Seven Secrets About Breast Cancer

Secret #1 The Money Spent On Research Into Breast Cancer Is Not Ensuring That Less Women Get Breast Cancer.
Secret #2 You Do Need To Act Against Getting Breast Cancer Before You Reach 50 And You Cannot Rely On Mammograms.
Secret #3 You Are At Risk Of Getting Breast Cancer Even If You Don't Have It In Your Family.
Secret #4 Most Of The Money Spent On Research Is Not Going Into Prevention To Ensure That Less Women Suffer The Devastating Effects Of Breast Cancer In The Future.
Secret #5 Most Women Are Not Breast Aware And Are Afraid Of Breast Cancer.
Secret #6 Women Are Not Given Lots Of Advice On How They Can Protect Their Breasts Against Breast Cancer.
Secret #7 Most Women Do Not Appreciate How Important Their Breasts Are And Do Not Do Everything They Can To Look After And Protect Them.
The above "secrets" are things which are not commonly known by most women and may be surprising to you. In this article, I intend to shed light on these facts and allow women to make up their own minds how they approach their breast health.
SECRET #1 THE MONEY SPENT ON RESEARCH INTO BREAST CANCER IS NOT ENSURING THAT LESS WOMEN GET BREAST CANCER.
The Pink Ribbon and Breast Cancer Awarenss Month was introduced in the US in 1985 and introduced to the UK in 1993. The Pink Ribbon Foundation is fronted by the Estee Lauder group of companies (known for cosmetics and skincare).
Since then the pink ribbon symbol has become synonymous with breast cancer and during the past 15 years billions of pounds have been raised in its name. Every October the world celebrates Breast Cancer Awareness Month and fund raising during that month is phenomenal. All the breast cancer charities vie with each other to see who can come up with the most innovative "pink" fundraising. They run pink parties and sell pink products in order to raise money. Many companies take part and do special promotions during October for their preferred charity. "Pink" is big business.
So with all this money being raised during October and also at other times during the year through events like charity runs and walks, is there an impact on the breast cancer rates in the UK and around the world? Are they coming down? Are fewer women suffering from the devastating effects of breast cancer?
Unfortunately, the answer is 'no'.
In the UK, from 1993-2004, breast cancer incidence has increased 18.5%, that is 1% per year. 1 in 9 women will get the disease during their lifetime with current projections of 1 in 7 by 2010. 45,500 women were diagnosed in 2005, which equates to 125 women every day. Worldwide more than a million women are diagnosed with breast cancer every year. It is also projected that breast cancer rates will rise most in developing countries, where women do not have access to top quality care and where they can also be treated as outcasts in certain societies.
Breast cancer survival rates have improved. Every year more than 12,300 women and 70 men die from breast cancer. Since the peak in the late 1980s breast cancer death rates have fallen by a third. Breast cancer drugs have helped to save women's lives but, as with any drugs, can have long-term side affects. Also the cost of these drugs puts great strain on the NHS. If breast cancer rates continue to increase as they have been doing, then, according to Professor Karol Sikora as reported in the Daily Mail on 09/09/08, "the next generation of drugs would keep patients alive longer, but could swallow half of the current NHS cancer budget within four years. (this refers to all cancer drugs at a cost of £50 billion).
With the billions being raised by people around the world in the name of breast cancer, is it right that actually more women are getting this devastating disease every year?
SECRET #2 YOU DO NEED TO ACT AGAINST GETTING BREAST CANCER BEFORE YOU REACH 50 AND YOU CANNOT RELY ON MAMMOGRAMS.
Women in the UK are offered breast screening by mammogram every three years from the age of 50. This is because breast cancer is still more common in women over 50 but also because the breast tissue of younger women is denser and, therefore, makes it more difficult for a mammogram to pick up on a potential breast lump.
However, this could be giving the message to younger women that they don't need to check their breasts themselves. Based on my experience during my breast health talks, very few younger women check their breasts. The main reasons for this are that no-one has shown them how to, they don't know what to do, they think that they only need to worry if breast cancer is in the family (see Secret #3) or they are afraid that they might find something.
For a younger woman it is even more important to check her breasts from her mid-twenties as breast cancer in younger women is usually much more aggressive as the breast cancer cells can multiply more rapidly than in older women. If girls were taught by their mothers to check their breasts from their mid-twenties, they would not be afraid - it would just be part of their general regime of looking after themselves. Also they would feel confident about what to do. Breast self-examination is easy to do once you have been shown how and there are even devices on the market which can help you do so with confidence and greater accuracy.
Breast cancer is the biggest killer of women aged 35-54, which means it makes sense for women in this age bracket to do everything they can to protect their breasts.
Furthermore, I do not believe that we should rely on mammograms either. Women are only screened every three years and, usually, a mammogram can only detect a breast tumour once it has been growing for 8 years. By the time the tumour reaches 10 years, it could be too late. The other thing to remember is that a mammogram can only screen the part of the breast which can be put into the "clamp". It cannot screen under the armpit or between the breasts for example.
Lastly, there is growing concern over the safety of mammograms. The following are extracts from an article written by Peter Leando PhD.
"Controversy has raged for years as to whether the risks related to the radiation exposure suffered from mammography are justified by the benefits gained ...... new evidence relating to the particular type of radiation used and the hard evidence relating to the clinical benefits of mammography have caused a serious re-evaluation of the justification of mammography as a screening test.
Radiation from routine mammography cannot be directly compared to other types of X-ray like chest X-ray etc because they are very different types of radiation.
The comparisons that have been used between a chest x-ray and mammography, 1/1,000 of a rad (radiation-absorbed dose) for a chest X-ray and the 1 rad exposure for the routine four films taken of both breasts for a mammographic screening exam results in some 1,000 times greater exposure. (This refers to the US, where they do four-way screening. In the UK typically only two-way screening is offered.)
This is considered a significant risk factor when extended over a ten year screening period and a potential accumulative dose of 10 rads. Unfortunately this is not the major risk posed by the particular type of radiation used by mammograms, mammography X-rays use a low energy form of ionising radiation that causes greater biologic damage than the high energy X-ray. The very low energy electrons affect the density of ionisation tracks that pass through the tissue, which can cause complex damage to the DNA and carcinogenic changes.
The radiation used by mammography is almost 5 times more effective at causing cancer." So, women do need to start checking their breasts from their early twenties and we cannot rely on mammograms 100%, particularly for younger women who would have a greater exposure to radiation during their lifetime if they were offered mammograms from a younger age. Also mammograms do not detect Inflammatory Breast Cancer (IBC) which is a much rarer form of the disease and does not involve a lump. This would only detected by a woman looking for changes to her breasts and reporting them to her doctor.
SECRET #3 YOU ARE AT RISK OF GETTING BREAST CANCER EVEN IF YOU DON'T HAVE IT IN YOUR FAMILY.
Amongst the hundreds of women I have talked to about breast health, the vast majority were under the false impression that breast cancer is primarily hereditary. They were surprised to hear that fewer than 10% of cases occur to women who have breast cancer in the family.
In fact, every woman is at risk and should take control of her own breast health to give herself the best possible chance of prevention or early detection.
The other most common acknowledged risk factors are:

