==!!!... Breast Cancer ... !!!==

[Dr.Ayman]

http://www.hendrickhealth.org/healthy/images/00042719.jpg

Definition

Breast cancer is the abnormal growth and uncontrolled division of cells in the breast. Cancer cells can invade and destroy surrounding normal tissue, and can spread throughout the body via blood or lymph fluid (clear fluid bathing body cells) to start a new cancer in another part of the body.

Description

Every woman is at risk for breast cancer. If she lives to be 85, there is a one out of nine chance that she will develop the condition sometime during the rest of her life. As a woman ages, her risk of developing breast cancer rises dramatically regardless of her family history. The breast cancer risk of a 25-year-old woman is only one out of 19,608; by age 45, it is one in 93. In fact, 80% of all breast cancers are found in women over age 50.

Causes & symptoms

There are a number of risk factors for the development of breast cancer, including:

Family history of breast cancer in mother or sister
Early onset of menstruation and late menopause
Reproductive history: women who had no children or have children late in life and women who have never breastfed have increased risk
History of abnormal breast biopsies.

However, more than 70% of women who get breast cancer have no known risk factors. While a breast cancer gene was discovered in 1994, only about 5% of breast cancers are believed to be related to the gene.

In addition, some studies suggest that high fat diets, bottle feeding instead of breastfeeding, or using alcohol may contribute to the risk profile. Some studies have also found that for certain women, hormone replacement therapy may contribute to the development of breast cancer. However, these findings have been criticized.

It is important to realize that not all lumps detected in the breast are cancerous. Many are benign and require only the removal of the lump. While having several risk factors may boost a woman's chances of having breast cancer, the interplay of factors is complex. The best way to assess breast cancer risk is by doing monthly self examinations to detect any lump at an early stage. The second is to have a regular mammogram, an x ray of the front and side of the breast that will detect cysts or tumors at the earliest possible stage. Seeking risk assessment consultation at one of the many breast cancer centers located throughout the United States is also helpful.

The changes in the breast that may be a sign of breast cancer include:

Lump or thickening in breast or armpit
Changes in a nipple (thickening, pulling in, bleeding or discharge)
Dimpled or reddened skin over the breast
Change in size or shape
Abnormality on a mammogram.

Diagnosis

More than 90% of all breast cancers are detected by mammogram (a low-dose x ray of the breast). Mammograms should be done to evaluate a suspicious lump. Screening mammograms should be ordered according to the doctor's guidelines. Despite the controversy about the cost-effectiveness of mammograms for women in their 40s, most doctors agree with the current American Cancer Society guidelines that recommend screening mammograms every year or two for women between 40 and 49, and every year after age 50. Women with a family history of breast cancer may want to have a mammogram every year after age 40.

A typical mammography screening includes two views of each breast (one from above, and one from the side). Normally, the technician examines the x-ray pictures immediately to make sure no further x rays are needed, or to decide whether an ultrasound may be required.

If anything irregular is detected, such as a mass, changes from earlier mammograms, abnormalities of the skin, or enlargement of the lymph nodes, further testing may be recommended. This could include an ultrasound of the breast, a biopsy or needle sampling, or consultation with a breast surgeon.

Biopsy of the breast is a removal of breast tissue for examination by a pathologist. An excisional biopsy is a surgical procedure in which the entire lump area and some surrounding tissue is removed for examination. If the mass is very large, an incisional biopsy is done where only a portion of the area is removed and analysed. Needle biopsy can be done in two methods. An aspiration needle biopsy uses a very fine needle to withdraw cells and fluid from the mass for analysis. A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue from the mass that can be analyzed. These analyses can determine whether the mass is benign (non-cancerous) or cancerous and therefore, whether further treatment is required.

To find out if the cancer has spread to other parts of the body (metastasized), doctors remove some underarm lymph nodes to test for cancer cells that have spread and to assist in making decisions for treatment. Checking to see if there are cancer cells in the lymph nodes is also a way to tell how advanced the cancer is ("staging" cancer). Breast cancer is rated from Stage 0 to Stage IV. Staging uses the diagnostic information to tell the cancer physician (oncologist) how widespread the disease is and includes:

Stage 1-The cancer is no larger than 2 cm and no cancer cells are found in the lymph nodes.
Stage 2-The cancer is no larger than 2 cm but has spread to the lymph nodes or is larger than 2 cm but has not spread to the lymph nodes.
Stage 3A-Tumor is larger than 5 cm and has spread to the lymph nodes or is smaller than 5 cm, but has spread to the lymph nodes, which have grown into each other.
Stage 3B-Cancer has spread to tissues near the breast or to lymph nodes inside the chest wall, along the breastbone.
Stage 4-Cancer has spread to skin and lymph nodes near the collarbone or to other organs of the body

Treatment

The best chance for successful treatment is to find breast cancer early. Treatment options include surgery, chemotherapy and radiation. Breast cancer is treated in two ways, locally to eliminate tumor cells from the breast by surgery and radiation, and to systemically destroy cancer cells that have traveled to other parts of the body. Systemic therapy includes the use of drugs in chemotherapy and hormonal treatments to reduce the amount of estrogen circulating in the blood.

