CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0355/03553.txt

Text File | 1994-01-17 | 12.2 KB | 272 lines

$Unique_ID{BRK03553}
$Pretitle{}
$Title{Cancer, Breast}
$Subject{Cancer Breast Carcinoma of the Breast Cancer of the Breast Female
Breast Cancer Male Breast Cancer Inflammatory Breast Cancer Benign Tumors of
the Breast Benign Breast Disease Mastitis Paget's Disease of the Breast}
$Volume{}
$Log{}

Copyright (C) 1990, 1991 National Organization for Rare Disorders, Inc.

807:
Cancer, Breast

** IMPORTANT **
It is possible that the main title of the article (Breast Cancer) is not
the name you expected.  Please check the SYNONYM listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Carcinoma of the Breast
     Cancer of the Breast

Disorder Subdivisions:

     Female Breast Cancer
     Male Breast Cancer
     Inflammatory Breast Cancer

Information on the following disorders can be found in the Related
Disorders section of this report:

     Benign Tumors of the Breast
     Benign Breast Disease
     Mastitis
     Paget's Disease of the Breast

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Breast Cancer is one of approximately 200 different types of cancer.
Cancer is a disease in which abnormal cell development occurs, causing
destruction of healthy cells.  Breast Cancer is one of the most common forms
of cancer.  Generally, breast cancer is discovered by the patient or
physician as a hard, irregularly-shaped mass within the breast.  It can also
be detected by mammogram (breast x-ray).  When detected early, breast cancer
is treatable.  People who have first degree relatives with breast cancer are
at increased risk and should enter a breast cancer screening program on a
continuous basis.

Symptoms

Breast Cancer is usually discovered by the patient or physician as a
painless, usually hard lump in the breast.  In rare cases, pain and
tenderness may also occur.  Other symptoms may include changes of the breast
such as the shape, contour, swelling, thickening, skin dimpling, or pore
enlargement.  Retraction or scaliness of the nipple may also occur.  Bloody
discharges occur in about 33% of patients with breast cancer and in about 30%
of patients with a benign (noncancerous) condition; discharges from the
nipple that are not bloody are usually not related to cancer.

In inflammatory breast cancer, the breast is inflamed and swollen, and
its surface dimples like the surface of an orange peel (peau d'orange).

There is a rare form of male breast cancer.  The symptoms are generally
the same as those found in female breast cancer.  Male breast cancer accounts
for 1% of all malignant breast carcinomas.

Causes

Like most forms of cancer, the exact cause of breast cancer is not known.
Some risk factors that are statistically linked with breast cancer are
hormonal effects such as early menstruation, late menopause, first pregnancy
after the age of 40, or a family history of the disease (especially in first-
degree relatives such as mothers and sisters).  Other risk factors are age
(two-thirds of breast cancer patients are post-menopausal women), living in a
Western society (such as the United States, possibly because of diet), and
possibly a diet high in fat and dairy products or high consumption of
alcohol.

In men who have Klinefelter's Syndrome (or other metabolic changes of
estrogen levels in males), or idiopathic gynecomastia (excessive development
of the male breast), there is an increased risk of developing male breast
cancer.  (For more information choose "Klinefelter" as your search term in
the Rare Disease Database).

Researchers have developed a mouse with the genetic form of breast
cancer.  Breeding these mice may lead to enhanced understanding and treatment
of breast cancer.

Scientists are using genetic mapping in hopes of finding the way that
inherited forms of breast cancer may develop.  A gene located on the long arm
(q) arm of chromosome 17, BRCA1, is suspected of being responsible for
inherited forms of breast cancer.

Some researchers at Utah Medical Center are suggesting Proliferative
Breast Disease (PBD), a benign multiplication breast tissue which is an
inherited condition, is often present in women who later develop breast
cancer

Human traits, including the classic genetic diseases, are the product of
the interaction of two genes, one received from the father and one from the
mother.  Breast cancer can be inherited as an autosomal dominant trait, and
there may be a recessive form of breast cancer as well.

In dominant disorders a single copy of the disease gene (received from
either the mother or father) will be expressed "dominating" the other normal
gene and resulting in appearance of the disease.  The risk of transmitting
the disorder from affected parent to offspring is fifty percent for each
pregnancy regardless of the sex of the resulting child.

In recessive disorders, the condition does not appear unless a person
inherits the same defective gene for the same trait from each parent.  If one
receives one normal gene and one gene for the disease, the person will be a
carrier for the disease, but usually will show no symptoms.  The risk of
transmitting the disease to the children of a couple, both of whom are
carriers for a recessive disorder, is twenty-five percent.  Fifty percent of
their children will be carriers, but healthy as described above.  Twenty-five
percent of their children will receive both normal genes, one from each
parent, and will be genetically normal.

Affected Population

Breast Cancer affects about 130,000 women in the United States annually, and
usually occurs between the ages of 35 and 65.  Although very rare, breast
cancer occurs in males at 1% of the rate found in females.

Related Disorders

Often, other types of tumors can be similar to the malignant tumors of breast
cancer.  Most lumps found in the breast are benign tumors or cysts
(fibroadenomas, papillomas).  Benign (noncancerous) breast disease (mammary
dysplasia) such as cystic disease (lumpy breasts) or inflammatory diseases
such as mastitis (inflammation of the breast) or fat necrosis may mimic
symptoms of breast cancer.

