Рак молочной железы

Рак молочной железы
МКБ-10	C50.
МКБ-9	174-175
OMIM	114480
DiseasesDB	1598
MedlinePlus	000913
eMedicine	med/2808

Рак молочной железы — это злокачественная опухоль железистой ткани молочной железы. В мире это наиболее частая форма рака среди женщин, поражающая в течение жизни от 1:13 до 1:9 женщин в возрасте от 13 до 90 лет. Это также второе по частоте после рака лёгких онкологическое заболевание в популяции в целом (считая и мужское население). Количество случаев рака молочной железы в развитых странах резко увеличилось после 1970-х годов. За этот феномен считают частично ответственным изменившийся стиль жизни населения развитых стран (в частности то, что в семьях стало меньше детей и сроки грудного вскармливания сократились).

Поскольку молочная железа состоит из одинаковых тканей у мужчин и женщин, рак молочной железы иногда встречается и у мужчин, но случаи РМЖ у мужчин составляют менее 1 % от общего количества больных РМЖ.

Исторические описания

Женская грудь после мастэктомии

Рак молочной железы является одной из самых изученных и изучаемых форм рака. Древнейшее из известных описаний рака молочной железы (хотя сам термин «рак» ещё не был известен и не использовался) было найдено в Египте и датируется примерно 1600 годом до нашей эры. Так называемый «Папирус Эдвина Смита» описывает 8 случаев опухолей или изъязвлений молочной железы, которые были подвергнуты лечению прижиганием огнём. Текст гласит: «От этой болезни нет лечения; она всегда приводит к смерти».

В течение многих столетий врачи описывали подобные случаи в своей практике с тем же печальным заключением. Никаких сдвигов в лечении рака молочной железы не происходило до тех пор, пока в XVII-м веке врачи не добились лучшего понимания работы кровеносной и лимфатической систем организма и не смогли понять, что рак молочной железы распространяется (метастазирует) по лимфатическим путям и в первую очередь поражает ближайшие — подмышечные — лимфатические узлы. Французский хирург Жан-Луи Петит (1674—1750) и вскоре после него шотландский хирург Бенджамин Белл (1749—1806) были первыми, кто догадался удалять при раке молочной железы не только саму молочную железу, но и ближайшие лимфатические узлы и подлежащую грудную мышцу. Их успешная работа была подхвачена Уильямом Стюардом Холстедом, который в 1882 году ввёл в широкую медицинскую практику технически усовершенствованный вариант этой операции, которую он назвал «радикальной мастэктомией». Операция стала настолько популярной при раке молочной железы, что даже получила название по имени её изобретателя — «мастэктомия Холстеда» или «мастэктомия по Холстеду».

В настоящее время исследована экспрессия различных генов в опухолях молочной железы и выделены различные молекулярные типы опухоли. Клинически, они имеют существенно различный риск развития метастазов и требуют различной терапии. Коллекция данных по экспрессии 17816 генов в опухолях молочной железы доступна онлайн и используется не только для медико-биологических исследований, но и как ставший классическим тестовый пример для визуализации и картографии данных.

Гистологические типы РМЖ

• Протоковый рак in situ
• Дольковый рак in situ
• Инвазивный протоковый рак
• Инвазивный дольковый рак
• Рак молочной железы с признаками воспаления
• Медуллярный рак
• Коллоидный рак
• Папиллярный рак
• Метапластический рак

Пути улучшения результатов лечения

Существуют три основных пути улучшения результатов лечения рака молочной железы:

• ранняя диагностика;
• первичная и вторичная профилактика;
• адекватное лечение.

Китайские исследователи рекомендуют употреблять в пищу соевые продукты для профилактики и лечения рака молочной железы. Исследование, опубликованное в журнале Canadian Medical Association Journal и процитированное в февральском журнале Nature (2 февраля 2011), показало, что пациенты в чью диету входили соевые изофлавоноиды, имели более низкий риск рецидива рака молочной железы, чем те, кто употреблял небольшое количество соевых продуктов или не употреблял их вовсе.