• Age - breast cancer is more common in women over 50
• Early puberty - it is worrying that puberty is starting younger, with most girls starting their periods at primary school
• Late pregnancy - many woman are opting to have children later
• Late onset menopause
• Not having children and not breastfeeding - this was known as early as the 18^th century when a doctor in Italy noticed that nuns had higher levels of breast cancer than the general population
• Being overweight - this applies mainly to post-menopausal women
• Alcohol - over-consumption increases the risk of breast cancer

Acknowledged risk factors account for around 50% of breast cancer cases. For the remainder, there are no definite reasons.
There are a growing number of scientists, commercial companies and individuals who believe that this remaining 50% is due to the rise of the number of chemicals which have been introduced over the past 50 years. They are used in our food, in our toiletries, in the workplace, in our clothes, in our furnishings - in fact, in every aspect of our lives. Many of these chemicals are endocrine disrupting chemicals (EDC's), also known as hormone disruptors or oestrogen mimickers. In simple terms, they act like oestrogen in our bodies and could be responsible for changing our delicate hormone balance which controls events like pregnancy, puberty, menopause.
An interesting example of the levels of oestrogen of British women was examined in a collaborative study undertaken in the late 80's between Oxford University, the Chinese Academy of Preventive Medicine Beijing, Guys, and the Dept. of Preventive Medicine, L.A., California. They compared blood-serum concentrations of hormones linked to breast cancer between women in rural China and in Britain. The results showed that British women who are exposed to toxic chemicals in their everyday lives had increasingly higher levels of oestradiol (oestrogen) than women living a rural lifestyle in China (see table below).
On this theme, the Guardian online reported on 22/05/07 that 'Beijing blames pollutants for rise in killer cancers'.
Oestradiol levels higher in British women by: Age 35 - 44 36% Age 45 - 54 90% Age 55 - 64 171%
SECRET #4 MOST OF THE MONEY SPENT ON RESEARCH IS NOT GOING INTO PREVENTION TO ENSURE THAT FEWER WOMEN SUFFER THE DEVASTATING EFFECTS OF BREAST CANCER IN THE FUTURE.
As we know, billions of pounds are raised every year worldwide in the name of breast cancer and most of this money is received by the mainstream breast cancer charities. In my opinion, the areas which should be targeted by these funds are prevention, treatment and care. You would probably expect these areas, at least, to be treated with equal importance and the funds available allocated accordingly.
Let's first take a look at the mainstream breast cancer charities in this country, namely Cancer Research UK (who obviously deal with all cancers), Breakthrough Breast Cancer, Breast Cancer Campaign and Breast Cancer Care.
Cancer Research UK has done a huge amount of research into breast cancer and their website has a wealth of useful information with a lot of detail on breast cancer. Their slogan is 'Together We Will Beat Cancer'. The charity offers funding schemes to scientists. Their research strategy is directed at reducing mortality from cancer and more women are surviving breast cancer than ever before. Cancer Research UK is looking trying to prevent breast cancer in women known to be at high risk of developing it (approx 10% of sufferers). Doctors have looked into using tamoxifen and other hormone blocking drugs such as anastrozole (Arimidex) to lower the risk of breast cancer in women with a strong family history. This work has to be done very carefully. These women are healthy and the treatment aimed at preventing breast cancer must not risk their health in other ways.
Breakthrough Breast Cancer supports a programme of cutting-edge biological research to reach their vision of 'a future free from the fear of breast cancer'. Breakthrough set up the UK's first dedicated breast cancer research centre in 1999, the Breakthrough Toby Robins Breast Cancer Research Centre. Breakthrough is funding The Generations Study whosepurpose is primarily to investigate environmental, behavioural, hormonal and genetic causes of breast cancer, and secondarily to investigate the causes of other cancers and diseases, by means of a UK cohort study to be established of more than 100,000 women in the UK aged 18 years and older at entry.
However, when you look at environmental factors as a possible risk factor, it seems to be dismissed because it is too difficult to research due to the huge amount of chemicals to which we are exposed in our everyday lives. You can read more at their website under "risk factors".
As I have mentioned, I am one of the many people who believe that certain chemicals which act like oestrogen in our bodies are a contributing factor in rising breast cancer rates. I am disappointed to see that Breakthrough are not even including this as a possible risk factor, particularly as we know that excessive oestrogen has been linked to breast cancer cell growth.
Breast Cancer Campaign cites its mission is to beat breast cancerby funding innovative world-class research to understand how breast cancer develops, leading to improved diagnosis, treatment, prevention and cure. The charity is supporting 97 projects worth over £12.8 million in 41 locations throughout the UK. Over the past 13 years, Campaign has awarded 232 grants with a total value of over £23 million to universities, medical schools / teaching hospitals and research institutes across the UK. Campaign's breast cancer research gap analysis document has been published by the open access journal Breast Cancer Research. The document entitled 'Evaluation of the current knowledge limitations in breast cancer research: a gap analysis' is the product of two and a half year project. It involved around 60 of the key breast cancer scientists in the UK.
Through their website, they sell products of various types and the companies who own those brands donate part of their profits to the Campaign. They include things like lip gloss, perfume, toiletries, clothing and stationery. Some of us would say that many of the products include harmful ingredients and are not actually contributing to the breast health of the ladies buying them! I was also disappointed that, although they mention prevention in their mission statement, I have one of their leaflets that shows prevention only receives 1% of their budget.
