Breast Cancer

Some methods used to diagnose breast carcinoma are mammograms, MRI’s, and biopsies (NCI, 2010). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). Each stage has different prognoses with varying survival rates as well (Marissa, 2011). There are also many ways to prevent breast cancer including maintain a healthy weight, avoiding the alcohol consumption, and by getting an annual mammogram (Reynolds, 2010). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. women, making it the first truly common breast cancer susceptibility gene (Metcalf Metcalf, 2008). Other breast diseases besides breast cancer are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). These diseases do not necessarily lead to breast cancer and can be treated (Sacks, 2011; Silverman, 1994). Keywords: – breast cancer, ducts, lobules, tumor, invasive (infiltrating carcinoma), noninvasive (noninfiltrating carcinoma), Ductal Carcinoma In Situ (DCIS), Invasive Lobular Carcinoma (ILC), intraductal carcinoma, nonfunctioning breast tissue, estrogen, lymph nodes, mammogram, MRI (magnetic resonance imaging), core biopsy, somatic mutations, fine needle aspiration biopsy, stereotactic biopsy, FGFR2, BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, metastasis, fat necrosis, fibrocystic breast disease Breast Cancer Cells are the building blocks of living things and cancer grows out of normal cells in the body (Dugdale, 2010). Cancer is the uncontrolled growth of abnormal cells in the body (Dugdale, 2010). Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer doesn’t allow normal blood function by abnormal cell division in the blood stream (Peter, 2011). Normal cells in the body follow an orderly process of growth, division, and death, this is called apoptosis, and when this process breaks down, cancer begins to form (Peter, 2011). Cancer has been around since prehistoric times, and breast cancer is one of the earliest forms to have been mentioned (Eisenpreis, 1999). In the United States, breast cancer death rates are higher than those for any other cancer, besides lung cancer (breastcancer. org, 2012). Today, about 1 in 8 women (12%) will develop breast cancer in her lifetime (Martin, 2012). Breast cancer is a cancer that starts in the tissues of the breast (Yi-Bin David, 2011). In rare cases, breast cancer can start in other areas of the breast (Yi-Bin David, 2011). Breast cancer can be invasive or noninvasive (Yi-Bin David, 2011). Invasive meaning it has spread from the milk duct (lobule) to the other tissues in the breast (Eisenpreis, 1999). Noninvasive means that it has not yet invaded other breast tissue (Yi-Bin David, 2011). Types of Breast Cancer Breast cancer can begin in different areas of the breast – the ducts, the lobules, or sometimes, the tissue in between (breastcancer. org, 2012). There are several different types of breast cancer, including breast cancer in men (breastcancer. org, 2012). Some include Ductal Carcinoma In Situ, Invasive Lobular Carcinoma, and Male Breast Cancer (breastcancer. rg, 2012). Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is a noninvasive breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues of the breast (Yi-Bin David, 2011). It may progress to invasive cancer if it is left untreated (Yi-Bin David, 2011). DCIS is the earliest form of breast cancer and is usually found during a mammogram done as part of breast cancer screening (Mayo Clinic Staff, 2011). Because of the increased use of mammograms, the rate at which DCIS is diagnosed has increased dramatically in recent years (Mayo Clinic Staff, 011). When a woman has DCIS, she is at higher risk for the cancer coming back or also at higher risk for developing a new breast cancer than a person who has never had breast cancer before (breastcancer. org, 2012). Experts believe that 20 to 50% of women with DCIS will later develop an invasive breast cancer within 10 years of the DCIS diagnosis (Hoffman, 2010). The risk of lymph node involvement with ductal carcinoma in situ is only 1% to 2% so the lymph nodes under the arm do not need to be removed, as may be  the case with other types of breast cancer (Hoffman, 2010). In seven out of 10 cases, breast-conserving lumpectomies – instead of mastectomies – were an effective treatment option (Hoffman, 2010). This will depend upon the size of your tumor and the extent of its spread throughout your breast and the surrounding lymph nodes (Hoffman, 2010). While DCIS isn’t life-threatening, it does require treatment to prevent the condition from becoming invasive (Mayo Clinic Staff 2011). Most recurrences happen within 5 to 10 years after the first diagnosis and the chances of that happening are under 30 percent (breastcancer. rg, 2012). Invasive Lobular Carcinoma is an invasive type of breast cancer that begins in the milk-producing glands (lobules) of the breast (Mayo Clinic Staff, 2011). When a person has ILC, this means that the cancer cells have broken out of lobule where they started and they now have the potential to spread to other areas or tissues of the body (Mayo Clinic Staff, 2011). This type of cancer is more difficult to se e on imaging because of the way it grows with spreading branches (Hopkins, 2012). The treatments for invasive lobular carcinoma fall into two broad categories: Local and Systemic Treatment. Local treatments treat the tumor and the areas surrounding it, such as the chest and lymph nodes (breastcancer. org, 2012). Systemic treatments travel throughout the body to destroy any type of cancer cells that may have left the original tumor and traveled to other tissues to reduce the risk of the cancer coming back (breastcancer. org, 2012). ILC cells can proceed to infiltrate fatty tissue and create a web-like mass (Stephan, 2008). This web of cancer cells may feel like a thickened area of breast tissue, and may not cause concern or pain at first (Stephan, 2008). Unfortunately, if it is left undetected, ILC can develop into a mass that is about ? inch ( 2 centimeters) to about 2 inches (5 centimeters) or bigger in size, before causing more noticeable symptoms (Stephan, 2008). Breast cancer in men is a very rare disease (Attebery, Adams ; Weiss, 2011). But the truth is that boys and girls, men and women all have breast tissue (Attebery, Adams ; Weiss, 2011). Men have a small amount of nonfunctioning breasts tissue (breast tissue that cannot produce milk) that is concentrated in the area directly behind the nipple on the wall of the chest (Attebery, Adams ; Weiss, 2011). A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating carcinoma (ASC, 2012). Some symptoms that may occur in males developing breast cancer include lumps, changes to the nipple or breast skin, or discharge of fluid from the nipple (National Cancer Institute, 2011). Men who have an altered gene related to breast cancer have an increased risk of developing breast cancer (National Cancer Institute, 2012). The major problem is that breast cancer in men is more often than not diagnosed later than breast cancer in women because men are less likely to be suspicious of an abnormality in that area (Wax, 2012). Also, their small amount of breast tissue is harder to feel, making it more difficult to catch these cancers early, and allowing tumors to spread more quickly to the surrounding tissues (Wax, 2012). Breast cancer in men is detected the same way as breast cancer is detected in women – through self-examination, clinical examination, or mammography (x-ray of the breast) (ASC, 2012). Methods for Diagnosis Breast cancer is sometimes found after symptoms appear, but many women with early breast cancer have no symptoms (American Cancer Society, 2011). This is why getting the recommended screening tests before any symptoms develop is so important (American Cancer Society, 2011). Three types of methods used for diagnosis are mammograms, MRI’s, and biopsies (NCI, 2010). A mammogram is a low-dose x-ray picture of the breast and can be used to check for breast cancer in women who don’t have any signs or symptoms of the disease. (NCI, 2010) The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine (Webmd, 2010). There are different types of mammograms including Screening mammograms and Diagnositc mammograms (Webmd, 2010). Mammograms detect tiny bits of calcium that develop in dead cancer cells (Hoffman, 2010). As more and more cancer cells age and die, theses calcifications grow nd on the mammogram, they appear as a shadowy area (Hoffman, 2010). Current guidelines from the American College Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40, even if they have no symptoms or family history of breast cancer (ACR, 2010). For every 1,000 women who have screening mammogram: 100 are recalled to get more mammogr aphy or ultrasound images, 20 are recommended for needle biopsy and 5 are diagnosed with breast cancer (ACR, 2010). A mammography unit is a rectangular box that houses the tube in which x-rays are produced (Radiological Society of North America, 2011). Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate (Radiological Society of North America, 2011). A brief medical history and a history of specific problems related to the breast, such as pain or a palpable lump (one that is felt), is obtained prior to the mammogram (Stoppler, 2011). All jewelry and clothing in the chest and breast area are removed prior to the mammogram (Stoppler, 2011). The patient’s breasts are then placed on a firm flat panel and a gentle, but firm pressure is applied to the breast with another panel, resulting in compression of the breast between the two panels (Stoppler, 2011). The compression of the breast is necessary to obtain quality mammograms and spreads the breast tissue out so that the x-ray image displays the inner breast tissue with good resolution (Stoppler, 2011). Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them (Radiological Society of North America, 2011). As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black (Radiological Society of North America, 2011). The results of the mammogram can be given to the patient either by the radiologist at the completion of the mammogram or by the patient’s doctor who ordered the mammogram (Stoppler, 2011). An abnormal mammogram does not mean you have cancer (Stoppler, 2011). In some cases, it may just be an area of thicker or denser breast tissue, a cyst, or a benign lump such as a fibro adenoma (Stoppler, 2011). Unlike mammography which uses low dose x-rays to produce an image of the breast, MRI (Magnetic Resonance Imaging) uses powerful magnetic fields and radio waves to create images of the breast (Imaginis, 2012). The MRI system has the ability to switch magnetic fields and radio waves to achieve views in any plane and from any orientation while x-ray mammography requires re-orientation of the breast and mammography system for each view desired (Imaginis, 2012). MRI is a huge magnet and the woman gets put in the middle of the magnet; the magnetic field is turned on and then turned off again (Eisenpreis, 1999). The way the magnetized cells return to normal gives an image (Eisenpreis, 1999). The MRI finds lumps better than it tells whether or not they are cancerous (Eisenpreis, 1999). However, MRI can be good at showing how big a cancer is, once it has been found on the mammogram (Eisenpreis, 1999). A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer and is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram, ultrasound, or magnetic resonance imaging (MRI) (Marshall, 2009). During a fine-needle aspiration biopsy, the doctor inserts a thin needle into a lump and removes a sample of cells or fluid (Marshall, 2009). Nowadays, doctors might have decided to do something called stereotactic biopsy, where a patient lies on a table, with her breasts hanging down (Eisenpreis, 1999). A mammogram is taken to show where the lump is and a device holding a needle quickly shoots in and removes a few cells from the lesion (Eisenpreis, 1999). There is also something called a core biopsy that uses a larger needle to take out a piece of tissue, instead of just cells (Eisenpreis, 1999). A doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted and once the area is numb, a small cut is made in the skin from where the needle with a special tip is inserted into breast tissue (Marshall, 2009). Three to twelve samples will be taken to acquire the most accurate results (Marshall, 2009). Classifications and Associated Prognoses The stages of breast cancer are usually expressed as a number on a scale of 0 through IV – with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body (Marisa, 2011). Cancer stage is based on four characteristics; the size of the cancer, hether the cancer is invasive or non-invasive, whether the cancer is in the lymph nodes, whether the cancer has spread to other parts of the body beyond the breast (Marisa, 2011). Sometimes doctors use the term â€Å"locally advanced† or regionally advanced† to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast’s shape, and lymph node enlargement that is visible or that the doctor can feel during an exam (Marisa , 2011). The three ways that cancer spreads in the body are: Through tissue where cancer invades surrounding normal tissue, through the lymph system where the cancer invades the lymph system and travels through the lymph vessels to other places in the body, and through the blood, where cancer invades the veins and capillaries and travels through the blood to other places in the body (NCI, 2009). When cancer cells break away from the primary (original) tumor and travel through the lymph nodes or blood to other places in the body, another (secondary) tumor may form (NCI, 2009). This process is called metastasis (NCI, 2009). The stage of the breast cancer can help the patient and the doctor understand the prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all the other results in the pathology report (Marisa, 2011). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). The TNM staging system classifies cancers based on their T, N, and M stages (ACS, 2012). The letter â€Å"T† followed by a number 0 to 4 describes the tumor’s size and spread to the skin or to the chest wall under the breast (ACS, 2012). The letter â€Å"N† followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. The letter â€Å"M† followed by a 0 or 1 indicates whether the cancer has spread to distant organ (ACS, 2012). There are typically five stages (0 to 4) with sub-stages that indicate the prognosis for breast cancer (Lippman, 2005). Stage 0 where the carcinoma is insitu and no lymph nodes are affected had 99 percent 5 year survival rate (ACS, 2012). Stage IA also has a high rate, 92 percent, in which the tumor is equal to 2 centimeters (ACS, 2012). In stage IB, the tumor is 2 centimeters with micro metastases in 1 to 3 axillary lymph nodes but the cancer has not spread to distant sites (ACR, 2012). In stage IIA, the cancer cells have moved to the ipsilateral nodes and the 5 year survival rate lowers to 82 percent (Lippman, 2012). In stage IIB, the cancer cells have spread to movable ipsilateral nodes and the tumor is over 5 centimeters (Lippman, 2012). The 5 year survival rate lowers to 65 percent (ACS, 2012). In stage IIIA, there is no evidence of a primary tumor and no distant spreading (ACS, 2012). The 5 year survival rate lowers to 47 percent (Lippman, 2005). The tumor could be between 2 and 5 centimeters but there is still no distant spreading at this point (ACS, 2012). In stage IIIB the tumor has extended to the chest wall but there is still no distant metastases (Lippman, 2005). The 5 year survival rate lowers again to a 44 percent (Lippman, 2005). In stage IV the cancer can be any size (any T) and may or may not have spread to nearby lymph nodes (any N) (ACS, 2012). It has spread to distant organs or to lymph nodes far from the breast (M1) (ACS, 2012). The most common sites of spread are the bone, liver, brain, or lung (ACS, 2012). The survival rate lowers to 14 percent (Lippman, 2005). Prevention Methods Three ways to prevent breast cancer are by maintaining a healthy weight, avoiding alcohol consumption, and getting an annual mammogram (Reynolds, 2010). Mammogram screening, early diagnosis and better treatments have all contributed to the reduction in breast cancer cases by around 2 percent a year and the improved survival rate in the U. S. (Reynolds, 2010). Experts say now the focus needs to shift on improving personal lifestyle habits to prevent the disease even more (Reynolds, 2010). Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread (NCI, 2010). A medical team found an 11 percent lower risk of breast cancer in those women consuming the more healthful diet, including more whole grains, fruits and vegetables and less fatty, processed foods (Reynolds, 2010). They also found that those consuming large amounts of alcohol had a 21 percent increased risk (Reynolds, 2010). Drinking alcohol during adolescence has been linked to an increased risk of breast cancer, especially for girls with a family history of the disease (Reynolds, 2010). Exercise also plays a role in the reduction of breast cancer risk (Reynolds, 2010). In one study from the Women’s Health Initiative, as little as 1. 25 to 2. 5 hours per week of brisk walking reduced a woman’s risk by 18 percent (Reynolds, 2010). Walking 10 hours a week reduce the risk more (Reynolds, 2010). Diet and exercise can lead to weight reduction, another positive lifestyle change that can influence breast cancer disease risk (Reynolds, 2010). Many breast cancers are fueled by estrogen, a hormone produced in fat tissue (Reynolds, 2010). Experts suspect that more fat tissue equals more estrogen resulting in more cases of breast cancer that could possibly be avoided (Reynolds, 2010). Genetic ; Hereditary Influence According to researchers, the mutations in the gene, which is called FGFR2, raise the risk of breast cancer by 20 to 60 percent. (Metcalf ; Metcalf, 2008). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. omen, making it the first truly common breast cancer susceptibility gene (Metcalf ; Metcalf, 2008). Women with faulty copies of the genes BRCA1 or BRCA2 have 50 percent to 85 percent chance of getting breast cancer in their lifetimes, but they are rare genes and only account for 5 percent to possibly 10 percent of breast cancer cases (Metcalf ; Metcalf, 2008). Only 7% of all breast cancers are hereditary (Hirshaut ; Pressman, 2008). Of these hereditary cancers, 45% is caused by BRCA1 while 35% is caused by BRCA2 (Hirshaut ; Pressman, 2008). (Hirshaut ; Pressman, 2008). Variations of the  BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, and  TP53  genes increase the risk of developing breast cancer (Chen, 2007). The  AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, and  RAD51  genes are associated with breast cancer (Chen, 2007). Cancers occur when a buildup of genetic mutations in critical genes – those that control cell growth and division or the repair of damaged DNA – allow cells to grow and divide uncontrollably to form a tumor (Honrado, Osorio, Palacios ; Benitez, 2006). These changes, which are called somatic mutations, are not inherited (Honrado, Osorio, Palacios ; Benitez, 2006). Less commonly, gene mutations inherited from a parent increase the risk of developing cancer (Honrado, Osorio, Palacios ; Benitez, 2006). In people with these inherited genetic changes, additional somatic mutations in other genes must occur for cancer to develop (Honrado, Osorio, Palacios ; Benitez, 2006). Additional factors that may influence a person’s risk of developing breast cancer include gender, age, ethnic background, a history of previous breast cancer, certain changes in breast tissue, and hormonal factors (Thompson ; Easton, 2004). A history of breast cancer in closely related family members is also an important risk factor, particularly if the cancer occurred at an early age (Thompson ; Easton, 2004). Women who have inherited certain mutations in these genes have a high risk of developing breast cancer, ovarian cancer, and several other types of cancer during their lifetimes (Thompson ; Easton, 2004). Inherited changes in several other genes, including CDH1, PTEN, STK11, and TP53, have been found to increase the risk of developing breast cancer (Thompson ; Easton, 2004). In hereditary breast cancer, the way that cancer risk is inherited depends on the gene involved (Walsh ; King, 2007). For example, mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant patter, which means one copy of the altered gene in each cell is sufficient to increase a person’s chance of developing cancer (Walsh ; King, 2007). In other cases, the inheritance of breast cancer risk is unclear (Walsh ; King, 2007). It is important to emphasize that people inherit an increased risk of cancer, not the disease itself (Walsh ; King, 2007). Not all people who inherit mutations in these genes will develop cancer (Walsh ; King, 2007). Other Breast Diseases Two other diseases found in the breast other than breast carcinoma are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). Fybrocystic breast disease is a commonly used phrase to describe painful, lumpy breasts (Sacks 2011). Hormones made in the ovaries can make a woman’s breasts feel swollen, lumpy, or painful before during menstruation each month (Sacks 2011). Fibrocysitc changes in the breast with the menstrual cycle affect over half of women (Sacks, 2011). Symptoms are usually worse right before the menstrual period, and then improve after the period starts (Sacks, 2011). Symptoms can include pain in both breasts, breasts that feel swollen and heavy, pain or discomfort under the arms, and thick or lumpy breasts (Sacks, 2011). This disease can be treated with medication like acetaminophen or ibuprofen (Sacks, 2011). Breast Fat necrosis is a benign condition that can occur in your breast (Silverman. 1994). It consists of fatty tissue that has been bruised, injured, or has died (Silverman, 1994). Once fatty tissue has been injured or has died, it can gradually change into scar tissue or may collect as liquid within an oil cyst (Silverman, 1994). Fat necrosis does not lead to the development of breast cancer, but it may sometimes cause breast pain (Silverman, 1994). An area of fat necrosis in your breast may feel like a fairly hard lump, or like a section of thick skin (Silverman, 1994). The person may see some drainage from the nipple that is nearest to the bruised region (Silverman, 1994). The nipple may sometimes even pull inward a little bit or the breast skin may dimple above the lump of fat necrosis (Silverman, 1994). Each case of fat necrosis is unique, so treatments will vary but if the fat necrosis has occurred recently, using warm compresses may help it subside (Silverman, 1994). When fat necrosis causes pain, the person can use ibuprofen and aspirin, but if that doesn’t help, ask your doctor if a prescription medication may be used (Silverman, 1994). About 39,520 women in the U. S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50 (â€Å"Learn about cancer,† 2011). These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness (â€Å"breastcancer. org,† 2012). References Peter, C. (2011, October 20). Medical news today. Retrieved from http://www. medicalnewstoday. com/info/cancer-oncology/ breastcancer. org. (n. d. ). (2012, March 14). Retrieved from http://www. breastcancer. org/symptoms/understand_bc/statistics. jsp Yi-Bin , C. , ; David , Z. (2011, 15 12). A. d. a. m. medical encyclopedia. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001911/ Mayo Clinic Staff. (2011, June 23). Ductal carcinoma in situ (dcis). Retrieved from http://www. mayoclinic. com/health/dcis/DS00983 Avon Foundation Breast Cancer (n. d. ). In http://www. hopkinsmedicine. org/avon_foundation_breast_center/breast_cancers_other_conditions/invasive_lobular_carcinoma. html. Stephan, P. (2008, July 24). Invasive Lobular Carcinoma. Retrieved from about. com website: http://breastcancer. about. com/od/types/p/ilc. html Dugdale, D. (2010, August 14). Pubmed. Retrieved from http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0002267/ Martin, L. (2012, January 18). Breast cancer facts. WebMD. Retrieved from http://women. webmd. om/guide/breast-cancer-arm-yourself-with-facts National Cancer Insitute. (2012). National cancer institute. Retrieved from http://www. cancer. gov/cancertopics/pdq/treatment/malebreast/Patient/page1 Attebery, L. , Adams, J. H. , ; Weiss, M. (2011, november 22). Male breast cancer. Retrieved from http://www. breastcancer. org/symptoms/types/male_bc/ National Cancer Institute. ( 2011). Male breast cancer. Retrieved from http://www. nlm. nih. gov/medlineplus/malebreastcancer. html Wax, A. (2011). Breast cancer in men: Symptoms, causes, treatments. Retrieved from http://www. webmd. com/breast-cancer/guide/breast-cancer-men American Cancer Society. (2011, September 29). American cancer society. Retrieved from http://www. cancer. org/Cancer/BreastCancer/DetailedGuide/breast-cancer-diagnosis NCI. (2010, September 22). National cancer institute. Retrieved from http://www. cancer. gov/cancertopics/factsheet/detection/mammograms Marshall, S. (2010, November 12). Webmd. Retrieved from http://women. webmd. com/mammogram-16573 Hoffman, M. (2010 February 18). Ductal carcinoma (invasive and in situ. Retrieved from http://www. webmd. com/breast-cancer/ductal-carcinoma-invasive-in-situ ACR. (2012). Mammography facts. Retrieved from http://www. ammographysaveslives. org/facts. aspx Hirshaut, Y. , ; Pressman, P. I. (2008). Breast cancer: The complete guide. (5th ed. ). New York, NY: Bantam Dell. Radiological Society of North America. (2011, June 24). Radiologyinfo. org. Retrieved from http://www. radiologyinfo. org/en/info. cfm? pg=mammo ASCO. (2011, January 26). Breast Cancer- Male Retrieved from http://www. cancer. net/patient/Cancer Types/Breast Cancer – Male/? skid= Stoppler, M. C. (2011). Medicinenet. Retrieved from http://www. medicinenet. com/mammogram/article. html Imaginis. (2012). Breast cancer mri – magnetic resonance imaging. Retrieved from http://www. maginis. com/mri-scan/magnetic-resonance-breast-imaging-mri-mr-3 Eisenpreis, B. (1999). A young woman’s guide to breast cancer prevention. New York: The Rosen Publishing Group. Marshall, S. (2009, April 29). Breast biopsy. Retrieved from http://women. webmd. com/breast-biopsy Metcalf, T. , Metcalf, G. (2008). Perspective on diseases and disorders. (1 ed. ). Michigan: Thomson Gale. Chen, S. ( 2007, April 10). Meta-analysis of BRCA1 and BRCA2 penetrance. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Honrado, E. , Osorio, A. , Palacios, J. , Benitez, J. (2006, September 25). Pathology and gene expression of hereditary breast tumors associated with brca1, brca2 and chek2 gene mutations. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer/show/References Thompson, D. , Easton, D. (2004, July 9). The genetic epidemiology of breast cancer genes. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Walsh, T. , King, M. (2007, February 11). Ten genes for inherited breast cancer. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Marisa , W. (2011, August 03). Stages of breast cancer. Retrieved from http://www. breastcancer. org/symptoms/diagnosis/staging. jsp NCI. 2009). Breast cancer treatment (pdq). Retrieved from http://www. cancer. gov/cancertopics/pdq/treatment/breast/Patient/page2 Lippman, M. E. (2005). Cancer monthly. Retrieved from http://www. cancermonthly. com/cancer_basics/breast. asp American Cancer Society. (2012, March 06). Breast cancer. Retrieved from http://www. cancer. org/Cancer/BreastCancer/DetailedG uide/breast-cancer-staging Reynolds, D. (2010, March 26). Emaxhealth. Retrieved from http://www. emaxhealth. com/1506/98/36185/one-third-breast-cancer-cases-avoided-diet-and-exercise. html NCI. (2010, September 22). National cancer institute. Retrieved from http://www. cancer. ov/cancertopics/factsheet/detection/mammograms Sacks, D. N. (2011, November 16). Fibrocystic breast disease. Retrieved from http://www. nlm. nih. gov/medlineplus/ency/article/000912. htm Silverman, P. (1994, July). Breast fat necrosis – symptoms, causes and treatments. Retrieved from http://breastcancer. about. com/od/whenitsnotcancer/tp/Breast-Fat-Necrosis. htm American Cancer Society. U. S. Breast cancer statistics. (2011, September 29). Retrieved from http://www. cancer. org/Cancer/BreastCancer/index Hail, J. (2011, 09). National breast cancer foundation, inc.. Retrieved from http://www. nationalbreastcancer. org/About-Breast-Cancer/ Breast Cancer Breast Cancer Breast Cancer Some methods used to diagnose breast carcinoma are mammograms, MRI’s, and biopsies (NCI, 2010). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). Each stage has different prognoses with varying survival rates as well (Marissa, 2011). There are also many ways to prevent breast cancer including maintain a healthy weight, avoiding the alcohol consumption, and by getting an annual mammogram (Reynolds, 2010). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. women, making it the first truly common breast cancer susceptibility gene (Metcalf Metcalf, 2008). Other breast diseases besides breast cancer are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). These diseases do not necessarily lead to breast cancer and can be treated (Sacks, 2011; Silverman, 1994). Keywords: – breast cancer, ducts, lobules, tumor, invasive (infiltrating carcinoma), noninvasive (noninfiltrating carcinoma), Ductal Carcinoma In Situ (DCIS), Invasive Lobular Carcinoma (ILC), intraductal carcinoma, nonfunctioning breast tissue, estrogen, lymph nodes, mammogram, MRI (magnetic resonance imaging), core biopsy, somatic mutations, fine needle aspiration biopsy, stereotactic biopsy, FGFR2, BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, metastasis, fat necrosis, fibrocystic breast disease Breast Cancer Cells are the building blocks of living things and cancer grows out of normal cells in the body (Dugdale, 2010). Cancer is the uncontrolled growth of abnormal cells in the body (Dugdale, 2010). Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer doesn’t allow normal blood function by abnormal cell division in the blood stream (Peter, 2011). Normal cells in the body follow an orderly process of growth, division, and death, this is called apoptosis, and when this process breaks down, cancer begins to form (Peter, 2011). Cancer has been around since prehistoric times, and breast cancer is one of the earliest forms to have been mentioned (Eisenpreis, 1999). In the United States, breast cancer death rates are higher than those for any other cancer, besides lung cancer (breastcancer. org, 2012). Today, about 1 in 8 women (12%) will develop breast cancer in her lifetime (Martin, 2012). Breast cancer is a cancer that starts in the tissues of the breast (Yi-Bin David, 2011). In rare cases, breast cancer can start in other areas of the breast (Yi-Bin David, 2011). Breast cancer can be invasive or noninvasive (Yi-Bin David, 2011). Invasive meaning it has spread from the milk duct (lobule) to the other tissues in the breast (Eisenpreis, 1999). Noninvasive means that it has not yet invaded other breast tissue (Yi-Bin David, 2011). Types of Breast Cancer Breast cancer can begin in different areas of the breast – the ducts, the lobules, or sometimes, the tissue in between (breastcancer. org, 2012). There are several different types of breast cancer, including breast cancer in men (breastcancer. org, 2012). Some include Ductal Carcinoma In Situ, Invasive Lobular Carcinoma, and Male Breast Cancer (breastcancer. rg, 2012). Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is a noninvasive breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues of the breast (Yi-Bin David, 2011). It may progress to invasive cancer if it is left untreated (Yi-Bin David, 2011). DCIS is the earliest form of breast cancer and is usually found during a mammogram done as part of breast cancer screening (Mayo Clinic Staff, 2011). Because of the increased use of mammograms, the rate at which DCIS is diagnosed has increased dramatically in recent years (Mayo Clinic Staff, 011). When a woman has DCIS, she is at higher risk for the cancer coming back or also at higher risk for developing a new breast cancer than a person who has never had breast cancer before (breastcancer. org, 2012). Experts believe that 20 to 50% of women with DCIS will later develop an invasive breast cancer within 10 years of the DCIS diagnosis (Hoffman, 2010). The risk of lymph node involvement with ductal carcinoma in situ is only 1% to 2% so the lymph nodes under the arm do not need to be removed, as may be  the case with other types of breast cancer (Hoffman, 2010). In seven out of 10 cases, breast-conserving lumpectomies – instead of mastectomies – were an effective treatment option (Hoffman, 2010). This will depend upon the size of your tumor and the extent of its spread throughout your breast and the surrounding lymph nodes (Hoffman, 2010). While DCIS isn’t life-threatening, it does require treatment to prevent the condition from becoming invasive (Mayo Clinic Staff 2011). Most recurrences happen within 5 to 10 years after the first diagnosis and the chances of that happening are under 30 percent (breastcancer. rg, 2012). Invasive Lobular Carcinoma is an invasive type of breast cancer that begins in the milk-producing glands (lobules) of the breast (Mayo Clinic Staff, 2011). When a person has ILC, this means that the cancer cells have broken out of lobule where they started and they now have the potential to spread to other areas or tissues of the body (Mayo Clinic Staff, 2011). This type of cancer is more difficult to se e on imaging because of the way it grows with spreading branches (Hopkins, 2012). The treatments for invasive lobular carcinoma fall into two broad categories: Local and Systemic Treatment. Local treatments treat the tumor and the areas surrounding it, such as the chest and lymph nodes (breastcancer. org, 2012). Systemic treatments travel throughout the body to destroy any type of cancer cells that may have left the original tumor and traveled to other tissues to reduce the risk of the cancer coming back (breastcancer. org, 2012). ILC cells can proceed to infiltrate fatty tissue and create a web-like mass (Stephan, 2008). This web of cancer cells may feel like a thickened area of breast tissue, and may not cause concern or pain at first (Stephan, 2008). Unfortunately, if it is left undetected, ILC can develop into a mass that is about ? inch ( 2 centimeters) to about 2 inches (5 centimeters) or bigger in size, before causing more noticeable symptoms (Stephan, 2008). Breast cancer in men is a very rare disease (Attebery, Adams ; Weiss, 2011). But the truth is that boys and girls, men and women all have breast tissue (Attebery, Adams ; Weiss, 2011). Men have a small amount of nonfunctioning breasts tissue (breast tissue that cannot produce milk) that is concentrated in the area directly behind the nipple on the wall of the chest (Attebery, Adams ; Weiss, 2011). A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating carcinoma (ASC, 2012). Some symptoms that may occur in males developing breast cancer include lumps, changes to the nipple or breast skin, or discharge of fluid from the nipple (National Cancer Institute, 2011). Men who have an altered gene related to breast cancer have an increased risk of developing breast cancer (National Cancer Institute, 2012). The major problem is that breast cancer in men is more often than not diagnosed later than breast cancer in women because men are less likely to be suspicious of an abnormality in that area (Wax, 2012). Also, their small amount of breast tissue is harder to feel, making it more difficult to catch these cancers early, and allowing tumors to spread more quickly to the surrounding tissues (Wax, 2012). Breast cancer in men is detected the same way as breast cancer is detected in women – through self-examination, clinical examination, or mammography (x-ray of the breast) (ASC, 2012). Methods for Diagnosis Breast cancer is sometimes found after symptoms appear, but many women with early breast cancer have no symptoms (American Cancer Society, 2011). This is why getting the recommended screening tests before any symptoms develop is so important (American Cancer Society, 2011). Three types of methods used for diagnosis are mammograms, MRI’s, and biopsies (NCI, 2010). A mammogram is a low-dose x-ray picture of the breast and can be used to check for breast cancer in women who don’t have any signs or symptoms of the disease. (NCI, 2010) The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine (Webmd, 2010). There are different types of mammograms including Screening mammograms and Diagnositc mammograms (Webmd, 2010). Mammograms detect tiny bits of calcium that develop in dead cancer cells (Hoffman, 2010). As more and more cancer cells age and die, theses calcifications grow nd on the mammogram, they appear as a shadowy area (Hoffman, 2010). Current guidelines from the American College Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40, even if they have no symptoms or family history of breast cancer (ACR, 2010). For every 1,000 women who have screening mammogram: 100 are recalled to get more mammogr aphy or ultrasound images, 20 are recommended for needle biopsy and 5 are diagnosed with breast cancer (ACR, 2010). A mammography unit is a rectangular box that houses the tube in which x-rays are produced (Radiological Society of North America, 2011). Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate (Radiological Society of North America, 2011). A brief medical history and a history of specific problems related to the breast, such as pain or a palpable lump (one that is felt), is obtained prior to the mammogram (Stoppler, 2011). All jewelry and clothing in the chest and breast area are removed prior to the mammogram (Stoppler, 2011). The patient’s breasts are then placed on a firm flat panel and a gentle, but firm pressure is applied to the breast with another panel, resulting in compression of the breast between the two panels (Stoppler, 2011). The compression of the breast is necessary to obtain quality mammograms and spreads the breast tissue out so that the x-ray image displays the inner breast tissue with good resolution (Stoppler, 2011). Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them (Radiological Society of North America, 2011). As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black (Radiological Society of North America, 2011). The results of the mammogram can be given to the patient either by the radiologist at the completion of the mammogram or by the patient’s doctor who ordered the mammogram (Stoppler, 2011). An abnormal mammogram does not mean you have cancer (Stoppler, 2011). In some cases, it may just be an area of thicker or denser breast tissue, a cyst, or a benign lump such as a fibro adenoma (Stoppler, 2011). Unlike mammography which uses low dose x-rays to produce an image of the breast, MRI (Magnetic Resonance Imaging) uses powerful magnetic fields and radio waves to create images of the breast (Imaginis, 2012). The MRI system has the ability to switch magnetic fields and radio waves to achieve views in any plane and from any orientation while x-ray mammography requires re-orientation of the breast and mammography system for each view desired (Imaginis, 2012). MRI is a huge magnet and the woman gets put in the middle of the magnet; the magnetic field is turned on and then turned off again (Eisenpreis, 1999). The way the magnetized cells return to normal gives an image (Eisenpreis, 1999). The MRI finds lumps better than it tells whether or not they are cancerous (Eisenpreis, 1999). However, MRI can be good at showing how big a cancer is, once it has been found on the mammogram (Eisenpreis, 1999). A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer and is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram, ultrasound, or magnetic resonance imaging (MRI) (Marshall, 2009). During a fine-needle aspiration biopsy, the doctor inserts a thin needle into a lump and removes a sample of cells or fluid (Marshall, 2009). Nowadays, doctors might have decided to do something called stereotactic biopsy, where a patient lies on a table, with her breasts hanging down (Eisenpreis, 1999). A mammogram is taken to show where the lump is and a device holding a needle quickly shoots in and removes a few cells from the lesion (Eisenpreis, 1999). There is also something called a core biopsy that uses a larger needle to take out a piece of tissue, instead of just cells (Eisenpreis, 1999). A doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted and once the area is numb, a small cut is made in the skin from where the needle with a special tip is inserted into breast tissue (Marshall, 2009). Three to twelve samples will be taken to acquire the most accurate results (Marshall, 2009). Classifications and Associated Prognoses The stages of breast cancer are usually expressed as a number on a scale of 0 through IV – with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body (Marisa, 2011). Cancer stage is based on four characteristics; the size of the cancer, hether the cancer is invasive or non-invasive, whether the cancer is in the lymph nodes, whether the cancer has spread to other parts of the body beyond the breast (Marisa, 2011). Sometimes doctors use the term â€Å"locally advanced† or regionally advanced† to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast’s shape, and lymph node enlargement that is visible or that the doctor can feel during an exam (Marisa , 2011). The three ways that cancer spreads in the body are: Through tissue where cancer invades surrounding normal tissue, through the lymph system where the cancer invades the lymph system and travels through the lymph vessels to other places in the body, and through the blood, where cancer invades the veins and capillaries and travels through the blood to other places in the body (NCI, 2009). When cancer cells break away from the primary (original) tumor and travel through the lymph nodes or blood to other places in the body, another (secondary) tumor may form (NCI, 2009). This process is called metastasis (NCI, 2009). The stage of the breast cancer can help the patient and the doctor understand the prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all the other results in the pathology report (Marisa, 2011). A staging system is standardized way for the cancer care team to summarize information about how far a cancer has spread (ACS, 2012). The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system (ACS, 2012). The TNM staging system classifies cancers based on their T, N, and M stages (ACS, 2012). The letter â€Å"T† followed by a number 0 to 4 describes the tumor’s size and spread to the skin or to the chest wall under the breast (ACS, 2012). The letter â€Å"N† followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. The letter â€Å"M† followed by a 0 or 1 indicates whether the cancer has spread to distant organ (ACS, 2012). There are typically five stages (0 to 4) with sub-stages that indicate the prognosis for breast cancer (Lippman, 2005). Stage 0 where the carcinoma is insitu and no lymph nodes are affected had 99 percent 5 year survival rate (ACS, 2012). Stage IA also has a high rate, 92 percent, in which the tumor is equal to 2 centimeters (ACS, 2012). In stage IB, the tumor is 2 centimeters with micro metastases in 1 to 3 axillary lymph nodes but the cancer has not spread to distant sites (ACR, 2012). In stage IIA, the cancer cells have moved to the ipsilateral nodes and the 5 year survival rate lowers to 82 percent (Lippman, 2012). In stage IIB, the cancer cells have spread to movable ipsilateral nodes and the tumor is over 5 centimeters (Lippman, 2012). The 5 year survival rate lowers to 65 percent (ACS, 2012). In stage IIIA, there is no evidence of a primary tumor and no distant spreading (ACS, 2012). The 5 year survival rate lowers to 47 percent (Lippman, 2005). The tumor could be between 2 and 5 centimeters but there is still no distant spreading at this point (ACS, 2012). In stage IIIB the tumor has extended to the chest wall but there is still no distant metastases (Lippman, 2005). The 5 year survival rate lowers again to a 44 percent (Lippman, 2005). In stage IV the cancer can be any size (any T) and may or may not have spread to nearby lymph nodes (any N) (ACS, 2012). It has spread to distant organs or to lymph nodes far from the breast (M1) (ACS, 2012). The most common sites of spread are the bone, liver, brain, or lung (ACS, 2012). The survival rate lowers to 14 percent (Lippman, 2005). Prevention Methods Three ways to prevent breast cancer are by maintaining a healthy weight, avoiding alcohol consumption, and getting an annual mammogram (Reynolds, 2010). Mammogram screening, early diagnosis and better treatments have all contributed to the reduction in breast cancer cases by around 2 percent a year and the improved survival rate in the U. S. (Reynolds, 2010). Experts say now the focus needs to shift on improving personal lifestyle habits to prevent the disease even more (Reynolds, 2010). Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread (NCI, 2010). A medical team found an 11 percent lower risk of breast cancer in those women consuming the more healthful diet, including more whole grains, fruits and vegetables and less fatty, processed foods (Reynolds, 2010). They also found that those consuming large amounts of alcohol had a 21 percent increased risk (Reynolds, 2010). Drinking alcohol during adolescence has been linked to an increased risk of breast cancer, especially for girls with a family history of the disease (Reynolds, 2010). Exercise also plays a role in the reduction of breast cancer risk (Reynolds, 2010). In one study from the Women’s Health Initiative, as little as 1. 25 to 2. 5 hours per week of brisk walking reduced a woman’s risk by 18 percent (Reynolds, 2010). Walking 10 hours a week reduce the risk more (Reynolds, 2010). Diet and exercise can lead to weight reduction, another positive lifestyle change that can influence breast cancer disease risk (Reynolds, 2010). Many breast cancers are fueled by estrogen, a hormone produced in fat tissue (Reynolds, 2010). Experts suspect that more fat tissue equals more estrogen resulting in more cases of breast cancer that could possibly be avoided (Reynolds, 2010). Genetic ; Hereditary Influence According to researchers, the mutations in the gene, which is called FGFR2, raise the risk of breast cancer by 20 to 60 percent. (Metcalf ; Metcalf, 2008). A genetic mutation that raises the risk of breast cancer is found in up to 60 percent of U. S. omen, making it the first truly common breast cancer susceptibility gene (Metcalf ; Metcalf, 2008). Women with faulty copies of the genes BRCA1 or BRCA2 have 50 percent to 85 percent chance of getting breast cancer in their lifetimes, but they are rare genes and only account for 5 percent to possibly 10 percent of breast cancer cases (Metcalf ; Metcalf, 2008). Only 7% of all breast cancers are hereditary (Hirshaut ; Pressman, 2008). Of these hereditary cancers, 45% is caused by BRCA1 while 35% is caused by BRCA2 (Hirshaut ; Pressman, 2008). (Hirshaut ; Pressman, 2008). Variations of the  BRCA1,  BRCA2,  CDH1,  PTEN,  STK11, and  TP53  genes increase the risk of developing breast cancer (Chen, 2007). The  AR,  ATM,  BARD1,  BRIP1, CHEK2, DIRAS3,  ERBB2,  NBN,  PALB2,  RAD50, and  RAD51  genes are associated with breast cancer (Chen, 2007). Cancers occur when a buildup of genetic mutations in critical genes – those that control cell growth and division or the repair of damaged DNA – allow cells to grow and divide uncontrollably to form a tumor (Honrado, Osorio, Palacios ; Benitez, 2006). These changes, which are called