Факторы риска

Факторы риска развития рака молочной железы:

• отсутствие в анамнезе беременностей и родов;
• первые роды после 30 лет;
• раннее менархе (до 12 лет);
• поздняя менопауза (после 55 лет);
• отягощенный семейный анамнез (онкозаболевания у кровных родственников);
• больные, леченные по поводу рака женских половых органов;
• травма молочной железы в анамнезе;
• ожирение;
• сахарный диабет;
• гипертоническая болезнь;
• злоупотребление алкоголем;
• употребление экзогенных гормонов - при непрерывном употреблении экзогенных гормонов с целью контрацепции или лечения – более 10 лет.

Симптомы рака молочной железы на ранних стадиях заболевания могут отсутствовать или характеризоваться появлением в молочной железе небольших малочувствительных подвижных масс. Рост опухоли сопровождается нарушением ее подвижности, фиксацией, розоватыми или оранжевыми выделениями из соска.

Сигналы тревоги

Сигналы тревоги рака молочной железы:

• наличие уплотнений или опухолевидных образований в одной или обеих молочных железах;
• выделения из соска любого характера, не связанные с беременностью или лактацией;
• эрозии, корочки, чешуйки, изъязвления в области соска, ареолы;
• беспричинно возникающая деформация, отек, увеличение или уменьшение размеров молочной железы;
• увеличение подмышечных или надключичных лимфоузлов.

Выявление врачом хотя бы одного из указанных «сигналов тревоги» требует срочного направления больной к онкологу-маммологу. Скриннинг рака молочной железы проводится при физикальном обследовании молочной железы врачом любой специальности ежегодно, а также ежемесячного самообследования молочных желез. Маммография проводится женщинам от 35 до 50 лет раз в 2 года. (при отягощенном личном и семейном анамнезе – 1 раз в год), женщинам после 50 лет – ежегодно. Профилактика рака молочной железы заключается в устранении факторов, способствующих его развитию, а также в оптимальной диспансеризации женщин с гиперпластическими процессами и своевременном адекватном их лечении, включая оперативные методы. Диагностика данного заболевания должна быть комплексная. Методами исследования являютья узи молочных желез, термомаммография и маммография. Велика роль анализа крови на онкомаркер. Для установления типа опухоли делают гистологическое исследование тканей.

См. также

• Розовая лента

Prevention in High-risk Women

Prophylactic oophorectomy (removal of ovaries), post-child-bearing, reduces the risk of developing breast cancer by 50 %, as well as reducing the risk of developing ovarian cancer by 96 %. The side effects of Oophorectomy may be alleviated by medicines other than hormonal replacement. Non-hormonal biphosphonates (such as Fosamax and Actonel) increase bone strength and are available as once-a-week pills. Low-dose Selective Serotonin Reuptake Inhibitors (e.g. Paxil, Prozac) alleviate vasomotor menopausal symptoms, i.e. «hot flashes».

Prevention of Environmental Causes

Fewer than 10 percent of breast cancers are genetic. When all known risk factors and characteristics are added together, including family history, genetics, smoking and obesity, more than 50 percent of breast cancer cases remain unexplained. According to State of the Evidence 2006 - What Is the Connection Between the Environment and Breast Cancer?”,a report which reviews and analyzes nearly 350 journal-published scientific studies on environmental links to breast cancer:

• Over 100,000 synthetic chemicals are registered for use today in the United States, with an additional 1,000 new chemicals added each year, yet less than 10 percent of these chemicals have been tested for their effects on human health. Large numbers of these chemicals are found in products we come into contact with every day and compelling scientific evidence points to these chemicals as contributing to the development of breast cancer, either by altering hormone function or gene expression
• Many toxic chemicals are now credibly linked to serious chronic diseases including breast cancer. Furthermore, new science demonstrates that even very small amounts of some chemicals can have adverse health effects, particularly in pregnant mothers, infants and small children. See State of the Evidence

