There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.
a.Lowering your risk:
Risk can be loweredby changing those risk factors that can be changed.
1.Maintain a healthy body weight (BMI less than 25) throughout your life.
üWeight gain in midlife, independent of BMI, has been shown to significantly increase breast cancer risk. Additionally, and elevated BMI has been conclusively shown to increase the risk of post-menopausal breast cancer.
2.Minimize or avoid alcohol.
üAlcohol use is the most well established dietary risk factor for breast cancer.
üThe Harvard Nurses' Health study, along with several others, has shown consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.
3.Consume as many fruits and vegetables as possible.
üEat seven or more servings of all cruciferous vegetables (broccoli, cabbage, brussels sprouts, cauliflower) ; dark leafy greens (collards, kale, spinach) ; carrots and tomatoes daily. The superstar fruits include citrus, berries and cherries.
üNote: it is best to eat cruciferous vegetables raw or lightly cooked, as some of the phytochemicals believed to offer protection against breast cancer are destroyed by heat.
4.Exercise regularly the rest of your life.
üMany studies have shown that regular exercise provides powerful protection against breast cancer.
5.Do your fats right!
üMinimize consumption of omega-6 fats (sunflower, safflower, corn and cottonseed oils), saturated fats and trans fats.
üMaximize your intake of omega-3 fats, especially from oily fish (salmon, tuna, mackerel, sardines, lake trout and herring).
üConsume monounsaturated oils (canola, olive oil, nuts/seeds, avocados) as your primary fat source, as these foods have potential anticancer properties.
6.Do your carbs right!
üMinimize consumption of the high glycemic index, white flour, white rice, white potatoes, sugar and products containing them.
üThese foods trigger hormonal changes that promote cellular growth in breast tissue.
üReplace these carbs with whole grains and beans/legumes. Beans/legumes because of their high fiber and lignan content are especially special.
7.Consume whole food soy products regularly
üOnly consume organic, non-GMO (genetically modified) soy. Epidemiologic studies have shown a positive association between soy consumption and reduced breast cancer risk.
8.Minimize exposure to pharmacologic estrogens and xeno-estrogens.
üDo not take prescription estrogens unless medically indicated.
üAlso avoid estrogen-like compounds found in environmental pollutants, such as pesticides and industrial chemicals.
üBuy organic produce if you can afford it; otherwise, thoroughly wash all non-organic produce.
üMinimize exposure to residual hormones found in non-organic dairy products, meat and poultry.
9.Take your supplements daily.
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10.Maintain a positive mental outlook.
üEngage in self-nurturing behaviors regularly. Develop rich, warm and mutually beneficial relationships with family and friends. Get adequate sleep (7-8 hours per night). The mind-body associations with breast cancer are significant.
b.Finding breast cancer early:
Other than lifestyle changes, the most important action a woman can take is to follow early detection guidelines.
What role do genes play in breast cancer ? -One or more genes in the cell are mutated -Creating an abnormal protein or no protein at all -Information provided by the abnormal protein is different from that of the normal protein -Cells multiply uncontrollably.
Types of Genetic Mutation Germline mutation -Born with a genetic mutation in all their cells -Acquire a genetic mutation in a single cell during one’s lifetime.
Somatic mutation -An acquired mutation is passed to all cells that develop from that single cell -Cause by environmental factors Eg. Cigarette smoking
Gene Mutation -Occur in *tumor suppressor genes *Make proteins that prevent tumor formation by limiting cell growth
-Mutation in the tumor suppressor gene A loss of the ability to restrict tumor growth Cancer develops.