somatic mutations, are not inherited (Honrado, Osorio, Palacios ; Benitez, 2006). Less commonly, gene mutations inherited from a parent increase the risk of developing cancer (Honrado, Osorio, Palacios ; Benitez, 2006). In people with these inherited genetic changes, additional somatic mutations in other genes must occur for cancer to develop (Honrado, Osorio, Palacios ; Benitez, 2006). Additional factors that may influence a person’s risk of developing breast cancer include gender, age, ethnic background, a history of previous breast cancer, certain changes in breast tissue, and hormonal factors (Thompson ; Easton, 2004). A history of breast cancer in closely related family members is also an important risk factor, particularly if the cancer occurred at an early age (Thompson ; Easton, 2004). Women who have inherited certain mutations in these genes have a high risk of developing breast cancer, ovarian cancer, and several other types of cancer during their lifetimes (Thompson ; Easton, 2004). Inherited changes in several other genes, including CDH1, PTEN, STK11, and TP53, have been found to increase the risk of developing breast cancer (Thompson ; Easton, 2004). In hereditary breast cancer, the way that cancer risk is inherited depends on the gene involved (Walsh ; King, 2007). For example, mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant patter, which means one copy of the altered gene in each cell is sufficient to increase a person’s chance of developing cancer (Walsh ; King, 2007). In other cases, the inheritance of breast cancer risk is unclear (Walsh ; King, 2007). It is important to emphasize that people inherit an increased risk of cancer, not the disease itself (Walsh ; King, 2007). Not all people who inherit mutations in these genes will develop cancer (Walsh ; King, 2007). Other Breast Diseases Two other diseases found in the breast other than breast carcinoma are breast fat necrosis and fibrocystic breast disease (Sacks, 2011; Silverman, 1994). Fybrocystic breast disease is a commonly used phrase to describe painful, lumpy breasts (Sacks 2011). Hormones made in the ovaries can make a woman’s breasts feel swollen, lumpy, or painful before during menstruation each month (Sacks 2011). Fibrocysitc changes in the breast with the menstrual cycle affect over half of women (Sacks, 2011). Symptoms are usually worse right before the menstrual period, and then improve after the period starts (Sacks, 2011). Symptoms can include pain in both breasts, breasts that feel swollen and heavy, pain or discomfort under the arms, and thick or lumpy breasts (Sacks, 2011). This disease can be treated with medication like acetaminophen or ibuprofen (Sacks, 2011). Breast Fat necrosis is a benign condition that can occur in your breast (Silverman. 1994). It consists of fatty tissue that has been bruised, injured, or has died (Silverman, 1994). Once fatty tissue has been injured or has died, it can gradually change into scar tissue or may collect as liquid within an oil cyst (Silverman, 1994). Fat necrosis does not lead to the development of breast cancer, but it may sometimes cause breast pain (Silverman, 1994). An area of fat necrosis in your breast may feel like a fairly hard lump, or like a section of thick skin (Silverman, 1994). The person may see some drainage from the nipple that is nearest to the bruised region (Silverman, 1994). The nipple may sometimes even pull inward a little bit or the breast skin may dimple above the lump of fat necrosis (Silverman, 1994). Each case of fat necrosis is unique, so treatments will vary but if the fat necrosis has occurred recently, using warm compresses may help it subside (Silverman, 1994). When fat necrosis causes pain, the person can use ibuprofen and aspirin, but if that doesn’t help, ask your doctor if a prescription medication may be used (Silverman, 1994). About 39,520 women in the U. S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50 (â€Å"Learn about cancer,† 2011). These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness (â€Å"breastcancer. org,† 2012). References Peter, C. (2011, October 20). Medical news today. Retrieved from http://www. medicalnewstoday. com/info/cancer-oncology/ breastcancer. org. (n. d. ). 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Marshall, S. (2009, April 29). Breast biopsy. Retrieved from http://women. webmd. com/breast-biopsy Metcalf, T. , Metcalf, G. (2008). Perspective on diseases and disorders. (1 ed. ). Michigan: Thomson Gale. Chen, S. ( 2007, April 10). Meta-analysis of BRCA1 and BRCA2 penetrance. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Honrado, E. , Osorio, A. , Palacios, J. , Benitez, J. (2006, September 25). Pathology and gene expression of hereditary breast tumors associated with brca1, brca2 and chek2 gene mutations. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer/show/References Thompson, D. , Easton, D. (2004, July 9). The genetic epidemiology of breast cancer genes. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Walsh, T. , King, M. (2007, February 11). Ten genes for inherited breast cancer. Retrieved from http://ghr. nlm. nih. gov/condition/breast-cancer Marisa , W. (2011, August 03). Stages of breast cancer. 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Critics - Essay Example n find the character of Gregor Samsa going through the process of metamorphosis, changing shapes and finally reaching final stage that is death in his case. The setting of the story is Gregor’s Samsa’s room as we can find the narrator discussing this room in depth where Gregor Samsa moves around the whole day. Gregor Samsa takes the shape of an insect due to which, his family and associates start staying away from him and feel unpleasant about his presence. He changes his appearance from being a human to an insect that is disagreeable for all due to which, he got alienated. It is Gregor’s Samsa’s room where he alienates himself from the rest of the world. In fact, he was already isolated when he was a human being and after being an insect, his isolation and loneliness intensified. This can also be a sign of an alienated society in which, no one has any association to any one and no one is interested in any other person. Lastly, the transformed state of Gregor Samsa, that is being an insect can be a symbol of his alienation that he already felt and near death, he started to take refuge of his own room and people started showing less interest in him as he was of no use for anyone. He knew this fact that because of his ailment, people will start considering him a burden so he shut himself down in his

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Bars and Night Clubs - Essay Example The dance floor is usually lighted by different kinds of lights which spark through out the club. The feel given to a night club is different than that to other clubs and bars in terms of the themes and environment given to the clubbers. The music in night clubs is usually played by a DJ who plays fast music such as pop or dance items. The lighting forms an important aspect in the night clubs as the revolving lights of different colors in the night club gives a charm to the whole night club. Different types of lighting have been arranged for the night clubs which give effect to the whole night club. Flashing of different colored lights is a common sight in these clubs. Similarly the audio system used in night clubs is of immense importance as the whole night club dances to the rhythm of the music. It can be said that night clubs are basically designed to give the clubbers a change in the environment of dancing and a freedom which not all the clubbers can experience in the outer world . The dance floor is usually lit up by flashing lights in which people cannot usually view the faces of each other clearly. Nowadays night clubs also include a bar which provides people with beer and alcohol to drink. The night clubs are usually open in the night and closed in the daylight hours.

