Breast Cancer Resource Guide - UConn Health

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INTRODUCTIONPersonalized Care for your newBreast Cancer DiagnosisWe are thankful that you have chosen the Breast CancerProgram at UConn Health to receive your care. We haveexperts in all specialties to draw from, to assist you withprevention, diagnosis, treatment, survivorship, exercise,dietary information, complementary medicine, clinical trialsand more. Like this guide, your care will be personalized sothat you receive the most appropriate therapies for yourdiagnosis and general medical health. We intend to provideyou with comprehensive support, to enable you to make thisjourney with information and understanding.Personalized medicine occurs at all levels. It is basedupon understanding each patient and his or her wishesand level of physical and emotional functioning. It is specificto breast size, tumor type, and available standard andexperimental therapies. Most importantly, it depends onthe goals of each patient.Our goal is to personalize the care you receive, starting withthis guide. We hope you will provide us feedback on howwell this works for you.Sincerely,Susan Tannenbaum, M.D.Director of the Clinical and Translational Breast Program00.01

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MY HEALTH CARE TEAM BACK TO CONTENTSMy Health Care TeamMedical Oncologist:Counselor / Therapist:Contact Information:Contact Information:Radiation Oncologist:Nutritionist / Dietitian:Contact Information:Contact Information:Surgeon / Surgical Oncologist:Pharmacist:Contact Information:Pharmacy:Contact Information:Plastic / Reconstructive Surgeon:Contact Information:OTHER TEAM MEMBERS:Name:Specialty:Primary Care Doctor:Contact Information:Contact Information:Name:Oncology Nurse:Specialty:Contact Information:Contact Information:Oncology Social Worker:Name:Contact Information:Specialty:Contact Information:01.01

BREAST CANCER BASICS BACK TO CONTENTSBreast Cancer BasicsThe breast is mostly made up of fatty tissue. Within this tissue is a network of lobes, which are made up ofsmall, tube-like structures called lobules that contain milk glands. Tiny ducts connect the glands, lobules, andlobes, carrying the milk from the lobes to the nipple, located in the middle of the areola (darker area thatsurrounds the nipple). Blood and lymph vessels also run throughout the breast. Blood nourishes the cells,and the lymphatic system drains bodily waste products. The lymph vessels connect to lymph nodes, whichare tiny, bean-shaped organs that help fight infection.Breast cancer developmentIn the United States, breast cancer is the most common cancer diagnosed in women (excluding skin cancer).Men may also develop breast cancer, but less than 1% of all people with breast cancer are men. Breast cancerbegins when healthy cells in the breast change and grow uncontrollably, forming a mass called a tumor.A tumor can be benign (noncancerous) or malignant (cancerous). A benign tumor does not spread to otherparts of the body and is rarely life-threatening. A malignant tumor, on the other hand, can spread beyondwhere it began to other parts of the body.Most breast cancers start in the ducts, but some begin in the lobules. Almost 75% of all breast cancers beginin the cells lining the milk ducts and are called ductal carcinomas. Cancer that begins in the lobules is calledlobular carcinoma. The difference between ductaland lobular cancer is determined by the pathologist(a doctor who specializes in interpreting laboratorytests and evaluating cells, tissues, and organs todiagnose disease) after examining a piece of thetumor removed during a biopsy.If the disease has spread outside the duct or lobuleand into the surrounding tissue, it is called invasiveor infiltration ductal or lobular carcinoma. Cancerthat is located only in the duct or lobule is called insitu, meaning “in place.” Most in situ breast cancersare ductal carcinoma in situ (DCIS). Currently,oncologists recommend surgery to remove DCIS tohelp prevent the cancer from becoming an invasivebreast cancer and spreading to other parts of thebreast or the body. Radiation therapy and hormonaltherapy may also be recommended for DCIS.02.01