The extent of surgery depends on the type of breast cancer, whether the disease has spread, and the patient's age and health. If the tumor is less than about 1.6 inches or there isn't much chance it will return, the patient and doctor may opt for removal of the tumor alone (lumpectomy) followed by radiation therapy.

Studies have shown that conservative treatment (a lumpectomy or partial mastectomy) offers the same odds of survival as does removal of the entire breast (total mastectomy) in someone with a small breast tumor that has not spread into the nearby lymph nodes. New studies suggest that after lumpectomy, a combination of chemotherapy and radiation offers the best chance of long-term survival.

If the tumor is larger, a total (or simple) mastectomy may be needed. If the cancer has spread to the chest muscles, most doctors believe a radical mastectomy is the best solution. This operation is now used only when the cancer has spread to the chest muscle.

In a lumpectomy, the doctor removes:

The lump
Some of the tissue around it
Some of the lymph nodes under the arm may be removed (auxillary dissection) and tested to see if the cancer has spread there.

Even if no cancer is found in the nodes, radiation always follows lumpectomy and treatment may include chemotherapy.

In a modified radical mastectomy, the doctor removes:

The entire breast
The underarm lymph nodes
The lining over the chest muscle (but not the muscles themselves).

A radical mastectomy is almost never done, but if necessary the doctor removes:

The breast
The chest muscles
All of the lymph nodes under the arm.

Surgery can be combined with breast reconstruction (creating a new breast-shaped mound), either right away or later on. Patients who want breast reconstruction should tell the doctor before surgery, since this could change the way the surgeon operates.

Removing the tumor and a border of normal tissue around it will remove the cancer while saving most of the breast tissue. However, the longer a tumor has been growing in the breast, the more likely it will be that the cancer cells have spread to the lymph nodes. These nodes under the arm or in the chest are a common place for breast cancer cells to spread. During surgery, some of the nodes are removed to check for cancer cells.

The presence of cancer cells in the lymph nodes may require more extensive surgery. If the cancer has spread to the nodes, the patient will need either radiation, chemotherapy, hormone therapy, or a combination of all three after surgery. This is called "adjuvant therapy."

Radiation

Once the cancer has been removed, the doctor may recommend radiation to destroy or shrink any remaining breast cancer cells. Radiation stops the cancer cells from dividing. It works especially well on fast-growing tumors. Unfortunately, it also stops some types of healthy cells from dividing. Healthy cells that divide quickly, like those of the skin and hair, are affected the most. This is why radiation can cause fatigue, skin problems, and hair loss.

[Dr.Ayman]

Chemotherapy

Breast cancer surgery may be followed by chemotherapy in even the earliest stages. Chemotherapy is administered either orally or by injection into a blood vessel. It is usually given in cycles, followed by a period of time for recovery, followed by another course of drugs. Treatment time may range between four to nine months.

There may be significant side effects with some types of chemotherapy, including nausea and vomiting, temporarily hair loss, mouth or vaginal sores, fatigue, weakened immune system, and infertility. However, chemotherapy for early breast cancer uses medications that cause few side effects.

Hormone therapy

The growth of some breast cancer cells may be slowed by the drug tamoxifen. Given each day as a pill, tamoxifen travels throughout the bloodstream, affecting all cells in the body. Tamoxifen treatment lasts at least two years, and often as long as five. Research suggests that tamoxifen may lower the chance that a breast cancer can return by between 25% and 35%.

Side effects of tamoxifen may include a slightly higher risk of cancer of the lining of the uterus (endometrial cancer). The risk increases if the drug is taken for more than five years. Other side effects include menopause-like symptoms like weight gain, hot flashes, and mood swings.

Other possible hormone treatments include the use of progestins, estrogens, and androgens. In rare cases, the surgeon may suggest removal of the ovaries (oophorectomy) in pre-menopausal women as a way of eliminating the main source of estrogen, which can boost the growth of some breast tumors.

Stem cell treatment

Stem cell treatment is used to treat advanced breast cancer. By first removing a woman's stem cells from her bone marrow or blood, the doctor can use very high doses of chemotherapy or radiation to kill cancer cells. Because this also kills healthy white blood cells, leaving the woman vulnerable to infection, the stem cells are then replaced, where they restore the body's ability to fight infection.