Genes related to Breast Cancer
1) BReast CAncer gene 1 (BRCA1) >Tumor suppressor cell
>Provides instruction in repairing damaged DNA. ~Natural and medical radiation ~Environmental exposures
>Regulate activities of other genes >Involve in embryonic development >Regulate cell division
How are changes in the BRCA1 gene related to health conditions ??? >Mutation ~Abnormally short version of BRCA1 protein ~Prevent protein from being made ~Change protein building blocks (amino acids)
~Delete large segment of DNA from BRCA1 *Unable to help repair damaged DNA *Unable to fix mutation
Defects accumulate , allow cells to grow and divide uncontrollably. Form TUMOR
Where is the BRCA1 gene located? chromosome 17: base pairs 38,449,839 to 38,530,993 (photo will be shown on friday)
2) BReast CAncer gene 2 (BRCA2) >Tumor suppressor cell
>Provides instruction in repairing damaged DNA. *Natural and medical radiation *Environmental exposures
>Maintaining the stability of a cell’s genetic information >Regulate cytokinesis
How are changes in the BRCA2 gene related to health conditions ???
>Mutation ~Insert or delete a small number of DNA building blocks (nucleotides) ~*Fanconi anemia type D1 (FA-D1) *when two faulty copies of the BRCA2 gene are present in each cell -reduce the amount of the BRCA2 protein to very low levels.
>increased risk of ovarian cancer, prostate cancer, pancreatic cancer, fallopian tube cancer, male breast cancer, and an aggressive form of skin cancer called melanoma.
Where is the BRCA2 gene located? chromosome 13: base pairs 31,787,616 to 31,871,804
3) CDH1 4) PTEN 5) STK11 6) TP53
How does a woman know if breast cancer runs in the family? Breast cancer may run in the family if first-degree relatives (mothers, sisters, children) / many close relatives (first-degree relatives, grandmothers, aunts, nieces, grandaughters, cousins) have been diagnosed with breast cancer, especially before age 50.
What is a woman's risk if breast cancer runs in the family? >woman's first-degree relative developed breast cancer woman’s risk is double the average woman's risk
>two first-degree relatives developed breast cancer woman’s risk is 5 times the average risk
>uncertain how much a woman's risk of breast cancer is increased when a man in the family has breast cancer.
Breast Composition - a mass of glandular, fatty, and fibrous tissues.
Lobules – milk glands that produce milk Ducts – transport milk from lobules to nipple Nipple Areola – pink or brown pigmented region surrounding the nipple. Connective (fibrous) tissue that surrounds the lobules and ducts. Fats
(will show the photo of the composition of breast on friday, sorry, the internet connection here is too terrible)
What is Breast Cancer ? -Uncontrolled growth of breast cells, forming tumor. -mutations, abnormal changes in the gene -Benign (not dangerous) *Grow slowly *Do not invade nearby tissues -Malignant ( dangerous , cancerous) *Spread to other parts of the body
Where does breast cancer begin ?
-Cell of lobules -ducts -Less commonly : Stromal tissues ( fatty and fibrous connective tissues)
Common form of breast cancer : -Ductal Carsinoma In Situ (DCIS) Ductal epithelial cells undergo malignant transformation and proliferate intraluminally. Debris can calcify (tiny calcium deposits) 5 pathologic subtypes : comedo, papillary, micropapillary, solid and cribriform. Lesions represent a combination of at least 2 of these subtypes
-Lobular Carsinoma In Situ (LCIS) ↑ in the no. of cells within the lobules Lobular pattern Rarely detected by examination or mammography As a marker for development of invasive cancer
-Infiltrating Ductal Carsinoma Most commonly diagnosed breast tumor. Invasive Lobules ?? wall of ducts ?? fatty tissue of breast (possible to other regions of the body) Tendency to metastasize via lymphatics
-Infiltratiltrating Lobular Carsinoma Invasive Begins in lobules , able to metastasize (lymph nodes) Tendency to be more multifocal. Indian file arrangement of small tumor cells
Less common form of breast cancer : -Tubular Carcinoma Invasive Forms distinct boundary between tumor tissue and normal tissue. Rarely metastasize.