In Paget's Disease of the Breast there are changes in the nipple such as
scaliness, oozing or crusting, and patches on the nipple and/or areola.  This
is caused by an underlying cancer (usually an adrenocarcinoma).  Diagnosis is
made by skin biopsy.  (For more information on this disorder, choose "Paget's
Disease of the Breast" as your search term in the Rare Disease Database).

Therapies:  Standard

Generally, in diagnosing breast cancer, a mammogram (breast x-ray) is
performed first.  Thermography, another breast imaging technique, may be used
in some cases but it is not as sensitive as mammography.  Biopsy is made to
confirm malignancy.  If necessary, other tests may include a complete blood
count, chest x-ray, and tests or scans for involvement of liver or bone.

It is important to determine how far the disease has spread since this
determines the appropriate treatment program.  First, physicians determine
what "stage" the disease is in.  The stage depends on the number and location
of malignant sites, and if the cancer has traveled.  Treatment is based upon
the individual; it varies from patient to patient.  In general, the earlier
breast cancer is diagnosed, the better the prognosis is.

A mastectomy is the standard treatment for people with breast cancer.  A
segmental mastectomy (or lumpectomy) for removal of the lump and surrounding
tissue may be all that is necessary, or removal of the entire breast and
surrounding lymph nodes (found in the armpit) be required.  Radical
mastectomy is removal of the entire breast, lymph nodes and underlying chest
muscle, and is rarely performed in recent years.  For most patients, breast
reconstruction or plastic surgery can correct any disfigurements left by the
surgery.  The decision on the type of treatment is left to the patient and
the surgeon.

Radiation therapy (radiotherapy) and/or chemotherapy are treatment
options for breast cancer.  Radiation may be used to destroy cancer cells.
Chemotherapy involves the use of "anticancer" drugs.  There are several drug
combinations now in use such as CMF (cyclophosphamide, methotrexate, and 5-
fluorouracil), or CMFVP (CMF plus vincristine and prednisone).  All these
drugs may produce adverse side effects and must be carefully monitored by a
doctor.

Endocrine therapy, also called hormone manipulation, benefits about 30%
of breast cancer patients.  Other treatment is symptomatic and supportive.

Therapies:  Investigational

Another breast imaging technique used to diagnose breast cancer is
sonography, or "ultrasound," (the use of high-frequency sound waves to form
special pictures) which is still in experimental stages.

Two hormonal threrapies are being tested by the FDA for treatment of
metastatic breast cancer.  They are sponsored by Adria Laboratories, Inc.,
P.O. Box 16529, Columbus, OH 43216-6529.  They are titled 6-
methylenandrosta-1, 4-Diene 3, 17-Dione and Toremifene.

The National Cancer Institute conducts clinical trials on new drugs being
tested for breast cancer and other forms of cancer.  To learn about locations
of these investigations, contact the Cancer Information Service listed in the
Resources section of this report.


Autologous Bone Marrow transplants (ABMT) are being studied as a
treatment for Metastic Breast Cancer.  A study of ABMT, printed in the April
15, 1992 issue of the medical journal JAMA, revealed ABMT increased life
expectancy by an average of six months in these patients at a cost of
$115,800 per year of life gained.  Twenty percent of women who underwent ABMT
lived five years after the procedure and were still in remission.  Three
percent of women died as a direct result of the treatment.

This disease entry is based upon medical information available through
April 1992.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources
For more information on Breast Cancer, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT 06812-1783
     [phone]

     Y-ME
     18220 Harwood Ave.
     [phone]
     [phone]

     American Cancer Society
     1599 Clifton Rd., NE
     Atlanta, GA  30329
     [phone]

     NIH/National Cancer Institute
     9000 Rockville Pike, Bldg. 31, Rm. 1A2A
     Bethesda, MD 20892
     1-800-4-CANCER

     The National Cancer Institute has developed PDQ (Physician Data Query), a
computerized database designed to give the public, cancer patients and
families, and health professionals quick and easy access to many types of
information vital to patients with this and many other types of cancer.  To
gain access to this service, call:
     Cancer Information Service (CIS)
     1-800-4-CANCER
     In Washington, DC and suburbs in Maryland and Virginia, 636-5700
     In Alaska, 1-800-638-6070
     In Oahu, Hawaii, [phone] (Neighbor islands call collect)

References

CECIL TEXTBOOK OF MEDICINE, 18th Ed.:  James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders Co., 1988.  Pp. 1452-1458.

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, ed.-in-chief; Little, Brown
and Co., 1987.  Pp. 1112-1120.

MENDELIAN INHERITANCE IN MAN, 8th Ed.:  Victor A. McKusick; Johns Hopkins
University Press, 1986.  Pp. 114, 843.

WORLD BOOK MEDICAL ENCYCLOPEDIA:  Erich E. Brueschke, M.D., et al, eds;
World Book, Inc., 1988.  Pp. 147.

Research Resources Reporter, National Institutes of Health, June, 1991.
P. 5.

EFFICACY AND COST EFFECTIVENESS OF AUTOLOGOUS BONE MARROW TRANSPLANTATION
IN METASTIC BONE CANCER., Hillner, et al., JAMA, April 15, 1992, (vol 267,
No. 15)).  Pp. 2055-2061.