Prognosis

The prognosis for breast cancer depends on the type and stage of cancer. Most patients can return to a normal lifestyle within a month or so after surgery. Exercises can help the patient regain strength and flexibility, and avoid building up too much fluid. Arm, shoulder, and chest exercises may help.

It is normal after breast cancer treatment to be depressed or moody, to cry, lose appetite, or feel unworthy or less interested in sex. If these problems last for a long time, counseling or a support group can help. Many women have found a support group of breast cancer survivors to be an invaluable help during this stage.

Prevention

While breast cancer can't be prevented, it can be diagnosed from a mammogram at an early stage when it is most treatable. Mammography remains the best way of detecting signs of breast cancer. A baseline mammogram should be done by age 35, so that a normal x ray can be used to compare future mammograms, even when there is no reason to believe there is a lump or cyst. In addition, women should check their own breasts at the same time each month.

Research over the past 15 years has shown that the drug tamoxifen has reduced the chance of a second unrelated breast cancer in women who have had one breast cancer. Scientists don't yet know, however, if tamoxifen can prevent breast cancer in women who have never had the disease.

[Dr. MacabrE]

Very amazing information you got there Dr Ayman

keep it like that way so we can learn more



thank u Dr ayman






MacabrE

[Dr.Ayman]

you are welcome:)

[Dr.Dawa]

thank you dr.ayman:):)

==============================================
Resources:
BOOKS
Hirshaut, Yashar and Peter Pressman. Breast Cancer: The Complete Handbook. New York: Bantam, 1996.
Kneece, Judy C. Finding a Lump in Your Breast: Where to Go, What to Do. Columbia, S.C.: Educate Publishing, 1996.
Lauersen, Niels and Eileen Stukane. The Complete Book of Breast Care. New York: Fawcett Columbine, 1996.
Love, Susan and Karen Lindsey. Dr. Susan Love's Breast Book. Reading, MA: Addison-Wesley, 1995.
Mayer's, Musa. Holding Tight, Letting Go: Living with Metastatic Breast Cancer. Sebastopol, CA: O'Reilly & Associates, 1997.
McGinn, Kerry A. The Informed Woman's Guide to Breast Health. Palo Alto, CA: Bull Publishing.
Porter, Margit Esser. Hope is Contagious: The Breast Cancer Tretament Survival Handbook. New York: Simon & Schuster, 1997.
Stoppard, Miriam. The Breast Book. New York: DK Publishing, 1996.
PERIODICALS
Fackelmann, Kathy."Refiguring the odds" Science News, 144 (July 31, 1993): 76-77.
Family Circle editors."Early detection: The best defense." Family Circle, (Oct. 31, 1992): 107.
ORGANIZATIONS
American Cancer Society. (800) ACS-2345. http://www.cancer.org.
Cancer Care, Inc. (800) 813-HOPE. http://www.cancercareinc.org.
Cancer Information Service of the NCI. (1-800-4-CANCER). http://wwwicic.nci.nih.gov.
National Alliance of Breast Cancer Organizations. 9 East 37th St., 10th floor, New York, NY 10016. (888) 80-NABCO.
National Coalition for Cancer Survivorship. 1010 Wayne Ave., 5th Floor, Silver Spring, MD 20910. (301) 650-8868.
National Women's Health Resource Center. 2425 L St. NW, 3rd floor, Washington, DC 20037. (202) 293-6045.
==============================================

[Dr.Ayman]

:)

[dr_messo]

nice word dr.ayman


waiting for more dear ..

:) :)

[H@SSOOM]

waaaaaaaaaaaaaaw

nice topic dear ayman


thankx

[Dr.Ayman]

i hope that you increase your knowledge by this topic

and we are waiting from you dears

:)



Best Regard,

[Dr.E]

Thank you Dr.Ayman for this topic and excuse me for this interaction.. Although it occurs infrequently, breast cancer can affect men as well as women. In many ways the disease appears similar in the two sexes. However, because male breast cancer is so uncommon, it has been difficult for researchers to accumulate extensive data, and several aspects of the disease have been the subjects of disagreement. In general, men tend to be somewhat older than women at the time of diagnosis, and the disease is often at a more advanced state. Like women, men are commonly treated with surgery for primary disease. For advanced disease, they usually receive some kind of hormone therapy, which is even more effective in men than in women. Men are less likely than women to develop cancer subsequently in the opposite breast, but more likely to have, or to have had, a second type of cancer. In the past, men were thought to have a poorer prognosis than women, but it now appears that in cases that are otherwise comparable any differences in prognosis are slight. The critical factors are prompt diagnosis and treatment.

