nipples that appear inverted or flattened, swollen lymph nodes under the armpit, and sometimes swollen lymph nodes of the neck.

DIAGNOSIS

Early detection remains the best way to prevent debilitation and death from breast cancer. Traditionally, mammography, clinical breast examinations (CBE), and breast self examinations (BSE) have been accepted as legitimate breast screening modalities.

Genetic testing: Women with BRCA1 or BRCA2 (both primary genes involved in breast cancer) genetic mutations may be advised to begin screening at age 25 because of their increased risk for developing breast cancer.

Breast self-examination (BSE): In about 80% of breast cancer cases, the woman detects the lump herself. Women are advised to examine their breasts on a monthly basis starting around age 20. Women may be able to detect early signs of cancer if they become proficient at BSE and familiar with the usual appearance and feel of their breasts. A study did find that women who perform regular breast self-exams might be more likely to undergo unnecessary biopsies after finding breast lumps. Breast self-examination should be performed once a month at the same time each month, one week after a woman's period.

Clinical breast exam (CBE): Unless there is a family history of cancer or other factors that place the individual at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly CBE. During this exam, the doctor examines the breasts for lumps or other changes. He or she may be able to feel lumps missed by self-examination and will also look for enlarged lymph nodes in the armpit (axillary).

Mammography: Overall mammography is a very effective breast cancer screening tool, and has the ability to detect breast cancers before they can be felt. It may be more effective at detecting tumors in older women than in younger women, and not all cancers can be detected by this method. Images on mammograms appear in gradations of black, gray and white depending on the density of the tissue. Bone shows up as white, fat appears dark gray, and cancerous tumors appear a lighter shade of gray or white.

Unfortunately, dense normal breast tissue can also appear light gray on a mammogram, which can make mammograms harder to interpret in younger women, since they tend to have breast tissue that is denser. After menopause, though, breast density usually begins to decrease, making the mammograms of older women easier to read. For this reason, it is important to follow the guidelines for clinical breast examination (CBE) and to practice regular breast self-examination (BSE).

If a lump in the breast is found, either by breast self-exam or mammography, other tests will be performed in order to make a diagnosis. The only proven way to reduce the risk of dying from breast cancer is by having regular mammograms after the age of 50.

Computer-aided detection (CAD): Radiologists normally view X-rays and mammograms, and their skills and experience play a large part in determining the accuracy of the test results. In CAD, a computer scans the mammogram after a radiologist has reviewed it. CAD identifies more suspicious areas on the mammogram, but many of these areas may later prove to be normal. Using mammography and CAD together may increase the cancer detection rate.

Digital mammography: In this procedure, an electronic process is used to collect and display X-ray images on a computer screen. This allows the radiologist to alter contrast and darkness, making it easier to identify subtle differences in tissue. In addition, the images can be transmitted electronically, so women who live in remote areas can have their mammograms read by an expert who is based elsewhere.

Magnetic resonance imaging (MRI): MRI uses a magnet linked to a computer to take pictures of the interior of the breast. Although not used for routine screening, MRIs can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. Some centers may use MRI as an additional screening tool for high-risk women who have dense breast tissue on a mammogram. MRIs aren't recommended for routine screening because they have a high rate of false-positive results, which lead to unnecessary anxiety and biopsies. They are also expensive and not readily available.

Ductal lavage: In this procedure, the doctor inserts a tiny, flexible tube (catheter) into the lining of a duct in the breast and withdraws a sample of cells. The cells are then examined for precancerous changes that might eventually lead to disease. These changes show up long before tumors can be detected on a mammogram. Ductal lavage isn't recommended as a screening tool for high-risk women. It is a new procedure with risks, including the rate of false-negative results and its inability to determine the exact location of abnormal cells and whether they will lead to cancer.

Breast ultrasound (ultrasonography): The doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures deep within the body. Because it doesn't use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. Breast ultrasound isn't used for routine screening because it has a high rate of false-positive results.

Molecular breast imaging (MBI): This experimental technique tracks the movement of a radioactive isotope that's taken up by breast tissue, particularly the tumors. Images are taken of the breast when the radioactive isotope signals are detected. In preliminary studies, MBI found small tumors that both mammography and ultrasound missed. This procedure uses lighter compression, and may be more comfortable than mammography. The MBI takes about 40 to 50 minutes as opposed to 15 minutes for a mammogram, and the procedure is more invasive due to the injection. It is still unclear how abnormal findings are biopsied, and the studies remain ongoing.

