Breastfeeding And Diabetes

If you are a diabetic and have a baby, there are certain things to keep in mind while you are breastfeeding. Firstly, studies have proven that breastfeeding a baby can help to prevent type 1 diabetes development. Babies who breastfeed until at least six months will be at a lower risk for type 1 diabetes. Doctors generally recommend that mothers breastfeed their children until nine to twelve months.

Doctors are unsure if the positive effects of nursing come from special nutrients in the colostrum (the special milk from mothers) or if it because babies who are breastfed often grow at a more regular pace than those who are fed from cow’s milk. Babies weaned on cow’s milk often experience growth spurts rather than the steady growth associated with mother’s milk. If you are a diabetic, consider breastfeeding to help lower your child’s chances of diabetes due to genetic predisposition.

Breastfeeding is not only positive for the babies, but also for the mothers. Breastfeeding can help maternal weight loss, and it is particularly important for diabetic women to maintain a healthy weight. Some breastfeeding mothers find it easier for them to manage their diabetes because their glucose levels stay more constant and they have a remission of some symptoms while breastfeeding.

Just like during pregnancy, breastfeeding requires much blood sugar level monitoring from the mother. You will probably find that your need for insulin is lower than before your pregnancy. Insulin will not enter your baby’s body because it is too large to be carried on the breast milk. However, if you have type 2 diabetes and are taking diabetes medication, talk with your doctor to make sure that you are on a type of medication that will be healthiest for both you and for your baby.

Breastfeeding means that you have to be extra careful of your nutrition, so be sure to see your doctor or dietitian to create a meal plan that will work for you. It is important to eat regular snacks when you are breastfeeding because you want to keep your blood glucose levels constant. You will need to increase your caloric intake by about 500 calories a day to meet your baby’s nutritional needs. You can do this simply by drinking a glass of milk each time you breastfeed, which will keep you both hydrated and full of vitamins.

In order to maintain a balanced diet, experts suggest that mothers eat 20% of calories from protein, 40-60% from carbohydrates, and 30-40% from fruits and vegetables. Keeping up with all of these food groups will ensure that your body has the nutrients to provide for the baby.

As a breastfeeding mother, low blood sugar is an increased risk. However, by eating a healthy diet full of legumes, whole grains, other healthy foods, you will be able to keep low blood sugar at bay. Drinking lots of fluids is also an important part of having a healthy blood sugar level. Most importantly, monitor your blood glucose levels and record the results frequently. Having a newborn baby around will mean that you are very busy, but it is also the time when it is most important to take care of yourself so that you will be able to care for your baby.

When the baby is born, often it is a good idea to immediately allow the baby to breastfeed, which will prevent low blood sugar. Some hospitals will try to take babies away for observation. You can ask politely, and firmly insist that you baby stays with you for the first feeding and for some initial bonding time. If you are hospitalized after the baby is born, ask to bring your baby with you so that you will still be able to breastfeed. Diabetic mothers are not often hospitalized, but since breastfeeding is even more important for diabetic mothers, it is important to keep this in mind.

Some diabetic mothers may find that their milk comes in late, between two days to two weeks. In the meantime, use a breastpump and speak to your doctor to establish the best solution for you and your baby. Even babies who are too weak to breastfeed can be fed breastmilk that has been pumped.

Breastfeeding is a bonding experience for mothers and babies. Diabetics can breastfeed and gain even more benefits than the emotional closeness, such as lowered diabetes risk for the baby, and improved diabetes control for the mother.
by: Vivian L. Brennan

Asbestos Law Overview

Exposure to asbestos can cause Mesothelioma, a rare form of cancer, and Asbestosis, a noncancerous scarring of the lungs by asbestos fibers.

Asbestos products liability lawsuits have arisen most often from two situations: 1) claims brought against suppliers of raw asbestos fiber, where employees of manufacturers of asbestos products actually or allegedly had contracted asbestos-related diseases as a result of exposure to asbestos supplied to the manufacturer, and 2) claims against manufacturers of products brought where insulators and other asbestos workers allegedly or actually had contracted asbestos-related diseases as a result of exposure to the manufactured products.

The major defense put forward by companies sued for asbestos exposure was that the company was unaware of the dangers of asbestos, though this defense doesn't often prevail. Some manufacturers also contend that lung damage was caused by smoking, because asbestos and lung injuries are similar.

Asbestos law is a relatively new field of law. The first asbestos lawsuit was not filed until 1966. The first legal victory for an asbestosis sufferer was not until 1973. In the 1980s, however, during a wave of asbestosis cases, many companies began filing bankruptcies to avoid paying huge punitive damages. Within a few years, the entire asbestos textile industry was in bankruptcy, as were several major asbestos insulation manufacturers. Nevertheless, asbestos cases continued; instead of the manufacturers of asbestos bringing lawsuits, however, those exposed to asbestos began bringing lawsuits. Asbestos products were banned in the United States in 1989.

