Can Chinese Herbal Medicine Treat Cancer? The Research Says Yes

Western medicine has been rejecting Chinese Herbal Medicine for decades. It is not simply because it is foreign, or even unsubstantiated. It is not as if there isn’t any scientific and clinical research being done on traditional Chinese herbs. The reality is that western pharmaceutical medicine has been reluctant to embrace treatments that come without patents. Yes, unfortunately, it appears that money is the matter.

Western doctors are not necessarily to blame. Most are focused upon caring for their patients. But the tools they receive from those that control the flow of medicines to prescribe are watching the dollars. And herbal therapies simply don’t have the same potential for profits.

Large cancer review shows successes of Chinese herbs

A large scale review of research from Australian and Chinese University scientists has proven with thousands of studies through hundreds of thousands of cancer patients that Chinese herbal medicine offers significant treatment for most types of cancers – including breast cancer.
 

The research comes from Australia’s University of Western Sydney and the Beijing University of Chinese Medicine. The researchers analyzed and reviewed 2,964 human clinical studies that involved 253,434 cancer patients. Among these were 2,385 randomized controlled studies and 579 non-randomized controlled studies.

These studies covered most of the cancer types, but the cancers most studied were lung cancer, liver cancer, stomach cancer, breast cancer, esophageal cancer, colorectal cancer and nasopharyngeal (throat and sinus) cancer. Yes, breast cancer was the fourth most-studied type of cancer among these thousands of clinical studies.

The researchers discovered that the overwhelming majority of studies – 90% of the clinical studies – utilized herbal medicine.

The researchers found that 72% of these studies applied Traditional Chinese Medicine alongside conventional treatment, but a full 28% applied Traditional Chinese Medicine separately to experimental groups.

In terms of cancer patients, about 64% were given both TCM and conventional medical treatments. The rest were given TCM therapy alone, but a little over half of them did not qualify whether the patient was given conventional treatment at some point in the past.

Because of the large number of studies, there were different types of results, depending upon the type of study, the type of treatment, and the outcome measures tested. Still, in a full 1,015 studies or 85% of those that reported on symptoms, TCM treatment resulted in improvement of cancer symptoms with many of those reporting reduced pain. Another 883 studies – 70% – showed increased survival rates. Another 38% showed reduced tumor size, and 28% showed increased quality of life. Another 19% showed lower relapse rates and another 7% showed reduced complications.

The researchers also found that only a few studies tested TCM acupuncture treatment in cancer therapy. In their discussion they qualified that acupuncture treatment in cancer therapy to alleviate pain is quite popular in the U.S., but in Chinese cancer studies, herbal medicine therapy is the leading type of holistic treatment for cancer.

Other research validates evidence

This study follows another extensive review of research published in 2012 on TCM cancer treatment. This study comes from Norway’s National Research Center in Complementary and Alternative Medicine and the University of Tromsø, Norway, also with collaboration with the Beijing University of Chinese Medicine.
 

This earlier study reviewed significantly fewer studies, compiling 716 trials that included 1,198 cancer patients with either leukemia, stomach cancer, liver cancer or esophageal cancer.

Among these studies, 98.5% used herbal medicine, and again, acupuncture therapy was rare. In this study, symptom improvement was achieved in 85% of the patients that used the TCM therapy.

A large review confirms results

In yet another study – this one much larger than the second – 1,217 clinical studies between 1958 and 2011, involving 92,945 patients were analyzed and reviewed by researchers from the Beijing University of Chinese Medicine. Among these studies, 66% of the patients were treated with TCM therapy alone, while 34% of the patients were treated with a combination of TCM and conventional cancer therapy. Also, 82% of the patients were given herbal medicines orally.

Only 5% of the patients were given more than one type of TCM therapy. This means that 95% were treated with one type of TCM therapy.

This study found that among the studies treating cancer, symptom relief was the prominent result among 88% of the studies and among 88% of the patients tested with TCM therapy. Increased survival rates resulted in 73% of patients. Among all the rest of the studies, 96% of the trials resulted in symptom relief and 92% of the patients reported cancer symptom relief.

Astounding results
 

Did we get this right? Was that 88% and 92% symptom improvement or relief among thousands of studies and nearly 100,000 cancer patients? And 85% improvement of cancer symptoms among 716 clinical studies? And 85% symptom improvement among 1,015 clinical studies among a review involving over 250,000 cancer patients that tested the effectiveness of Chinese herbal medicine against cancer?
 

It sounds pretty solid that Chinese herbal medicine does indeed treat cancer and overwhelmingly results in the improvement or relief of symptoms as well as longer survival rates and reduced metastases.
 

Now why again is Western conventional medicine still refusing to at least consider herbal medicine therapy in cancer treatment? Could there be a profit motive involved? Could it have to do with the fact that herbal medicines cannot be patented? In other words, is Western conventional medicine ignoring inexpensive natural treatments that could help millions of cancer patients simply because of profits?
 

