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75-457: The system is designed to standardize reporting and is used by medical professionals to communicate a patient's risk of developing breast cancer , particularly for patients with dense breast tissue . The document focuses on patient reports used by medical professionals, not "lay reports" that are provided to patients. The BI-RADS is published by ACR in the form of the BI-RADS Atlas . As of 2013

150-498: A breast implant or transferring excess tissue from another part of the body. Chemotherapy reduces the chance of cancer recurring in the next ten years by around a third. However, 1-2% of those on chemotherapy experience life-threatening or permanent side effects. To balance these benefits and risks, chemotherapy is typically offered to those with a higher risk of cancer recurrence. There is no established risk cutoff for offering chemotherapy; determining who should receive chemotherapy

225-404: A 30–50% increased risk of being diagnosed with breast cancer themselves. 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. Women with certain genetic variants are at higher risk of developing breast cancer. The most well known are variants of

300-472: A 50% increased risk of developing breast cancer. Variants in other tumor suppressor genes can also increase one's risk of developing breast cancer, namely p53 (causes Li–Fraumeni syndrome ), PTEN (causes Cowden syndrome ), and PALB1 . Breast changes like atypical ductal hyperplasia found in benign breast conditions such as fibrocystic breast changes , are correlated with an increased breast cancer risk. Diabetes mellitus might also increase

375-433: A biopsy reveals cells that are cancerous but have not yet spread beyond their original location. This condition, called carcinoma in situ , is often considered "precancerous" rather than a dangerous cancer itself. Those with ductal carcinoma in situ (in the mammary ducts) are at increased risk for developing true invasive breast cancer – around a third develop breast cancer within five years. Lobular carcinoma in situ (in

450-613: A family history of breast cancer. About five to ten percent of cases are the result of an inherited genetic predisposition, including BRCA mutations among others. Breast cancer most commonly develops in cells from the lining of milk ducts and the lobules that supply these ducts with milk. Cancers developing from the ducts are known as ductal carcinomas , while those developing from lobules are known as lobular carcinomas . There are more than 18 other sub-types of breast cancer. Some, such as ductal carcinoma in situ , develop from pre-invasive lesions . The diagnosis of breast cancer

525-535: A government or Department of Health pays for the license). There are also arrangements for free access in much of Latin America and in "low-income countries", typically via HINARI . All countries have free access to two-page abstracts of all Cochrane Reviews and short plain-language summaries of selected articles. Cochrane Reviews appear to be relatively underused in the United States for two reasons: 1) Public access to

600-685: A person's age can also impact prognosis. Breast cancer before age 35 is rare, and is more likely to be associated with genetic predisposition to aggressive cancer. Conversely, breast cancer in those aged over 75 is associated with poorer prognosis. Up to 80% of the variation in breast cancer frequency across countries is due to differences in reproductive history that impact a woman's levels of female sex hormones ( estrogens ). Women who begin menstruating earlier (before age 12) or who undergo menopause later (after 51) are at increased risk of developing breast cancer. Women who give birth early in life are protected from breast cancer – someone who gives birth as

675-407: A role in the development of breast cancer. 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 relative risk is increased by 35% to 50%. A lack of physical activity has been linked to about 10% of cases. Sitting regularly for prolonged periods

750-514: A second "diagnostic" mammogram and ultrasound – to confirm its presence and location. A biopsy is then taken of the suspected tumor. Breast biopsy is typically done by core needle biopsy , with a hollow needle used to collect tissue from the area of interest. Suspected tumors that appear to be filled with fluid are often instead sampled by fine-needle aspiration . Around 10–20% of breast biopsies are positive for cancer. Most biopsied breast masses are instead caused by fibrocystic breast changes ,

825-817: A second one. Some respond to a third sequential therapy as well. Adding an mTOR inhibitor , everolimus , can further slow the tumors' progression. Those with HER2-positive metastatic disease can benefit from continued use of trastuzumab, alone, in combination with pertuzumab, or in combination with chemotherapy. Those whose tumors continue to progress on trastuzumab benefit from HER2-targeted antibody drug conjugates (HER2 antibodies linked to chemotherapy drugs) trastuzumab emtansine or trastuzumab deruxtecan . The HER2-targeted antibody margetuximab can also prolong survival, as can HER2 inhibitors lapatinib , neratinib , or tucatinib . Certain therapies are targeted at those whose tumors have particular gene mutations: Alpelisib or capivasertib for those with mutations activating