-Mucinous Carcinoma Slow growing lesions Mucus-producing cancer cells Bulky Rarely metastasize. Better prognosis (expected outcome) than other common types of invasive carsinoma.
-Medullary Carcinoma Invasive Poorly differentiate tumor Distinct boundary between tumor tissue and normal tissue.
-Inflammatory breast cancer Inflamed breast Red and warm Dimples Thick ridges Cancer cells blocking the lymph vessels Extremely fast growing
-Paget’s disease of the nipple Milk duct → skin of nipple and aerola Breast skin may appear crusted, red or oozing. Nipple changes No lump is felt
-Phylloides tumor Can be benign or malignant Develop in the connective tissues of the breast. Treated by surgical remove.
How am I supposed to cope with this? There are so many things that you can do in order to cope with the fact that your mum has been diagnosed with cancer. Below are some suggestions about what might help you to cope. Try these out, or talk to your friends and family about new ideas you have. Email us about what works for you.
* Look after your own health - maybe go to bed a little bit earlier and try to eat a healthy diet. When your body is under emotional stress, it can also be under extra physical stress too. If you are not feeling well, see your doctor or talk to another adult who can help you. * Give yourself time to adjust and understand what is happening - don’t expect that you should be able to deal with this straight away. Some people take years to work through their emotions, you have a head start because you are reading this website. Keep reading, exploring your feelings and talking to other people and it will slowly start to make sense. * Express your feelings - be prepared to talk about the tough stuff, otherwise you might start to think your feelings don’t matter. * Get information - find out as much as you feel you need in order to understand what is happening to your mum. Some people prefer not to know the detail. Others like to learn everything. It is totally up to you. * Keep a diary - write down all of your thoughts and feelings each day. Look back over your notes and see how far you have come since you first found out about your mum. * Do some exercise - swim, ride, beach, surf, walk, run, play a sport at school etc. It is amazing how good you will feel after you get some of your negative energy out and forget about life for a little while. * Get creative - write a story, play some music, draw a picture, design a new computer game etc. * Connect with other young people who have coped with cancer in their family. Feeling alone is one of the worst things, but you are not the only one. You don’t always have to talk about the cancer with them, but just having fun with someone who knows what it’s all about can be such a relief. * Spend time with your friends. It might just be hanging out, going to a movie or listening to music. It’s good to do something that feels ‘normal’ when everything around you is changing. * Let yourself be sad. Being sad won’t make it worse, and most times people who bottle up their feelings get stressed out later on anyway. Sometimes you can feel that if you start to cry you will never stop. That’s OK. You won’t feel this sad forever. You just won’t. * Have some fun. Having fun doesn’t mean that you are selfish or don’t care about your mum. It is a way of building up some supplies of good things inside to help you get through the tough times. It will also make her feel better to see you enjoying yourself. * Keep going to school, doing the things you used to do where possible. Working hard at school can be a way of having a break from thinking about the cancer, and when you do well, it makes you feel more confident that you really will be able to handle things. * Find your own way of coping - even if it seems strange. Some people write on little bits of paper about what is really getting to them. Then they fold up that piece of paper and put it in a special little box called a worry box. Other people just go somewhere private or outdoors and yell and scream and shout until they feel better! * Work out what used to relax you - it might have been listening to music, going to the beach, going to the movies, whatever it is - try it again. It will usually make you feel much better. * Sometimes it might seem like a good idea to drink away your problems or take drugs to forget about things for a while. Sometimes drinking and taking drugs can seem a release from all the stress, but they lead to health problems themselves and that then just adds to all the drama you’re already dealing with. It just doesn’t work. You have to work through the tough stuff before you can feel better.
Here are a variety of types of mastectomy in use, and the type that a patient decides to undergo (or whether he or she will decide instead to have a lumpectomy) depends on factors such as size, location, and behavior of the tumor (if there is one), whether or not the surgery is prophylactic, and whether or not the patient intends to undergo reconstructive surgery.