BREAST CANCER BASICS BACK TO CONTENTSMedical illustrations for many types of cancer are available at carcinoma is situ (LCIS) is not consideredcancer and is usually monitored by the doctor. LCISin one breast is a risk factor for developing invasivebreast cancer in both breasts.Other less common types of breast cancer includemedullary, mucinous, tubular, metaplastic, andpapillary breast cancer, as well as other even rarertypes. Inflammatory breast cancer is a fastergrowing type of cancer that accounts for about 1%to 5% of all breast cancers. It may be misdiagnosedas a breast infection because there is often swellingof the breast and redness of the breast skin thatstarts suddenly. Paget’s disease is a type of cancerthat begins in the ducts of the nipple. The skin oftenappears scaly and may be itchy. Although it isusually in situ, it can also be invasive cancer. Theserarer types of breast cancer are not covered in thisguide, but information about them can be foundat cancer spreadAs a cancerous breast tumor grows, cancer cellsmay break away and be carried to other parts ofthe body by the bloodstream or lymphatic system.During this process, known as metastasis, the cancercells grow and develop into new tumors. One of thefirst places breast cancer usually spreads is to theregional lymph nodes.Breast cancer can also spread farther away from thebreast to other parts of the body, such as the bones,lungs, and liver. Less commonly, breast cancer mayspread to the brain. However, even if the cancerspreads, it is still named for the area where it began.For example, if breast cancer spreads to the lungs,it is called metastatic breast cancer, not lung cancer.No matter the size, location, whether the cancer hasspread, or how far it has spread, breast cancer canbe treated and/or managed.

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSWelcome to the Neag Comprehensive Cancer CenterBreast Nurse Navigator Program.The Breast Nurse Navigator Program provides a support system for the patient and her family at this difficulttime and collaborates with each patient’s medical team to oversee and expedite the quality and pace of care.As a certified oncology nurse with years of experience in both the surgical and medical aspects of oncology,I specialize in diseases of the breast. I am here to guide and support you during your cancer treatment. Inaddition, I will help you to: Navigate through the UConn Health care system with ease Answer your questions Understand the information about your diagnosis and treatments Make connections with our interdisciplinary care team based on your needsFeel free to contact me any time on our Breast Referral phone at 860.480.1981. I look forward tospeaking with you.Sincerely,Molly Tsipouras RN, BSN, OCN, CPBN-IC263 Farmington AvenueFarmington, CT, 06034860.480.1981mtsipouras@uchc.edu03.01

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSPrimary Role as a Breast Nurse Navigator: Initiate communication with patients uponlearning they have a suspicious mammogram ora positive finding. Collaborate with members of the patient’smedical team. Support physicians and their office staff in thecomprehensive care of breast cancer patients,including consultation regarding resourcesand services. Educate patient and family about specificcancer diagnoses and treatment options and howto handle side effects of treatment. Guide breast health patients through the healthcare system by assisting with access issues andhelping them arrive prepared to ask the rightquestions. Act as clinicians, care coordinators, educators andcounselors for patients and families. Improve patient outcomes through education,support and monitoring.03.02 Coordinate care with other health care providerssuch as nutritionists, social workers, clergy andcounselors. Coordinate and facilitate Tumor Board meetingswith medical staff. Connect patients to community and socialsupport services. Facilitate patient interaction and communicationwith health care staff and providers to getquestions answered. Provide breast health education to individualsand groups. Provide a learning library for patients that includeslanguage-specific materials. Assist breast health patients in finding ways topay for their breast health care. Help patients find balance during cancertreatment. Help patients learn about image enhancement.