Fine needle aspiration: A thin needle is inserted into the lump and a sample is withdrawn. This test helps to determine if the lump is fluid-filled (a cyst, usually not cancerous) or a solid tumor. It can be performed in a doctor's office with local anesthesia. The sample, regardless if it is fluid or solid, is sent to the laboratory for further analysis.

Core biopsy: A larger needle is inserted into a lump or an abnormal area seen on a mammogram, and the tissue sample is removed. The sample is analyzed for cancer cells, and this procedure is usually performed at a hospital with local anesthesia.

Surgical biopsy: The lump and surrounding tissue is removed surgically before being sent to a laboratory for analysis. This procedure needs to be done in a hospital with either a local or general anesthetic.

Stereotactic biopsy. This technique is used to sample and evaluate an area of concern that can be seen on a mammogram, but cannot be felt or seen on an ultrasound. During the procedure, a radiologist takes a core needle biopsy using the mammogram as a guide. Stereotactic biopsy usually takes about an hour and is performed using local anesthesia.

Wire localization. A doctor may recommend this technique when a worrisome lump is seen on a mammogram, but can't be felt or evaluated with a stereotactic biopsy. Using the mammogram as a guide, a thin wire is placed in the breast and is guided toward the lump. Wire localization is usually performed right before a surgical biopsy, and is a way to help the surgeon find the area to be removed and tested.

Estrogen and progesterone receptor tests: If a biopsy reveals malignant cells, estrogen and progesterone receptor tests are usually performed on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. If the cancer cells have receptors for estrogen, progesterone or both, the doctor may recommend treatment with a drug tamoxifen, which prevents estrogen from binding to these sites.

Staging: Staging breast cancer is used to help determine the course of treatment and the prognosis. Staging is based on the size of the tumor, how much of the breast tissue is cancerous, whether the underarm (axillary) lymph nodes are also cancerous, and whether cancer can be found in other parts of the body. The five-year survival rate for localized breast cancer (not spread to the axillary lymph nodes) is 96%. If cancer has spread regionally, the rate is 77%. For those women who are diagnosed with metastatic disease, the five-year survival rate is only 5 to 10%. Stage 0 cancers are also called noninvasive, or in situ (in one place) cancers. Stage I to IV cancers are invasive tumors that have the ability to spread to other areas.

COMPLICATIONS

Complications of breast cancer include depression, loss of sexual interest, cachexia (physical weakness, muscle loss, and weight loss), cerebral metastases (brain), lymphangitis carcinomatosa (inflammation of the lymph vessels secondary to cancer), breast lumps, opsoclonus (uncontrolled eye movement), lung metastases, brachial plexus neuropathy (nerve damage), back pain, liver metastases, bone metastases, prostate specific antigen levels raised (plasma or serum in men), bone pain, CEA raised (marker for colon cancer), renal metastases (kidney), mastalgia (breast pain), pleural effusion (fluid around the lungs), lymphadenopathy (swelling of the lymph nodes), leucoerythroblastic anemia (blood condition), cutaneous metastasis (skin), osteosclerosis (abnormal hardness and density of the bone), and nipple discharge.

TREATMENT

Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. Several experimental treatments are now offered on a limited basis or are being studied in clinical trials. Treatment for breast cancer depends on the type and stage of cancer, age, risk factors, the size and shape of the breasts, and the patient's feelings about their body.

Treatment usually begins within a few weeks after diagnosis. Unless the cancer is detected at an extremely advanced stage and life is in immediate jeopardy, generally there is time to get a second opinion and discuss the various treatment options such as a combination of chemotherapy, radiation and surgery.

Other factors that affect treatment decisions include lymph node status, tumor size, tumor grade, tumor type, hormone receptors, HER2/neu, proliferation rate (growth rate), metastatic tests, and oncotype diagnoses (genetics).

A healthcare team for breast cancer patients may include surgeons, oncologists, plastic surgeons, radiation oncologists, as well as the individual's personal physician.

Surgery: Years ago, the only type of breast cancer surgery was radical mastectomy, which removed the entire breast along with chest muscles beneath the breast and all the lymph nodes under the arm. Today, this operation is rarely performed. Instead, the majority of women are candidates for breast-saving operations such as lumpectomy. Less radical mastectomies and mastectomy with reconstruction are also options.