We’ll let them answer this question, as actions speak louder than words.

                                                  Guangzhou Fuda Cancer Hospital.

Love and touch make patients overcome cancer

Getting cancer is a disaster for a family. No one will igorne the pain and sadness from patients even the doctors and nurses, care more about patients and fight the cancer with them are not only about “duty”, it is human natutal affect. Only when have the same feeling, we are easy to touched and make us to try every effect to save the patients, so the “uncurable” cancer may be“ treatable”.

Kecheng Xu, a doctor who have studied cancer for decades, he is also a liver cancer patient. Since her mother died of advanced cancer, he decided to study the cancer for his whole life, so i wonder a doctor who spend his lifetime to study the cancer treatments with great hope to save more cancer patients, whether his story is touched for people?

Dr.Xu have mentioned that treating disease need theory and practice, it is a combination among science,technology and art as well as a ”Extreme Challenge” for advanced cancer patients. Actually, doctors face with ordeal when meeting patient everytime. They have to do countless clinical surgeries to get rich experience in treating people, for young doctors they have to learn from the professional and rich-experience doctors untill they are skillful enough or better than their teachers. For the past few years, our doctors have accepted a large number of “challenges”, every patient will be regarded as doctors’ challenge, they are team to discuss the patients’ condition and share the research idea and their experience to decide the best treatment for every patient. For get more advanced and effective treatments’ research, the doctors carry out the academic discussion with different countries every year, and visit the cancer survivor who achieve long-term survival after the treatments in our hospital from other countries, is to be able to make breakthrough of cancer treatments through knowing patients daily lifestyle, idea, and ways to fight cancer, hope can breakthrough and improve the existing clinical medicine technology to save more patients.

However, cancer therapies are not just methods to treat cancer, the more are the social love and emotion from doctors, nurses, patients, families and friends, I think helping patients to overcome cancer ultimately are love and strengh of solidarity. I have met a 60 year-old patient, there are several small or larger multiple tumors in his liver, his blood protein more than 200 microgramme. “though i have studies the liver cancer for decades, when i saw this liver patient i was shocked, that remind me of my mother died of terminal liver cancer 40 years ago, even though it is useless at that time i still sent for several best professors from Shanghai to treat my mother, no matter what kind of situation at that time, i still hope to catch any chance even there is little to save my mom in my heart, whatever cost i have to pay . Maybe the same feeling of loss and sorrow from the patient, when i meet them, there is always a twinge pain deep down my heart” the Dr.Xu said.

For this liver cancer patients, like his physical condition the surgery is impossible, chemo only do harm rather than good, radiation work little. Though cryosurgery is effective with liver cancer, but just good for less number tumors. “facing his daughter, I have no choice, i have to create the condition and try, finally i decided to use combined immunotherapy for cancer, hope can let tumor into “sleep” and live peaceful with cancer. The results showed that i was right, that may be one of the touch things, which stimulate myself to create new idea, it is a thought of breakthrough.” Dr. Xu said. Now, this pancreatic cancer patient have less tumor in his body, the survival cancer cells have been sleep and didn't recur again . After that, we went to his home, he is no longer focus on his work like before, the more he likes to do now are that not only play flute and erhu for his neighbors and friends every day, but also keep goldfish, rabbits and hamsters, he looks so happy and enjoyable. Maybe his families’ love to their father touch us, we are easy to be moved, then we keep on going to accept more challenges.

                                            Guangzhou Fuda Cancer Hospital

The prevention , symptom and diagnose of melanoma

Melanoma is a malignant tumor of melanocytes. Melanocytes produce the dark pigment, melanin, which is responsible for the color of skin. These cells predominantly occur in skin, but are also found in other parts of the body, including the bowel and the eye (see uveal melanoma). Melanoma can originate in any part of the body that contains melanocytes. Melanoma is less common than other skin cancers. However, it is much more dangerous if it is not found early. It causes the majority (75%) of deaths related to skin cancer. Worldwide, doctors diagnose about 160,000 new cases of melanoma yearly. In women, the most common site is the legs and melanomas in men are most common on the back. It is particularly common among Caucasians, especially northwestern Europeans living in sunny climates. There are high rates of incidence in Oceania, Northern America, Europe, Southern Africa, and Latin America, with a paradoxical decrease in southern Italy and Sicily. This geographic pattern reflects the primary cause, ultraviolet light (UV) exposure crossed with the amount of skin pigmentation in the population.