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSMaking the DiagnosisTest DescriptionsYou may find it useful at this point in your care touse the “My Medical and Lifestyle History” form atthe end of this chapter to record your information.Try to fill in as much as possible before yourappointment. You might also ask your doctor towrite a few notes on the last page of that long form,and to mark your lump location on Figure B.Mammogram: A mammogram is a low-dose digital2D radiograph (X-ray) of the breast with computerassisted detection (CAD). Some studies have shownCAD to have the potential to increase the sensitivityof screening mammography. With CAD, a computermarks areas of interest on the mammogram in orderto call them to the attention of the radiologist whois reading the image. In the absence of such marks,these areas might be overlooked.You will have one or more tests that will help yourhealth care team determine what kind of breastcancer you have. Descriptions of possible testsfollow. Some tests, such as a mammogram orultrasound, look at your breast tissue from outsideof your body. Other tests, such as biopsies, take asmall sample of your breast tissue or fluid to look atyour cells under a microscope.Accurate diagnosis is critical to effective treatment.Your health care team will take great care todiagnose exactly the type of breast cancer youhave. That’s because the choice of treatmentdepends on the characteristics of the tumor, howfar it has progressed (“stage”) and more.After your diagnostic tests have been performed, youwill probably see a surgeon. Be sure to bring to yourappointment the results of all of the diagnostic testsyou have had, including films and written reports.Tomosynthesis: Also currently available is 3D mammography in conjunction with 2D mammography/CAD: this is called tomosynthesis. Health careproviders should strongly consider recommendingtomosynthesis for women with heterogeneouslyand extremely dense breasts. Tomosynthesis has alower “call back” rate and has a higher specificity forbreast cancer when compared with 2D mammography.Ultrasound: A test in which sound waves are usedto create a picture of the inside of your breast.A technician moves a handheld device over theoutside of the breast. The device transmitsinformation about the contents of a lump andwhether these contents are solid or liquid. The testis painless and is usually very quick. This is typicallyused when the patient is younger than 30 or whena mammogram has been inconclusive.MRI (magnetic resonance imaging): This scan ishighly sensitive and may over-detect changes inbreast tissue. It does, however, provide usefulinformation when it is used along with other tests,such as mammogram and ultrasound, especiallywhen those tests have been inconclusive. Amongthose for whom this test may be useful are womenwho have dense breasts or those who have anincreased risk of breast cancer because of familyor personal history. If your situation requires youto have an MRI, be sure to have it at a facility thatcan also perform MRI-guided biopsies (see biopsydescriptions next). That way, you can have asuspicious area biopsied at the same time youhave the MRI.03.03

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSBiopsy: This is a procedure that removes cells fromthe body so they can be examined and analyzed bya pathologist. There are several types of biopsies.Which one(s) you have will depend on your specificcondition.MRI-guided biopsy: The interventional radiologistuses magnetic resonance imaging to pinpoint theexact location of the abnormality and perform aminimally invasive procedure to extract a sampleof the suspicious cells.Core needle biopsy: This test is typically usedwhen clumps appear on ultrasound or mammogram results, but are too small to feel by hand.This is usually done with local anesthesia. Oncethe breast is numbed, the doctor uses eitherstereotactic or ultrasound technology to guidea needle to the abnormal area and take tissuesamples. This needle acts like the puncher that’sused to pierce ears. Several passes are usuallydone to make sure that enough tissue is collectedfor pathology testing.Needle localized excisional biopsy: This test isalso used when clumps appear on ultrasound ormammogram results, but are too small to feel byhand. In the X-ray department, your breast will becleaned and numbed with a local anesthetic. Theradiologist will use a mammogram or ultrasoundto guide a wire to the clump. Once the wire is inplace, you will return to the operating room wherea surgeon will use the wire as a guide to surgicallyremove the abnormal tissue.Fine needle aspiration: A thin needle is used todraw cells from the lump. If the lump is a cyst thathas a lot of fluid, your doctor might drain(aspirate) that fluid through the needle. This isusually done with a local anesthesia. This type ofbiopy has limitations, since it can obtain so fewcells. It can diagnose cancer, but provides littleadditional information about it.03.04Sentinel node biopsy: This minor surgery isusually performed on an outpatient basis usinggeneral anesthesia. The procedure begins with theinjection of a radiotracer material and/or blue dyeinto the area around the breast tumor. The firstone to three lymph nodes to receive the dye areremoved and tested to determine whether cancercells are spreading from the tumor to the lymphsystem. This procedure should be performed onlyby a specially trained and experienced surgeon.Each test evaluates the tissue obtained for somethingdifferent. Feel free to ask your doctor or nurse whya particular test is being conducted on you.