The Breast Cancer Fund suggests the following environmental prevention methods:

• Practice Healthy Purchasing: Don’t bring toxic chemicals home from the store. Choose chlorine-free paper products to reduce dioxin, a carcinogen released when chlorinated products are incinerated. Read food labels, and choose pesticide-free, organic produce and hormone-free meats and dairy products. Replace harmful household cleaners that contain bleach with cheaper, nontoxic alternatives like baking soda, borax soap and vinegar. Look for alternatives to chemical weed and bug killers— many contain toxic chemicals that accumulate in our bodies.

• Use Caution with Plastics: Some plastics leach hormone-disrupting chemicals called phthalates into the substances they touch. Polyvinyl chloride (PVC) plastics release carcinogens into our air and water during the production process. PVC plastics are especially dangerous in toys that children put in their mouths, so keep an eye out for nontoxic toys. Further, never put plastic or plastic wrap in the microwave, as this can release phthalates into food and beverages.

• Advocate for Clean Air: The soot and fumes released by factories, automobiles, diesel trucks and tobacco products contain chemicals called polycyclic aromatic hydrocarbons (PAHs) that are linked to breast cancer. Indeed, breathing these compounds from secondhand tobacco smoke may increase your risk for breast cancer more than active smoking. Stay away from secondhand smoke, and advocate for stronger clean air protections.

• Avoid Unnecessary Radiation: Ionizing radiation is a known cause of breast cancer. Radiation damage to genes is cumulative over a lifetime—thus many low doses may have the same effect as a single high dose. Mammograms, other X-rays and CT scans expose you to radiation. While mammography screening may benefit postmenopausal women, mammography for women in their 30s and 40s remains controversial. Whenever you have an X-ray or scan, request a lead shield to protect the areas of your body not being X-rayed.

• Explore Alternatives to Artificial Estrogens: Women who have prolonged exposure to estrogens are at higher risk for breast cancer, and major studies continue to show an increased risk when postmenopausal women use hormone replacement therapy (HRT). Women who use both birth control pills and—later in life—HRT face an even greater risk of breast cancer than those who use neither. Explore your options with healthcare professionals.

• Advocate for Safe Cosmetics: Chemicals linked to cancer and birth defects do not belong in cosmetics, period. However, some popular brands of shampoo, deodorant, face cream and other everyday products contain these dangerous chemicals. The Breast Cancer Fund demands safer products and smarter laws by letting cosmetics companies know they need a makeover. The public can join BCF in asking cosmetic companies to sign the Compact for Safe Cosmetics, a pledge to substitute chemicals linked to birth defects, infertility, cancer, brain damage and other serious health consequences with safer alternatives. For more info visit Campaign for Safe Cosmetics

Симптомы

Рак молочной железы на ранних стадиях протекает бессимптомно и не причиняет боли. Обычно рак молочной железы обнаруживают до появления симптомов - либо на маммографии, либо женщина чувствует появление уплотнения в груди. Так же может появиться не исчезающее в течение менструального цикла уплотнение в подмышечной ямке или над ключицей. Прочие симптомы:

• Прозрачные или кровянистые выделения из груди
• Втяжение соска
• Изменение цвета или структуры кожи груди^{[источник не указан 215 дней]}.

Screening

Due to the high incidence of breast cancer among older women, screening is now recommended in many countries. Screening methods suggested include breast self-examination and mammography. Mammography has been shown to reduce breast cancer-related mortality by 20-30 %. Routine (annual) mammography of women older than 50 is encouraged as a screening method to diagnose early breast cancer and has demonstrated a protective effect in multiple clinical trials.

Normal (left) versus cancerous (right) mammography image.

Mammography is still the modality of choice for screening of early breast cancer, and breast cancers detected by mammography are usually smaller than those detected clinically.