The Male Breast
The breast of the adult male is similar to the breast of a preadolescent girl. It consists primarily of a few branching ducts lined by flattened cells and surrounded by connective tissue. In girls, these cells and ducts develop in response to hormones secreted during puberty.
In males, too, breast tissues are capable of responding to hormonal stimulation. Enlargement of the male breast due to growth of the ducts and supporting tissues is known as gynecomastia. Approximately 40 percent of all adolescent boys experience temporary breast enlargement, probably in response to hormones being secreted by the testes. Adolescent gynecomastia typically disappears within a year or two.
In older men the growth of breast tissue can be stimulated by several commonly used drugs and a number of diseases. In addition to the hormone estrogen, which is used to treat cancer of the prostate, gynecomastia can be cause by non-hormonal drugs widely prescribed for cardiovascular disorders (digitalis), high blood pressure (reserpine, spironolactone), migraines (ergotamine), and seizures (phenytoin). Gynecomastia can also occur in conjuction with cancer of the testes or the adrenal glands, cirrhosis of the liver, chronic renal dialysis, and a chromosomal disorder known as Klinefelter's syndrome. There is no evidence that forms of gynecomastia that are not estrogen-induced substantially alter the risk of male breast cancer.
The accumulation of fat in obese men can make the breast appear enlarged, but this is not true gynecomastia.

Cancer of the Male Breast
All of the types of breast cancer seen in women can occur in men, although some are quite rare. Not surprisingly, lobular carcinomas are very unusual, because lobules are normally absent from the male breast.
Almost all breast cancers in men, like most breast cancers in women, are carcinomas. The most common kind is infiltrating ductal carcinoma, which accounts for 73 percent of the cancers in men. Men can also develop Paget's disease and inflammatory carcinoma. Various sarcomas may occur, too, although they are uncommon.

To be continued..

[Dr.E]

Symptoms of Male Breast Cancer
A painless lump, usually discovered by the patient himself, is by far the most common first symptom of male breast cancer. Typically the lump appears beneath the areola, where breast tissue is concentrated.
However, a lump is seldom the only symptom. Men are more likely than women to have nipple discharge (sometimes bloody) and sign of local spread, including nipple retraction, fixation to the skin or the underlying tissues, and skin ulceration. About half the men with breast cancer have palpable axillary lymph nodes.
Most male breast cancers are not large. One study that reviewed a large number of cases found that 51 percent of the tumors were less than 3 centimeters in diameter. The largest, however, measured 28 by 16 centimeters.

Delayed Diagnosis
The fact that breast cancer in men has often spread locally before it is diagnosed - even though the small male breast should facilitate early diagnosis - has been attributed to several factors. Indeed, the very smallness of the male breast could be a factor. Lacking the bulk of the typical female breast, even a small carcinoma in a male lies close to the skin above it and the tissues of the chest wall beneath it. Consequently, the cancer can more readily invade these nearby structures. It has also been suggested that the location of male tumors, centered around the areola as most of them are, may facilitate the spread of cancer. Such centrally located tumors are thought by some to have easy access to internal mammary lymph pathways.
However, many people are unaware that men can develop breast cancer, and neither individual men themselves nor their physicians regularly examine men's breasts. Furthermore, when men discover signs of breast cancer they tend to delay before seeing a physician. A 1972 review of cases diagnosed since 1900 showed that men waited 18 months, on the average, before seeking medical advice; for men diagnosed since 1951, this dropped to 10 months, such a delay may in part occur because some men perceive breast cancer as a flaw in their masculinity and are reluctant to acknowledge its presence.

To be continued..

[Dr.E]

Rick Factors in Male Breast Cancer
Age
The incidence of breast cancer in men. like breast cancer in women, increases with increasing age. Although it has been reported in a 5-year-old boy, it is rare before age 35. The average of men at diagnosis is close to 65, about 5 years older than the average age for women.

Ethnicity
According to NCI's Surveillance, Epidemiology, and End Results (SEER) Program, breast cancer affects 14 black men in every million and 8 white men in every million. Some studies have also suggested that the incidence is higher among Jewish males of European ancestry.

Geography
In Egypt, male breast cancer represents 6 percent of all breast cancers, and in Zambia it accounts for 15 percent. It has been suggested that one contributing factor might be an excess of estrogen resulting from scistosomiasis, a liver disease produced by parasites. Others have proposed a link with liver disease caused by malnutrition.

Socioeconomic Status
A recent study comparing male breast cancer patients from five metropolitan areas with men of comparable backgrounds who did not have breast cancer found that the breast cancer patients were more likely to be college graduates and employed as professionals or managers.