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSUnderstanding YourPathology ReportAfter examination, testing and, in some cases,surgical removal of the tumor, your health care teamwill know a great deal more about your cancer. Thisinformation will appear on your pathology report.The findings that appear on the pathology reportwill help you and your health care team decide onthe best course of treatment.The next few paragraphs will help you betterunderstand the information you will see on thepathology report.Where It IsBreast tumors may begin in the cells of either the“lobules,” the structures that produce milk, or the“ducts,” the structures that carry milk from thelobules to the nipple.Noninvasive or InvasiveBreast cancer is first identified as either noninvasiveor invasive. Noninvasive (in situ) cancer is one thatdoesn’t seem to be growing into surrounding tissue.About one in seven breast cancers is noninvasive.Ductal Carcinoma In Situ (DCIS)Normal breast with noninvasiveductal carcinoma in situ (DCIS) in anenlarged cross–section of the duct.Breast profile:A. DuctsB. LobulesC. Dilated section of duct to hold milkD. NippleE. FatF. Pectoralis major muscleG. Chest wall/rib cageEnlargement:A. Normal duct cellsB. Ductal cancer cellsC. Basement membraneD. Lumen (center of duct)Invasive Ductal Carcinoma (IDC)Normal breast with invasive ductalcarcinoma (IDC) in an enlargedcross-section of the ductBreast profile:A. DuctsB. LobulesC. Dilated section of duct to hold milkD. NippleE. FatNoninvasiveThere are two main kinds of noninvasive cancers: Ductal carcinoma in situ (DCIS) – This type ofcancer is in the breast ducts. It may becomeinvasive if not treated. Lobular carcinoma in situ (LCIS) – Confined tothe lobules of the breast, LCIS is not a “true”cancer. It is a warning sign that an invasive cancermay occur in the future in either breast. About onein three LCIS tumors becomes invasive.F. Pectoralis major muscleG. Chest wall/rib cageEnlargementA. Normal duct cellB. Ductal cancer cells breakingthrough the basement membraneC. Basement membraneIllustrations courtesy of breastcancer.orgFor more information on DCIS / more information on LCIS /www.breastcancer.org03.05

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSInvasiveInvasive cancers are those that grow outside theducts or lobules where they begin. Invasive cancersare sometimes call “infiltrating” cancers. There aretwo main types of invasive breast cancers: Invasive ductal carcinoma – This type begins inthe ducts, but grows into the surrounding normaltissue inside the breast. It is the most commonform of invasive cancer, representing about 70percent of all cases. Depending on how the cellsof this cancer appear under the microscope, yourreport may describe them in different ways. Forexample:– Tubular cancer cells look like tubes– Medullary cancer looks like brain tissue– Mucinous cancer produces mucous– Papillary cancer has cells that form finger-likeprojections Invasive lobular carcinoma – This starts insidethe lobules, but grows into the surrounding normaltissue inside the breast. It is the second mostcommon type, representing about 10 percent ofbreast cancer cases.For more information about invasive breast cancersee: http://www.breastcancer.org03.06Invasive Lobular Carcinoma (ILC)Normal breast with invasive lobularcarcinoma (ILC) in an enlargedcross–section of the lobule.Breast profile:A. DuctsB. LobulesC. Dilated section of duct to hold milkD. NippleE. FatF. Pectoralis major muscleG. Chest wall/rib cageEnlargement:A. Normal cellsB. Lobular cancer cells breakingthrough the basement membraneC. Basement membraneIllustration courtesy of

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSUncommon Forms of Breast CancerIn addition to the types of cancer mentioned before,there are some rare forms of breast cancer. Theseinclude inflammatory breast cancer (IBC),cystosarcoma phylloides, Paget’s disease andangiosarcoma.the extent of the cancer and its response to initialchemotherapy, but these treatments usuallyinvolve surgery, radiation, and perhaps additionalchemotherapy.IBC information provided by Susan AsciInflammatory Breast Cancer (IBC)Inflammatory breast cancer (IBC) is a somewhatrare form, accounting for 1 percent to 4 percent ofall breast cancers.IBC is an advanced and aggressive breast cancerthat travels through the lymphovascular system,causing blockage of the lymph vessels in the skinover the breast. This results in the breast having ared and swollen appearance. The skin may developa thick, pitted appearance that resembles an orangepeel and is referred to as “peau d’orange.”While IBC can occur at any age, the average age ofthose diagnosed is under the age of 45. It is important to note that not all breast cancer presents itselfin the form of a lump.Symptoms of IBC include: Redness of the skin, such as a “rash” or sunburnedappearance Nipple flattening or retraction Thickening or hardening of the skin Dimpling or pitted appearance Skin feels warm Increase in breast size, swelling Possible tenderness in the breastIf you notice these symptoms, report them to a doctorimmediately. Inflammatory breast cancer is consideredthe most aggressive form of breast cancer, andimmediate treatment is needed after diagnosis.IBC is difficult to detect on a mammogram becausethe cancer does not typically form a lump that iseasily seen with the standard technology available.Diagnosis will likely result from a biopsy.Current treatment usually involves initial chemotherapy to stop the cancer from spreading and toreduce the mass. Additional treatments depend onThe “Grade” of the CancerExperts use the term “grade” to describe howdifferent the cancer cells are from normal cells. Yourreport may say the cancer is: Grade 1 – Cells are well-differentiated. That is,they look a lot like normal cells. These are usuallyslow-growing. Grade 2 – Cells are moderately differentiated.They do not look like normal cells. They growfaster than normal cells. Grade 3 – Cells are poorly differentiated. That is,they do not look at all like normal cells. They areusually fast-growing.03.07

