About the breast
Since the time of Eve, the breast has been an organ that has represented nourishment as well as tenderness and compassion. Technically speaking, the breast is a modified sweat gland that arises in the developing fetus from the fifth week of gestation. From this beginning in the mother's womb, the breast varies in shape under the influence of hormones throughout the many phases of a woman's life.
Facts about breast cancer
Chances of a woman getting breast cancer as she ages. Misconceptions about breast cancer. The American Cancer Society guidelines.
It is important to remember that a woman's breasts are continually changing. Factors such as age, the monthly menstrual cycle, pregnancy, breast feeding, birth control or other hormone pills, menopause, bruises or blows to the breast can cause these changes.   In addition, breasts vary in size, shape and texture - even from each other on the same woman. Because most breast lumps are found by women themselves, you should learn how to examine your breasts and do so monthly. (Click here for instructions in monthly self-examinations.) As you do this, you will develop more confidence in knowing how your breasts normally feel and you should be able to recognize any changes. If you do find a change, don't let fear keep you from seeing your doctor, as most breast lumps are benign. When breast cancer is found and treated early, a woman has more treatment choices and a good chance of complete recovery, so early detection is very important.   Breasts are made up of ducts, lobes, lobules, fibrous tissue and fat with underlying muscle and bones (ribs). Therefore, it is normal for breasts to feel lumpy or uneven. Before your menstrual period begins, and sometimes during your period, you can have tenderness, pain or lumps in your breasts because of the extra fluid that collects in the tissue. This is normal.
If you'd like to know more, please continue in this journey of discovery:
An Inside View
Puberty (Spring)
At the onset of puberty, breast buds enlarge, becoming palpable, coin-like discs beneath the nipple. Growth during this phase may even proceed asymmetrically because of the fluctuating hormonal environment and variable end-organ sensitivity. Thus, the detection of an asymmetric lump beneath the nipple prior to puberty should not be cause for concern. This asymmetric development is self-limited and breast growth equalizes in most women. Biopsy should not be considered, as removal of the breast bud will result in failure of breast development.
Maturation and lactation (Summer)
As the breast grows, subcutaneous adipose and connective tissue increase in volume, with the formation of lobule ducts, which have an important role in lactation.   Pregnancy clearly has a profound effect on the breast, during which there is generalized proliferation of lobules in the duct network which is lined by two types of cells: an inner epithelial layer surrounded by a thinner discontinuous layer of moyepithelial cells, which play a major role in milk expression during lactation, influenced by specific hormones.
Aging changes (Autumn and Winter)
This occurs as women age, with hormonal alternation at the time of menopause.
The menopause
What exactly does the menopause mean?
The menopause is simply the name given to the time is a women's life when she stops having monthly periods and becomes unable to have any more children. Usually it happens when you are between 45 and 55 years old. The menopause is often called the change of life or simply the change.
Why does it happen?
During your childbearing years your ovaries produce oestrogen every month, associated with the ripening of the some eggs. Ostrogen is one of the hormone which help to get the womb ready for a fertilised egg. If no egg fertilised that month, the ostrogen stops being produced and the lining of the womb breaks down and is lost through through the vagina. This what happens when you have a period. As you approach the menopause your ovaries produce no oestrogen at all and your period stop completely.
What symptoms might I experience?
Your periods
As you get nearer to the periods tend heavier and last longer. At this stage they may come closer together than usual. Later on they become more irregular gaps between them until they stop altogether. In a few women they may continue to be regular and simply stop without warning.