Marketing Essay Example | Topics and Well Written Essays - 1250 words - 4

Marketing - Essay Example A marketing strategy is the means that the producer uses to focus and identify various ways he can influence the decision of his customers to purchase his products. The marketing concept to be used should satisfy consumer needs and help the producer to achieve in increasingly competitive markets. To achieve competitive advantage, in an increasingly competitive market place, the producer should establish an effective market strategy that will influence consumer wishes and win them into his side. Erich claims that the manufacturing of various products factors in behavior and wishes of buyers because the producer wishes to influence and change buyers’ interests in production. This statement raises ethical concerns about whether marketing is ethically professional; this is because producers aim to manipulate consumer behaviors in various ways of marketing. Producers manufacture consumer behavior in various ways for instance, through packaging. Producers package their products in a way to attract attention of the buyers to a certain brand, promote its image, and influence the perception of buyers about the brand2. Packaging can as well impart unique value to brands, and act as a differentiation tool – for instance, aid buyers select the brand from various same brands, stimulate buyers purchasing behavior. Producers use various packaging aspects such as packaging color, material, wrapper design, background image, creativity and printed information to tailor consumer wishes. Packaging color attracts buyers’ attention through its attractiveness, while packaging materials prevents brand loss as high quality materials attracts more buyers. For instance, some water production companies’ offers a clear packaging; in fact, these packaging uses pale blue bottles and a plastic seal at the middle of its lid. Apparently, use of pale blue on the bottle is an indication of water purity. Moreover, the packaging entails a vivid logo; for example, mountai ns, and brand names aimed at representing the nature of the product offered to consumers3. Packaging and branding information assist in the process of building brand reputation and customers’ appeal; in fact, it serves as an indication that the brand is fit for human health and consumption. They also indicate the quality, purity, and safety of the brand creating a strong competitive advantage over competitor brands. The design of the wrapper attracts consumer wishes, for instance, children prefer wrappers that are more sensitive. Therefore, packaging plays a critical function in marketing communication; thus, could be considered as a critical way of manufacturing consumer wishes to demand and buy product. Producers use their company reputation to tailor consumer wishes. Experts agree that every business, despite its competitiveness, trivial, or outsized, they chiefly rely on repute for triumph, survival, and customer satisfaction. Customers, personnel, vendors, financiers, co mmunication networks, and monitors may have an elemental outcome. They all have essential perceptions regarding other businesses they interrelate with on a daily basis. These perceptions extensively influence their decisions on their interests to purchase from, work with, and market or support these companies. Therefore, producers strove to offer an effectual, responsive customer service, which is vital to product promotion and

LSTD206 Capstone Paper Essay Example | Topics and Well Written Essays - 750 words

LSTD206 Capstone Paper - Essay Example This informs the basis of the establishment of sound client-relations policies, which do not only serve as the basis of informing how a firm relates with its clients, but also as a marketing tool for the firm, since good client experience is a recipe for increased customer base for a firm (Brink & Berndt, 2008). Therefore, this discussion seeks to establish the client-relations policies that a legal firm should establish to enhance its client relationship as well as its marketing, communication, advertising, confidentiality and conflict of interest handling. This discussion is important for a legal firm, since it creates insights into the relevant strategies that such firms should apply to enhance a productive relationship with the clients, and thus be able to maintain a secured client base, in the face of the ever increasing competition. Discussion Client reception is the core of productive client-relations policies formulation, considering that it is the reception that clients get when they first visit a firm that determines their first impression of the firm, and the consequent future interactions with the firm (Silk, 2012). This being the case, it is therefore significant to ensure that the receptionists and the customer relationship officers within a firm follows certain guidelines that enhances a positive and productive relationship with the client, which enable the firm to project a positive image to the clients, and thus attract them for further visits and interactions. Thus, courtesy and helpfulness is the basis of the customer relationship policy, where the receptionists and the customer relationship officers address the clients with respect and integrity, while offering the essential help that a client could require (Knackstedt, 2008). While being courteous, respectful and helpful serves to enable the client feel comfortable within the firm and feel valued and appreciated as a stakeholder to the firm, it plays the vital role of enticing the customer to make repeat visits. Thus, courteousness, helpfulness and respectfulness serves both as a client recognition and appreciation strategies, as well as firm marketing strategies that encourages further business. Confidentiality is paramount in the legal relationship business, considering that the relationship between a client and a legal firm entails the discussion of sensitive personal, business or family matters, which should not be introduced to the public domain (Nollkamper, 2008). Thus, a confidentiality policy is vital within a legal firm, to ensure that the relationship between a client and the firm, and the issues discussed between them remains between the two parties, and can only be disclosed whenever it is necessary, may be in a court of law. Through implementing the confidentiality policy, a firm is able to ensure that the customer feels comfortable while dealing with the firm, through the knowledge that the personal and confidential information shared with the firm will remain as such, without any risk of unnecessary exposure (Silk, 2012). Client communications and legal advice is yet another aspect that requires that a policy guideline is established to safeguard the relationship. The policy applicable under this concept

Starbucks Canada Case Study Example | Topics and Well Written Essays - 1250 words

Starbucks Canada - Case Study Example There are several important criteria that should be taken into account while assessing various mobile payment options. To begin with, it is the compatibility with the devices that the company and the clients have. It has been mentioned before that a significant number of clients use iPhones, but they will be useless in case Starbucks Canada engages NFC technology. On the other hand, an introduction of the Bluetooth beacons it difficult as well since the company in question does not have them and will have to order them.The second criteria are the amount of money that introduction of technology will cost. For example, should Starbucks Canada rely on the software which was developed in house, it will require the minimum cost for upgrade of the equipment and this will not result in significant expenses? On the other hand, installation of BLE beacons will require the assistance of a professional who is paid $50 per hour. If one multiplies this amount of money by the number of stores that will have to be equipped with beacons, one will realize that it will result in significant expenditures.The cost training of the personnel should also be taken into account. While some options provide an outstanding experience for the customers (they will be able to pay for their coffee without even taking their smartphone out of their pocket), the same option might cause so difficulties for the employees of Starbucks. In order to be able to avoid them, they will have to be trained and this will require both time and money.