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSThe Size of the CancerThe medical community measures cancers incentimeters (cm). A centimeter is roughly one-thirdof an inch. The size helps your health care teamdetermine the “stage” of the cancer (see below).MarginWhen the breast cancer is surgically removed, thesurgeon’s goal is to remove the entire tumor andleave no cancer cells behind. So he/she removesan extra “margin” of normal tissue along with thecancer. The pathologist examines this margincarefully to determine if it is free of cancer cells.On your pathology report, the margin may bedescribed in one of several ways: Negative or clean – No cancer cells are seen atthe edge of the tissue. This usually means noadditional surgery is needed. Positive – Cancer cells are seen right at the edgeof the tissue. Additional surgery may be needed. Close – Cancer cells are close to the edge of thetissue. Additional surgery may be needed.Lymphatic or Vascular InvasionA network of blood vessels (vascular structures)and lymph channels carry fluids to and from breasttissue and other parts of the body. If cancer cells arefound in these fluid channels, there is an increasedrisk that the cancer may return. Your pathologyreport will indicate whether lymphatic or vascularinvasion is: Present – Cancer cells have been found; or Absent – Cancer cells have not been found.03.08Estrogen Receptor (ER) and ProgesteroneReceptor (PR)These tests reflect whether a cancer responds to awoman’s hormones. They give your health care teaminformation about the likelihood that the cancerwill respond to a form of treatment called hormonalmanipulation. You may see one of these terms onyour report: ER-positive – The cells have receptors for thehormone estrogen. ER-negative – The cells do not have receptors forestrogen. PR-positive – The cells have receptors for thehormone progesterone. PR-negative – The cells do not have receptors forthe hormone progesterone.The report will also tell you the number of cells thathave receptors. This may be expressed in one of twoways: As a percentage – You will see a number between0 percent (none has receptors) and 100 percent(all have receptors); or As a number between 0 and 3 – “0” indicatesno receptors; “1 ” indicates a small number ofreceptors; “2 ” indicates a medium number ofreceptors; and “3 ” indicates a large number ofreceptors.

UNDERSTANDING YOUR DIAGNOSIS BACK TO CONTENTSHER-2/NEUHER-2/NEU is a receptor on the surface of cells.It regulates cell growth. Cancers with too manyHER-2 receptors tend to grow quickly and notrespond well to hormone therapy. However, newertreatments that specifically target HER-2 areproving very effective. Your pathology report willindicate your HER-2 status. It may be: Positive; Negative; or Borderline.Lymph Node InvolvementLymph nodes are located under your arm. They arefilters along the lymph channels that carry lymphfluid from the breast back to the bloodstream. Thepathologist will examine the lymph nodes removedalong with the breast tissue to see if cancer cellsare present in them. Your report may indicate thatlymph nodes are:StagingAfter the tests are done and the lab reports havedetermined what kind of breast cancer you have,your doctor will “stage” the tumor. The purpose ofstaging the tumor is to help determine yourprospects for recovery and the best treatments forthe stage of your disease. The stage tells how largeyour tumor is and how far the cancer has spread.Three letters are used in the staging of breast cancer: “T” – Stands for tumor characteristics, includingtumor size and any involvement of skin or thechest wall behind the breast. “N” – Stands for lymph nodes. It indicates how farthe cancer has traveled through the lymph nodesthat drain the breast region. Lymph nodes arefound under your arm and at other sites. “M” – Stands for metastasis, that is, whethercancer cells have traveled (metastasized) beyondyour breast and lymph node regions. Negative – No cancer cells are seen in the lymphnodes; orStaging is complicated and should be discussedwith your oncologist. Positive – Cancer cells are seen in the lymphnodes.For a fact sheet on breast cancer staging, tection/stagingAlso ng.jspAdditional ResourcesAmerican Cancer Societywww.cancer.orgAmerican Society of Clinical Oncologywww.cancer.netBreast Cancer Network of Strength (formerly theY-ME Breast Cancer Organization)www.networkofstrength.org03.09