Breast Cancer Care, as its name suggests, is primarily concerned with the care and treatment of ladies going through breast cancer. It provides invaluable information and support.
I applaud all of these organisations who are dedicated to their work to help us understand and treat breast cancer.
However, I still believe that the risk factor of certain chemicals affecting our delicate hormone balance should be taken seriously and that all the available research should be studied. It is important to note that only 50% of breast cancer cases can be put down to one of the acknowledged risk factors. What is this remaining 50%? What has changed in our world over the past 50 years? It is also interesting that other countries are recognising the dangers of these chemicals and banning substances. I also believe in adopting the 'precautionary principle', which means that if there is a doubt over the safety to public health, then we should not wait until it is too late but take action as soon as possible. It has also been proved that there are alternatives to these potentially harmful chemicals when we see the growing number of companies who are selling safer food, cosmetics and toiletries.
This is why I am an active supporter of Breast Cancer UK, the only charity whose main focus is primary prevention. We are determined that breast cancer should be a 'preventable' disease not an 'inevitable' one. There is lots of research available on the link between endocrine disrupting chemicals and breast cancer. It is time that this was taken into account when looking at breast cancer risk factors.
SECRET #5 MOST WOMEN ARE NOT BREAST AWARE AND ARE AFRAID OF BREAST CANCER.
Despite the huge focus on being breast aware, particularly during Breast Cancer Awareness month in October, the majority of women are not breast aware. In fact, most women pay little attention to their breasts and do very little to look after them, except maybe during breastfeeding. Our breasts represent our femininity - they make us feel sexy and they nourish our children. Yet most women don't even know what their breasts feel like, let-alone check them for anything unusual.
It is so important that women take control of their own breast health by undertaking monthly self-examination to check for any changes. If they find a lump and go to their doctor straight away, the chances are the lump will be benign (80% are) or, if it is cancerous, they are giving themselves the best possible chance of recovery. At Stage One, women have around a 95% chance of surviving beyond 5 years. At Stage One the lump is less than 2cm and has not spread to the lymph nodes or anywhere else in the body. At Stage Four this survival rate drops to 1 in 10. The average size of lump discovered accidentally by women who don't check their breasts regularly is approximately 3.6 cm.
I have spoken with hundreds of women through my breast education work and most women do not check their breasts because they don't know what to do, they don't realize that all women are at risk, they don't know about the four stages of breast cancer and the corresponding survival rates, they don't really think about the need to do anything to look after their breasts or they are afraid that they might find something.
According to research by Breast Cancer Campaign, breast cancer is the most feared disease amongst women. Fear is usually due to a lack of knowledge. This is certainly the case here. If women understood everything detailed here, they would want to give themselves the best chance of survival should they get the disease. The current approach to women's breast health obviously isn't getting through, which is why I believe it is time to get women to take control themselves and empower other women to do the same.
SECRET #6 WOMEN ARE NOT GIVEN LOTS OF ADVICE ON HOW THEY CAN PROTECT THEIR BREASTS AGAINST BREAST CANCER.
In the past, GP surgeries used to run Well Woman clinics where any woman could go and see a doctor or nurse and be given advice about looking after herself with practical information like being shown how to check her breasts. Very few surgeries offer these clinics now. This is one of the reasons that I started my Breast Health Presentations. I talk to women in the workplace or in other gatherings and empower them with information, which helps to remove some of their fear. I also show them how to check their breasts and talk to them about their bra-wearing habits, how to avoid harmful chemicals in their everyday lives and how to benefit from detoxifying breast massage.
As we know, breast cancer is the most feared disease amongst women and understanding how it develops, the risk factors and, most importantly, how to protect against it, will make women feel more in control and positive towards their breast health.
During October and other events during the year, the focus is on breast cancer rather than breast health. I am one of those people who believe that the more you focus on something negative, the more you will get of it. This is why it is time to change that focus.
I believe that it is definitely time for women to take their breast health into their own hands, which is why I have launched my new campaign "Healthy Breasts For Every Woman". You can read more at www.healthybreastscampaign.co.uk.
SECRET #7 MOST WOMEN DO NOT APPRECIATE HOW IMPORTANT THEIR BREASTS ARE AND DO NOT DO EVERYTHING THEY CAN TO LOOK AFTER AND PROTECT THEM.
As I mentioned before, most women give very little thought to their breasts. They get up in the morning and they may give them a wash in the shower. They then shove them into a cage we call a bra (and most women wear a bra that doesn't fit them properly) and forget about them for the rest of the day. It is amazing that we live in a society which is obsessed with breasts and women do very little to protect this most precious part of their body. It is also amazing that women spend a fortune on looking after every other part of their body with creams and lotions and forget about their breasts! I know that once women understand more about breast health and don't feel so helpless in the face of breast cancer that they do want to be proactive and take control of their breast health.