In more recent developments, by March 2003, the Supreme Court had ruled that mental anguish damages resulting from the fear of developing cancer may be recovered under the Federal Employers' Liability Act by a railroad worker suffering from the actionable damage asbestosis caused by work-related exposure to asbestos. However, emotional distress damages may not be recovered under the Federal Employers' Liability Act by disease-free asbestos-exposed workers

The U.S. Environmental Protection Agency (EPA) regulates the general public's exposure to asbestos in buildings, drinking water and the environment.

Diagnosing Mesothelioma

1. Physical Examination
As with all diseases, a doctor begins the mesothelioma diagnosis by doing a complete physical exam and reviewing your medical history. Because mesothelioma is almost always caused by breathing in asbestos exposure (see Causes of Mesothelioma), you should tell your doctor about your exposure to asbestos if you suspect you may have mesothelioma.After performing the physical exam, a doctor should have x-rays of the chest performed and, in some cases, pulmonary function tests to determine if the symptoms are consistent with malignant mesothelioma.

2. CT Scans and MRI's
In many cases, a doctor may order CT scans and/or MRI's to aid in the mesothelioma diagnosis. These tools allow a doctor to assess the size, location, and extent of the mesothelioma tumor in the chest or abdomen.

3. Biopsy to Diagnose Mesothelioma
All of the steps described above are only preliminary indications of mesothelioma. If, after performing these tests, a doctor suspects mesothelioma, a biopsy should be taken to confirm the mesothelioma diagnoses.

A biopsy is the procedure used for obtaining a tissue sample of the tumor. The two most common methods for removing tissue samples are a thorascoscopy and a broncoscopy.

A thoracoscopy is obtained by inserting a telescope-like instrument connected to a video camera (thoracoscope) through a small incision in the chest. The doctor then removes the tumor using special forceps with the aid of the camera. This procedure is used for diagnosing both pleural mesothelioma and pericardial mesothelioma.

A bronchoscopy involves inserting a flexible lighted tube through the mouth into the bronchi to remove tissue in the airway. This procedure is used for diagnosing pleural mesothelioma.

Although a biopsy is the most effective procedure for diagnosing mesothelioma, malignant mesothelioma cells can look like other types of cancer. Therefore,special laboratory testsare sometimes performed or electron microscopes are used to confirm a diagnosis of mesothelioma.

What is Asbestos and how does it relate to Mesothelioma?

Asbestos is the only known cause of mesothelioma. Asbestos is a combination of several minerals held together by silky strands of fibers. These fireproof fibers do not burn, and do not conduct heat or electricity. Because asbestos does not conduct heat well and is resistant to melting or burning, asbestos was used widely in all types of construction products up to the mid-1970s. Other products made with asbestos, such as insulation materials and automotive clutches and brakes, were designed principally to contain heat and sound.

Mesothelioma Chrysotile
Chrysotile asbestos is the main cause of malignant pleural mesothelioma. The three most common forms of asbestos are chrysotile, amosite, and crocidolite. Chrysotile or white asbestos accounts for approximately 95% of the asbestos used in US production of asbestos products and is the only member of the serpentine group of minerals.

The fine fibers of asbestos made it a great source for insulation and as a fire retardant but they their entry into the human body can trigger the onset of mesothelioma. Sometimes the asbestos fibers enter the body through the air and are breathed into the lung area of the body. Once they are taken in through the respiratory passages these fibers lodge themselves in the mesothelial cells around the lungs. This can cause direct damage to the lungs by traveling to the ends of small passages and reach the pleura area around the lungs.

Once lodged in the plural area these fibers can injure lung cells and cause lung cancer or asbestosis which is a term used to describe replacing healthy lung tissue with damaged or scar tissue. In addition, asbestos fibers can also be directly swallowed by people working in close of confined spaces with exposed asbestos. These fibers can go directly to the stomach and abdominal cavity and may lead to the development of stomach cancer or peritoneal mesothelioma.

The most common way to get is through directly working with asbestos as part of a job or career. Many people get mesothelioma as a result of their jobs working in mining, construction, shipbuilding and any other job that required a regular exposure to asbestos fibers. It is possible as well to get mesothelioma from being exposed to asbestos fibers in your home of office. Many houses still contain asbestos lined insulation that can be a grave danger if it becomes opened or exposed to humans. As long as the asbestos remains in a sealed unit or wrapped around a pipe with its exterior sealant intact, there is little danger. But if any of these materials break out of their sealed units they could easily contaminate any one who comes into contact with them.

Finally it is also possible to develop mesothelioma through direct physical contact with the clothes of someone else that has come directly into contact with asbestos. There are numerous cases of wives and spouses of miners and construction workers who have developed mesothelioma from breathing in the fibers that their husbands or wives brought home with them from the plant, mine or construction site. If that person worked in the insulation industry at a time when asbestos use was at its peak they have a much higher chance of developing this deadly disease than others who may have had minimal exposure to asbestos fibers as a result of their daily working activities.