Magnetic resonance imaging (MRI) has been shown to detect cancers that are not visible on mammograms, but it has several disadvantages. For example, although it is 27-36 % more sensitive, it is less specific than mammography. As a result, MRI studies will have more false positives (up to 5 %), which may have undesirable financial and psychological costs. It is also a relatively expensive procedure, and one which requires the intravenous injection of a chemical agent to be effective. Proposed Indications for using MRI for screening include:

• Strong family history of breast cancer
• Patients with BRCA-1 or BRCA-2 oncogene mutations
• Evaluation of women with breast implants
• History of previous lumpectomy or breast biopsy surgeries
• Axillary metastasis with an unknown primary tumor
• Very dense or scarred breast tissue

Ultrasound alone is not adequate as a screening tool but it is a useful additional for the characterization of palpable tumours and directing image-guided biopsies.

The U.S. National Cancer Institute recommends screening mammography with a baseline mammogram at age 35, mammograms every two years beginning at age 40, and then annual mammograms beginning at age 50. In the UK, women are invited to attend for screening once every three years beginning at age 50. Women with one or more first degree relatives (mother, sister, daughter) with premenopausal breast cancer should begin screening at an earlier age. It is usually suggested to start screening at an age that is 10 years less than the age at which the relative was diagnosed with breast cancer.

Diagnosis

The diagnosis of breast cancer is established by the pathological examination of removed breast tissue. Such tissue is generally obtained at the time of surgical treatment. A number of procedures have been devised to obtain tissue or cells prior to the treatment for histological or cytological examination. Such procedures include fine-needle aspiration, nipples aspirates, ductal lavage, core needle biopsy, and local surgical biopsy. Most of these diagnostic steps, however, have some limitations as they may not yield enough tissue or miss the cancer, while the surgical biopsy already becomes an invasive procedure. Imaging tests are used to detect metastasis and include chest x-ray, bone scan, CT, MRI, and PET scanning. Ca 15.3 (carbohydrate antigen 15.3, epithelial mucin) is a tumor marker determined in blood which can be used to follow up disease activity.

Breast cancer is staged. Not only will this allow for better understanding of the disease process, but it will also facilitate interpretation of data, and determine treatment. Prognosis is closely linked to results of staging.

Summary of stages:

• Stage 0 — Carcinoma in situ
• Stage I — Tumor (T) does not exceed 2 cm, no axillary lymph nodes (N) involved.
• Stage IIA — T 2-5 cm, N negative, or T <2 cm and N positive.
• Stage IIB – T > 5 cm, N negative, or T 2-5 cm and N positive (< 4 axillary nodes).
• Stage IIIA – T > 5 cm, N positive, or T 2-5 cm with 4 or more axillary nodes
• Stage IIIB — T has penetrated chest wall or skin, and may have spread to < 10 axillary N
• Stage IIIC – T has > 10 axillary N, 1 or more supraclavicular or infraclavicular N, or internal mammary N.
• Stage IV — Distant metastasis (M)

Breast lesions are examined for certain markers, notably sex steroid hormone receptors. About two thirds of postmenopausal breast cancers are estrogen receptor positive (ER+) and progesterone receptor positive (PR+). Receptor status modifies the treatment as, for instance, ER+ lesions are more sensitive to hormonal therapy.

Treatment

The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy. At present, the treatment recommendations after surgery (adjuvant therapy) follow a pattern. This pattern may be adapted as every two years a worldwide conference takes place in St. Gallen, Switzerland to discuss the actual results of worldwide multi-center studies. Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases which follow different rules for therapy. Treatment possibilities include Radiation Therapy, Chemotherapy, Hormone Therapy, and Immune Therapy.

An online resource for helping to quantify the relative risks and benefits of chemotherapy v. hormonal therapy is Adjuvant! Online (see below).

In planning treatment, doctors can also use microarray tests like Oncotype DX or MammaPrint that predict breast cancer recurrence risk based on gene expression.

The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which can help patients cope with the many issues that come up in a supportive environment with other people with experience with similar issues. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.