What You Should Know About Breast Cancer

Breast cancer is the most common malignancy in women and the second leading cause of cancer death, exceeded only by lung cancer in 1985. One woman in eight who lives to age 85 will develop breast cancer at some time during her life.
At present there are over 2 million women living in the United States who have been treated for breast cancer. About 41,000 women will die from the disease. The chance of dying from breast cancer is about 1 in 33. However, the rate of death from breast cancer is going down. This decline is probably the result of early detection and improved treatment.
Breast cancer is not just a woman's disease. The American Cancer Society estimates that 1600 men develop the disease yearly and about 400 may die from the disease.
Breast cancer risk is higher among those who have a mother, aunt, sister, or grandmother who had breast cancer before age 50. If only a mother or sister had breast cancer, your risk doubles. Having two first-degree relatives who were diagnosed increases your risk up to five times the average.
Although it is not known exactly what causes breast cancer; sometimes the culprit is a hereditary mutation in one of two genes, called BRCA1 and BRCA2. These genes normally protect against the disease by producing proteins that guard against abnormal cell growth, but for women with the mutation, the lifetime risk of developing breast cancer can increase up to 80 percent, compared with 13 percent among the general population. In effect, more than 25 percent of women with breast cancer have a family history of the disease.
For women without a family history of breast cancer, the risks are harder to identify. It is known that the hormone estrogen feeds many breast cancers, and several factors - diet, excess weight, and alcohol consumption - can raise the body's estrogen levels.
Early Signs
Early signs of breast cancer include the following:
- A lump which is usually single, firm and most often painless is detected.
- An area of the skin on the breast or underarm is swollen and has an unusual appearance.
- Veins on the skin surface become more prominent on one breast.
- The affected breast nipple becomes inverted, develops a rash, changes in skin texture, or has a discharge other than breast milk.
- A depression is found in an area of the breast surface.
Types and Stages of Breast Cancer
There are many different varieties of breast cancer. Some are fast-growing and unpredictable, while others develop more slowly and steady. Some are stimulated by estrogen levels in the body; some result from mutation in one of the two previously mentioned genes - BRCA1 and BRCA2.
Ductal Carcinoma In-Situ (DCIS): Generally divided into comedo (blackhead), in which the cut surface of the tumor shows extrusion of dead and necrotic tumor cells similar to a blackhead, and non-comedo types. DCIS is early breast cancer that is confined to the inside of the ductal system. The distinction between comedo and non-comedo types is important, as comedocarcinoma in-situ generally behaves more aggressively and may show areas of micro-invasion through the ductal wall into surrounding tissue.
Infiltrating Ductal: This is the most common type of breast cancer, representing 78 percent of all malignancies. On mammography, these lesions can appear in two different shapes -- stellate (star- like) or well circumscribed (rounded). The stellate lesions generally have a poorer prognosis.
Medullary Carcinoma: This malignancy comprises 15 percent of breast cancers. These lesions are generally well circumscribed and may be difficult to distinguish from fibroadenoma by mammography or sonography. With this type of breast cancer, prognostic indicators estrogen and progesterone receptor are negative 90 percent of the time. Medullary carcinoma usually has a better prognosis than other types of breast cancer.
Infiltrating Lobular: Representing 15 percent of breast cancers, these lesions generally appear in the upper outer quadrant of the breast as a subtle thickening and are difficult to diagnose by mammography. Infiltrating lobular can involve both breasts (bilateral). Microscopically, these tumors exhibit a linear array of cells and grow around the ducts and lobules.
Tubular Carcinoma: This is described as orderly or well-differentiated carcinoma of the breast. These lesions make up about 2 percent of breast cancers. They have a favorable prognosis with nearly a 95 percent 10-year survival rate.
Mucinous Carcinoma: Represents 1-2 percent of carcinoma of the breast and has a favorable prognosis. These lesions are usually well circumscribed (rounded).
Inflammatory Breast Cancer: This is a particularly aggressive type of breast cancer that is usually evidenced by changes in the skin 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 reveals tumors in the lymphatic and vascular channels about 50 percent of the time.
Stages of Breast Cancer
The most common type of breast cancer is ductal carcinoma. It begins in the lining of the ducts. Another type, called lobular carcinoma, arises in the lobules. When cancer is found, the pathologist can tell what kind of cancer it is - whether it began in a duct (ductal) or a lobule (lobular) and whether it has invaded nearby tissues in the breast (invasive).
When cancer is found, special lab tests of the tissue are usually done to learn more about the cancer. For example, hormone (estrogen and progesterone) receptor tests can help determine whether hormones help the cancer to grow. If test results show that hormones do affect the growth of the cancer (a positive test result), the cancer is likely to respond to hormonal therapy. This therapy deprives the cancer cells of estrogen.