                                    Edited by Guangzhou Fuda Cancer Hospital

According to a WHO report, about 48,000 melanoma related deaths occur worldwide per year.The treatment includes surgical removal of the tumor. If melanoma is found early, while it is still small and thin, and if it is completely removed, then the chance of cure is high. The likelihood of the melanoma coming back or spreading depends on how deeply it has gone into the layers of the skin. For melanomas that come back or spread, treatments include chemo- and immunotherapy, or radiation therapy.

Signs and symptoms

Early signs of melanoma are changes to the shape or color of existing moles or, in the case of nodular melanoma, the appearance of a new lump anywhere on the skin (such lesions should be referred without delay to a dermatologist). At later stages, the mole may itch, ulcerate or bleed. Early signs of melanoma are summarized by the mnemonic "ABCDE":

•Asymmetry
•Borders (irregular)
•Color (variegated)
•Diameter (greater than 6 mm (0.24 in), about the size of a pencil eraser)
•Evolving over time

These classifications do not, however, apply to the most dangerous form of melanoma, nodular melanoma, which has its own classifications:

•Elevated above the skin surface
•Firm to the touch
•Growing
 

Metastatic melanoma may cause nonspecific paraneoplastic symptoms, including loss of appetite, nausea, vomiting and fatigue. Metastasis of early melanoma is possible, but relatively rare: less than a fifth of melanomas diagnosed early become metastatic. Brain metastases are particularly common in patients with metastatic melanoma. It can also spread to the liver, bones, abdomen or distant lymph nodes.

Cause

All cancers are caused by damage to the DNA inside cells. This damage can be inherited in the form of genetic mutations, but in most cases, it builds up over a person's lifetime and is caused by factors in their environment. DNA damage causes the cell to grow out of control, leading to atumor. Melanoma is usually caused by damage from UV light from the sun, but UV light from sunbeds can also contribute to the disease.

Genetics

See also: List of genes mutated in pigmented cutaneous lesions

A number of rare mutations, which often run in families, are known to greatly increase one’s susceptibility to melanoma. Several different genes have been identified as increasing the risk of developing melanoma. Some rare genes have a relatively high risk of causing melanoma; some more common genes, such as a gene called MC1R that causes red hair, have a relatively lower elevated risk. Genetic testing can be used to determine whether a person has one of the currently known mutations.

One class of mutations affects the gene CDKN2A. An alternative reading frame mutation in this gene leads to the destabilization of p53, a transcription factor involved in apoptosis and in fifty percent of human cancers. Another mutation in the same gene results in a nonfunctional inhibitor ofCDK4, a cyclin-dependent kinase that promotes cell division. Mutations that cause the skin condition xeroderma pigmentosum (XP) also seriously predispose one to melanoma. Scattered throughout the genome, these mutations reduce a cell’s ability to repair DNA. Both CDKN2A and XP mutations are highly penetrant (meaning that the chances of a person carrying the mutation to express the phenotype is very high).

Familial melanoma is genetically heterogeneous, and loci for familial melanoma have been identified on the chromosome arms 1p, 9p and 12q. Multiple genetic events have been related to the pathogenesis (disease development) of melanoma.The multiple tumor suppressor 1 (CDKN2A/MTS1) gene encodes p16INK4a – a low-molecular weight protein inhibitor of cyclin-dependent protein kinases (CDKs) – which has been localised to the p21 region of human chromosome 9.

Other mutations confer lower risk, but are more prevalent in the population. People with mutations in the MC1R gene, for example, are two to four times more likely to develop melanoma than those with two wild-type (typical unaffected type) copies of the gene. MC1R mutations are very common; in fact, all people with red hair have a mutated copy of the gene. Mutation of the MDM2 SNP309 gene is associated with increased risk of melanoma in younger women.

UV radiation

The UV radiation from tanning beds increases the risk of melanoma.The International Agency for Research on Cancer finds that tanning beds are "carcinogenic to humans" with people who begin using tanning devices before age 30 75% more likely to develop melanoma.

In a study scientists reveal that the dose of UV radiation is deciding factor and can lead to different pathway. The p16 pathway is favored at low doses of UV radiation and results in cell-cycle arrest, to the contrary; the p53 pathway is more responsive to higher doses and induces apoptosis depending on p53 mutation status.

Pathophysiology

The earliest stage of melanoma starts when the melanocytes begin to grow out of control. Melanocytes are found between the outer layer of the skin (the epidermis) and the next layer (the dermis). This early stage of the disease is called the radial growth phase, and the tumor is less than 1 mm thick. Because the cancer cells have not yet reached the blood vessels lower down in the skin, it is very unlikely that this early-stage cancer will spread to other parts of the body. If the melanoma is detected at this stage, then it can usually be completely removed with surgery.

When the tumor cells start to move in a different direction — vertically up into the epidermis and into the papillary dermis — the behaviour of the cells changes dramatically.