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900-597: A teenager has around a 70% lower risk of developing breast cancer than someone who does not have children. That protection wanes with higher maternal age at first birth, and disappears completely by age 35. Breastfeeding also reduces one's chance of developing breast cancer, with an approximately 4% reduction in breast cancer risk for every 12 months of breastfeeding experience. Those who lack functioning ovaries have reduced levels of estrogens, and therefore greatly reduced breast cancer risk. Hormone replacement therapy for treatment of menopause symptoms can also increase

975-403: A term that encompasses benign pockets of fluid, cell growth, or fibrous tissue . Breast cancers are classified by several grading systems, each of which assesses a tumor characteristic that impacts a person's prognosis. First, a tumor is classified by the tissue it arises from, or the appearance of the tumor tissue under a microscope. Most breast cancers (85%) are ductal carcinoma – derived from

1050-463: A woman's risk of developing breast cancer, though the effect depends on the type and duration of therapy. Combined progesterone /estrogen therapy increases breast cancer risk – approximately doubling one's risk after 6–7 years of treatment (though the same therapy decreases the risk of colorectal cancer ). Hormone treatment with estrogen alone has no effect on breast cancer risk, but increases one's risk of developing endometrial cancer , and therefore

1125-412: Is T3. Tumors that extend to the chest wall or to the skin are designated T4. N scores are based on whether the cancer has spread to nearby lymph nodes. N0 indicates no spread to the lymph nodes. N1 is for tumors that have spread to the closest axillary lymph nodes (called "level I" and "level II" axillary lymph nodes, in the armpit). N2 is for spread to the intramammary lymph nodes (on the other side of

1200-399: Is a collection of databases in medicine and other healthcare specialties provided by Cochrane and other organizations. At its core is the collection of Cochrane Reviews , a database of systematic reviews and meta-analyses that summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted clinical trials readily available and

1275-581: Is a key resource in evidence-based medicine . The Cochrane Library is a subscription-based database, published initially by Update Software and now published by John Wiley & Sons, Ltd. as part of Wiley Online Library. In many countries, including parts of Canada, the United Kingdom, Ireland, the Scandinavian countries, New Zealand, Australia, India, South Africa, and Poland, it has been made available free to all residents by "national provision" (typically

1350-412: Is another preventive measure in some high risk women. In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy , chemotherapy , hormonal therapy , and targeted therapy . Types of surgery vary from breast-conserving surgery to mastectomy . Breast reconstruction may take place at the time of surgery or at a later date. In those in whom

1425-401: Is assigned a grade based on how distinct it appears from healthy breast. Breast tumors are graded on three features: the proportion of cancer cells that form tubules, the appearance of the cell nucleus , and how many cells are actively replicating. Each feature is scored on a three-point scale, with a higher score indicating less healthy looking tissue. A grade is assigned based on the sum of

1500-796: Is associated with higher mortality from breast cancer. The risk is not negated by regular exercise, though it is lowered. Actions to prevent breast cancer include not drinking alcoholic beverages , maintaining a healthy body composition , avoiding smoking and eating healthy food . Combining all of these (leading the healthiest possible lifestyle) would make almost a quarter of breast cancer cases worldwide preventable. The remaining three-quarters of breast cancer cases cannot be prevented through lifestyle changes. Other risk factors include circadian disruptions related to shift-work and routine late-night eating. A number of chemicals have also been linked, including polychlorinated biphenyls , polycyclic aromatic hydrocarbons , and organic solvents . Although

1575-643: Is binary: M0 indicates no evidence metastases; M1 indicates metastases have been detected. TNM scores are then combined with tumor grades and ER/PR/HER2 status to calculate a cancer case's "prognostic stage group". Stage groups range from I (best prognosis ) to IV (worst prognosis), with groups I, II, and III further divided into subgroups IA, IB, IIA, IIB, IIIA, IIIB, and IIIC. In general, tumors of higher T and N scores and higher grades are assigned higher stage groups. Tumors that are ER, PR, and HER2 positive are slightly lower stage group than those that are negative. Tumors that have metastasized are stage IV, regardless of