Today mesothelioma is one of the most commonly recognized industrial or workplace diseases and special programs have been developed to recognize mesothelioma symptoms and to provide support to those who suffer from this disease.

Hormone Therapy

What are the hormone therapy choices?
If a breast cancer has estrogen and progesterone receptors, which means that these hormones may fuel the growth of these cancers, the treatment options are broader. Tamoxifen, of course, is the gold standard, and this drug is given to women with hormone-responsive breast cancer. It attaches to the estrogen receptor and deprives the cancer of a needed hormone. It thereby starves the cancer cell of a needed nutrient, if you will. The aromatase inhibitors do this by shutting off the residual production of estrogen at sites outside the ovaries. But they're in a sense doing the same thing as tamoxifen.

How much risk reduction is associated with hormone therapy?
Tamoxifen given for five years to women with hormone-responsive breast cancer lowers the risk of recurrence by 40 percent per year, and the overall benefit will be close to a one-third reduction in risk. There is no consistent evidence of benefit with tamoxifen beyond five years. In addition, the risk of developing uterine cancer increases with more exposure, so after five years you get no additional benefit, but you keep adding risk.


Related Programs:
Living with Breast Cancer Treatments: Personal Stories
Preventing Breast Cancer Recurrence: What's Right for Me?
Are Some Breast Cancers Different than Others?
Breast Cancer TestsWhat are the hormone therapy choices?If a breast cancer has estrogen and progesterone receptors, which means that these hormones may fuel the growth of these cancers, the treatment options are broader. Tamoxifen, of course, is the gold standard, and this drug is given to women with hormone-responsive breast cancer. It attaches to the estrogen receptor and deprives the cancer of a needed hormone. It thereby starves the cancer cell of a needed nutrient, if you will. The aromatase inhibitors do this by shutting off the residual production of estrogen at sites outside the ovaries. But they're in a sense doing the same thing as tamoxifen.
How much risk reduction is associated with hormone therapy?Tamoxifen given for five years to women with hormone-responsive breast cancer lowers the risk of recurrence by 40 percent per year, and the overall benefit will be close to a one-third reduction in risk. There is no consistent evidence of benefit with tamoxifen beyond five years. In addition, the risk of developing uterine cancer increases with more exposure, so after five years you get no additional benefit, but you keep adding risk.
The last few years have given us new options in adjuvant hormone therapy for postmenopausal women. It now looks increasingly like substituting or switching to or following that tamoxifen with an aromatase inhibitor further improves outcome.

We have three large randomized trials as of May of 2004, all of which show the same thing: The risk of a recurrence of breast cancer in the breast or a recurrence of breast cancer outside the breast is more greatly reduced when a woman is on a aromatase inhibitor compared to tamoxifen.

How could a postmenopausal woman decide between hormone therapies?
Choosing between tamoxifen, the standard therapy, and one of the newer aromatase inhibitors still remains somewhat tricky. On the one hand, there is no question that the likelihood of events is reduced when you take one of these new drugs over the short run. The big question is what do they do to bone density because aromatase inhibitors significantly lower estrogen, and that decreases bone density.

On the other hand, tamoxifen has some fairly well-described short-term side effects like an increased risk of uterine cancer and aside from that, an increased risk of vaginal complaints like bleeding or discharge. And these things seem to be less of an issue with the aromatase inhibitors. There is also an increased risk of blood clots with tamoxifen, and maybe stroke and even heart attacks. So we have to consider all these issues carefully. Obviously a woman, for example, who has had her uterus removed, has taken away one of the concerns with tamoxifen.

We simply don't know what the very best strategy is, so I think we have to say that doctors and their patients will have to individualize treatment.

Making Decisions in Early-stage Breast Cancer

While more than 200,000 North American women are diagnosed with breast cancer every year, most of the time the disease is found in its early, most curable stages. This bodes well for the long-term survival of these women, but there are often many treatment decisions to make in a relative short and stressful span of time. Once the benefits of a particular treatment for a particular patient are assessed, women and their medical teams must weigh the risks and benefits in order to design the best treatment plan.

Tools for better decision-making are now in the works. A study published the July 28th issue of the Journal of the American Medical Association evaluated a decision aid, called a decision board, which includes pictures and text, that physicians can use when presenting information about surgery, which is one of the first breast cancer treatment decisions. Researchers found that the decision board helped patients make a more informed choice when deciding whether to have a mastectomy or a lumpectomy; the women were also more satisfied with their decision six and 12 months later.

Below, Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City, talks about the goals of breast cancer therapy and how treatment decisions are best approached.