The next step in the evolution is the invasive radial growth phase, which is a confusing term; however, it explains the next step in the process of the radial growth, when individual cells start to acquire invasive potential. This step is important – from this point on the melanoma is capable of spreading. The Breslow's depth of the lesion is usually less than 1 mm (0.04 in), the Clark level is usually 2.

The following step in the process is the invasive melanoma — the vertical growth phase (VGP). The tumor attains invasive potential, meaning it can grow into the surrounding tissue and can spread around the body through blood or lymph vessels. The tumor thickness is usually more than 1 mm (0.04 in), and the tumor involves the deeper parts of the dermis.

The host elicits an immunological reaction against the tumor (during the VGP), which is judged by the presence and activity of the tumor infiltrating lymphocytes (TILs). These cells sometimes completely destroy the primary tumor; this is called regression, which is the latest stage of the melanoma development. In certain cases, the primary tumor is completely destroyed and only the metastatic tumor is discovered. About 40% of human melanomas contain activating mutations affecting the structure of the B-Raf protein, resulting in constitutive signaling through the Raf toMAP kinase pathway.

Diagnosis

Visual diagnosis of melanomas is still the most common method employed by health professionals.[24] Moles that are irregular in color or shape are often treated as candidates of melanoma. The diagnosis of melanoma requires experience, as early stages may look identical to harmless moles or not have any color at all. People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma. There is no blood test for detecting melanomas.

To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see "ABCDE" mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.

A popular method for remembering the signs and symptoms of melanoma is the mnemonic "ABCDE":

•Asymmetrical skin lesion.
•Border of the lesion is irregular.
•Color: melanomas usually have multiple colors.
•Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
•Enlarging: Enlarging or evolving
 

A weakness in this system is the diameter. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and all melanomas were malignant on day 1 of growth, which is merely a dot. An astute physician will examine all abnormal moles, including ones less than 6 mm in diameter. Seborrheic keratosis may meet some or all of the ABCD criteria, and can lead to false alarms among laypeople and sometimes even physicians. An experienced doctor can generally distinguish seborrheic keratosis from melanoma upon examination, or with dermatoscopy.

Some advocate the system "ABCDE", with E for evolution. Certainly moles that change and evolve will be a concern. Alternatively, some refer to E as elevation. Elevation can help identify a melanoma, but lack of elevation does not mean that the lesion is not a melanoma. Most melanomas are detected in the very early stage, or in-situ stage, before they become elevated. By the time elevation is visible, they may have progressed to the more dangerous invasive stage.

Nodular melanomas do not fulfill these criteria, having their own mnemonic, "EFG":

•Elevated: the lesion is raised above the surrounding skin.
•Firm: the nodule is solid to the touch.
•Growing: the nodule is increasing in size.

Prevention

Minimizing exposure to sources of ultraviolet radiation (the sun and sunbeds), following sun protection measures and wearing sun protective clothing (long-sleeved shirts, long trousers, and broad-brimmed hats) can offer protection. In the past, use of sunscreens with a sun protection factor (SPF) rating of 50 or higher on exposed areas were recommended; as older sunscreens more effectively blocked UVA with higher SPF. Currently, newer sunscreen ingredients (avobenzone, zinc, and titanium) effectively block both UVA and UVB even at lower SPFs. However, there are questions about the ability of sunscreen to prevent melanoma.This controversy is well discussed in numerous review articles, and is rejected by most dermatologists. This correlation might be due to the confounding variable that individuals who used sunscreen to prevent burn might have a higher lifetime exposure to either UVA or UVB. See Sunscreen controversy for further references and discussions. Using artificial light for tanning was once believed to help prevent skin cancers, but it can actually lead to an increased incidence of melanomas. Even though tanning beds emit mostly UVA, which causes tanning, it by itself might be enough to induce melanomas.

A good rule of thumb for decreasing ultraviolet light exposure is to avoid the sun between the hours of 9 a.m. and 3 p.m. or avoid the sun when one's shadow is shorter than one's height. These are rough rules, however, and can vary depending on locality and individual skin cancer risk.

Almost all melanomas start with altering the color and appearance of normal-looking skin. This area may be a dark spot or an abnormal new mole. Other melanomas form from a mole or freckle that is already present in the skin. It can be difficult to distinguish between a melanoma and a normal mole. When looking for danger signs in pigmented lesions of the skin, a few simple rules are often used.

FUDA Completed 100 Cases of NanoKnife (IRE), The Number of Which Ranks the First in Mainland China

In the morning of March 16, 2016, Guangzhou Fuda Cancer Hospital held a press conference, announcing that FUDA has completed 100 cases of NanoKnife, the number of which ranks the first in mainland China. Journalists from over ten media, including Xinhua News Agency, China News, Yangcheng Evening News, Nanfang Daily, Guangdong TV witnessed the moment. Two patients, Ms. Lu Mingying, winner of Rank Prize in England and Ms. Gregerson Gurli, a teacher from Denmark, who have gained benefits from Nanoknife  shared with the journalists their anti-cancer experience at the press conference.