Heredity
Several researchers have reported two or more cases of male breast cancer within a single family. Several of these reports have involved two brothers; one involved three brothers; and another described breast cancer in a man, his father, and his father's brother.

Hormones
Abnormal hormone activity, a factor that has been linked to the development of female breast cancer, could play a role in the development of male breast cancer as well. Several disorders with a hormonal component have been associated with an increased risk of male breast cancer, and numerous studies have suggested that men with breast cancer display abnormal patterns of hormone metabolism and excretion. In a possibly related finding, one study has indicated that men with breast cancer married at relatively older ages and failed to have children. In laboratory experiments, it is possible to produce breast cancer in male mice and rats by means of manipulating hormones. At the same time, it has long been known that men with breast cancer tend to respond well to hormone therapy.

Gynecomastia
The relationship between gynecomastia and breast cancer is unclear. Some authors report that as many as 20 percent of the male breast cancer patients in their studies have a history of gynecomastia. Gynecomastia is also a symptom of Klinefelter's syndrome, a chromosomal disorder that markedly increases a man's risk of developing breast cancer. Furthermore, gynecomastia is more common in areas such as Egypt, where male breast cancer accounts for a relatively large proportion of the total number of breast cancer cases.
On the other hand, numerous studies have found gynecomastia to be uncommon among breast cancer patients. Moreover, pathologists have identified no clear progression from the cell and tissue changes typical of gynecomastia to the changes characteristic of malignancy.

Klinefelter's Syndrome
Klinefelter's syndrome is a rare disorder characterized by an abnormal chromosome pattern (XXY), poorly developed sex organs, hormonal abnormalities, and gynecomastia. Men with this condition are 20 times more likely than the average man to develop breast cancer. They are also more likely to develop cancer in both breasts, or unusual types of second cancers.

Hormone-Containing Drugs
In the past a number of case reports suggested that estrogens taken to combat cancer of the prostate (a standard and widely used treatment, which is known to cause gynecomastia) might also cause male breast cancer. But more recent, large surveys have indicated that any such effect is very small. One hundred and fifty urologists surveyed by the American Medical Association identified on 2 of 17,000 prostate cancer patients treated with estrogens who had developed breast cancer. (Men with prostate cancer, it should be noted, have a shortened life expectancy, whereas breast cancer may take a long time to develop.) Breast tumors that do develop in men who have been treated for prostate cancer may represent metastasis from the prostate cancer rather than a primary malignancy originating in the breast.
In very large doses, however, estrogens may be more overtly linked to the development of male breast cancer. Two 20-year-old transsexuals who had sex-change operations, which included surgical castration and breast construction as well as large doses of estrogens, developed cancer within the following 5 years.

Testicular Disorders
A number of male breast cancer patients have a history of testicular infection (orchitis), testicular injury, or undescended testis.

Radiation
Radiation exposure, which is associated with an increased incidence of breast cancer in women, is also thought to play a role in the development of breast cancer in men. Several cases of male breast cancer have been linked to childhood radiation for benign disorders of the chest and neck. In one case breast cancer developed in a man who had been treated for childhood cancer with both radiation and chemotherapy.

Trauma
Several studies, especially older ones, suggested that a history of trauma to the breast preceded the diagnosis of male breast cancer in nearly 30 percent of all cases. However, most evidence suggests that nay link is coincidental, with the trauma perhaps calling attention to a preexisting tumor.

To be continued..

[Dr.E]

Diagnosis of Male Breast Cancer
The same procedures used to diagnose breast cancer in women can be used to diagnose breast cancer in men. These include medical history, physical examination, mammography, and thermography. As always, a definitive diagnosis can be made only by biopsy. Karyotyping, a technique used to determine a patient's chromosome pattern, might be used if a disorder like Klinefelter's syndrome is suspected. Studies to evaluate estrogen excretion patterns might also be performed.
In examining a man for breast cancer, a physician must distinguish between a malignant breast tumor and benign conditions, primarily gynecomastia, as well as cancers from other sites that have metastasized to the breast. Metastases to the breast from other types of cancer call for treatment of the primary cancer, whatever it is. Primary breast cancer, in contrast, is potentially curable through surgery and, perhaps, adjuvant therapy.
Unlike gynecomastia, which typically produces a swelling that is firm, well defined, and tender, a malignant breast lump is more likely to be hard, irregular, and painless. In both gynecomastia and breast cancer the lump can adhere to the areola, but a mass due to gynecomastia is not usually fixed to the underlying tissues, nor does it produce ulceration other changes in the nipple and areola. Such changes, as well as skin thickening, inflammation, nipple discharge (especially bloody discharge), and enlarged axillary nodes, are likely to be signs of malignancy. Examination of the testicles sometimes reveals tumors or other testicular lesions that can be responsible for breast enlargement. In general, both youth and bilateral disease favor a diagnosis of gynecomastia.
Mammography is a useful tool for distinguishing gynecomastia from breast cancer. On a mammogram gynecomastia tends to look smooth and form a symmetric cone backward from the nipple, while carcinoma is likely to have an irregular outline and sometimes looks like it is radiating fine needles. Typically carcinoma is dense, and possibly contains numerous tiny calcifications.