Lumpectomy: This operation saves as much of the breast as possible by removing only the lump plus a surrounding area of normal tissue. Many women can have lumpectomies (often followed by radiation therapy) instead of mastectomies, and in most cases survival rates for both operations are the same. A more attractive physical appearance is also a positive with lumpectomy in contrast to a mastectomy, which removes breast tissue. However, a lumpectomy may not be an option if a tumor is deep within the breast, if the individual has already had radiation therapy, had two or more areas of cancer in the same breast that are far apart, had a connective tissue disease that makes the individual sensitive to radiation, or if they are pregnant.

Partial or segmental mastectomy: Partial mastectomy involves removing the tumor as well as some of the breast tissue around the tumor and the lining of the chest muscles beneath it. Some lymph nodes under the arm also may be removed. In almost all cases, a course of radiation therapy will follow the operation.

Simple mastectomy: A simple mastectomy is the removal of all the breast tissue including the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, further treatment with radiation to the chest wall, chemotherapy or hormone therapy may be necessary.

Modified radical mastectomy: A modified radical mastectomy involves the removal of the entire breast and some underarm (axillary) lymph nodes, but leaves the chest muscles intact, making breast reconstruction less complicated. Complications include severe arm swelling (lymphedema), which is a common complication of mastectomy. The lymph nodes will be tested to see if the cancer has spread.

Sentinel lymph node biopsy: In invasive cancer, lymph nodes must be examined due to the spread of breast cancer to the lymph nodes under the arm. Surgeons used to remove as many lymph nodes as possible, greatly increasing the risk of numbness, recurrent infections, and serious swelling of the arm. A procedure was developed to detect sentinel nodes, which are the first nodes to receive the drainage from cancerous breast tumors. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares many women the need for a more extensive operation, and greatly decreases the risk of complications.

Reconstructive surgery: Breast reconstruction is a possibility that most women who undergo mastectomy may choose, and a plastic surgeon will perform the procedure. Options include reconstruction with a synthetic breast implant or reconstruction using the patient's own tissue to rebuild the breast. These operations can be performed at the time of the mastectomy or at a later date. Implants may cause pain, swelling, bruising, tenderness or infection, and they do age over time requiring replacement. There is also a long-term possibility of rupture, deflation, contracture, hardening and shifting.

Reconstruction with a tissue flap: Known as a transverse rectus abdominis myocutaneous (TRAM) flap, this surgery reconstructs the breast using tissue, including fat and muscle from the patient's abdomen. Sometimes the surgeon may also use tissue from the back or buttocks. Because the procedure is fairly complicated, recovery may take six to eight weeks, and future adjustments to the breast may be necessary. Complications include the risk of infection and tissue death. If the individual has little body fat, this type of reconstruction may not be an option.

Deep inferior epigastric perforator (DIEP) reconstruction: In DIEP, fat tissue from the abdomen is used to create a natural-looking breast. But because the abdominal muscles are left intact, the patient is less likely to experience complications than with traditional breast reconstruction. There may also be less pain involved, and the healing time may be reduced. Active women in particular tend to opt for this procedure because it maintains the abdominal wall muscles.

Reconstruction of the nipple and areola: After initial surgery with either tissue transfer or an implant, further surgery may be performed to create a nipple and areola. Using tissue from elsewhere in the body, the surgeon first creates a small mound to resemble a nipple. The surgeon may then tattoo the skin around the nipple to create an areola. The surgeon may also take a skin graft from elsewhere on the body, place it around the reconstructed nipple to slightly raise the skin and then tattoo the skin graft.

Radiation therapy: Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation is administered by a radiation oncologist or technician at a radiation center. In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancers. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor that has spread to more than four lymph nodes in the armpit.

Radiation is usually started three to four weeks after surgery. The patient will typically receive treatment five days a week for five to six consecutive weeks. The treatments are painless and are similar to getting an X-ray. Each takes about 30 minutes, and side effects include fatigue, nausea, vomiting, weight loss, and loss of appetite.

In a small percentage of women, more serious problems may occur, including arm swelling, damage to the lungs, heart or nerves, or a change in the appearance and consistency of breast tissue. Radiation therapy may also make it somewhat more likely that an individual will develop another tumor.