Prof. Niu Lizhi, President of FUDA, announced that Guangzhou Fuda Cancer Hospital has completed 100 cases of NanoKnife

A memorable moment

At 1:30 p.m., March 8, 2016, Prof. Niu Lizhi, President of Guangzhou Fuda Cancer Hospital walked into the operation room in the dark green surgical gown to perform one case of NanoKnife.

It was a memorable moment as it marks the 100th case of NanoKnife that Guangzhou Fuda Cancer Hospital has done. The patient lying on the operating table was Ms. Gregerson Gurli, a 68-year-old retired teacher from Denmark--a legendary woman. In 2007, she was diagnosed with pancreatic cancer with liver metastases. Her doctor in Denmark said she only had two to three months to live. As she found no other good treatment in several European hospitals, she came to Guangzhou Fuda Cancer Hospital for treatment in February 2008. Gurli has undergone cryoablation, iodine seeds implantation therapy and other comprehensive treatments at FUDA from 2008 till now. Despite that cancers are still present in her body, she has survived for over 8 years since diagnosis. It is the concept of living with cancer that has rendered her a prolonged life. 

Prof. Niu noted that the 100th case of NanoKnife was done on liver tumors. “Recently, Ms. Gurli has been found to have multiple neuroendocrine tumors in liver. There are three tumors detected, the largest is about 5cm in size and the other two are about 4cm and 2cm in size respectively. Considering that the masses are big in size and are close to important structures as hepatic diaphragm dome and hepatic hilus, NanoKnife therapy will be able to deliver higher safety and less side effects. ”

All was ready and the treatment got started. The medical team led by Prof. Niu performed ablation on the biggest mass first. The mass was located at the S7 of liver and had high activity. Under the guidance of ultrasound and CT scan, Prof. Niu punctured the two NanoKnife probes into the base of tumor for ablation. Then the probes were relocated to ablate the other two masses. The screen clearly showed that the masses became necrosis and gasification after ablation; small bubbles were formed; the previous high-density echo became lower...Prof. Niu was satisfied with the ablation result. He noted, “As NanoKnife is a highly secure and mini-invasive treatment, the multiple masses in liver can be ablated at one time. Today, three masses in her liver have been ablated. The procedure went smoothly.”Five great leaps achieved by FUDA in the research on and clinical application of NanoKnife. 

At the press conference, Prof. Niu Lizhi introduced to the reporters that NanoKnife is currently the latest cutting-edge ablation technology for tumor in the world. During the procedure, high electric-field and ultra-short pulses are given to destroy lipid bilayer structure of cancer cell membrane and form numerous irreversible nano-sized pores in the cell membrane. Cell membrane permeability will be changed to allow molecules of different sizes free access to cells, which will lead to cell death. NanoKnife has been approved by America FDA in April, 2012 and has been certified to CE certification of EU. In June 2015, NanoKnife was approved by Chinese FDA for clinical application. Guangzhou Fuda Cancer Hospital has been five No. 1 in terms of the research on and clinical application of NanoKnife.

1. FUDA is the first cancer hospital in mainland China to have introduced NanoKnife.
 

2. As early as in August 2014, Xu Kecheng and Niu Lizhi compiled and published New Technique of Cancer Ablation Irreversible Electroporation--the first monograph on NanoKnife in China.
 

3. On July 2, 2015, the first case of NanoKnife in mainland China was completed at FUDA. The patient was a 61-year-old pancreatic cancer patient from a Middle East country.
 

4. As of March 8, 2016, 100 cases of NanoKnife have been done for patients with advanced pancreatic cancer, liver cancer etc. It has ablated the lesions and improved the quality of life for cancer patients. The cases of NanoKnife that has been done at FUDA rank the first in mainland China.
 

5. The number of papers on NanoKnife published on authoritative magazines, including Journal of Interventional Radiology and Chinese Journal of Radiology, etc. ranks the first in China.
 

Prof. Niu Lizhi noted, “NanoKnife can achieve complete ablation on small tumors and control and shrink big tumors. Looking back on the 100 cases of NanoKnife we have done, we found that NanoKnife has been delivering good curative effect for pancreatic cancer and liver cancer patients. The remission rate exceeds 80%, approaching the world level. With the development of the technology and the accumulation of experience, I’m convinced that NanoKnife will bring benefits to more cancer patients.”

What is breast cancer?

Breast cancer is a type of cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.Cancers originating from ducts are known as ductal carcinomas, while those originating from lobules are known as lobular carcinomas. Breast cancer occurs in humans and other mammals. While the overwhelming majority of human cases occur in women, male breast cancer can also occur.