Staging and Prognosis
A man's prognosis, like a woman's, is influenced by the extent, or stage, or the disease at the time of diagnosis. Such features as positive axilary nodes, ulceration or fixation to underlying tissues, large tumor size, and tumor cells that exhibit highly malignant changes are all signs that the disease is more likely to have spread. Certain types of male breast cancer, including intraductal and papillary carcinomas, carry a better than average prognosis. The prognosis for Page's disease, however, is worse than the average, whereas in women it is better.
The most important prognosis variable is the status of the axillary nodes. Data from two studies indicate that men with negative nodes experienced 5- and 10-year survivals of 79 percent and 58 percent, respectively. The comparable figures for men with positive nodes were 28 and 6 percent.
Data from the SEER program found that 58 percent of the 88 men diagnosed between 1970 and 1973 were classified as having localized disease; 33 percent, regional disease; and 7 percent, distant spread (2 percent were unknown). The comparable SEER figures for women were similar - 48, 41,9, and 2 percent, respectively. In one large series of nearly 400 men with breast cancer, 34 percent of the men were classified as Stage I, 14 percent as Stage II, 40 percent as stage III, and 12 percent as Stage IV (Stage I being earliest, Stage IV most developed). The large proportion of Stage III cases was due in great part to fixation of the tumor to the skin. Preoperative staging procedures are the same for men as for women. The most useful tests for detecting distant spread are bone scan and liver function tests. Many believe that breast cancer carries a worse prognosis for men than for women. The 1973 SEER data indicated that 5-year relative survival for all stages of breast cancer was 65 percent for white men. When the disease was localized, these figures rose to 85 percent and 66 percent, respectively. But data from numerous recent studies differ, and they are difficult to compare with earlier figures since the studies may involve small numbers, use differing criteria, or rely on pooled data. Some show marked differences in survival between men and women, others show none. In general, when the figures are adjusted to take into account the fact that more men than women are dying from unrelated causes (in part related to their older average age), male-female differences diminish. Overall, women may have a survival advantage, but it is slight.

Hormone Receptor Assays
Breast tumor tissues contain hormone receptors in a high proportion of men - over 80 percent,18 compared to about 65 percent in women. This discrepancy correlates well with the fact that more men than women with breast cancer - two-thirds versus one-third - respond to hormonal therapy.3 Biopsy specimens from gynecomastia, unlike breast cancer tissue, tend to contain low levels of hormone receptors. Hormone receptors now play an important role in selecting the proper treatment for women with breast cancer, but it is not yet known how important they will prove in treating male breast cancer. Preliminary evidence suggests that very low levels of hormone receptors might correspond to a poor response to hormone therapy. If this proves true, hormone receptor assays could be useful in identifying those few men with advanced disease who will not benefit from ablative or additive hormonal therapy. It is not known if hormone receptor status indicates in men, as it can in women, a good prognosis.

To be continued..

[Dr.E]

Treatment
The treatment of male breast cancer is generally similar to the treatment of female breast cancer. The basic therapy for primary cancer that shows no signs of distant spread is surgery. In advanced disease, it is hormonal therapy.

Local Disease
Surgery
Mastectomy, or surgical removal of the breast, is the standard treatment for male breast cancer, and is used in approximately 80 percent of all cases. Radical mastectomy is used most frequently, although in men a skin graft is often needed to close the wound. Simple mastectomy has been used either when prognosis is good, for patients with very limited disease, or when prognosis is poor, for patients deemed too old or too ill for more extensive surgery.

Radiation
Primary radiation therapy has sometimes been used to treat men with Stage I cancer who were not otherwise strong enough to tolerate anesthesia and surgery. More often radiotherapy alone has been used to relieve symptoms in patients with disease too advanced for potentially curative surgery. Men with breast cancer are often treated with postoperative adjuvant radiation therapy, but the extent to which this procedure improves survival is not known. A recent review concluded that limited surgery coupled with postoperative irradiation affords good disease control.
Adjuvant Chemotherapy
The decision to use adjuvant chemotherapy to treat men with breast cancer must be made on an individual basis. In women, such prophylactic systemic therapy has apparently benefited patients who have no signs of distant metastasis but who have positive axillary lymph nodes. The disadvantages of giving toxic drugs, especially to older patients, must be weighed against the high rate of recurrence for men with positive nodes.