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1650-462: Is commonplace in most wealthy nations, but remains uncommon in the world's poorer countries. Still, mammography has its disadvantages. Overall, screening mammograms miss about 1 in 8 breast cancers, they can also give false-positive results, causing extra anxiety and making patients overgo unnecessary additional exams, such as bioposies . Those who have a suspected tumor from a mammogram or physical exam first undergo additional imaging – typically

1725-509: Is confirmed by taking a biopsy of the concerning tissue. Once the diagnosis is made, further tests are carried out to determine if the cancer has spread beyond the breast and which treatments are most likely to be effective. Breast cancer screening can be instrumental, given that the size of a breast cancer and its spread are among the most critical factors in predicting the prognosis of the disease. Breast cancers found during screening are typically smaller and less likely to have spread outside

1800-783: Is controversial. Chemotherapy drugs are typically given in two- to three-week cycles, with periods of drug treatment interspersed with rest periods to recover from the therapies' side effects. Four to six cycles are given in total. Many classes of chemotherapeutic agents are effective for breast cancer treatment, including the DNA alkylating drugs ( cyclophosphamide ), anthracyclines ( doxorubicin and epirubicin ), antimetabolites ( fluorouracil , capecitabine , and methotrexate ), taxanes ( docetaxel and paclitaxel ), and platinum-based chemotherapies ( cisplatin and carboplatin ). Chemotherapies from different classes are typically given in combination, with particular chemotherapy drugs selected based on

1875-425: Is highest among heavy drinkers. Globally, about one in ten cases of breast cancer is caused by women drinking alcoholic beverages. Alcohol use is among the most common modifiable risk factors. Obesity and diabetes increase the risk of breast cancer. A high body mass index (BMI) causes 7% of breast cancers while diabetes is responsible for 2%. At the same time the correlation between obesity and breast cancer

1950-442: Is injected near the tumor site, and several hours later the lymph node the dye accumulates in is removed. After surgery, many undergo radiotherapy to decrease the chance of cancer recurrence . Those who had lumpectomies receive radiation to the whole breast. Those who had a mastectomy and are at elevated risk of tumor spread – tumor greater than five centimeters wide, or cancerous cells in nearby lymph nodes – receive radiation to

2025-413: Is low-dose X-ray imaging of the breast, called mammography . Each breast is pressed between two plates and imaged. Tumors can appear unusually dense within the breast, distort the shape of surrounding tissue, or cause small dense flecks called microcalcifications . Radiologists generally report mammogram results on a standardized scale – the six-point Breast Imaging-Reporting and Data System (BI-RADS)

2100-453: Is nearly identical for all three modalities. Category 6 was added in the 4th edition of the BI-RADS. BI-RADS assessment categories are: An incomplete (BI-RADS 0) classification warrants either an effort to ascertain prior imaging for comparison, or to call the patient back for additional views and/or higher quality films. A BI-RADS classification of 4 or 5 warrants biopsy to further evaluate

2175-424: Is not at all linear. Studies show that those who rapidly gain weight in adulthood are at higher risk than those who have been overweight since childhood. Likewise, excess fat in the midriff seems to induce a higher risk than excess weight carried in the lower body. Dietary factors that may increase risk include a high-fat diet and obesity-related high cholesterol levels. Dietary iodine deficiency may also play

2250-486: Is only given to women who have undergone hysterectomies . 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. The use of hormonal birth control does not cause breast cancer for most women; if it has an effect, it

2325-400: Is placed into a device inserted at the surgical site the tumor was removed from. Fresh radioactive material is added twice a day for five days, then the device is removed. Surgery plus radiation typically eliminates a person's breast tumor. Less than 5% of those treated have their breast tumor grow back. After surgery and radiation, the breast can be surgically reconstructed , either by adding

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2400-462: Is small (on the order of 0.01% per user–year), temporary, and offset by the users' significantly reduced risk of ovarian and endometrial cancers. Among those with a family history of breast cancer, use of modern oral contraceptives does not appear to affect the risk of breast cancer. Drinking alcoholic beverages increases the risk of breast cancer, even among very light drinkers (women drinking less than half of one alcoholic drink per day). The risk

2475-526: Is the leading type of cancer in women, accounting for 25% of all cases. In 2018, it resulted in two million new cases and 627,000 deaths. It is more common in developed countries, and is more than 100 times more common in women than in men . For transgender individuals on gender-affirming hormone therapy , breast cancer is 5 times more common in cisgender women than in transgender men , and 46 times more common in transgender women than in cisgender men. Most people with breast cancer have no symptoms at

