HistoryThe oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization. The writing says about the disease, "There is no treatment." For centuries, physicians described similar cases in their practices, with the same conclusion. Ancient medicine, from the time of the Greeks through the 17th century, was based on humoralism, and thus believed that breast cancer was generally caused by imbalances in the fundamental fluids that controlled the body, especially an excess of black bile. Alternatively, patients often saw it as divine punishment. In the 18th century, a wide variety of medical explanations were proposed, including a lack of sexual activity, too much sexual activity, physical injuries to the breast, curdled breast milk, and various forms of lymphatic blockages, either internal or due to restrictive clothing. Although breast cancer was known in ancient times, it was uncommon until the 19th century,

Prominent women who died of breast cancer include Anne of Austria, the mother of Louis XIV of France; Mary Washington, mother of George, and Rachel Carson, the environmentalist.

The first case-controlled study on breast cancer epidemiology was done by Janet Lane - Claypon , who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.

In the 1980s and 1990s, thousands of women who had successfully completed standard treatment then demanded and received high-dose bone marrow transplants, thinking this would lead to better long-term survival. However, it proved completely ineffective, and 15–20% of women died because of the brutal treatment.

The 1995 reports from the Nurses' Health Study and the 2002 conclusions of the Women's Health Initiative trial conclusively proved that hormone replacement therapy significantly increased the incidence of breast cancer

Types of BCDuctal carcinoma in situ (DCIS)DCIS means that abnormal cells start in the cells lining the ducts without growing(invading) through the walls of the ducts into the tissue of the breast. Because theyhaven’t grown through the duct wall, these cells cannot spread to lymph nodes or otherorgans. But sometimes DCIS can go on to become an invasive cancer. That is why it issometimes called a pre-cancer. It is also sometimes called a non-invasive breast cancer..Nearly all women with cancer at this stage can be cured. Invasive (or infiltrating) ductal carcinoma (IDC)This is the most common breast cancer. It starts in the cells lining a duct, breaks throughthe wall of the duct, and invades (grows into) the tissue of the breast. From there it is ableto spread (metastasize) to nearby lymph nodes or other parts of the body. IDC accountsfor about 8 out of 10 invasive breast cancers.

Invasive (infiltrating) lobular carcinoma (ILC)This cancer starts in the cells lining the milk glands (the lobules). The cells grow throughthe wall of the lobules. From there, the cancer cells can spread (metastasize) to nearbylymph nodes or other parts of the body. About 1 in 10 invasive breast cancers are thistype.Inflammatory breast cancer (IBC)This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breastcancers. Often, there is no single lump or tumor. Instead, IBC makes the skin of thebreast look red and feel warm. It also may make the skin look thick and pitted, somethinglike an orange peel. The breast may get bigger, hard, tender, or itchy.In its early stages, inflammatory breast cancer is often mistaken for infection. Becausethere is no defined lump, it may not show up on a mammogram, which may make it evenharder to catch early. It has a higher chance of spreading and a worse outlook thaninvasive ductal or lobular cancer. For more details,.

Diagnosis of BCMammogramsA mammogram is an x-ray of the breast. It uses a very small amount of radiation. Ascreening mammogram is used to look for breast disease in women who do not seem tohave breast problems. Clinical breast examA clinical breast exam (CBE) is an exam of your breasts by a health expert such as adoctor, nurse practitioner, nurse, or physician assistant. The area under both arms willalso be checked.Breast awareness and breast self-examWomen should be aware of how their breasts normally look and feel and report anychanges to a doctor right away. Finding a change does not mean that you have cancer.A breast self-exam (BSE) is a step-by-step approach to checking your breasts forchanges. This exam can be done on a schedule. The best time to do BSE is when your breasts are not tender or swollen. If you find anychanges, see a doctor right away.It's OK for women not to do BSE or to do it once in a while.

MRI (magnetic resonance imaging)MRI scans use magnets and radio waves (instead of x-rays) to produce very detailed,cross-sectional images of the body.

Breast ultrasoundAn ultrasound uses sound waves to outline a part of the body. The sound wave echoes arepicked up by a computer to create a picture on a computer screen. For a breast ultrasound,a small, microphone-like instrument is placed on the skin of the breast after gel isapplied.

BiopsyA biopsy is done when other tests show that you might have breast cancer. The only wayto know for sure is for you to have a biopsy. During this test, cells from the area ofconcern are removed so they can be studied in the lab.

HER2/neu status: About 1 out of 5 breast cancers have too much of a protein calledHER2/neu. Tumors with increased levels of HER2/neu are called HER2-positive. Thesecancers tend to grow and spread faster than other breast cancers unless they are treatedwith certain drugs that target the HER2/neu protein HER2/neu testing should be done on all newly diagnosed breast cancers.Tests of gene patterns: Looking at the patterns of a number of genes at the same timecan help tell whether or not some breast cancers are likely to come back after the firsttreatment. This can help when deciding whether more treatment, such as chemotherapy,might be useful

Risk factors you cannot changeGender: Breast cancer is about 100 times more common in women than in men.Age: The chance of getting breast cancer goes up as a woman gets older.Genetic risk factors: Inherited changes (mutations) in certain genes like BRCA1 andBRCA2 can increase the risk.