Hot flushes
Hot flushes are the commonest symptom of the menopause. They often begin before your period stop, but only during the week of the period. They are likely to come on more frequently after your periods have stopped and can persist for several years. Hot flushes are harmless but can be quite a nuisance. You suddenly feel very hot, particularly around a round the breast, neck and face, and you will probably turn bright red. The flush usually lasts for less than a minute. It is often accompanied by sweating and followed by a feeling of cold and shivering. Some women complained of palpitations an unpleasant feeling that the heart beating very rapidly. Many women find that the hot flushes occur at night, and this can be very tiring, especially if you have to get up to wash or change your nightie. Needless to say, this sort of thing can also cause stress on a couple's relationship as the husband regularly find him self woken up suddenly in the middle of the night.
Osteoporosis
Osteoporosis or thinning of the bones affects most middle-aged and elderly women to some extent, but you are unlikely to notice that it is happening. Osteoporosis is the reason why many elderly women have shrunk in height, and often seem rather stooped. This is due to a very gradual collapse of the bones in the spine. Sometimes this causes backache.
Hormone replacement therapy
Your doctor can help
No longer is grin and bear the only treatment for the menopause. If your doctor advises it you can take Hormone Replacement Therapy (HRT). HRT consists of low doses of oestrogen that help to replace the body's own oestrogens which are lost at the menopause. Tablets are the most common form of HRT. This usually cosists of a continuos monthly course of 28 days of oestrogen tablets combined with 10-14 day course of progestogen, which produces a regular withdrawal bleed, or period and helps to protect the lining of the womb.
If you have had hysterectomy
If you have had an operation to remove your womb (i.e. if you have had a hysterectomy), you will not have monthly bleeding while you are taking HRT, and you will not need to take progestogen tablets as will as your womb, have been removed, you may be prescribed HRT, even if you are nowhere near the usual menopausal age. This is because lack of oestrogen caused by removal of the ovaries causes a premature menopause with all the typical symptoms of hot flushes, etc.
How long should you take HRT?
For relief of menopausal symptoms you may be prescribed HRT for up to 2 years. Some women may be prescribed HRT on a long terms basis (5-10 years or more), particularly if you are at risk of developing osteoporosis. It is advisable not to stop therapy without consulting your doctor.
The benefits of HRT
HRT provides very relief from the unpleasant symptoms caused by lack of oestrogen, such as hot flushes and vaginal dryness. HRT also slows down thinning of the bones, reducing the risk of fractures. It can sometimes also help to improve your emotional state, but you should remember that this only applies if your depression or the increased risk of heart attacks and arterial disease that occur after the menopause. HRT is not suitable for all treatment, that has improved the well-being of millions of women worldwide.
Hormone replacement therapy - The facts
• HRT replaces the natural hormones that are lacking at the menopause. • HRT relieves hot flushes, vaginal dryness, frequent urination and other unpleasant symptoms, when these are due to lack of ostrogen. • HRT also helps to prevent thinning of the bones. • HRT can be taken as tablets, creams, patches or implants. • HRT is not the same as the contraceptive pill. The types of hormones are different from those used in the pill. • HRT using combined oestrogen and progestogen is not though to increases the risk of cancer of the lining of the womb. • HRT occasionally causes breast tenderness or nausea, but changing to a different type of tablet can often cure these. • HRT can help many women, but it is not suitable for everyone. Your doctor will be able to advise you on what is best for you.