2550-401: Is the most common globally – where a higher number corresponds to a greater risk of a cancerous tumor. A mammogram also reveals breast density; dense breast tissue appears opaque on a mammogram and can obscure tumors. BI-RADS categorizes breast density into four categories. Mammography can detect around 90% of breast tumors in the least dense breasts (called "fatty" breasts), but just 60% in

2625-411: Is typically recommended for at least five years after surgery and chemotherapy, and is sometimes continued for 10 years or longer. Women with breast cancer who had a lumpectomy or a mastectomy and kept their other breast have similar survival rates to those who had a double mastectomy. There seems to be no survival advantage to removing the other breast, with only a 7% chance of cancer occurring in

2700-632: The Atlas is divided into three publications: While BI-RADS is a quality control system, in day-to-day usage the term BI-RADS refers to the mammography assessment categories. These are standardized numerical codes typically assigned by a radiologist after interpreting a mammogram. This allows for concise and unambiguous understanding of patient records between multiple doctors and medical facilities. The assessment categories were initially developed for mammography and later adapted for use with MRI and ultrasound findings. The summary of each category, given below,

2775-492: The BRCA genes BRCA1 and BRCA2 . Women with pathogenic variants in either gene have around a 70% chance of developing breast cancer in their lifetime, as well as an approximately 33% chance of developing ovarian cancer . Pathogenic variants in PALB2 – a gene whose product directly interacts with that of BRCA2 – also increase breast cancer risk; a woman with such a variant has around

2850-484: The HER2 -targeted antibody trastuzumab to chemotherapy reduces the chance of cancer recurrence and death by at least a third. Trastuzumab is given weekly or every three weeks for twelve months. Adding a second HER2-targeted antibody, pertuzumab slightly enhances treatment efficacy. In rare cases, trastuzumab can disrupt heart function, and so it is typically not given in conjunction with anthracyclines, which can also damage

2925-487: The Cochrane Library in the United States is limited (the state of Wyoming is an exception, having paid for a license to enable free access to Cochrane Reviews for all residents of Wyoming). 2) The government-funded U.S. National Library of Medicine maintains an alternative database MEDLINE , which is free of charge to everyone and has significantly more extensive coverage than Cochrane. From 26 March to 26 May 2020,

3000-578: The Cochrane Library provided temporary unrestricted access to everyone in every country in response to the COVID-19 pandemic . The Cochrane Library consists of the following databases after significant changes in 2018: The Cochrane Library now also features results from Special Collections and Editorials as well as an option to link out to other reviews compiled by Epistemonikos . The Cochrane Database of Systematic Reviews, Cochrane Protocols, and CENTRAL are produced by Cochrane . The Cochrane reviews take

3075-536: The affected person's health and the different chemotherapeutics' side effects. Anthrocyclines and cyclophosphamide cause leukemia in up to 1% of those treated. Anthrocyclines also cause congestive heart failure in around 1% of people treated. Taxanes cause peripheral neuropathy , which is permanent in up to 5% of those treated. The same chemotherapy agents can be given before surgery – called neoadjuvant therapy – to shrink tumors, making them easier to safely remove. For those whose tumors are HER2-positive, adding

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3150-553: The breast (nearly two thirds of cases) have the best prognoses – over 99% survive at least five years. Those whose tumors have metastasized to distant sites have relatively poor prognoses – 31% survive at least five years from the time of diagnosis. Triple-negative breast cancer (up to 15% of cases) and inflammatory breast cancer (up to 5% of cases) are particularly aggressive and have relatively poor prognoses. Those with triple-negative breast cancer have an overall five-year survival rate of 77% – 91% for those whose tumors are confined to

3225-431: The breast , with eczema -like red, scaly irritation on the nipple and areola . Advanced tumors can spread (metastasize) beyond the breast, most commonly to the bones, liver, lungs, and brain. Bone metastases can cause swelling, progressive bone pain , and weakening of the bones that leads to fractures . Liver metastases can cause abdominal pain, nausea, vomiting, and skin problems – rash , itchy skin, or yellowing of

3300-444: The breast, near the chest center), or for axillary lymph nodes that appear attached to each other or to the tissue around them (a sign of more severely affected tissue). N3 designates tumors that have spread to the highest axillary lymph nodes (called "level 3" axillary lymph nodes, above the armpit near the shoulder), to the supraclavicular lymph nodes (along the neck), or to both the axillary and intramammary lymph nodes. The M score