Advanced Disease
Patterns of recurrence and metastasis are similar in men and women.12 Distant metastases most often affect the bones, lungs, lymph nodes, liver, and brain. Recurrences appear, on the average, within 2 years of initial treatment. Locally advanced disease or isolated metastases can be treated in men, as they are in women, by either surgery or radiotherapy. Extensive metastases are treated primarily by hormonal manipulation. More recently, chemotherapy has also been tried.

Ablative Hormone Therapy
For 40 years it has been known that, in a substantial portion of men with advanced breast cancer, surgery to remove the testes (orchiectomy) can cause tumors to shrink,metastases to clear up, and symptoms to disappear, for periods lasting from months to years. More recently, similar results have been achieved by removal of the adrenal glands (adrenalectomy) and the pituitary gland (hypophysectomy).
Orchiectomy, or surgical castration, is usually the initial ablative procedure because it produces a high response rate with few surgical complications. Men who respond to orchiectomy as well as those who fail to do so may respond subsequently to either adrenalectomy or hypophysectomy, and these operations can be used sequentially.
One large review established that orchiectomy produced tumor regression in two-thirds of the men treated; the median response lasted 22 months. Adrenalectomy led to a response in three-fourths of the patients, which lasted for a median period of 26 months. Hypophysectomy succeeded in more than half of the men, with responses lasting for a median duration of 20 months. These therapies not only produced tumor regression and relief of symptoms, but they also lengthened the responders' survival.

Additive Hormone Therapy
Several reports have suggested that additive hormone therapy, which is so widely used in women, is of little value in treating male breast cancer. Other reports, however, particularly from European centers, indicate that hormones such as the synthetic estrogen, diethylstilbestrol (DES), can be effective. For example, on study found that DES produced long remissions (a median of 60 months) in nearly two-thirds of the men with metastases to soft tissue sites such as skin and lymph nodes; however, no patients with bone metastases responded. Some men with breast cancer have also responded to progesterone.

Antiestrogens
To date, only a few men with breast cancer have been treated with the antiestrogen drug, tamoxifen. Initial results indicate that tamoxifen will produce remissions in nearly half of those men treated.

Chemotherapy
Although few men have been treated for advanced breast cancer with chemotherapeutic agents, in one series 18 men were given a variety of drugs. For the most part, they received one drug at a time, not combinations. The overall response rate was 44 percent, and all types of metastases responded. In view of the fact that endocrine therapy benefits so many men, chemotherapy is likely to play a secondary role in advanced male breast cancer. However, in the future, estrogen receptor status could help identify men less likely to respond to hormone manipulations. For them, chemotherapy might be the more appropriate treatment.

Rehabilitation
Little has been written about the psychosocial problems that men face in adjusting to breast cancer. In addition to the types of feelings that beset other cancer patients, a man who has breast cancer is confronted with several special challenges. To begin with, the rarity of his condition could leave him feeling particularly alone and helpless, especially if his physician has seldom or never treated the disorder before. Second, having a disease that is predominantly female, and one that involves hormone imbalances, might be seen as a threat to the patient's masculinity. The problem is further complicated if the patient must undergo surgical castration or take feminizing estrogens. Finally, loss of arm strength following radical mastectomy can incapacitate a man whose work or recreation involves physical activity.

Future Considerations
The small numbers of men who develop breast cancer make it unlikely that large prospective trials can ever be undertaken to compare various therapies. However, it is possible that institutions that see more than the usual number of cases could collaborate in building up a fund of reliable information. In the meantime, it is important that individual physicians and surgeons keep careful records to document the cases of the several hundred men who develop breast cancer each year in the United States.
To improve the prognosis of male breast cancer, broader efforts are needed to let men know that the disease exists and that, like other cancers, it can be cured or controlled if it is diagnosed and treated promptly.

[Dr.E]

References
1. S.J. Cutler and J.L. Young, Jr., eds. "Third National Cancer
Survery: Incidence Data." National Cancer Institute Monograph 41,
U.S
Department of Health and Human Services Publication No. (NIH)
75-787, 1975.

2. American Cancer Society. 1983 Facts and Figures. New York: The
American Cancer Society, 1982.

3. Richard B. Everson and Marc E. Lippman. "Male Breast Cancer," in
Breast Cancer, Volume 3. William L. McGuire, ed. New York:
Plenum Plublishing Corporation, 1979.

4. Bernard Roswit and herbert Edlis. "Carcinoma of the Male Breast:
A Thirty Year Experience and Literature Review. Current Concepts
in Cancer." Radiation Oncology Biology Physics 4:711-716, 1978.