Surgery

Depending on the staging and type of the tumor, just a lumpectomy (removal of the lump only) may be all that is necessary or removal of larger amounts of breast tissue may be necessary. Surgical removal of the entire breast is called mastectomy.

Standard practice requires that the surgeon must establish that the tissue removed in the operation has margins clear of cancer, indicating that the cancer has been completely excised. If the tissue removed does not have clear margins, then further operations to remove more tissue may be necessary. This may sometimes require removal of part of the pectoralis major muscle which is the main muscle of the anterior chest wall.

During the operation, the lymph nodes in the axilla are also considered for removal. In the past, large axillary operations took out ten to forty nodes to establish whether cancer had spread — this had the unfortunate side effect of frequently causing lymphedema of the arm on the same side as the removal of this many lymph nodes affected lymphatic drainage. More recently the technique of sentinel lymph node (SLN) dissection has become popular as it requires the removal of far fewer lymph nodes, resulting in fewer side effects. The sentinel lymph node is the first node that drains the tumor and subsequent SLN mapping can save 65-70 % of patients with breast cancer from having a complete lymph node dissection for what could turn out to be a negative nodal basin. SLN biopsy is indicated for patients with T1 abd T2 lesions (<5cm) and carries a number of recommendations for use on patient subgroups .

Radiation therapy

Radiation therapy consists of the use of high powered X-rays or gamma rays (XRT) that precisely target the area that is being treated. These X-rays or gamma rays are very effective in destroying the cancer cells that might recur where the tumor was removed. These X-rays are delivered by a machine called a linear Accelerator or LINAC. Alternatively, the use of implanted radioactive catheters (brachytherapy), similar to those used in prostate cancer treatment, is being evaluated. The use of radiation therapy for breast cancer is usually given after surgery has been performed and is an essential component of breast conserving therapy. The purpose of radiation is to reduce the chance that the cancer will recur.

Radiation therapy works for breast cancer by eliminating the microscopic cancer cells that may remain near the area where the tumor was removed during surgery. Since by the nature of radiation and its effects on normal cells and cancer cells alike the dose that is given is to ensure that the cancer cells are eliminated. However, the dose cannot be given in one sitting. Radiation causes some damage to the normal tissue around where the tumor was but normal healthy tissue can repair itself. The treatments are given typically over a period of five to seven weeks, performed five days a week. Each treatment session takes about fifteen minutes per day. Breaking the treatments up over this extended period of time gives the healthy normal tissue a chance to repair itself. Cancer cells do not repair themselves as well as normal cells, which explains the efficacy of radiation therapy.

Although radiation therapy can reduce the chance that breast cancer will recur in the breast, it is much less effective in prolonging patient survival. The National Cancer Institute reviews this information. in a paragraph that begins:"Breast-conserving surgery alone without radiation therapy . . ." The NCI includes six studies; none of them found a survival benefit for radiation therapy. Abstracts from all six studies are available for review. Patients who are unable to have radiation therapy after lumpectomy should consult with a surgeon who understands this research and who believes that lumpectomy (or partial mastectomy) alone is a reasonable treatment option.

Indications for radiation

Indications for radiation treatment are constantly evolving. Patients treated in Europe have been more likely in the past to be recommended adjuvant radiation after breast cancer surgery. Radiation therapy is usually recommended for all patients who had (lumpectomy, quadrant-resection). Radiation therapy is usually not indicated in patients with advanced (stage IV disease) except for palliation of symptoms like bone pain.

In general recommendations would include:

• As part of breast conserving therapyof breast cancer when the whole breast is not removed (lumpectomy or wide local excision)
• After mastectomy: Patients with higher chances of cancer recurring such as : large primary tumor and involvement of 4 or more lymph nodes.