* Simple mastectomy (or "total mastectomy"): In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the "sentinel lymph node"--that is, the first axillary lymph node that the would be expected to drain into--is removed. This surgery is sometimes done bilaterally (on both breasts) on patients who wish to undergo mastectomy as a cancer-preventative measure. Patients who undergo simple mastectomy can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less than 20-30 ml per day.
* Modified radical mastectomy: The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). In contrast to a radical mastectomy, the pectoral muscles are spared.
* Radical mastectomy (or "Halsted mastectomy"): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast. This procedure is more disfiguring than a modified radical mastectomy and provides no survival benefit for most tumors. This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall.
* Skin-sparing mastectomy: In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved as compared to traditional mastecomy resections serves to facilitate breast reconstruction procedures. Patients with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy.
* Subcutaneous mastectomy: Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastecomy for benign disease over fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position.
TREATMENT Many women receive more than one type of treatment.
-Divided to either Local Therapy or Systemic Therapy Local Therapy - Remove, destroy cancer in the breast. - Used to control disease in specific areas of metastasis occurs Systemic Therapy - Destroy/control cancer throughout the body.
Surgery Breast sparing surgery - Remove cancer(lump) but not the breast. - Underarm lymph nodes are removed as well (axillary lymph node dissection) - Usually coupled with radiation therapy after surgery to destroy remaining cancer cells.
Mastectomy Simple (total) mastectomy -removal of whole breast, some lymph nodes under arm removed removed.
Radical Mastectomy -removal of whole breast, most/all of lymph nodes under arm -often lining over the chest muscles is removed
Radiation Therapy (radiotherapy) - high energy rays to kill cancer cells by damaging cell DNA, hence loses ability to grow and divide - cancer cells less organized, harder to repair compared to normal cells. - may be performed before surgery to destroy cancer cells and shrink tumour. - may be used after breast sparing surgery or mastectomy to destroy cancer cells that remain in the area.
External radiation Radiation from large machine, linear accelerator, outside body Internal radiation (implant radiation) Implants (thin plastic tubes, catheters) containing radioactive substance (pellets, seeds) put directly into breast.
Chemotherapy - Anticancer drugs used to kill cancer cells - A combination of drugs is used - Drugs given as a pill or injection into a vein (IV) – enter bloodstream and travel through body - Stops growth/multiplication of cancer cells - kill them - Used to reduce size of breast tumour before surgery - Used after surgery to destroy cancer cells that may have spread - Possibility of killing normal cells which divide rapidly (eg. blood cells)
Classes of drugs Alkylators - Damage proteins that control growth in the genes of the tumour cell (eg. cyclophosphamide) Antimetabolites - Act as false building blocks (bases in nucleotides) in a cancer cell’s genes, causing it to die as it gets ready to divide . (eg. fluorouracil) Antibiotics (against growth, not those that fight infection) -potent inhibitors of gene replication (eg. Adriamycin) Antimiototic agents -natural agents that rob cellular genes of the ability to reproduce themselves during division (stops mitosis) (eg. vincristine fr periwinkle plant) Antimicrotubule -natural agents which interfere with cell structure, microtubules, during cell division. (eg. Taxol (paclitaxel) fr yew tree)
Hormone Therapy - For hormone-receptor-positive breast cancer - some tumours need hormones(estrogen, progesterone) to grow - uses drugs OR surgery to lower the amount of hormone in body OR block action of estrogen on body
Type of Hormonal therapy medicines Aromatase inhibitors -aromatase is enzyme that synthesizes estrogen Selective Estrogen Receptor Modulators (SERMs) - ability to selectively inhibit or stimulate estrogen like action in various tissues (eg. Tamoxifen) Estrogen Receptor Downregulators (ERDs) - sit in estrogen receptors in breast cells, blocks effect of estrogen in breast tissues
Targeted Therapy (Biologycal Therapy) - helps immune system fight cancer
Herceptin (trastuzumab) -monoclonal antibody that binds to cancer cells - for breast tumours that have too much of a specific protein (HER2), Blocks ability of cancer cells to receive chemical signals that tell the cells to grow.