5. William L. Donegan. "Cancer of the Male Breast," in Cancer of the
Breast, William L. Donegan and John S. Spratt, eds. Philadelphia:
W.B. Saunders Company, 1979.

6. Lee G. Michels, Richard H. Gold, and Rolf D. Arndt. "Radiography
of Gynecomastia and Other Disorders of the Male Breast."
Radiology 122:117-122, 1977.

7. O. Scheike. "Factors Provoking Male Brast Cancer," in Risk
Factors in Breast Cancer. B.A. Stoll, ed. Chicago: year Book Medical
Publishers, 1976.

8. R.W. Crichlow. "Management of Male Breast Cancer," in Breast
Cancer Management - Early and Late. B.A. Stoll, ed. Chicago:
William Heinemann Medical Books Ltd., 1977.

9. R.W. Crichlow. "Carcinoma of the Male Breast." Surgery,
Gynecology & Obstetrics 134:1011-1019, 1972.

10. Ardyce J. Asire and Evelyn M. Shambaugh. "Cancer of the Breast,"
in Survival for Cancer of the Breast. U.S. Department of Health
and Human Services Publication No. (NIH) 78-1542, 1978.

11. R.S. Lin and I.I. Kessler. "Epidemiologic Findings in Male
Breast Cancer." Proceedings of the American Association for Cancer
Research 21:72, 1980.

12. Frank L. Meyskens, Jr., Douglass C. Tormey, and James P.
Neifeld. "Male Breast Cancer: A Review." Cancer Treatment Reviews
3:83-93, 1976.

13. A.I. Holleb, H.P. Freeman, and J.H.Farrow. "Cancer of Male
Breast, Part II." New York Journal of Medicine 68:656-663, 1968.

14. W.S. Symmers. "Carcinoma of Breast in Trans-sexual Individuals
After Surgical and Hormonal Interference with the Primary and
Secondary Sex Characteristics." British Medical Journal 2:83-85,
1968.

15. Donna K. Thompson, Frederick P. Li, and J. Robert Cassady.
"Breast Cancer in a Man 30 Years After Radiation for Metastatic
Osteogenic Sarcoma." Cancer 44:2362-2365, 1979.

16. W.L. Donegan and C.M. Perez-Mesa. "Carcinoma of the Male Breast:
A 30-Year Review of 28 Cases." Archives of Surgery 106:273-
279, 1973.

17. O. Scheike. "Male Breast Cancer. 5. Clinical Manifestations in
257 Cases in Denmark." British Journal of Cancer 28:552-561, 1973.

18. Michael A. Friedman, Philip G. Hoffman, Emmanuel M. Dandolos,
etal. "Estrogen Receptors in Male Breast Cancer: Clinical and
Pathologic Correlations." Cancer 47:134-137, 1981.

19. R. B. Everson, M.E. Lippman, W.L. McGuire,et al. "Clinical
Correlation of Steroid Receptors and Male Breast Cancer." Cancer
Research 40:991-997, 1980.

20. Naveen Gupta, Joseph L. Cohen, Charles rosenbaum, and Shanthi
Raam. "Estrogen Receptors in Male Breast Cancer." Cancer
46:1781-1784, 1980.

21. Roger Robinson and Eleanor D. Montague. "Treatment Results in
Males with Breast Cancer." Cancer 49:403-406, 1982.

22. Hwee-Yong Yap, Charles K. Tashima, George R. Blumenschein,
Gabriel N. Hortobagyi, and Nylene Eckles. "Chemotherapy for
Advanced Male Breast Cancer." Journal of the American Medical
Assocation 243:1739-1741, 1980.

23. G.G. Riberio. "The Results of Diethylstilbestrol Therapy for
Recurrent and Metastic Carcinoma of the Male Breast." British
Journal
of Cancer 33:465-467, 1976.

24. William G. Kraybill, Richard Kaufman, and David Kinne. "Tratment
of Advanced Male Breast Cancer." Cancer 47:2185-2189,
1981.

25. John S. Patterson, Linda A. Battersby, and Beverley K. Bach.
"Use of Tamoxifen in Advanced Male Breast Cancer." Cancer
Treatment Reports 64:801-804, 1980.

26. William L. Donegan, "Invited Commentary." World Journal of
Surgery 4:623-624, 1980.


Best regards,
Dr.E

[Dr.Dawa]

thank you Dr.E for your useful reply:) :)

[Dr.Ayman]

thanx all :)


Best Regard,

[dr_mido]

thank you dear ayman


i did not

read the hole subject

however ...

thank you :)

[Dr.Ayman]

you are welcome

dr_mido


:)