Other factors which may influence adding adjuvant

• Tumor close to or to the margins on pathology specimen
• Multiple areas of tumor (multicentric disease)
• Microscopic invasion of lymphatic or vascular tissues
• Microcopic invasion of the skin, nipple/areola, or underlying pectoralis major muscle
• Patients with <4 LN involved, but extension out of the substance of a LN
• Inadequate numbers of axillary LN sampled

Types of radiotherapy

Radiotherapy can be delivered in many ways. Most commonly this is done using radiation from linear accelerators. Since this is delivered from outside, one needs to restrict the amount of dose that can be given at one time so that normal tissues are not harmed. So the course usually lasts for several days, typically every day for 5 to 6 weeks. New technology has allowed more precise delivery of radiotherapy in a portable fashion- for example in the operating theatre. Targeted intraoperative radiotherapy (TARGIT) (coined by Dr Jayant S Vaidya in 1999) is a method of delivering therapeutic radiation from within the breast using a portable x-ray generator called Intrabeam^TM. It is undergoing clinical trials The Lancet in several countries at present to test whether it can replace the whole course of radiotherapy in selected patients. It may also be able provide a much better boost dose to the tumour bed and appears to provide superior controlRef. This will be tested in a Targit-B trial. More information about this is available at Targit literature Website and Targit trial website

Side effects of radiation therapy

The side effects of radiation have improved considerably over the past decades. Aside from general fatigue caused by the healthy tissue repairing itself there will probably be no side effects at all. Some patients do develop a suntan-like change in skin color in the exact area being treated. As with a suntan, this darkening of the skin will fade with time. Other side effects experienced with radiation are:

• reddening of the skin
• muscle stiffness
• mild swelling
• tenderness in the area
• long-term shrinking of the irradiated breast

Along with improved cosmetic outcome of treatment with radiation there are also other techniques for delivering radiation to the breast. One such new technology is using IMRT (intensity modulated radiation therapy) which the radiation oncologist can change the shape and intensity of the radiation beam at different points across and inside the breast. This allows for an even more focused beam of radiation directed at the tumor cells and leaving most of the healthy tissue unaffected by the radiation

Another new procedure involves a type of brachytherapy where a radioactive source is temporarily placed inside the breast in direct contact with the tumor bed (area where tumor was removed). This technique is called a Mammosite and is currently undergoing clinic trials.

Systemic therapy

Systemic therapy uses medications to treat cancer cells throughout the body. Any combination of systemic treatments may be used to treat breast cancer. Systemic treatments include chemotherapy, immune therapy, and hormonal therapy.

Chemotherapy

Chemotherapy can be given both before and after surgery. Neo-adjuvant chemotherapy is used to shrink the size of a tumor prior to surgery. Adjuvant chemotherapy is given after surgery to reduce the risk of recurrence.

There are several different chemotherapy regimens that may be used. The determination of the appropriate regimen depends on many factors including the character of the tumor, lymph node status, and the age and health of the patient. Possible chemotherapy regimens include:

• CMF: cyclophosphamide, methotrexate, and 5-fluorouracil
• FAC: 5-fluorouracil, doxorubicin, cyclophosphamide
• AC: doxorubicin and cyclophosphamide
• AC with paclitaxel administered after the AC
• TAC: docetaxel , doxorubicin, and cyclophosphamide
• FEC: 5-fluorouracil, epirubucin and cyclophosphamide for 6 cycles
• FEC for three cycles followed by docetaxel for three cycles
• Dose dense AC: doxorubicin and cyclophosphamide followed by paclitaxel
• TC: Taxotere (docetaxel) and cyclophosphamide

Since chemotherapy affects the production of white blood cells, a growth factor e.g. pegfilgrastim is sometimes administered along with chemotherapy. This has been shown to reduce, though not completely prevent the rate of infection and low white cell count.

Chemotherapy has increasing side effects as the patient’s age passes 65.