Chemotherapy: Chemotherapy uses drugs to destroy cancer cells and is given by mouth or into the veins. Chemotherapy for breast cancer may be used to cure the cancer, stop cancer from spreading to other parts of the body, slow cancer growth, kill cancer cells, and relieve the symptoms of breast cancer. Breast cancer patients who undergo chemotherapy may be given one drug or a combination of two or more drugs during treatment. A chemotherapy regimen is usually tailored specifically to the breast cancer patient. In general, chemotherapy for breast cancer patients is typically given in three to six month courses. These courses may occur daily, weekly, monthly or on some other schedule, depending on the body's response to the drugs. Chemotherapy sessions are not usually continuous, typically including rest cycles because chemotherapy drugs target both healthy and cancerous cells. Physicians have a variety of ways to monitor the effects of chemotherapy on the patient's cancer, including physical examinations, blood tests, CT scans, MRI scans, and x-rays.

For many women, chemotherapy causes unwanted side effects including hair loss, nausea, vomiting, and fatigue. Another side effect called "chemobrain" may occur. Chemobrain is the term for cognitive changes that occur during and after cancer treatment. Women undergoing adjuvant chemotherapy may have trouble finding words, a poor memory, decreased learning, processing speed, and ability to multitask. Up to one-third of people undergoing cancer treatment will experience cognitive impairment, though some studies report that at least half the participants have memory problems. Memory changes often continue for at least a year or two after treatment and may last longer.

Premature menopause and infertility also are potential side effects of chemotherapy. The older the individual is when treatment begins, the more likely they are to develop menopausal problems.

Commonly used chemotherapy drugs include CMF therapy that consists of cyclophosphamide (Cytoxan©), methotrexate (Mexate©, Folex©), and fluorouracil (Fluorouracil©, 5-Fu, Adrucil©). CAF therapy consists of cyclophosphamide, doxorubicin (Adriamycin©), and fluorouracil. AC therapy includes doxorubicin (Adriamycin©) and cyclophosphamide. Other combinations include doxorubicin (Adriamycin©) and cyclophosphamide with paclitaxel (Taxol©), doxorubicin (Adriamycin©), followed by CMF, and cyclophosphamide, epirubicin (Ellence©), and fluorouracil. Other chemotherapy drugs commonly used for treating women with breast cancer include docetaxel (Taxotere©), vinorelbine (Navelbine©), and gemcitabine (Gemzar©), and capecitabine (Xeloda©). Ixabepilone (Ixempra©) was approved by the U.S. Food and Drug Administration in October 2007 for use in patients with metastatic or locally advanced breast cancer who have not responded to certain other cancer drugs.

Abraxane© (paclitaxel protein-bound particles for injectable suspension): Abraxane© was approved by the U.S. Food and Drug Administration (FDA) in 2005 to help treat women with advanced breast cancer who have not responded well to combination chemotherapy, or who have relapsed within six months of chemotherapy. Abraxane© is similar to the drug Taxol© but it is not required to be dissolved in a toxic solvent prior to administration. This solvent can cause allergic reactions in some patients, and to counteract these reactions patients are often treated with steroids and antihistamines. Patients receiving Abraxane© do not need these pre-medications. Side effects of Abraxane© may include neutropenia (a reduction in white blood cell count), anemia (a decreased number of red blood cells and a reduced volume of hemoglobin, the protein within red blood cells that carries oxygen), infections, edema (swelling), nausea, vomiting, diarrhea, nerve damage, and severe pain in the muscles or joints.

Adriamycin© (doxorubicin): Adriamycin© is a chemotherapy drug commonly used to treat breast cancer and other cancers. Adriamycin© first disrupts, and then destroys the growth of cancer cells. It is usually administered intravenously (through the vein). Common side effects may include decreased white blood cell count with increased risk of infection, decreased platelet count with increased risk of bleeding, loss of appetite, darkening of nail beds and skin creases of hands, hair loss, nausea and vomiting, and mouth sores. Patients should be tested for heart problems before beginning Adriamycin© and should be continuously monitored for developing problems during treatment.

Aredia© (pamidronate disodium): Breast cancer has the potential to spread to almost any area of the body. After the axillary (armpit) lymph nodes, bone is the most common place to which breast cancer can spread. Aredia© reduces bone complications and bone pain in patients whose breast cancer has spread to the bone. Clinical studies have shown that patients who are given Aredia© tend to experience a delay in or reduction of bone pain, fractures, and other bone complications than patients who do not receive Aredia©. Aredia© is usually administered by intravenous injection. Possible side effects include fever, fatigue, nausea and vomiting, initial bone pain, lack of appetite, and anemia (decrease in red blood cells).