Other tests are sometimes done to help predict whether the cancer is likely to progress. For example, x-rays and other lab tests are done. Sometimes a sample of breast tissue is checked for a gene, known as the human epidermal growth factor receptor-2 (HER-2 gene) that is associated with a higher risk that the breast cancer will recur. Special exams of the bones, liver, or lungs are done because breast cancer may spread to these areas.
A woman's treatment options depend on a number of factors. These factors include her age and menopausal status; her general health; the size and location of the tumor and the stage of the cancer; the results of lab tests; and the size of her breast. Certain features of the tumor cells, such as whether they depend on hormones to grow are also considered.
In most cases, the most important factor is the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread. The following are brief descriptions of the stages of breast cancer and the treatments most often used for each stage. Other treatments may sometimes be appropriate.
Stage 0
Stage 0 is sometimes called non-invasive carcinoma or carcinoma in situ. Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule. These abnormal cells seldom become invasive cancer. However, they are an indicator of an increased risk of developing breast cancer in both breasts. The treatment for LCIS is a drug called tamoxifen, which can reduce the risk of developing breast cancer. A person who is affected may choose not to have treatment, but to monitor the situation by having regular checkups. And occasionally, the decision is made to have surgery to remove both breasts to try to prevent cancer from developing. In most cases, removal of underarm lymph nodes is not necessary.
Ductal carcinoma in situ (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 to invade the surrounding breast tissue. However, women with DCIS are at an increased risk of getting invasive breast cancer. Some women with DCIS have breast-sparing surgery followed by radiation therapy. Alternatively, they may choose to have a mastectomy, with or without breast reconstruction (plastic surgery) to rebuild the breast. Underarm lymph nodes are not usually removed. Also, women with DCIS may want to talk with their doctor about tamoxifen to reduce the risk of developing invasive breast cancer.
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 and invaded nearby tissue.
Stage I means that the tumor is about one inch across and cancer cells have not spread beyond the breast.
Stage II means one of the following:
The tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm.
The tumor is between 1 and 2 inches (with or without spread to the lymph nodes under the arm).
The tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.
The treatment options for early stage breast cancer are breast-sparing surgery followed by radiation therapy to the breast, and mastectomy, with or without breast reconstruction to rebuild the breast. These approaches are equally effective in treating early stage breast cancer. (Sometimes radiation therapy is also given after mastectomy.)
The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the breast, certain features of the cancer, and how the person feels about preserving the breast. With either approach, lymph nodes under the arm usually are removed.
Chemotherapy and/or hormonal therapy after primary treatment with surgery or surgery and radiation therapy are recommended for stage I and most frequently with stage II breast cancer. This added treatment is called adjuvant therapy. Systemic therapy sometimes given to shrink the tumor before surgeries called neoadjuvant therapy. This is given to try to destroy any remaining cancer cells and prevent the cancer from recurring, or coming back, in the breast or elsewhere.
Stage III
Stage III is also called locally advanced cancer. In this stage, the tumor in the breast may exhibit the following:
More than 2 inches across and the cancer has spread to the underarm lymph nodes.
The cancer is extensive in the underarm lymph nodes.
The cancer is spreading to lymph nodes near the breastbone or to other tissues near the breast.
Inflammatory breast cancer is a type of locally advanced breast cancer. In this type of cancer, the breast looks red and swollen (or inflamed) because cancer cells block the lymph vessels in the skin of the breast.
Patients with stage III breast cancer usually have both local treatment to remove or destroy the cancer in the breast and systemic treatment to stop the disease from spreading. The local treatment may be surgery and/or radiation therapy to the breast and underarm. The systemic treatment may be chemotherapy, hormonal therapy, or both. Systemic therapy may be given before local therapy to shrink the tumor or afterward to prevent the disease from recurring in the breast or elsewhere.
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 treatments for stage IV breast cancer are chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. Patients may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body.
Recurrent Cancer
Recurrent cancer means the disease has returned in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment.
Most recurrences appear within the first 2 or 3 years after treatment, but breast cancer can recur many years later.
Cancer that returns only in the area of the surgery is called a local recurrence. If the disease returns in another part of the body, the recurrence is called metastatic breast cancer. The patient may have one type of treatment or a combination of treatments for recurrent cancer.