Family history: Breast cancer risk is higher among women whose close bloodrelatives have this disease. Still, most women who get breast cancer do not have afamily history of this disease, so not having a relative with breast cancer doesn’tmean you won’t get it.Personal history of breast cancer: A woman with cancer in one breast has a greaterchance of getting a new cancer in the other breast or in another part of the samebreast. This is different from a return of the first cancer (called a recurrence).Race: Overall, white women are slightly more likely to get breast cancer thanAfrican-American women. African-American women, though, are more likely to dieof breast cancer. Asian, Hispanic, and Native-American women have a lower risk of

getting and dying from breast cancer.

Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer.Dense breast tissue can also make it harder for doctors to spot problems onmammograms.Certain benign (not cancer) breast problems: Women who have certain benign breast changes may have an increased risk of breast cancer. Some of these are more closely linked to breast cancer risk than others. Lobular carcinoma in situ: In this condition, cells that look like cancer cells are in the milk-making glands (lobules), but do not grow through the wall of the lobules and cannot spread to other parts of the body. It is not a true cancer or pre-cancer, but having LCIS increases a woman's risk of getting cancer in either breast later.Menstrual periods: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.Breast radiation early in life: Women who have had radiation treatment to the chestarea (as treatment for another cancer) as a child or young adult have a greatlyincreased risk of breast cancer. The risk from chest radiation is highest if the radiation were given during the teens, when the breasts were still developing.

Breast cancer risk and lifestyle choices

Not having children or having them later in life: Women who have not hadchildren, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant many times or pregnant when younger reduces breast cancer risk.

Certain kinds of birth control: Studies have found that women who are using birthcontrol pills or an injectable form of birth control called Using hormone therapy after menopause: Taking estrogen and progesterone aftermenopause (sometimes called combined hormone therapy) increases the risk ofgetting breast cancer. The breast cancer risk seems to go back to normal over timeonce the hormones are stopped. The use of estrogen alone after menopause does notseem to increase the risk of developing breast cancer, but it can increase the risk ofother cancers.Not breastfeeding: Some studies have shown that breastfeeding slightly lowersbreast cancer risk, especially if breastfeeding lasts 1½ to 2 years.Alcohol: The use of alcohol is clearly linked to an increased risk of getting breastcancer. Even as little as one drink a day can increase risk.Being overweight or obese: Being overweight or obese after menopause (or becauseof weight gain that took place as an adult) is linked to a higher risk of breast cancer.

Treatment & MedicationSurgery

Mastectomy

A mastectomy is the surgical removal of the breast, non-protruding breast tissue,

Breast reconstruction surgery may be conducted after the removal of the breast.

Lumpectomy

In this surgical procedure, the breast is conserved and the tumor is removed.

Radiation commonly follows a lumpectomy to try to rid the body of any other cancerous cells.

Radiation

Radiation, at high energy levels, has the ability to destroy what is in its path, including normal and abnormal cells

Chemotherapy

Chemotherapy works by destroying cells that are dividing and multiplying all the time.

Chemotherapy is used for treatment of breast cancer because there is a possibility of the cancer to spread to other parts of the body.

Chemotherapy works better for premenopausal women.

Systemic chemotherapy can prevent the spread of cancer.

Chemotherapy drugs are administered intravenously.

Hormone therapy for breast cancerCancers that have hormone receptors in the cells (are ER-positive or PR-positive) arecalled hormone receptor-positive. In those cancers, the female hormone estrogenpromotes the growth of the cancer. Hormone therapy for breast cancer works by blockingthe effects of estrogen or lowering estrogen levels.

It can be used to help reduce the risk of the cancer coming back after surgery. It is alsohelpful in treating advanced breast cancer.

Radiation therapy Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).

Removing the breast cancer (lumpectomy). During lumpectomy, which may be referred to as breast-sparing surgery or wide local

excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for

smaller tumors.

Removing the entire breast (mastectomy). Mastectomy is surgery to remove all of your breast tissue. Most mastectomy procedures

remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola (simple mastectomy).

In a skin-sparing mastectomy, the skin over the breast is left intact to improve reconstruction and appearance.

Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph

nodes, your surgeon will discuss with you the role of removing the lymph nodes that receive the lymph drainage from your tumor. If no

cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes

need to be removed.

Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel node, your surgeon will discuss

with you the role of removing additional lymph nodes in your armpit.

Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed

(contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast. Discuss your breast cancer

risk with your doctor, along with the benefits and risks of this procedure.

TNM staging systemTNM (Tumor, Node, Metastasis) is another staging system researchers use to provide more details about how the

cancer looks and behaves.

The TNM system is based on three characteristics:

size (T stands for tumor)

lymph node involvement (N stands for node)

whether the cancer has metastasized (M stands for metastasis), or moved beyond the breast to other parts of

the body.

The T (size) category describes the original (primary) tumor:

TX means the tumor can't be measured or found.

T0 means there isn't any evidence of the primary tumor.

Tis means the cancer is "in situ" (the tumor has not started growing into healthy breast tissue).

T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into

neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into

the breast tissue.

The N (lymph node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

NX means the nearby lymph nodes can't be measured or found.

N0 means nearby lymph nodes do not contain cancer.

N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in

them. The higher the N number, the greater the extent of the lymph node involvement.

The M (metastasis) category tells whether or not there is evidence that the cancer has traveled to other parts of the

body:

MX means metastasis can't be measured or found.

M0 means there is no distant metastasis.

M1 means that distant metastasis is present.