What is the goal of treatment for early-stage breast cancer?
The goal of therapy for early-stage breast cancer is cure, and there are many ways to get there. Different treatment choices will often be associated with different side effect profiles, and that's where we have to have a long discussion weighing the risks and benefits of different approaches.

For early-stage breast cancer, most people will say they're willing to put up with fairly substantial side effects in the short run because their hope is that they will never hear from the cancer again. If we're going to think of a scale, it will be tipped towards more toxicity for more benefit. When we're treating advanced cancer, however, the scale may be tipped the other way. People may not want to deal with a whole lot of toxicity or give up quality of life for very marginal benefits. So these are the kinds of decisions that come into play.

What's the goal of surgery for a woman who has early-stage disease?
For early-stage disease, the goal of surgery is to remove all of the cancer with clear margins around it and to determine the risk of spread by looking at the status of the lymph nodes under the armpit.

In the early days of breast cancer surgery, the procedure of choice was a mastectomy. But the National Surgical Adjuvant Breast and Bowel Project (NSABP) conducted a series of randomized studies that showed that just as many women could be cured with a lumpectomy and radiation therapy as could be cured with mastectomy. Women who choose lumpectomy need the radiation because it lowers the risk of local recurrence in the breast.

Does everyone require radiation therapy after lumpectomy?
There is a movement afoot to look very carefully at some subgroups of people who may not need radiation after a lumpectomy. For example, researchers are looking at women with DCIS (ductal carcinoma in situ), which is a precancer that remains confined to the ducts, so we don't call it an invasive cancer. It does not have the potential, that we know of, to spread distantly beyond the breast.

As the degree of invasiveness of the cancer goes down and as the age of the patient goes up, the risk of recurrence is lower. Hence, the potential gains from radiation may be smaller.

How do women decide between mastectomy and lumpectomy?
The choice of mastectomy vs. lumpectomy is a fairly difficult one for some people. On the one hand, the mastectomy is over with quickly. You can choose to do reconstruction right away or at a later date. On the other hand, the lumpectomy allows you to preserve the breast, but generally requires four to six weeks of postoperative radiation therapy five days a week.

Some variables are technical. For example, if there is a large cancer in a small breast and the cosmetic result of a lumpectomy will be unacceptable, doctors and patients may select mastectomy. But there can be a large cancer in a woman with a very large breast that's amenable to lumpectomy.

In addition, patients who live far from a radiation center, who have economic issues with coming for treatment every day, may elect to have a mastectomy simply so they're not having to come to the hospital for six weeks for daily treatments. So there are many factors that can influence this decision and not all of them are medical.

Do women have a lot of anxiety over local recurrence following a lumpectomy?
I think there is a lot of anxiety over recurrence in the breast, although we try to counsel people that that's not the major issue. In the end, what matters is whether the cancer spreads throughout the body or not. In the rare case of a local recurrence in the preserved breast, one can treat that with mastectomy.

What is the goal of adjuvant (post-surgical) therapy?
The goal of adjuvant therapy is to kill cancer cells that might have spread beyond the breast and lymph nodes before the surgery took place. They're out and about in the body, and we don't have a way of identifying exactly where they are so we have to treat with medicines that circulate throughout the body and kill cancer cells wherever they may be.

How much does chemotherapy reduce risk of recurrence?
Chemotherapy across the board lowers the annual rate of recurrence by about 24 percent. And this adds up, depending on the absolute risk of a patient, to roughly a one-fifth to one-quarter or slightly better reduction in risk at five years. That's the average for old chemotherapy regimens like CMF (Cytoxan, methotrexate and fluorouracil). Most modern chemotherapy regimens that work better than CMF will obviously offer even greater advantage.

How is someone's personal benefit from chemotherapy assessed?
Chemotherapy decision-making is really challenging for everybody involved. We first have to ask ourselves what's the benefit of chemotherapy generally. Then we have to apply that to the individual patient, which means calculating her individual risk of recurrence.

Once we get into that discussion, adjuvant chemotherapy is not generally recommended unless women will likely reduce their risk of recurrence with chemotherapy by at least 1 percent. Some people will set it even higher. Clinicians often set it at 2 or 3 percent, but patients surveyed after treatment typically set it at 1 percent.

When we talk about these small benefits of 1, 2 or 3 percent, we're talking about prevention of recurrence at five years. That's the threshold that most people are focused on. If you took 10 years, of course, the benefits would be larger because risk reduction with chemotherapy improves each year. So it's often a question of how young you are. A woman who's 85 years old, and facing a very high risk of breast cancer recurrence, might decide chemotherapy is not worth it because her overall probability of living much beyond 90 is limited. Her chance of dying of another disease is high. But a 30-year-old, even looking at a very small difference at five years, might decide it's easily worth it, because she can extrapolate out to 10 years and 15 years and 20 years.