The benefit versus harms of breast cancer screening is controversial. The characteristics of the cancer determine the treatment, which may include surgery, medications (hormonal therapy and chemotherapy), radiation and/or immunotherapy.Surgery provides the single largest benefit, and to increase the likelihood of cure, several chemotherapy regimens are commonly given in addition. Radiation is used after breast-conserving surgery and substantially improves local relapse rates and in many circumstances also overall survival.

Worldwide, breast cancer accounts for 22.9% of all cancers (excluding non-melanoma skin cancers) in women.[5] In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women). Breast cancer is more than 100 times more common in women than in men, although men tend to have poorer outcomes due to delays in diagnosis.
 

Prognosis and survival rates for breast cancer vary greatly depending on the cancer type, stage, treatment, and geographical location of the patient. Survival rates in the Western world are high;[6] for example, more than 8 out of 10 women (84%) in England diagnosed with breast cancer survive for at least 5 years.In developing countries, however, survival rates are much poorer.

Signs and symptoms

The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump. The earliest breast cancers are detected by a mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer.
 

Indications of breast cancer other than a lump may include thickening different from the other breast tissue, one breast becoming larger or lower, a nipple changing position or shape or becoming inverted, skin puckering or dimpling, a rash on or around a nipple, discharge from nipple/s, constant pain in part of the breast or armpit, and swelling beneath the armpit or around the collarbone. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.

Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange;[9] the absence of a discernible lump may delay detection dangerously.
 

Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as skin changes resembling eczema, such as redness, discoloration, or mild flaking of the nipple skin. As Paget's disease of the breast advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's disease of the breast also have a lump in the breast.
 

In rare cases, what initially appears as a fibroadenoma (hard, movable non-cancerous lump) could in fact be a phyllodes tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant.

Occasionally, breast cancer presents as metastatic disease—that is, cancer that has spread beyond the original organ. The symptoms caused by metastatic breast cancer will depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.

Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are called non-specific, meaning they could be manifestations of many other illnesses.

Most symptoms of breast disorders, including most lumps, do not turn out to represent underlying breast cancer. Fewer than 20% of lumps, for example, are cancerous,and benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. Nevertheless, the appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Risk factors

Main article: Risk factors of breast cancer
The primary risk factors for breast cancer are female sex and older age.Other potential risk factors include: lack of childbearing or lack of breastfeeding, higher levels of certain hormones,certain dietary patterns, and obesity.
 

Lifestyle

See also: List of breast carcinogenic substances
Smoking tobacco appears to increase the risk of breast cancer, with the greater the amount smoked and the earlier in life that smoking began, the higher the risk. In those who are long-term smokers, the risk is increased 35% to 50%. A lack of physical activity has been linked to ~10% of cases.

The association between breast feeding and breast cancer has not been clearly determined; some studies have found support for an association while others have not. In the 1980s, the abortion–breast cancer hypothesis posited that induced abortion increased the risk of developing breast cancer. This hypothesis was the subject of extensive scientific inquiry, which concluded that neither miscarriages nor abortions are associated with a heightened risk for breast cancer.There may be an association between use of oral contraceptives and the development of premenopausal breast cancer, but whether oral contraceptives use may actually cause premenopausal breast cancer is a matter of debate. If there is indeed a link, the absolute effect is small.In those with mutations in the breast cancer susceptibility genes BRCA1 or BRCA2, or who have a family history of breast cancer, use of modern oral contraceptives does not appear to affect the subsequent[clarification needed (subsequent to what?)] risk of breast cancer.

There is a relationship between diet and breast cancer, including an increased risk with a high fat diet,alcohol intake, and obesity. Dietary iodine deficiency may also play a role.

Other risk factors include radiation,and shift-work.A number of chemicals have also been linked including: polychlorinated biphenyls, polycyclic aromatic hydrocarbons, organic solvents and a number of pesticides.Although the radiation from mammography is a low dose, it is estimated that yearly screening from 40 to 80 years of age will cause approximately 225 cases of fatal breast cancer per million women screened.

Genetics

Some genetic susceptibility may play a minor role in most cases.Overall, however, genetics is believed to be the primary cause of 5–10% of all cases. In those with zero, one or two affected relatives, the risk of breast cancer before the age of 80 is 7.8%, 13.3%, and 21.1% with a subsequent mortality from the disease of 2.3%, 4.2%, and 7.6% respectively.In those with a first degree relative with the disease the risk of breast cancer between the age of 40 and 50 is double that of the general population.