Arimidex© (anastrozole): Arimidex© was FDA approved in 1996 to treat advanced (metastatic) breast cancer in patients who have not responded well to treatment with the drug tamoxifen. Clinical trials are currently underway to determine whether women with advanced breast cancer would benefit more from taking Arimidex© than tamoxifen. Arimidex© is usually taken orally, and possible side effects include general feelings of weakness, decreased energy levels, headache, nausea, mild diarrhea, increased or decreased appetite, sweating, hot flashes, vaginal dryness, and temporary hair thinning.

Aromasin (exemestane): Aromasin© (exemestane) was FDA approved in 1999 to treat advanced (metastatic) breast cancer in post-menopausal women. Aromasin© works by binding to the body's aromastase enzyme, an enzyme responsible for producing the hormone estrogen. Many breast cancer cells depend on estrogen to grow and multiply quickly. Once Aromasin© has binded to the aromastase enzyme, estrogen cannot be produced by the enzyme. This lack of estrogen "starves" cancer cells preventing them from growing. Aromasin© is usually taken orally, and possible side effects include hot flashes, nausea, fatigue, increased sweating, and increased appetite.

Cytoxan© (cyclophosphamide): Cytoxan© (cyclophosphamide) is a chemotherapy drug commonly used to treat breast cancer and other cancers. Cytoxan© first disrupts cancer cells and then destroys them. Cytoxan© is given by mouth or intravenously (through the vein) over 30-60 minutes. Common side effects may include decreased white blood cell count with increased risk of infection, hair loss, nausea and vomiting, loss of appetite, sores in mouth or on lips, diarrhea, and ceasing of menstrual periods.

Ellence© (epirubicin): Ellence© was approved by the FDA in 1999 to treat early-stage breast cancer after breast surgery (lumpectomy or mastectomy) in patients whose cancer has spread to the axillary (underarm) lymph nodes. Ellence© helps reduce the likelihood that breast cancer will return, and improves a patient's chances of survival. Ellence© is given intravenously (through the vein) in combination with other chemotherapy drugs, such as cyclophosphamide and fluorouracil. Possible side effects include nausea, vomiting, diarrhea, inflammation of the mouth (stomatitis), hair loss, and reduction in white blood cells (myelosuppression).

Fareston© (toremifene): Similar to tamoxifen, Fareston© is an anti-estrogen (SERM, selective estrogen-receptor modulator). Fareston© binds to estrogen receptors on breast cancer cells preventing them from growing and dividing. Advanced breast cancer patients are usually prescribed one 60 milligram tablet of Fareston© daily. Possible side effects include hot flashes, nausea, weight gain, allergic reactions (such as skin rashes), and headache.

Femara© (letrozole): Femara© was approved by the FDA in 1997 to help treat advanced (metastatic) breast cancer in women whose breast cancer tumors have not responded well to tamoxifen. Femara© works by reducing the total amount of estrogen in the body (circulating estrogen levels), thereby limiting the amount of estrogen that can affect breast cancer cells. In post-menopausal women, the body produces estrogen from other hormones known as androgens by an enzyme called aromatase. Femara© is an aromatase inhibitor and blocks aromatase from converting androgen into estrogen, thus lowering the amount of estrogen in the body. Possible side effects may include musculoskeletal pain (pain in the skeleton or legs, arms or back), nausea, headache, joint pain, fatigue, and difficulty breathing.

Herceptin© (trastuzumab): Herceptin© is FDA approved to treat advanced metastatic breast cancer in women who over-express the HER2 gene. HER2 (also written HER-2/neu) is a growth factor found on the surface of cells that plays a key role in regulating cell growth. Some women are born with or experience a mutation of the HER2 gene throughout their lifetime. When altered, extra HER2 receptors may be produced. This over-expression of HER2 causes cells to grow, divide, and multiply more rapidly than normal , which can lead to breast cancer. Women who over-express the HER2 gene tend to have aggressive breast cancers that spread quickly to other regions of the body. Herceptin© seeks out HER2 and attaches itself to the protein receptor on the surface of cells. By binding to the cells, Herceptin© has been reported to slow the growth and spread of tumors that have an overabundance of HER2 protein receptors. Herceptin© is usually given intravenously in an outpatient clinical setting. Possible side effects include weakening of the heart muscle, reduction of white blood cells (leukopenia or neutropenia), diarrhea, anemia, and abdominal pain or infection.