CARE AFTER TREATMENT
Breast Reconstruction - Reasons for breast reconstruction ~ maintain self-esteem and confidence ~body image reinforcement ~appearance for professional reasons ~avoid inconvenience of mammary prosthesis - Two types of breast reconstruction: ~using implants (saline or silicon or both) ~using either the stomach or back muscles
External Prostheses - helps restore body image - made of silicon gel - may be worn inside bra and closely copies natural contours of breast
Follow Up Treatment - to look after emotional wellbeing and support - regular checkups (mammograms, clinical examinations)
Breast cancer and medical tests go hand in hand. Most tests will fall into the following categories: 1.Screening tests (ST) : - For people who appear healthy - Purpose to find breast cancer early
2.Diagnostic tests (DT): - For people who are suspected of having breast cancer due to symptoms or screening test results. - to determine whether breast cancer is present - if Yes, has the cancer travelled outside the breast - to gather more information to make decisions for treatment
Will first focus on screening tests
Clinical Breast Examination - Doctor looks for differences in size/shape between breasts. - Skin checked for rahs, dimpling or abnormal signs. - Nipples checked for fluid - Breasts felt for lumps, including underarm and collarbone area.
Screening Mammogram - Picture of breasts made with X-rays - Aged >40 to undergo screening every 1-2 years. - Might show lumps before it is felt (early detection)
Breast Self Examination - Performed monthly to check for any change in breasts.
DIAGNOSTIC TESTS
Clinical Breast Exam - Doctor feels each breast for lumps and looks for other problems. - If lump is present, feel its size, shape and texture - Benign lumps – soft, smooth, round and movable. - Malignant lumps – firmly attached and oddly shaped
Diagnostic Mammograms - X-ray pictures of the breast - To learn more about unusual breast changes - Focus on specific area of the breast (may have special techniques and more views than screening mammograms)
Ultrasound - Pictures made from reflected sound waves off tissues and processed by a computer. - Shows whether lump is solid or filled with fluid (cyst-not cancer). - May be used along with a mammogram.
Magnetic Resonance Imaging (MRI) - Uses powerful magnet linked to a computer. - Makes detailed pictures showing different planes of the tissue. - May be used along with a mammogram.
Biopsy - Fluid or tissue removed from breast to determine whether it is cancer - Fine-needle aspiration ~ thin needle used to remove fluid from a breast lump (checked for cancer by a pathologist) - Core biopsy/needle biopsy ~ thick needle used to remove breast tissue (checked for cancer cells) - Surgical biopsy ~ surgeon removes a sample tissue (checked for cancer cells)
Hormone receptor test - Test done on breast tissue if it is determined to be cancerous - Shows whether tissue has certain hormone receptors ~Tissues with these receptors needs hormones (estrogen/progesterone) to grow
STAGING Before treatment can be carried out, the extent (stage) of cancer needs to be known. Stages based on SIZE of the tumour and whether it has SPREAD. Involves X-rays and lab tests.
Stage 0 (carcinoma in situ-abnormal cells remain in the tissue where they first formed) -Lobular carcinoma in situ -Ductal carcinoma in situ
Stage I - Early stage of invasive breast cancer - Tumour no more than 2cm
Stage II (4types) Size of Tumour Spread to lymph nodes under the arm? <2cm Yes 2-5cm No 2-5cm Yes >5cm No
Stage III (locally advanced cancer - spread from where it started to nearby tissue or lymph nodes)
IIIA - No more than 5 cm across/ more than 5cm - Spread to underarm lymph nodes that are attached to each other or other structures - Spread to lymph nodes behind to breastbone.