Breast Self-Exams Interactive tutorial

To view your Breast Self-Exams Calendar, click here. The following movie will teach you how to perform  Breast Self-Exam (BSE). “This movie is for medical purposes only – viewer discretion is advised!” Many thanks to The Susan G. Komen, Breast Cancer Foundation. Please click here and then choose: About Breast Cancer -> Early Detection and Screening -> Breast Self-Exam

Breast diseases Interactive tutorial

The following movie describes the anatomy of Breast Cancer, it will teach you all you need to know about breast cancer. “This movie is for medical purposes only – viewer discretion is advised!” Many thanks to The Susan G. Komen, Breast Cancer Foundation. Please click here and then choose: Anatomy of Breast Cancer -> English Version

Breast cancer detection
Before we begin our discussion of breast cancer itself, it is important to remember that the breast is an organ like any other in our bodies. Sometimes it may be tender, hurt, become inflamed or even express some discharge. However, most of these occurrences are due to benign causes or changes. In fact, about 80% of breast diseases are benign while only 20% are cancerous.
It is fortunate for women that the breast lies outside the body cavity. Hence, we can visually notice or feel many abnormalities with our own hands, unlike problems in our body's internal organs. While it is imperative to keep in mind that the majority of breast diseases are not cancerous; the gravity of breast cancer itself should be a strong motivation to follow the guidelines for early detection.
What causes breast cancer?
	Science is still debating specific causes of breast cancer. However, women, especially those in developing countries, should be reassured it is a medical problem and not a social disease.
What is cancer of the breast?
Cancer of the breast can have all the features which are characteristic of cancers in general. The tumour usually arises from the cells of milk sacs or milk ducts, although malignant tumour occasionally arise from the supporting structure. Even a cancer arising from the sacs or ducts may show variation.
It may grow into the duct canal and signal its presence early with bleeding from the nipple. Alternatively, it may grow into the breast tissue as a mass which is usually very hard, but may with some kinds of tumours be soft. It is however, far more common to be a hard mass in the breast and most often, but not always, painless. Very occasionally a serous bloody nipple discharge can herald the onset of cancer. Cancer of the breast occurs almost exclusively in women - it is one hundred times more common in women than men. It is rare in women under 30 years old, and becomes more common after age 50.
Risk factors in breast cancer
We do not yet know the causes of breast cancer but research is adding to our knowledge every year. Studies of large numbers of women with the disease have identified a number of risk factors which increase the chances of developing breast cancer. They are:
1 Age. Breast cancer is more commonly found in women over the age of 50. 2 Previous breast cancer. 3 Strong family history of premenopausal breast cancer. If more that one first degree relative (mother,sister) has had breast cancer, then there is an increased risk for developing the disease. 4 A precancerous finding of "atypical epithelial hyperplasia" on biopsy. 5 Age at first pregnancy. Women who are over 30 when they have their first child run a slightly greater risk of developing breast cancer than women who had children before the age of 25. 6 menstruation. Onset of the menstrual periods (menarche) at a young age (before 12) and their discontinuation (menopause) at an older age has been associated with a slightly increased risk of breast cancer. 7 Diet. Evidence suggests that high intake of dietary fat is related to an increased incidence of breast cancer. However, this relationship requires further research.
In addition to these risk factors, the use of female sex hormones (estrogen) is associated with the increased occurrence of breast cancer in laboratory animals. In women of childbearing age, however, extensive studies on the effects of the birth control pill (which contain female sex hormones) have failed to demonstrate any increased risk of breast cancer. There is a misconception that an injury to the breast causes breast cancer. There is no evidence to support this statement. Rather it may be what first draws a woman's attention to a cancer which is already present. The effects of spontaneous or induced abortions and pesticide exposure on the risk of breast cancer are under study. Results to date suggest that breast feeding may confer some benefit

Protect yourself from breast cancer
Mammography & physical examination
All women between 50-69 years should have a mammogram every two years in combination with physical examination of the breasts by a trained health professional. A mammogram is a special x-ray of the breast using very small amounts of radiation. Visit your provincial breast cancer screening program or see your family physician to arrange for a mammogram.
These two procedures together (mammography and clinical breast examination) lead to earlier diagnosis of breast cancer and a significant improvement in survival. A woman at higher risk should consult her Physician for a personalized schedule.
Breast self examination
Although less reliable than mammography and physical examination of the breasts, by 40 years of age all women should practice breast self-examination (BSE} regularly, at the same time each month and they should continue this practice even after menopause. When practicing BSE be sure to examine all of your breast tissue, and the tissues in your armpits, using the pads of your fingers. As well, it is recommended that you visually examine your breast, looking particularly for differences between the breasts. Women's clinic can provide you with information on how to perform BSE. You can also ask your physician or your provincial screening centre to teach you BSE.
What are you looking for?
The most common sign of breast cancer is a mass, lump or thickening in the breast. The mass is rarely painful but some women report an unusual sensation in the area. Bleeding from the nipple may occur with cancers that grow into the duct system. Changes in the shape of the breast, such as differences between the size or shape of the two breasts, a recent in-drawing of a nipple, or pulling in of the skin so as to cause a dimple, are also important signs. You should remember, however, that while these signs may indicate an early cancer, they are more likely due to a non-cancerous disease. Therefore, while you certainly should see your physician immediately if you discover any of these signs, you should remember that the most likely cause will be some simple, easily treated disease rather that cancer.
Diet
While proof is lacking that diet affects your risk of developing breast cancer, for overall good health, it is wise to follow Guidelines for healthy eating. 1 Enjoy a variety of foods 2 Emphasize cereals, breads, other grain products, vegetables and fruits. 3 Choose lower fat dairy products, leaner meats, and foods prepared with little or no fats. 4 Achieve and maintain a healthy body weight by enjoying regular physical activity and healthy eating. 5 Limit salt, alcohol and caffeine.
How is breast cancer diagnosed?
If a lump is found in your breast, either through mammography, physical examination by a trained health professional or by breast self-examination, your physician will usually perform a more extensive physical examination. Depending on the findings, additional tests may be suggested. If the lump appears to be a cyst (a sac filled with fluid) your physician may insert a needle into the cyst area to remove the fluid. If it proves to be non-cancerous, nothing further usually needs to be done. If the lump appears to be solid, a special type of needle biopsy or surgical biopsy may be advised. This may require a local or a general anesthetic. All or part of the lump will be removed for examination under the microscope. The diagnosis can then be established accurately. Remember, however, that most biopsies prove the mass to be non-cancerous, or benign.