Megace© (megestrol): Megace© is used to treat advanced breast cancer, typically in women who do not respond well or become resistant to tamoxifen. Megace© is a synthetic form of the hormone progesterone. Progesterone is normally secreted by the corpus luteum of the ovary and placenta, and then acts to prepare the uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote development of secondary sexual characteristics. Progesterone also counteracts some of the negative effects of estrogen (many breast cancers depend on estrogen to grow and reproduce). Because Megace© is considered non-toxic, there are few documented side effects associated with the drug. The most common side effect is fluid retention.

Nolvadex© (tamoxifen): Tamoxifen has been the most commonly prescribed drug to treat breast cancer since its approval by the U.S. Food and Drug Administration (FDA) in the 1970s. Tamoxifen is an anti-estrogen and works by competing with the hormone estrogen by binding to estrogen receptors in breast cancer cells. By blocking estrogen in the breast, tamoxifen helps slow the growth and reproduction of breast cancer cells. In 1998, tamoxifen became the first drug to be approved by the FDA to prevent breast cancer after research showed it reduced the chances of developing breast cancer by 50% in high risk women. Tamoxifen is taken orally, and possible side effects include hot flashes, irregular menstrual cycles, unusual vaginal discharge or bleeding, and irritation of skin around the vagina.

Taxol© (paclitaxel): Taxol© was isolated from a Pacific yew tree and first approved by the FDA in 1992 to treat advanced (metastatic) breast cancer. In 1999, the FDA also approved Taxol© to treat early stage breast cancer in patients who have previously received chemotherapy with the drug doxorubicin. Taxol© is called a mitotic inhibitor because it interferes with cells during mitosis (cell division). Taxol© is usually given intravenously over one or more hours. Possible side effects include a reduced white blood cell count (myelosuppression), hair loss (alopecia), and numbness in the extremities (peripheral neuropathy).

Taxotere© (docetaxel): Taxotere© (generic name, docetaxel) is a cancer drug that resembles Taxol© in chemical structure. Taxotere© was FDA approved in 1996 to treat advanced breast cancer in patients who have not responded well to chemotherapy with the drug doxorubicin. In 1998, it was also approved by the FDA to treat breast cancer that has spread into other areas of the breast or to other parts of the body after treatment with standard chemotherapy. Docetaxel inhibits the division of breast cancer cells by acting on the cell's internal skeleton. The drug is usually given intravenously (through the vein) once every three weeks. Each treatment typically takes around one hour, though the dosage will vary depending on the patient's medical situation. Other medications may be used to counter the side effects of Taxotere©; for example, dexamethasone is commonly used to prevent fluid retention. Other possible side effects include decrease in white blood cells (leukopenia), fever (often a warning sign of infection), fluid retention, allergic reactions, and hair loss.

Xeloda© (capecitabine): Xeloda© has been FDA approved since April 1998 as a treatment for advanced breast cancer in patients who have not responded well to chemotherapy that included Taxol© and Adriamycin©. Xeloda works by converting to a substance called 5-fluorouracil in the body. In some patients, Xeloda helped shrink tumor size by killing cancer cells. Side effects may include diarrhea, nausea and vomiting, stomatitis (sores in mouth and throat), loss of appetite or decreased appetite, and excessive water loss from the body (dehydration). Some of the side effects from Xeloda© may become severe. Patients should report any side effects to their physicians immediately. Xeloda© is taken orally and is usually prescribed in a 21-day cycle (14 days of treatment followed by a seven-day rest period).

Zoladex© (goserelin acetate): Zoladex© is FDA approved to treat advanced breast cancer and prostate cancer. Zoladex© works by blocking estrogen from breast cancer cells (and blocking testosterone in men) thereby starving these cells. The drug is typically given by injection under the skin (subcutaneously). Zoladex© is a systemic treatment and cannot distinguish between normal cells and cancer cells; therefore, a variety of side effects are possible, including hot flashes, decreased sexual desire, absence of menstruation, vaginal dryness, and breast swelling or tenderness.