IIIB - Grown into chest wall OR skin of the breast. (swelling and lumps in breast skin) - Spread to underarm lymph nodes that are attached to each other or other structures - Spread to lymph nodes behind to breastbone. - Inflammatory breast cancer (red and swollen because cancer cell blocks lymph vessels)
IIIC - Tumour of any size. - Spread to lymph nodes behind breastbone and under the arm. - Spread to lymph nodes above or below the collarbone.
Stage IV (distant metastatic cancer) -spread to other parts of the body.
A risk factor is anything that affects your chance of getting a disease, such as breast cancer. However, having a risk factor, or even several, does not mean that you will get the disease. Most women who have one or more breast cancer risk factors never develop the disease, while many women with breast cancer have no apparent risk factors. Even when a woman with risk factors develops breast cancer, it is hard to know just how much these factors may have contributed to her cancer.
General risk factors: 1. Gender -Simply being a woman is a main risk factor for the development of breast cancer.
- Women’s breast cells are constantly exposed to the growth-promoting effects of the female hormones estrogen and progesterone, which increases the chances of getting breast cancer.
2. Aging -The risk of getting breast cancer increases as you age
3. Genetic risk factors -About 5-10% of breast cancer cases are thought to be hereditary, resulting from gene mutation.
• BRCA 1 and BRCA 2
These are the most common inherited mutations. In normal cells, these genes help to prevent cancer by making proteins that help keep the cells from growing abnormally. When a mutated copy of this gene is inherited, there is increased chances (about 80%)of getting breast cancer and ovarian cancer.
• Changes in other genes
o ATM: The ATM gene normally helps repair damaged DNA. Certain families with a high rate of breast cancer have been found to have mutations of this gene.
o CHEK2: Increases breast cancer risk about twofold when it is mutated. In women who carry the CHEK2 mutation and have a strong family history of breast cancer, the risk is greatly increased.
o p53: Inherited mutations of the p53 tumor suppressor gene can also increase the risk of developing breast cancer, as well as several other cancers such as leukemia, brain tumors, and sarcomas (cancer of bones or connective tissue).
o PTEN: The PTEN gene normally helps regulate cell growth. Inherited mutations in this gene cause Cowden syndrome, a rare disorder in which people are at increased risk for both benign and malignant breast tumors, as well as growths in the digestive tract, thyroid, uterus, and ovaries.
4. Family history of breast cancer • Breast cancer risk is higher among women whose close blood relatives have this disease.
• Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2 first-degree relatives increases
• About 20% to 30% of women with breast cancer have a family member with this disease. (It's important to note this means that 70% to 80% of women who get breast cancer do not have a family history of this disease.)
5. Race and ethnicity • White women are slightly more likely to develop breast cancer than are African-American women.
• African-American women are more likely to die of this cancer.
• African-American women tend to have more aggressive tumors, although why this is the case is not known
• Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.
6. Personal History of Breast Cancer • A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a recurrence (return) of the first cancer.
7. Dense breast tissue • Women with denser breast tissue (as seen on a mammogram) have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer.
• Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
8. Certain benign breast conditions • Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer.
o Non-proliferative lesions
o Proliferative lesions without atypia
o Proliferative lesions with atypia
9. Menstrual periods • Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer.
• This may be related to a higher lifetime exposure to the hormones estrogen and progesterone.
10. Previous chest radiation • had radiation therapy to the chest area as treatment for another cancer, increased risk for breast cancer
Lifestyle-related factors and breast cancer risks: 1. Not having children, or having them later in life • Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk.
• Having many pregnancies and becoming pregnant at an early age reduces breast cancer risk.
• Pregnancy reduces a woman's total number of lifetime menstrual cycles, which may be the reason for this effect.
2. Recent oral contraceptive use • Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them, but this risk seems to decline once their use is stopped.
3. Using post-menopausal hormone therapy • Post-menopausal hormone therapy (PHT), (hormone replacement therapy (HRT)), has been used for many years to help relieve symptoms of menopause and to help prevent osteoporosis (thinning of the bones).