In less than 5% of cases, genetics plays a more significant role by causing a hereditary breast–ovarian cancer syndrome.This includes those who carry the BRCA1 and BRCA2 gene mutation.These mutations account for up to 90% of the total genetic influence with a risk of breast cancer of 60–80% in those affected.Other significant mutations include: p53 (Li–Fraumeni syndrome), PTEN (Cowden syndrome), and STK11 (Peutz–Jeghers syndrome), CHEK2, ATM, BRIP1, and PALB2. In 2012, researchers said that there are four genetically distinct types of the breast cancer and that in each type, hallmark genetic changes lead to many cancers.

Medical conditions

Certain breast changes: atypical hyperplasia and lobular carcinoma in situ found in benign breast conditions such as fibrocystic breast changes are correlated with an increased breast cancer risk.

Pathophysiology

Breast cancer, like other cancers, occurs because of an interaction between an environmental (external) factor and a genetically susceptible host. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues. Cells become cancerous when they lose their ability to stop dividing, to attach to other cells, to stay where they belong, and to die at the proper time.

Normal cells will commit cell suicide (apoptosis) when they are no longer needed. Until then, they are protected from cell suicide by several protein clusters and pathways. One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently "on", rendering the cell incapable of committing suicide when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations. Normally, the PTEN protein turns off the PI3K/AKT pathway when the cell is ready for cell suicide. In some breast cancers, the gene for the PTEN protein is mutated, so the PI3K/AKT pathway is stuck in the "on" position, and the cancer cell does not commit suicide.
 

Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.

Failure of immune surveillance, the removal of malignant cells throughout one's life by the immune system. Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.[50][51] In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer.
 

In the United States, 10 to 20 percent of patients with breast cancer and patients with ovarian cancer have a first- or second-degree relative with one of these diseases. The familial tendency to develop these cancers is called hereditary breast–ovarian cancer syndrome. The best known of these, the BRCA mutations, confer a lifetime risk of breast cancer of between 60 and 85 percent and a lifetime risk of ovarian cancer of between 15 and 40 percent. Some mutations associated with cancer, such as p53, BRCA1 and BRCA2, occur in mechanisms to correct errors in DNA. These mutations are either inherited or acquired after birth. Presumably, they allow further mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs.However there is strong evidence of residual risk variation that goes well beyond hereditary BRCA gene mutations between carrier families. This is caused by unobserved risk factors. This implicates environmental and other causes as triggers for breast cancers. The inherited mutation in BRCA1 or BRCA2 genes can interfere with repair of DNA cross links and DNA double strand breaks (known functions of the encoded protein) These carcinogens cause DNA damage such as DNA cross links and double strand breaks that often require repairs by pathways containing BRCA1 and BRCA2.However, mutations in BRCA genes account for only 2 to 3 percent of all breast cancers.Levin et al. say that cancer may not be inevitable for all carriers of BRCA1 and BRCA2 mutations.About half of hereditary breast–ovarian cancer syndromes involve unknown genes.
 

Diagnosis

Most types of breast cancer are easy to diagnose by microscopic analysis of a sample—or biopsy—of the affected area of the breast. There are, however, rarer types of breast cancer that require specialized lab exams.
 

The two most commonly used screening methods, physical examination of the breasts by a healthcare provider and mammography, can offer an approximate likelihood that a lump is cancer, and may also detect some other lesions, such as a simple cyst.[60] When these examinations are inconclusive, a healthcare provider can remove a sample of the fluid in the lump for microscopic analysis (a procedure known as fine needle aspiration, or fine needle aspiration and cytology—FNAC) to help establish the diagnosis. The needle aspiration may be performed in a healthcare provider's office or clinic using local anaesthetic if required.[clarification needed] A finding of clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, physical examination of the breasts, mammography, and FNAC can be used to diagnose breast cancer with a good degree of accuracy.
 

Other options for biopsy include a core biopsy or vacuum-assisted breast biopsy, which are procedures in which a section of the breast lump is removed; or an excisional biopsy, in which the entire lump is removed. Very often the results of physical examination by a healthcare provider, mammography, and additional tests that may be performed in special circumstances (such as imaging by ultrasound or MRI) are sufficient to warrant excisional biopsy as the definitive diagnostic and primary treatment method.

Classification

Main article: Breast cancer classification
 

Breast cancers are classified by several grading systems. Each of these influences the prognosis and can affect treatment response. Description of a breast cancer optimally includes all of these factors.

Histopathology. Breast cancer is usually classified primarily by its histological appearance. Most breast cancers are derived from the epithelium lining the ducts or lobules, and these cancers are classified as ductal or lobular carcinoma. Carcinoma in situ is growth of low grade cancerous or precancerous cells within a particular tissue compartment such as the mammary duct without invasion of the surrounding tissue. In contrast, invasive carcinoma does not confine itself to the initial tissue compartment.
 