Zometa© (zoledronic acid): Zometa© was approved by the FDA in 2002 to treat breast cancer that has spread to the bone (a condition commonly referred to as bone metastases). Zometa© is also FDA-approved to treat multiple myeloma (a type of bone cancer), all other solid tumors, and bone metastases resulting from prostate cancer. Zometa© belongs to a class of drugs called bisphosponates, which may be helpful in bone metastases by slowing the destruction of bone cells in breast cancer patients. Zometa© may also prevent cancer cells from growing in bone. Studies involving more than 3,000 patients taking zometa© have shown an approximate 14% decrease in the number of patients with bone problems, compared to those who did not take Zometa©. Zometa© is administered intravenously and takes approximately 15 minutes after preparation. Possible side effects include pain nausea and vomiting, fever, fatigue, and constipation. Women who are pregnant or breastfeeding should avoid zometa©. In rare cases, Zometa© can cause injury to the kidneys.

Medications for side effects of chemotherapy: Some patients who experience certain side effects of chemotherapy may be prescribed medications to counteract these effects. Several drugs are now available for use alone or in combination to help reduce a few of the most common side effects, such as nausea, vomiting, and fatigue.

 Anzemet (dolasetron mesylate): Anzemet© helps prevent and relieve nausea and vomiting from surgery or chemotherapy. Researchers believe that nausea and vomiting during chemotherapy is associated with the release of serotonin from special cells in the small intestine. Anzemet© blocks these nerve endings in the intestine and prevents signals to the central nervous system. Anzemet© is available in tablet form and by injection.

Compazine© (prochlorperazine): Prochlorperazine helps control nausea and vomiting after surgery or chemotherapy. Prochlorperazine is available in capsule, tablet, and liquid form, and by suppository or injection. Prochlorperazine can cause drowsiness and may interact with other medications or alcohol.

Kytril© (granisetron hydrochloride): Kytril© is an anti-nausea medication FDA approved for patients undergoing chemotherapy. Kytril© is typically given 60 minutes before chemotherapy. In some cases, a second dose is given about 12 hours after the first dose. Kytril© is available in tablet form and by injection.

Phenergan© (promethazine): Promethazine has sedative, antihistamine, and mild anti-nausea properties. It may be used to help prevent or treat nausea due to chemotherapy. Promethazine may be available in tablet form or as an oral syrup, suppository or injection.

Procrit© (epoetin alfa): Procrit© helps the body produce more red blood cells, which helps relieve fatigue due to chemotherapy. Since chemotherapy affects both normal and cancerous cells, it can decrease the number of red blood cells, which leads to anemia (feeling of extreme tiredness).

Zofran© (ondansetron): Zofran© helps to relieve nausea and vomiting associated with chemotherapy. Zofran© is available in pill form, as a liquid solution, and by injection. The first dose of Zofran© (tablet form) is usually administered 30 minutes before chemotherapy and then at regular intervals for one to two days after chemotherapy.

Patients who experience low blood cells counts during chemotherapy may also be given medications to help raise blood cell or platelet counts. For example, patients who suffer from neutropenia, a decrease in the number of neutrophils (a type of white blood cell), may be given certain growth factors, such as the granulocyte-macrophage colony stimulating factor (GM-CSF, sargramostim, or Leukine©) or granulocyte colony stimulating factor (G-CSF, filgrastim, or Neupogen©).

High-dose chemotherapy: High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells. Studies have reported that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast cancer.

New clinical trials: A number of new approaches to treating cancer are being studied, with an emphasis on methods that can successfully treat women or extend their survival with minimal side effects. Among these are drugs that block the biochemical switches that cause normal cells to turn cancerous. A procedure known as anti-angiogenesis, which targets the blood vessels that supply nutrients to cancer cells, is also being studied. Nonsurgical methods being studied to remove breast tissue include techniques that use heat or cold to kill cancer cells deep within the breast, leaving only minimal scars.

Ductal Carcinoma in situ (DCIS): Treatment of DCIS may include breast-conserving surgery with or without radiation or hormone therapy, and total mastectomy with or without hormone therapy.

Lobular Carcinoma in situ (LCIS): Treatment of LCIS may include biopsy to diagnose LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. Tamoxifen may be used to reduce the risk of developing breast cancer. Bilateral prophylactic mastectomy is a treatment choice sometimes used in women who have a high risk of getting breast cancer.

Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer: Treatment of stage I, stage II, stage IIIA, and operable stage IIIC breast cancer may include breast-conserving therapy to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy or a modified radical mastectomy with or without breast reconstructive surgery. Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy, systemic chemotherapy with or without hormone therapy, hormone therapy, and the monoclonal antibody Herceptin© combined with systemic chemotherapy.