Hormonal treatment

Patients with estrogen receptor positive tumors will typically receive a hormonal treatment after chemotherapy is completed. Typical hormonal treatments include:

• Tamoxifen is typically given to premenopausal women to block the estrogen receptor on cells to prevent the transport of estrogen into the cell
• Aromatase inhibitors are typically given to postmenopausal women to lower the amount of estrogen in their systems
• GnRH-analogues
• ovarian ablation or suppression is used in premenopausal women

However, a recent statistic data shows breast cancer rate dropped dramatically in 2003 and the declining use of hormone could be the reason [3].

Targeted therapy

In patients whose cancer expresses an over-abundance of the HER2 protein the drug trastuzumab (Herceptin ®) is used to block the HER2 protein in breast cancer cells slowing their growth. This drug was originally used only in the treatment of patients with metastatic disease, however in the summer of 2005 two large clinical trials published results suggesting that patients with early-stage disease also benefit significantly from Herceptin.

Preclinical

Flax seeds

Preliminary research into flax seeds indicate that flax can significantly inhibit breast cancer growth and metastasis, and enhance the inhibitory effect of tamoxifen on estrogen-dependent tumors.

Alternative medicine

The use of traditional Chinese medicine to treat breast cancer has been claimed, but no successful clinical trials have yet been reported.

Prognosis

There are several prognostic factors associated with breast cancer. Stage is the single most important prognostic factor in breast cancer, as it will take into consideration local involvement, lymph node status and whether metastatic disease is present or not. The higher the stage at the time of diagnosis, the worse the prognosis of breast cancer is. Node negative breast cancer patients have a much better prognosis compared to node positive patients.

Presence of estrogen and progesterone receptors in the cancer cell is another important prognostic factor, and may guide treatment. Hormone receptor positive breast cancer is usually associated with much better prognosis compared to hormone negative breast cancer.

HER2/neu status has also been described as a prognostic factor. Patients whose cancer cells are positive for HER2/neu have more aggressive disease and may be treated with trastuzumab, a monoclonal antibody that targets this protein.

Ashkenazi Jewish women and black women tend to have higher rates of fatalities.

Breast cancer in males

Less than 1 % of breast cancers occur in men and incidence is about 1 in 100,000. Men with gynaecomastia do not have a higher risk of developing breast cancer. The treatment of men with breast cancer is similar to that in older women. Since the male breast tissue is confined to the area directly behind the nipple, treatment for males has usually been a mastectomy with axillary surgery. This may be followed by adjuvant radiotherapy, hormone therapy (such as tamoxifen), or chemotherapy.

Breast Cancer spreading elsewhere in the body

Most people understand breast cancer as something that happens in the breast. However it can spread via lymphatics to nearby lymph nodes usually those under the arm. That is why surgery for breast cancer always involves some type of surgery for the glands under the arm- either axillary clearance, sampling or sentinel node biopsy.

Advanced regional recurrence of breast cancer in the axillae

Breast cancer can also spread to other parts of the body via blood vessels. So it can spread to the lungs, pleura (the lining of the lungs), the liver, the brain and most commonly to the bones.

Seventy percent of the time that breast cancer spreads to other locations, it spreads to bone, especially the vertebrae and the long bones of the arms, legs and ribs. Breast cancer cells «set up housekeeping» in the bones and form tumors. When breast cancer is found in bones. It has usually spread to more than one site. At this stage, it is treatable, often for many years, but it is not curable.

Like normal breast cells, these tumors in the bone often thrive on female hormones, especially estrogen. Therefore, the doctor often treats the patient with medicines that lower her estrogen levels.

Usually the breast cancer spreads to many bones where it eats away at the health bone, causing weak spots. The bones break easily at those weak spots. That is why you will see breast cancer patients wearing braces, using a wheel chair or complaining of aching bones. If a patient had breast cancer in the past and notices pain in her bones, she should see her doctor^{[источник не указан 215 дней]}.

Breast cancer awareness

In the month of October, breast cancer is recognized by survivors, family and friends of survivors and/or victims of the disease. A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer.