GENETICS BACK TO CONTENTSGeneticsIf you’ve been diagnosed with breast cancer, youmay want to know more about the biology of thedisease. If there are other people with breast cancerin your family, you may wonder if your cancer ishereditary and whether your children or otherrelatives may also be at heightened risk. This sectionof the guide contains information that will help youbetter understand what is known so far about theconnection between genes and breast cancer. It willalso explain the role a genetic counselor may play inyour evaluation and management plan.The Role of GenesEvery cell in our bodies contains genes, tiny unitsof information that are passed along to us by ourparents. Each of us inherits two copies of each gene.Each cell in our body has 20,000 to 40,000 genes.Genes direct the growth and development of ourcells, and therefore of our bodies as a whole. Inaddition, most of our physical characteristics, suchas the color of our eyes and skin, how tall we areand our blood type, are influenced by genes tosome extent.An alteration or “mutation” in a gene is like atypographical error. When this genetic alterationis in a gene that controls cell growth, the “error”may enable cells to grow out of control.All cancers involve genetic alterations in a cell. Thegenetic alteration causes the cell to transform into acancer cell that can eventually multiply and becomea tumor.Genetic alterations that lead to cancer may developin isolated cells during an individual’s lifetime. Theseare called “acquired” or “sporadic” alterations. They arenot passed on to future generations.Other genetic alterations are hereditary. That is, thealteration is already present in all of our cells whenwe are born and can be inherited by our children whenthe alteration is passed on in the sperm or egg.Hereditary CancerCertain families have multiple members affectedwith cancer because of a specific inherited genemutation. Individuals in these families may have asignificantly increased risk of developing cancer.Only a small percentage (5 to 10 percent) of breastcancers can be traced to hereditary mutations.When cancer occurs in one or more close relatives,we may begin to suspect that it is not by chance. So04.01

GENETICS BACK TO CONTENTSit is prudent to look into whether these occurrencesmight be hereditary. We will be more likely tosuspect it is hereditary if the cancers are the sametype (breast cancer, for example) or a particularcombination of cancers (such as breast and ovariancancers).Gene Mutations That Cause HereditaryBreast CancerWhile only a small percentage of breast cancersare hereditary, the majority of them are due tohereditary mutations in two particular genes: BRCA1and BRCA2. The abbreviations stand for breastcancer gene 1 and breast cancer gene 2. An evensmaller percentage are due to other hereditary genemutations. For example, gene mutations in PTENare associated with Cowden’s syndrome, and genemutations in p53 are associated with Li-Fraumenisyndrome.The BRCA1 and BRCA2 genes are examples of tumorsuppressor genes. The role of tumor suppressorgenes is to slow down cell division, repair DNAmistakes, and tell cells when to die naturally. Weall possess these genes, having inherited one copyof each from each of our parents. Those of us whoinherit an altered form of one of these genes are athigher risk of developing breast or ovarian cancer.The mutations in these genes may interfere with acell’s ability to put the brakes on its growth. Withoutthe brakes, cells may grow out of control and beginthe process of developing a tumor.For more information about the role of cells andgenes, visit and enter the searchterm, “tumor suppressor genes.”Hereditary Breast and Ovarian CancerMutations in the BRCA1 and BRCA2 genes increasethe risk of developing both breast cancer and ovariancancer. The medical community has identified riskfactors that tend to indicate the presence of a BRCAmutation in a family.Signs of hereditary breast-ovarian cancer syndromein a family include, but are not limited to: Breast cancer at age 50 or younger. Breast cancer in both breasts in a woman, whenthe first cancer occurred under 50.04.02 At least one family member with breast cancerunder age 50 and one with ovarian cancer on thesame side of the family, or breast and ovariancancer in the same individual. Breast cancer in men. Ashkenazi Jewish heritage. Three or more close relatives on the same sideof the family with breast or ova

Breast cancer development In the United States, breast cancer is the most common cancer diagnosed in women (excluding skin cancer). Men may also develop breast cancer, but less than 1% of all people with breast cancer are men. Breast cancer begins when healthy cells in the breast change and grow uncontrollably, forming a mass called a tumor.

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