Stage IIIB and inoperable stage IIIC breast cancer: Treatment of these categories of breast cancer may include systemic chemotherapy, systemic chemotherapy followed by surgery (breast conserving therapy or total mastectomy) with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.

Stage IV and metastatic breast cancer: Treatment of stage IV or metastatic breast cancer may include hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin©), radiation therapy and/or surgery for relief of pain and other symptoms, and new high-dose chemotherapy with stem cell transplants are being tested in clinical trials. Bisphosphonate drugs can be given to reduce bone disease and pain when cancer has spread to the bone.

Inflammatory breast cancer (IBC): Treatment of inflammatory breast cancer may include systemic chemotherapy, systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), lymph node dissection, followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given. Monoclonal antibody therapy including lapatinib (Tykerb©) and trastuzumab (Herceptin©) may be given.

Recurrent breast cancer: Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast or chest wall may include surgery (radical or modified radical mastectomy), radiation therapy, or both, systemic chemotherapy or hormone therapy, and clinical trials of trastuzumab (Herceptin©) combined with systemic chemotherapy are currently being done.

Men with breast cancer: More than 1,000 men in the United States are diagnosed with breast cancer every year. While men are 150 times less likely to develop breast cancer than women, male breast cancer should not be ignored. Usually, the first sign is a lump in the breast, which tends to be misdiagnosed. In general, men are diagnosed at a later stage of the disease; however, when matched against women with the same stage and age, the prognosis for men is the same. Any mass in the breast of a man should be thoroughly examined. The risk for developing breast cancer is higher for men with enlargement of the breast tissue (gynecomastia). A modified radical mastectomy is the usual course of treatment for men. Radiation may also be given. Almost 90% of men with breast cancer have the type of tumors that respond to hormone therapy.

Male breast cancer is similar to female breast cancer in that the information on symptoms, diagnosis, treatment, and living with the disease is the same. Men, however, do not need routine screening.

Follow-up: Follow-up will require frequent medical visits, often every three to four months for the first five years after the initial diagnosis. Follow-up visits should focus on determining whether cancer has appeared in the opposite breast, in the same breast, or in areas other than the breasts. In general, signs and symptoms often lead to the diagnosis of a recurrence. It is important to inform the physician about any changes in health such as coughing, dizziness, headaches, or pain no matter how minor they seem.

Prognosis: Thirty percent of patients without node involvement and 75% of patients with node involvement at diagnosis will develop metastatic disease (cancer that has spread to other tissues). Metastatic disease generally develops within five years after the initial diagnosis, although it can occur as many as 10 or more years later. Metastatic disease (Stage IV) is incurable, and the five-year survival rate is about 5 to 10%.

PREVENTION

Physical activity: Regular exercise may reduce the complications of breast cancer and reduce the risks of developing the disease. Large studies support household activity as being associated with a significantly reduced risk of breast cancer in postmenopausal and premenopausal women.

Diet: Reducing fat and red meat while increasing vegetables and whole grains may reduce the chances of developing breast cancer. One large study of almost 2500 women found that a lifestyle intervention reducing dietary fat intake, with modest influence on body weight, might improve relapse-free survival of breast cancer patients receiving conventional cancer management. In one study, during 12 years of follow-up of 90,659 premenopausal women, the greater the red meat intake correlated with an elevated risk of breast cancers that were estrogen and progesterone receptor positive, but not to those that were estrogen and progesterone receptor negative.

An increase in fiber has also been reported to reduce the chances of developing breast cancer.

The phytochemical (plant-chemical) indole-3-carbinol, found in cruciferous vegetables like cabbage and broccoli might directly contribute to breast cancer protection. An increase in soy and soy products as source of isoflavones was found to be inversely associated with high mammographic density, a marker for breast cancer risk. Estrogenic activity by soy may be linked to breast cancer development in some studies, with other studies reporting no correlation between dietary phytoestrogens and breast cancer.

Weight loss: A lower body mass index (BMI) has been correlated with a lower chance of developing breast cancer.

Decrease alcohol consumption: Although a glass of wine may be beneficial for heart health, findings from a prospective study suggest that moderate alcohol consumption may increase the risk of breast cancer risk. It should be noted that some components of alcoholic beverages, such as hops have estrogenic activity, which may be linked to breast cancer development in some studies. However, some studies have reported no correlation between dietary phytoestrogens and breast cancer.

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