Double Drug Combo Could Shut Down Abnormal Blood Vessel Growth That Feeds Disease

A new study by researchers at Weill Cornell Medical College shows combining two already-FDA approved drugs may offer a new and potent punch against diseases in which blood vessel growth is abnormal -- such as cancer, diabetic retinopathy, macular degeneration and rheumatoid arthritis.
Their study, published in the Sept. 11 issue of the journal Developmental Cell, is the first to show that a protein, sphingosine 1-phosphate receptor-1 (S1P1), is a key player in angiogenesis -- the growth process of new blood vessels in the body from pre-existing vessels. S1P1, previously known to modulate immune system function, is the target of the approved drug fingolimod used to treat the autoimmune neurological disease multiple sclerosis.
Researchers have discovered that S1P1 works hand-in-hand with vascular endothelial growth factor (VEGF), which stimulates blood vessel growth. VEGF is the target of a number of different cancer drugs that have not proven to be as effective as originally envisioned in shutting down the excess blood vessels that provide nutrients to growing tumors and other diseases that rely on extra blood supply.
"The body needs to make new blood vessels that transport oxygen and blood. We now know that VEGF starts the process of sprouting new blood vessels from existing vessels, and S1P1 finishes it," says Dr. Timothy Hla, professor of pathology and laboratory medicine and director of the Center for Vascular Biology at Weill Cornell.
"Angiogenesis is abnormal in many diseases; by targeting both S1P1 and VEGF, it may be more effective to strike out disease than using just VEGF inhibitors alone," he says.
Not only are VEGF inhibitors currently used to treat cancer, these drugs are also used to block excessive angiogenesis in the eyes of diabetics and vascular proliferation that occurs in the wet form of age-related macular degeneration. "We are intrigued to see what the potential for treating these eye diseases would be if S1P1 axis was also targeted," Dr. Hla says.
In rheumatoid arthritis, which is driven by reactive and inflammatory immune cells, a S1P1 inhibitor could block both immune and blood vessel-related mechanisms, and therefore may be beneficial, based on the study's findings. In addition, Dr. Hla points out that while the existing approved S1P1 inhibitor fingolimod has had some adverse effects in some multiple sclerosis patients, there are new inhibitors of S1P1 being developed by many companies that could also be tested in combination with a VEGF inhibitor for treating these diseases.
An Antenna that Senses Blood Flow
Angiogenesis is needed for many normal tissue growth, repair and regenerative processes, which ultimately results in increased blood flow and oxygenation of tissues.
The Hla laboratory has long been interested in defining the molecular mechanisms of the angiogenic process, in which endothelial cells from pre-existing blood vessels sprout, move and then change to form new vascular channels. Dr. Hla was first to identify S1P1 as a key angiogenic response gene, and he also successfully cloned and characterized the receptor.
In this study, the research team shows that as new blood vessel networks form, the resulting blood flow activates S1P1 on the surface of endothelial cells and relays signals inside these cells to stabilize new blood vessel networks.
"The S1P1 molecule acts like an antenna to sense blood flow. If blood flow is reduced, then normal S1P1 signaling is interrupted, destabilizing blood vessel formation, causing the endothelium to undergo an inflammatory process," Dr. Hla says. "This happens in many diseases with abnormal vessels, including rheumatoid arthritis, psoriasis and even cancer."
In their laboratory studies, the researchers found that blocking S1P1 resulted in abnormal endothelial function and blood vessel growth. Inhibiting S1P1 causes new vessels to leak and become unstable. Blocking S1P1 would be beneficial, for example, to cut off the blood supply feeding a cancerous tumor, researchers report.
"This research defines one of the fundamental mechanisms of blood vessel growth that is vital to normal health and that also fuels many diseases," he says. "This research could ultimately lead to our ability to better modulate blood vessel health and growth, especially in diseases that depend on extra blood to sustain them."
The study was supported by grants from the National Institutes of Health.
Dr. Hla's co-authors include Bongnam Jung, Dr. Hideru Obinata, Dr. Sylvain Galvani, Dr. Karen Mendelson, Dr. Bisen Ding, Dr. Shahin Rafii and Dr. Todd Evans from Weill Cornell; Dr. Athanasia Skoura from Pfizer Inc.; and Dr. Bernd Kinzel and Dr. Volker Brinkmann from Novartis Institutes for Biomedical Research in Basel, Switzerland.