• 2 main types of PHT:
For women who still have a uterus (womb), doctors generally prescribe estrogen and progesterone (known as combined PHT). Because estrogen alone can increase the risk of cancer of the uterus, progesterone is added to help prevent this.
For women who no longer have a uterus (those who've had a hysterectomy), estrogen alone can be prescribed. This is commonly known as estrogen replacement therapy (ERT).
• Combined PHT: Long-term use (several years or more) of combined post-menopausal hormone therapy increases the risk of breast cancer and may also increase the chances of dying of breast cancer. Large studies have found that there is an increased risk of breast cancer related to the use of combined PHT. It also increases the likelihood that the cancer may be found at a more advanced stage, possibly because it reduces the effectiveness of mammograms.
The increased risk from combined PHT appears to apply only to current and recent users. A woman's breast cancer risk seems to return to that of the general population within 5 years of stopping combined PHT.
• ERT: The use of estrogen alone does not appear to increase the risk of developing breast cancer significantly, if at all. But when used long term (for more than 10 years), ERT has been found to increase the risk of ovarian and breast cancer in some studies.
At this time there appear to be few strong reasons to use post-menopausal hormone therapy (combined PHT or ERT), other than possibly for the short-term relief of menopausal symptoms. The decision to use PHT should be made by a woman and her doctor after weighing the possible risks and benefits (including the severity of her menopausal symptoms), and considering her other risk factors for heart disease, breast cancer, and osteoporosis. If a woman and her doctor decide to try PHT for symptoms of menopause, it is usually best to use it at the lowest dose that works for her and for as short a time as possible.
4. Not breast-feeding • Some studies suggest that breast-feeding may slightly lower breast cancer risk, especially if breast-feeding is continued for 1½ to 2 years. But this has been a difficult area to study, especially in countries such as the United States, where breast-feeding for this long is uncommon.
• The explanation for this possible effect may be that breast-feeding reduces a woman's total number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or going through early menopause).
5. Alcohol • Use of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed.
• Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol.
6. Being overweight or obese • Being overweight or obese has been found to increase breast cancer risk, especially for women after menopause.
• Before menopause, your ovaries produce most of your oestrogen and fat tissues produces a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman's estrogen comes from fat tissue. Having more fat tissue after menopause can increase your estrogen levels and thereby increase your likelihood of developing breast cancer.
The connection between weight and breast cancer risk is complex. For example, the risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.
7. Lack of physical activity • Evidence is growing that physical activity in the form of exercise reduces breast cancer risk.
There are other unproven, controversial and uncertain effect on breast cancer risk. For full text, see http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp
Due to some confusion over which styles of debate we should adopt, I am here to clarify how it will happen during the debate session.
There are 2 groups, Pro vs Anti. Each group is consisted of 4 members, with the first one being the captain of his respective teams. Namely, Majid(Pro) and Viran(Anti).
Each speaker is given 3 minutes to voice out their views, starting from the Pro Speaker 1, then Anti Speaker 1, followed by Pro Speaker 2, then Anti Speaker 2, and so on till Anti Speaker 4.
Speakers are allowed to rebut the points given by their opposing teams, while also to express their own views based on their stance WITHINtheir 3 minsperiod. Speakers are to decide on how long they should spend rebutting in their given 3 mins period; or not rebutting at all. However if all 3 minutes are spent only on rebutting, and no points are given at all, it would disadvantage that particular team.
When all speakers are done, both teams are given 1 minute to prepare their summary speeches. One person from each team shall present the speech in 2 minutes time.
I will be reminding every speaker when his/her time is 15 seconds from up, therefore he/she should end his/her speech within the remaining 15 seconds.
In this way, it would be more in order and easier to regulate. So in the end the debate session will take slightly more than 30 minutes to finish.
Please let me know if you have any questions. Tata :)