How do you balance the benefits of chemotherapy with the side effects?
People are very worried about the side effects of chemotherapy. In fact, often they're more focused on the side effects than the potential benefits. The side effects traditionally included hair loss, nausea and vomiting, risk of infection, fatigue.

But the last 10 years have been exciting, not only because of better therapies, but also because of better ways of treating the side effects and supporting people through their therapy. We have much better anti-nausea medicines, for example, so vomiting has now become relatively rare. One of the things we still struggle with is fatigue. We don't have a direct way to deal with the fatigue that's common with chemotherapy. And we don't have a way to deal with the hair loss that occurs.

Then there are the life-threatening side effects that are long term, such as leukemia or heart failure. They are, thankfully, very rare. They are in many cases associated with specific drugs, and we may reserve the use of those drugs for very high-risk situations where the benefits of therapy dramatically outweigh those risks.

In the last few years, we've developed chemotherapy regimens that have fewer of these side effects and are, in many cases, shorter than traditional therapy, so the duration of these side effects can be shortened, as well.

Role Reversal: Chemo Before Surgery for Breast Cancer

When it comes to breast cancer treatment, there is usually a standard sequence of events. First a woman has surgery to remove the tumor, then, if necessary, she has chemotherapy to kill any remaining cancer cells in the body. But the results of a number of studies suggest reversing the order of treatment, giving chemotherapy before surgery in order to offer certain women with early-stage breast cancer an added benefit; this approach is called neoadjuvant therapy.

"Neoadjuvant chemotherapy refers to giving chemotherapy upfront before we do surgery." says Harry Bear, MD, PhD, a professor with the division of surgical oncology at Virginia Commonwealth University in Richmond. "It can be used for the express purpose of shrinking a tumor that might be too big for lumpectomy. For selected patients, if we’re able to shrink the tumor, we’re able to do a lumpectomy instead of having to remove the whole breast."

At one time, it was hoped that giving chemotherapy before surgery might give all women better treatment options. The idea was that neoadjuvant chemotherapy would offer better survival rates than post-operative chemotherapy because cancer cells would be killed earlier in the disease process. But such a survival advantage has not been demonstrated in studies. A review of nine clinical trials of neoadjuvant chemotherapy involving almost 4,000 women was published in February 2005 in the Journal of the National Cancer Institute (JNCI). The study researchers, from the University of Ioannina School of Medicine in Greece, found that women who received chemotherapy before surgery had similar rates of survival, disease progression and cancer spread as women who were treated with post-operative chemotherapy, which is known as adjuvant chemotherapy.

The researchers did find that the women who had neoadjuvant chemotherapy had higher rates of local recurrences, or recurrences in the breast and nearby lymph nodes. Local recurrences don’t hurt a woman’s chances of survival, but any return of the cancer in nearby tissue after the initial surgery means that a woman would most likely have to undergo a mastectomy after all. The researchers found that these recurrences were most likely to occur in women who did not have any surgery because their tumors had disappeared completely after the neoadjuvant chemotherapy.

And for women who do have surgery to remove the remains of their tumor after chemotherapy the procedure is often is often trickier. The goal of any surgery is to remove the cancer with a wide margin of tissue around it to ensure that you are getting all of the cancer cells out of the body. This wide margin is called a "negative" margin.

"If you’re doing surgery right away, you know where the cancer is, and we have a large body of knowledge that shows that if you take the cancer out with a large margin [around the tumor], there will be a low rate of recurrence." says Monica Morrow, MD, the chair of the department of surgery at the Fox Chase Cancer Center in Philadelphia. "But when some cancers die after chemotherapy, they die in a patchy fashion, so if you do surgery after chemotherapy, a negative margin might not mean the same thing." She adds that the greater possibility that part of the tumor will be left in the breast requires "a greater need for close communication between the surgeon, the pathologist and the radiation oncologist."

For now, neoadjuvant chemotherapy is only offered to women with a large tumor in a small breast who want a lumptectomy. But this approach to treatment may play a greater role in the future. Some researchers hope that neoadjuvant chemotherapy can one day be used to test the impact of a given chemotherapy drug on a particular tumor, allowing women to quickly switch to a more effective chemotherapy combination. But first scientists have to identify cancer markers that will indicate whether a chemotherapy drug is working.

"One of the other theoretical advantages to neoadjuvant chemotherapy—and this is really why it’s a very exciting focus for a lot of our research protocols—is that it allows us to look at features of the tumor that are associated with either a good response to a particular drug or no response to a particular drug." Dr. Bear says. "We are hoping that, eventually, we’ll get to a point where we can look at patient’s tumor with very sophisticated tests and be able to determine whether a particular tumor should be treated with drug A or drug B or whether neither one of those drugs is good."