Grade. Grading compares the appearance of the breast cancer cells to the appearance of normal breast tissue. Normal cells in an organ like the breast become differentiated, meaning that they take on specific shapes and forms that reflect their function as part of that organ. Cancerous cells lose that differentiation. In cancer, the cells that would normally line up in an orderly way to make up the milk ducts become disorganized. Cell division becomes uncontrolled. Cell nuclei become less uniform. Pathologists describe cells as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade) as the cells progressively lose the features seen in normal breast cells. Poorly differentiated cancers (the ones whose tissue is least like normal breast tissue) have a worse prognosis.
 

Stage. Breast cancer staging using the TNM system is based on the size of the tumor (T), whether or not the tumor has spread to the lymph nodes (N) in the armpits, and whether the tumor has metastasized (M) (i.e. spread to a more distant part of the body). Larger size, nodal spread, and metastasis have a larger stage number and a worse prognosis.
 

The main stages are:
Stage 0 is a pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).
Stages 1–3 are within the breast or regional lymph nodes.
Stage 4 is 'metastatic' cancer that has a less favorable prognosis.
 

Receptor status. Breast cancer cells have receptors on their surface and in their cytoplasm and nucleus. Chemical messengers such as hormones bind to receptors, and this causes changes in the cell. Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2.
 

ER+ cancer cells depend on estrogen for their growth, so they can be treated with drugs to block estrogen effects (e.g. tamoxifen), and generally have a better prognosis. HER2+ breast cancer had a worse prognosis, but HER2+ cancer cells respond to drugs such as the monoclonal antibody trastuzumab (in combination with conventional chemotherapy), and this has improved the prognosis significantly.Cells with none of these receptors are called triple-negative although they frequently express receptors for other hormones such as androgen receptor and prolactin receptor.
 

In cases of breast cancer with low risk for metastasis, the risks associated with PET scans, CT scans, or bone scans outweigh the possible benefits.This is because these procedures expose the patient to a substantial amount of potentially dangerous ionizing radiation.
DNA assays. DNA testing of various types including DNA microarrays have compared normal cells to breast cancer cells. The specific changes in a particular breast cancer can be used to classify the cancer in several ways, and may assist in choosing the most effective treatment for that DNA type.
 

Prevention

Women may reduce their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children. These modifications might prevent 38% of breast cancers in the US, 42% in the UK, 28% in Brazil and 20% in China. The benefits with moderate exercise such as brisk walking are seen at all age groups including postmenopausal women.Marine omega-3 polyunsaturated fatty acids appear to reduce the risk.
 

Removal of both breasts before any cancer has been diagnosed or any suspicious lump or other lesion has appeared (a procedure known as prophylactice bilateral mastectomy) may be considered in people with BRCA1 and BRCA2 mutations, which are associated with a substantially heightened risk for an eventual diagnosis of breast cancer.
 

The selective estrogen receptor modulators (such as tamoxifen) reduce the risk of breast cancer but increase the risk of thromboembolism and endometrial cancer. There is no overall change in the risk of death.The benefit of breast cancer reduction continues for at least five years after stopping a course of treatment with these medications.

Screening

Main article: Breast cancer screening
Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to achieve an earlier diagnosis under the assumption that early detection will improve outcomes. A number of screening test have been employed including: clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.
 

A clinical or self breast exam involves feeling the breast for lumps or other abnormalities. Clinical breast exams are performed by health care providers, while self breast exams are performed by the person themselves.Evidence dose not support the effectiveness of either type of breast exam, as by the time a lump is large enough to be found it is likely to have been growing for several years and thus soon be large enough to be found without an exam.Mammographic screening for breast cancer uses X-rays to examine the breast for any uncharacteristic masses or lumps. During a screening, the breast is compressed and a technician takes photos from multiple angles. A general mammogram takes photos of the entire breast, while a diagnostic mammogram focuses on a specific lump or area of concern.
 

A number of national bodies continue to recommend breast cancer screening. For the average woman, the U.S. Preventive Services Task Force recommends mammography every two years in women between the ages of 50 and 74, the Council of Europe recommends mammography between 50 and 69 with most programs using a 2 year frequency,and in Canada screening is recommended between the ages of 50 and 74 at a frequency of 2 to 3 years. These task force reports point out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation. Whether MRI as a screening method has greater harms or benefits when compared to standard mammography is not known.
 

The Cochrane Collaboration (2011) states that the best quality evidence neither demonstrates a reduction in either cancer specific, nor a reduction in all cause mortality from screening mammography. When less rigorous trials are added to the analysis there is a reduction in breast cancer specific mortality of 0.05% (a relative decrease of 15%).Screening results in a 30% increase in rates of over-diagnosis and over-treatment, resulting in the view that it is not clear whether mammography screening does more good or harm. Cochrane states that, due to recent improvements in breast cancer treatment, and the risks of false positives from breast cancer screening leading to unnecessary treatment, "it therefore no longer seems reasonable to attend for breast cancer screening" at any age.