Novel Surgery Removes Rare Tumor, Rebuilds Face and Jaw

surgical approach, it's possible to rebuild a functional lower jaw and mouth, and preserve a patient's ability to eat and speak after removing an invasive facial tumor, according to a new report from Henry Ford Hospital in Detroit.
This case study not only documents a successful surgical technique to create a fully functional lower jaw, but also reports the rare occurrence of a bone cancer (osteosarcoma) that spread from the patient's right femur to his jaw bone.
Most commonly, osteosarcoma is found in the long bones of the leg and does not spread to other parts of the body.
"The bone tumor involved nearly all of his jaw bone, lower lip, chin, neck skin, tongue and both cheeks, approximately the lower third of the face and upper half of his neck," says senior study author Tamer A. Ghanem, M.D., Ph.D., director of the Head and Neck Oncology & Microvascular Surgery Division and division head of the Department of Otolaryngology-Head and Neck Surgery at Henry Ford Hospital.
"We had to think outside the box to not only safely remove the tumor, but to allow for optimum functional outcome."
Dr. Ghanem will present this unique case study this weekend at the poster session for the American Academy of Facial Plastic and Reconstructive Surgery annual meeting in Washington, D.C.
The case is centered on a 21-year-old African American male with a history of osteosarcoma, the eighth most common childhood cancer. It affects 5 million patients under the age 20 and about 500 adults ages 15-30 each year in the U.S.
The patient's osteosarcoma spread to his jaw bone about three years after the initial diagnosis. The facial tumor soon grew to nearly 10 lbs. of tissue and bone, making it difficult for him to speak and eat. The patient required a feeding tube.
Only three months after the surgery, the patient was able to talk and eat without assistance.
Prior to coming to Henry Ford Hospital, the patient underwent multiple treatments including mandible resection, radiation, chemotherapy and cryosurgery at another institution. All treatments were unsuccessful.
Dr. Ghanem and his colleague Francis Hall, M.D., devised a plan that would not only surgically remove the tumor and oral tongue, but rebuild the lower third of the patient's face -- all during a 20-hour surgical procedure.
The surgeons performed a near total mandibulectomy (surgical removal of the bone from the lower jaw), and removal of the tongue, mucous membrane from the inside of both cheeks and lower lip.
Dr. Ghanem performed the complex reconstruction of the face and jaw using dual microvascular free flaps from the fibula and shoulder areas.
"The reconstruction involved bone and skin transplanted from the patient's left leg, and a tissue complex from his shoulder blade area with its feeding blood supply compromised of multiple islands of skin and muscles to reconstruct all of the tissues," says Dr. Ghanem.
The subscapular free flap (skin and muscle from the shoulder) is a versatile donor system that offers distinct advantages in the reconstruction of head and neck defects. The shoulder's soft tissue offers mobility, while this area also has a diverse range of skin, bone and muscle available for use in reconstruction of massive facial defects.
Along with Dr. Ghanem and Dr. Hall, Henry Ford Hospital co-authors are Robert Deeb, M.D., and Linda Hsu.

Parents' Skin Cancer Concern Doesn't Keep Kids Inside

Pick your poison: sun exposure that leads to skin cancer or low physical activity that leads to obesity? In fact, a University of Colorado Cancer Center study published this week in the journal Preventing Chronic Disease shows that parents' concern about skin cancer doesn't make them keep their kids indoors.
"Actually, our hypothesis was the opposite -- that if parents were concerned about skin cancer they wouldn't let their children go out as much," says Alexander Tran, summer fellow working with Lori Crane, PhD, CU Cancer Center investigator and chair of the Department of Community & Behavioral Health at the Colorado School of Public Health.
The study used data from a 999 child cohort of 8 to 9-year-olds from within the group known as the Colorado Kids Sun Care Program, a research program ongoing since 1998. Phone interviews determined parents' level of concern about melanoma, asking questions including "How serious do you think melanoma is?" and "How easy or hard is it for doctors to treat a typical case of melanoma?" Parents were also asked how many hours per day their children spend outside and physical examinations determined kids' body mass indices (BMIs). Tran and Crane controlled for possible confounding factors including race, skin color and socioeconomic status.
"Our new hypothesis is that maybe we had the relationship reversed," Tran says. "Perhaps instead of higher melanoma concern leading to staying inside, it's the parents of kids who spend the most time outside who are most concerned about skin cancer. This is a good finding -- it suggests that children can get plenty of outdoor physical activity and prevent skin cancer by using good sun protection measures such as wearing a hat and shirt, and applying sunscreen."
"Some studies generate more questions than answers," Tran says. Further study within the Colorado Kids Sun Care Program will explore the interrelationships between skin cancer awareness