History Of Breast Cancer

Breast cancer is one of the oldest known forms of cancer tumors. Our oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 B.C. The Edwin Smith Papyrus, or writing, describes 8 cases of tumors or ulcers of the breast that were treated by cauterization, with a tool called "the fire drill." The writing says about the disease, "There is no treatment." [4] At least one of the described cases is male. This papyrus is 5 meters long and is kept in the New York Historical Society. Scholars believe that the actual document is a copy of an original document from the 30th century before Christ. In any case, for centuries, physicians described similar cases in their practises, with the same sad conclusion. It wasn't until greater understanding of the circulatory system was added to the body of medical knowledge in the 17th century that doctors made the link to the lymph glands in the armpit. The French surgeon Jean Louis Petit (1674-1750) and later the Scottish surgeon Benjamin Bell (1749-1806) were the first to remove the lymph nodes, breast tissue, and breast muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up to the 1970's and was performed on Betty Ford.

Types of breast cancer :
- DCIS: Ductal Carcinoma in Situ
- LCIS: Lobal Carcinoma in Situ
- Invasive ductal carcinoma
- Invasive lobal carcinoma
- Inflamatory breast cancer
- Paget's disease

Epidemiologic risk factors and etiology
It is important to have a model of causation of a disease in order to distinguish epidemiological risk factors or associations with disease, from the biological etiology and primary cause, secondary co-factors, and simple promoters of the disease, given the underlying primary cause. The first work on breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.

Today, breast cancer, like other forms of cancer, is considered to be a result of damage to DNA. How this mechanism may occur comes from several known or hypothesized factors (such as exposure to ionizing radiation). Some factors lead to an increased rate of mutation (exposure to estrogens) and decreased repair (the BRCA1, BRCA2 and p53 genes). Although many epidemiological risk factors, and biological co-factors and promoters have been identified, the majority of breast cancer incidence remains unattributable, and the primary cause is unknown.Dietary influences have been proposed and examined, but these are small effects, and do not distinguish differences in risk within populations, as well as they do between populations.A significant environmental effect was revealed by the large difference in breast cancer incidence between countries and continents, and a migration effect which slowly increases the risk of breast cancer even across generations after migration from a country of lower incidence to a country of higher incidence, such as moving from China or Japan to the United States.

Humans are not the only mammal prone to breast cancer. Some strains of mice, namely the house mouse (Mus domesticus) are prone to breast cancer which is caused by infection with the mouse mammary tumour virus (MMTV or "Bittner virus" for its discoverer Hans Bittner), by random insertional mutagenesis. Suspicion of MMTV or other viruses in human breast cancer is controversial, and the idea is not generally accepted for lack of direct and definitive evidence. There is much more research in diagnosis and treatment of breast cancer than in its cause.

Age
The risk of getting breast cancer increases with age. For a woman who lives to the age of 90 the chances of getting breast cancer her entire lifetime is about 14.3% or one in seven. [1] Men can also develop breast cancer, but their risk is less than one in 1000 (see sex and illness). [citation needed] This risk is modified by many different factors. In a very small (~ 5%) proportion of breast cancer cases, there is a strong inherited familial risk.

The probability of breast cancer rises with age but breast cancer tends to be more aggressive when it occurs in younger women. One type of breast cancer that is especially aggressive and disproportionately occurs in younger women is inflammatory breast cancer. It is initially staged as Stage IIIb or Stage IV. It also is unique because it often does not present with a lump so that it often is not detected by mammography or ultrasound. It presents with the signs and symptoms of a breast infection like mastitis.

Genes
Two genes, BRCA1 and BRCA2, have been linked to the rare familial form of breast cancer [citation needed]. Women in families expressing mutations in these genes have a much higher risk of developing breast cancer than women who do not.

Not all people who inherit mutations in these genes will develop breast cancer. Together with Li-Fraumeni syndrome (p53 mutations), these genetic aberrations determine around 5% of all breast cancer cases [citation needed], suggesting that the remainder is sporadic.

Recently it was found that newly discovered gene called BARD1 if exists in combination with BRCA2 gene may increase the risk of breast cancer to as much as 80 percent 1. Genetic counseling and genetic testing should be considered for families who may carry a hereditary form of cancer.

Alcohol
Alcohol generally appears to increase the risk of breast cancer in women. The U.K.s Review of Alcohol: Association with Breast Cancer concludes that "studies confirm previous observations that there appears to be an association between alcohol intake and increased risk of breast cancer in women. On balance, there was a weak association between the amount of alcohol consumed and the relative risk."