Treatment
Effective means of treating breast cancer are widely available and may be used alone or in combination, depending on your individual circumstances.
Surgery
Surgery is still the most commonly used treatment for localized breast cancer. However, the precise type of operation performed is determined after careful assessment and discussion between you and your doctor. The most common surgical procedures are: 1 Lumpectomy with axillary node dissection. This involves removal of the tumour, with a bit of adjacent normal breast plus the lymph glands of the armpit. 2 Modified radical mastectomy is the removal of the entire breast and tissue of the armpit. The surgeon performing the operation will be able to discuss with the patient the most appropriate procedure as each situation is unique, requiring an individual approach.
Radiation therapy
The use of radiation therapy in the management of breast cancer has been increasing in recent years. For many early cancers, radiation of the breast is used in combination with lumpectomy and surgical examination of the lymph glands in the armpit. In larger but still localized cancers, the armpit, the breast and the chest wall may be irradiated following surgical treatment. Finally, a number of complications due to spread of breast cancer to a distant site (e.g. pain) may be successfully treated with radiation. In these situations hormone or drug treatment may be given as well. The Goal of radiation treatment is to destroy cancer cells, but it may also damage normal cells within the irradiated area. This injury to normal tissues can lead to a variety of side effects depending on the area of the body treated. These side effects are usually temporary and resolve following the completion of radiotherapy.
Chemotherapy
Surgery and radiotherapy are very effective in removing or destroying cancerous tissue if it is known exactly where the cancer is and if adjacent essential normal organs and tissues can be preserved witout injury. Chemotherapy, on the other hand, once administered, is distributed through the entire body (the brain being the one exeption under certain circumstances), and is capable of destroying cancer cells wherever they exist. The major difficulty with cancer chemotherapy agents is that they must, while being destructive to cancer cells, be gentle on normal cells since their distribution is to both. Chemotherapy is often used as "adjuvant therapy", meaning that it is complementary to surgery and/or radiotherapy. 1 Where the primary tumour has been controlled by surgery or radiotherapy but a secondary tumour is known to exist, chemotherapy has proven helpful. 2 In some situations where the cancer is localized to one site, there are benefits to combining chemotherapy with the primary treatment. Extensive research has led to the development of many potent chemotherapeutic agents and skill in their uses. Side effects may occur when chemotherapy is used. They vary in their frequency and intensity depending on the drug being used and its dose. Some people have no apparent side effects. Any side effects should be reported to their physician. Most chemotherapy treatment does not require hospitalization but can be carried out in a clinic or in the physician's office.
Hormonal therapy
Breast cancer, in a great many cases, has been shown to be dependent for growth on the hormonal environment provided by the individual's body. More recently, it has become possible to predict with greater accuracy which breast cancers are likely to be hormone dependent. This provides yet another approach to suppressing the growth of these hormone-sensitive tumours. Sometimes suppression of tumour growth is achieved by reducing the level of appropriate hormones in the body through surgical removal, or x-ray destruction of the organ that normally produces these hormones (such as the ovary or adrenal gland). Drugs are now also available that serve to counteract the action of some of these hormones. On the other hand, tumour suppression is sometimes achieved by elevating the level of certain hormones by providing them in the form of drugs. Determining the effective combination to achieve hormone suppression is a complex matter and is dependent on many factors. Therefore this method of treatment should be discussed on an individual basis with the attending physician.
If, unfortunately cancer is diagnosed, clicking on any of the buttons below will give you some helpful questions to ask your doctor.
About treatments About radiation therapy About chemotherapy