Pink for October is an initiative started by Matthew Oliphant, which asks that any sites willing to help make people aware of breast cancer, change their template or layout to include the color pink, so that when visitors view the site, they see that the majority of the site is pink. Then after reading a short amount of information about breast cancer, or being redirected to another site, they are aware of the disease itself.

See also

• List of notable breast cancer patients according to occupation.
• List of notable breast cancer patients according to survival status.
• List of breast carcinogenic substances : cadmium.
• Mammary tumor for breast cancer in other animals.
• Breast reconstruction.
• Alcohol and cancer.
• Mammogram Quality Standards Act.
• National Breast Cancer Coalition
• Breast Cancer Action
• Breast Cancer Fund

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Библиография (на английском)

• Chu, S.Y.; Lee, N.C.; Wingo, P.A.; and Webster, L.A. Alcohol consumption and the risk of breast cancer. American Journal of Epidemiology 130(5):867-877, 1989.
• Friedenreich, C.M.; Howe, G.R.; Miller, A.B.; and Jain, M.G. A cohort study of alcohol consumption and risk of breast cancer. American Journal of Edidemiology 137(5):512-520, 1993.
• Longnecker, M.P.; Berlin, J.A.; Orza, M.J.; and Chalmers, T.C. A meta-analysis of alcohol consumption in relation to risk of breast cancer. Journal of the American Medical Association 260(5):652-656, 1988.
• Longnecker, M.P. Alcohol consumption in relation to risk of cancers of the breast and large bowel. Alcohol Health & Research World 16(3)':223-229, 1992.
• Nasca, P.C.; Baptiste, M.S.; Field, N.A.; Metzger, B.B.; Black, M.; Kwon, C.S.; and Jacobson, H. An epidemiological case-control study of breast cancer and alcohol consumption. International Journal of Epidemiology 19(3):532-538, 1990.
• Petri, A.L., et al. Alcohol intake, type of beverage, and risk of cancer in pre- and postmenopausal women. Alcoholism: Clinical & Experimental Research, 2004, 28(7), 1084—1090).
• Schatzkin, A.; Piantadosi, S.; Miccozzi, M.; and Bartee, D. Alcohol consumption and breast cancer: A cross-national correlation study. International Journal of Epidemiology 18(1):28-31, 1989.
• Webster, L.A.; Layde, P.M.; Wingo, P.A.; and Ory, H.W. Alcohol consumption and risk of breast cancer. Lancet 2(8352):724-726, 1983.

Ссылки (на английском)

• International Agency for Research on Cancer home page
• Australia: Cancer Control Bulletin Alcohol and cancer risk (PDF format)
• Johns Hopkins Avon Foundation Breast Center
• Oncology: Soy joy
• Breast cancer incidence by country
• National Cancer Institute - Breast Cancer Home Page
• Mayo Clinic: How the grading system for cancerous tumors was developed.
• Cornell University Alcohol and the Risk of Breast Cancer
• Breast Cancer Treatment Information and Pictures
• Interviews with Breast Cancer Experts
• State of the Evidence
• RadiologyInfo — The radiology information resource for patients: Breast Cancer
• National Breast Cancer Coalition
• Breast Cancer Action

Ссылки (на русском)

• Соя и рак груди: с точностью до наоборот
• Рак груди на Маммология.РУ
• Все о раке молочной железы
• Авторефераты по теме: рак молочной железы
• Лечение рака груди
• Лечение рака молочной железы
• Применение химиоэмболизации в лечении рака молочной железы
• Профилактика заболеваний молочной железы
• Чхиквадзе, В.Д. Хирургическое лечение рака молочной железы / В.Д. Чхиквадзе, С.А.Васильев, Ю.С. Васильев // Маммология: национальное руководство / под ред. В.П.Харченко, Н.И.Рожковой. – М., 2009. – Гл.9. - С.227-250.
• Булынский, Д.Н. Современные технологии диагностики и лечения рака молочной железы: учеб. пособие / Д.Н.Булынский, Ю.С. Васильев; под ред. С.В.Яйцева. – Челябинск, 2009. – 84 с.