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) concludes that "Chronic alcohol consumption has been associated with a small (averaging 10 percent) increase in a woman's risk of breast cancer (Friedenreich et al.; Longnecker; Nasca). According to these studies, the risk appears to increase as the quantity and duration of alcohol consumption increases. Other studies, however, have found no evidence of such a link (Chu et al. ; Schatzkin et al.; Webser et al)." [5]

The Committee on Carcinogenicity of Chemicals in Food, Consumer Products Non-Technical Summary concludes, "The new research estimates that a woman drinking an average of two units of alcohol per day has a lifetime risk of developing breast cancer 8% higher than a woman who drinks an average of one unit of alcohol per day. The risk of breast cancer further increases with each additional drink consumed per day. … The research also concludes that approximately 6% (between 3.2% and 8.8%) of breast cancers reported in the U.K. each year could be prevented if drinking was reduced to a very low level (i.e. less than 1 unit/week)."

It has been reported that "Two drinks daily increase the risk of getting breast cancer by about 25 percent." (NCI) but the evidence is inconsistent. The Framingham study has carefully tracked individuals since the 1940s. Data from that research found that drinking alcohol moderately did not increase breast cancer risk (Wellness Facts). Similarly, research by the Danish National Institute for Public Health found that moderate drinking had virtually no effect on breast cancer risk (Petri et al.).

Breast cancer constitutes about 7.3% of all cancers [6]. Among women, breast cancer comprises 60% of alcohol-attributable cancers.[3] One study suggests that women who frequently drink red wine may have an increased risk of developing breast cancer.

[4]"Folate intake counteracts breast cancer risk associated with alcohol consumption" [5] and "women who drink alcohol and have a high folate intake are not at increased risk of cancer" [6].

Those who have a high (200 micrograms or more per day) level of folate (folic acid or Vitamin B9) in their diet are not at increased risk of breast cancer compared to those who abstain from alcohol [7]. Foods rich in folate include citrus fruits, citrus juices, dark green leafy vegetables (such as spinach), dried beans, and peas. Vitamin B9 can also be taken in a multivitamin pill.

Obesity
Gaining weight after the menopause can increase a woman's risk. Putting on 9.9kg (22lbs) increased the risk of developing breast cancer by 18%.[8]

Light levelsResearchers at the National Cancer Institute and National Institute of Environmental Health Sciences have concluded a study that suggests that artificial light can be a cause of breast cancer.[9]

Hormones
The International Agency for Research on Cancer (IARC) in Lyon, France invited 21 scientists from eight countries in June 2005, to evaluate the risk of cancer for humans of combined estrogen-progesterone contraceptives and combined estrogen-progesterone menopausal therapy. The working group found that there is a small increase in the relative risk of breast cancer in current and recent users of combined oral contraceptives [citation needed].

The risk decreases to that of those who have never used such combined therapy ten years after cessation of use. The scientists described combined oral estrogen-progesterone contraceptives as "carcinogenic to humans." [10] They also found an increased risk of breast cancer in women under treatment with combined menopausal therapy, which is confined mostly to current or recent users, increases with duration of use and exceeds that in women taking estrogen-only therapy .

Other
Other established risk factors include not having children, delaying first childbirth, not breastfeeding, early menarche (the first menstrual period), late menopause, obesity and taking hormone replacement therapy. [11]

Unproven
- It has been hypothesized that abortion may increase the risk of breast cancer because ofhormones in early pregnancy. Recent large studies do not support this association. [12]

- Although not well quantified there has long been a concern about risk associated withenvironmental estrogenic compounds, such as dioxins, or phytoestrogens such as found in soy beans. [13]

- Aluminum salts such as those used in anti-perspirants have recently been classified asmetalloestrogens. In research published in the Journal of Applied Toxicology, Dr. Philippa D.Darby of the University of Reading has shown that aluminum salts increase estrogen-relatedgene expression in human breast cancer cells grown in the laboratory. [14]

Understanding Breast Cancer

The Breast
Women and men both have breasts.In women, breasts are made up of milk glands. The milk gland consists of lobules, where milk is made, and tubes called ducts that take milk to the nipples.In men, the development of the lobules is suppressed at puberty by testosterone, the male sex hormone.
Both female and male breasts contain supportive fibrous tissue and fatty tissue. Some breast tissue extends into the armpit (axilla). The armpits contain a collection of lymph nodes (also called lymph glands), which are part of the lymphatic system. The lymphatic system is part of the immune system and protects the body against disease and infection.

See the diagram








What is breast cancer?
Breast cancer starts in the ducts or lobules of the breast. Cells lining the ducts or lobules can grow out of control and develop into cancer.
Some breast cancers are found when they are still confined to the ducts or lobules of the breast. This is called pre-invasive breast cancer. The most common types are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).
Most breast cancers are found when they are invasive. This means the cancer has spread outside the ducts or lobules of the breast into surrounding tissue.

There are several types of invasive breast cancer :
- Early breast cancer: contained in the breast but may have spread to one or more lymph nodesin the armpit.
- Locally advanced breast cancer: may have spread to places near the breast, such as the chest(including the skin, muscles or bones of the chest), but the cancer isn’t found in other areas of the body.
- Metastatic breast cancer: the cancer cells spread from the breast to other areas of the body,such as the bones, liver or the lungs. It may also be called advanced breast cancer.