Cancer 'Turns Off' Important Immune Cells, Complicating Experimental Vaccine Therapies

A research report published in the September 2012 issue of the Journal of Leukocyte Biology offers a possible explanation of why some cancer vaccines are not as effective as hoped, while at the same time identifies a new therapeutic strategy for treating autoimmune problems.
In the report, scientists suggest that cancer, even in the very early stages, produces a negative immune response from dendritic cells, which prevent lymphocytes from working against the disease. Although problematic for cancer treatment, these flawed dendritic cells could be valuable therapeutic tools for preventing the immune system from attacking what it should not, as is the case with autoimmune disorders and organ transplants.
"Immunotherapy of cancer has been an elusive research target that, though promising, never seems to 'get there,'" said José Alexandre M. Barbuto, Ph.D., from the Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Sciences at the University of São Paulo, in São Paulo, Brazil. "This study helps us to better understand the mechanisms by which tumors avoid immune recognition and rejection and may, therefore, teach us how to actually engage effectively the immune system in the fight against tumors, thus achieving much better clinical responses and, consequently, quality of life, in our therapeutic approaches."
To make this discovery, researchers obtained a small sample of blood from breast cancer patients, and from healthy volunteers. The blood cells were then separated and induced to become dendritic cells. Researchers then used these laboratory-generated dendritic cells to induce responses from other immune system cells, namely lymphocytes. While dendritic cells from the healthy donors induced vigorous lymphocytic responses, dendritic cells from cancer patients induced mainly the activation of a specific type of lymphocyte, a regulatory lymphocyte that works as a "brake" for other types of lymphocytes.
"Understanding why the immune system does not recognize and eliminate cancer is critical to developing effective immunotherapies to fight the disease," said John Wherry, Ph.D., Deputy Editor of the Journal of Leukocyte Biology. "Immunologists have been trying to unravel the answer to this question for decades and have realized that the problem is both on the immune system side, and because cancer cells appear to actively 'fly under the radar' avoiding immune system detection. This article offers insights into the underlying mechanisms regulating a key immune cell type, the dendritic cell, involved in initiating anti-tumor responses."

Genetic Link to Prostate Cancer Risk in African Americans Found

Prostate cancer in African-American men is associated with specific changes in the IL-16 gene, according to researchers at the University of Illinois at Chicago College of Medicine.
The study, published online in the journal Cancer Epidemiology, Biomarkers & Prevention, establishes the association of IL-16 with prostate cancer in men of both African and European descent.
"This provides us with a new potential biomarker for prostate cancer," says principal investigator Rick Kittles, UIC associate professor of medicine in hematology/oncology.
Previously identified changes in the gene for IL-16, an immune system protein, were associated with prostate cancer in men of European descent. But the same changes in the gene's coded sequence -- called "polymorphisms" -- did not confer the same risk in African Americans.
Doubt was cast on IL-16's role in prostate cancer when researchers were unable to confirm that the IL-16 polymorphisms identified in whites were also important risk factors in African Americans, Kittles said.
Kittles and his colleagues used a technique called imputation -- a type of statistical extrapolation -- that allowed them to see new patterns of association and identify new places in the gene to look for polymorphisms. They found changes elsewhere in the IL-16 gene that were associated with prostate cancer and that were unique to African Americans.
Polymorphisms result from DNA mutations and emerge in the ancestral history of different populations. People of African descent are much more genetically diverse than whites, Kittles said, making the search for polymorphisms associated with disease more difficult.
Although the effect of the particular changes to the gene appear to be different in men of African versus European descent, it is likely that several of the polymorphisms in the gene alter the function of the IL-16 protein.
"This confirms the importance of IL-16 in prostate cancer and leads us in a new direction," Kittles said. "Very little research has been done on IL-16, so not much is known about it."
"We now need to explore the functional role of IL-16 to understand the role it is playing in prostate cancer," he said.
Ken Batai, graduate student in the UIC Institute for Human Genetics, was first author of the study. Other authors were Ebony Shah, Jennifer Newsome, and Maria Ruden of the UIC Institute for Human Genetics; Adam Murphy of Northwestern University; and Chiledum Ahaghotu of Howard University Hospital in Washington, D.C.
The study was supported by grants from the Department of Defense (DAMD W81XWH-07-1-0203) and National Cancer Institute/National Institutes of Health (RC2-CA148085-01 and U01-CA136792-02S1.)