How common is it?
Breast cancer is a common cancer diagnosed in women.About one in 11 women in NSW will develop breast cancer by the age of 75. Breast cancer can occur at any age. It is more common in women aged over 60 though around one-quarter of women are younger than 50. In NSW each year, around 4000 women are diagnosed with breast cancer.Men can also develop breast cancer, although this is rare. Around 30 men are diagnosed each year in NSW; this accounts for about 1% of all breast cancer.

What are the causes?
The exact cause of breast cancer is not known, but some factors may increase the risk:
- getting older
- more than half the women who are diagnosed with breast cancer are over 55
- having several close relatives, like a mother, sister or daughter, diagnosed with breast cancer
– these relatives can be from either the mother’s or father’s side of the family
- if you have had breast cancer before
- if you have had certain breast conditions such as atypical ductal hyperplasia, ductal carcinomain situ or lobular carcinoma in situ.

Some other factors that may increase a woman’s risk by a small amount include:
- not having children, or having a first child after the age of 30
- early age at first period (before 12 years)
- later age at natural menopause (after 55 years)
- drinking alcohol (more than two drinks a day)
- obesity or putting on a lot of weight after menopause
- using the oral contraceptive pill
– the risk is higher while taking the pill but goes down afteryou stop taking it
- not breastfeeding
- taking hormone replacement therapy (HRT) after menopause, especially if taken for fiveyears or longer.

Having some of these risk factors does not mean that you will develop breast cancer. Most women with breast cancer have no known risk factors, aside from getting older.

Breast cancer usually occurs in men over the age of 60 and is most common in men who have:
- several close members of their family (male or female) who have had breast cancer
- a relative diagnosed with breast cancer under the age of 40
- several members of the family with cancer of the ovary or colon- a rare genetic syndrome called Klinefelter’s syndrome. Men with this syndrome have threesex chromosomes (XXY) instead of the usual two (XY).

Inherited breast cancer gene
An inherited gene change may cause a small number (about 5%) of breast cancers. Two breast cancer genes have been found: BRCA1 and BRCA2.Women in families with an inherited gene change could be at increased risk of ovarian cancer. Men in these families may also be at more risk of breast cancer and prostate cancer.

People with a strong family history of breast cancer may have inherited a gene change, perhaps caused by BRCA1 or BRCA2. If you’re concerned about the health of your mother, sister or daughter, talk to your doctor about genetic testing.

Symptoms Of Breast Cancer

You may notice a change in your breast or your doctor may find an unusual breast change during a clinical breast exam or screening mammogram.Signs to look for include:

- a lump, lumpiness or thickening

- changes to the nipple

- such as a change in shape, crusting, a sore or an ulcer, redness or anipple that turns in (inverted) when it used to stick out

- changes to the skin of the breast

- such as dimpling of the skin, unusual redness or othercolour changes

- change in the shape or size of the breast

- this might be either an increase or decrease in size

- unusual discharge from the nipple without squeezing

- swelling or discomfort in the armpit

- persistent, unusual pain

- if this is not related to your normal monthly cycle, remains after aperiod and occurs in one breast only.

These changes don’t necessarily mean you have breast cancer. However, if you have any of these symptoms you should have them checked by your doctor without delay. Men’s symptoms are similar to women’s.

Early Sign Breast CancerEarly breast cancer causes no symptoms and is not painful. Usually breast cancer is discovered before any symptoms are present, either on mammography or by feeling a breast lump.A lump under the arm or above the collarbone that does not go away may be present. Other possible symptoms include breast discharge, nipple inversion and changes in the skin overlying the breast

Symptoms Of Breast Cancer

You may notice a change in your breast or your doctor may find an unusual breast change during a clinical breast exam or screening mammogram.Signs to look for include:

- a lump, lumpiness or thickening

- changes to the nipple

- such as a change in shape, crusting, a sore or an ulcer, redness or anipple that turns in (inverted) when it used to stick out

- changes to the skin of the breast

- such as dimpling of the skin, unusual redness or othercolour changes

- change in the shape or size of the breast

- this might be either an increase or decrease in size

- unusual discharge from the nipple without squeezing

- swelling or discomfort in the armpit

- persistent, unusual pain

- if this is not related to your normal monthly cycle, remains after aperiod and occurs in one breast only.

These changes don’t necessarily mean you have breast cancer. However, if you have any of these symptoms you should have them checked by your doctor without delay. Men’s symptoms are similar to women’s.

Early Sign Breast CancerEarly breast cancer causes no symptoms and is not painful. Usually breast cancer is discovered before any symptoms are present, either on mammography or by feeling a breast lump.A lump under the arm or above the collarbone that does not go away may be present. Other possible symptoms include breast discharge, nipple inversion and changes in the skin overlying the breast