3375-671: The breast. A 2013 Cochrane review found that it was unclear whether mammographic screening does more harm than good, in that a large proportion of women who test positive turn out not to have the disease. A 2009 review for the US Preventive Services Task Force found evidence of benefit in those 40 to 70 years of age, and the organization recommends screening every two years in women 50 to 74 years of age. The medications tamoxifen or raloxifene may be used in an effort to prevent breast cancer in those who are at high risk of developing it. Surgical removal of both breasts

3450-406: The breast; 12% for those with metastases. Those with inflammatory breast cancer are diagnosed after the cancer has already spread to the skin of the breast. They have an overall five-year survival rate of 39%; 19% for those with metastases. The relatively rare tumors with tubular, mucinous, or medullary growth tend to have better prognoses. In addition to the factors that influence cancer staging,

3525-460: The cancer has spread to other parts of the body, treatments are mostly aimed at improving quality of life and comfort. Outcomes for breast cancer vary depending on the cancer type, the extent of disease , and the person's age. The five-year survival rates in England and the United States are between 80 and 90%. In developing countries, five-year survival rates are lower. Worldwide, breast cancer

3600-788: The cancer, another is started. In addition to the chemotherapeutic drugs used for localized cancer, gemcitabine , vinorelbine , etoposide , and epothilones are sometimes effective. Those with bone metastases benefit from regular infusion of the bone-strengthening agents denosumab and the bisphosphonates ; infusion every three months reduces the chance of bone pain, fractures, and bone hypercalcemia . Up to 70% of those with ER-positive metastatic breast cancer benefit from additional endocrine therapy. Therapy options include those used in localized cancer, plus toremifene and fulvestrant , often used in combination with CDK4/6 inhibitors ( palbociclib , ribociclib , or abemaciclib ). When one endocrine therapy fails, most will benefit from transitioning to

3675-427: The chance of detecting potentially dangerous tumors. Regularly feeling one's own breasts for lumps or other abnormalities, called breast self-examination , does not reduce a person's chance of dying from breast cancer. Clinical breast exams, where a health professional feels the breasts for abnormalities, are common; whether they reduce the risk of dying from breast cancer is not known. Regular breast cancer screening

3750-431: The disease , there may be bone pain , swollen lymph nodes , shortness of breath , or yellow skin . Risk factors for developing breast cancer include obesity , a lack of physical exercise , alcohol consumption, hormone replacement therapy during menopause , ionizing radiation , an early age at first menstruation , having children late in life (or not at all), older age, having a prior history of breast cancer, and

3825-553: The efficacy of a particular medical intervention. Finished reviews are available as a full report with diagrams, in condensed form or as a plain language summary, in order to provide for every reader of the review. According to Journal Citation Reports , The Cochrane Database of Systematic Reviews has a 2021 impact factor of 11.874, ranking 20th of 172 journals in the Medicine, General and Internal category, down from 11th in 2020 (167 journals). Reviews are abstracted and indexed in

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3900-468: The following bibliographic databases : Science Citation Index Expanded , Scopus , CINAHL , EMBASE , MEDLINE . The Cochrane Library Feedback tool allows users to provide comments on and feedback of Cochrane Reviews and Protocols in The Cochrane Library. If accepted, the feedback will be published in a scrolling list of comments in reverse chronological order, with the most recent submission at

3975-573: The format of full-length methodological studies. Cochrane researchers will perform searches of medical and health databases including MEDLINE / PubMed , EMBASE , PsycINFO , CINAHL , etc.; a continually updated database of trials called the Cochrane Central Register of Controlled Trials (CENTRAL); hand searching, where researchers look through entire libraries of scientific journals by hand and; reference checking of obtained articles in order to identify additional studies that are relevant to

4050-835: The heart. After their chemotherapy course, those whose tumors are ER-positive or PR-positive benefit from endocrine therapy , which reduces the levels of estrogens and progesterones that hormone receptor-positive breast cancers require to survive. Tamoxifen treatment blocks the ER in the breast and some other tissues, and reduces the risk of breast cancer death by around 40% over the next ten years. Chemically blocking estrogen production with GnRH -targeted drugs ( goserelin , leuprolide , or triptorelin ) and aromatase inhibitors ( anastrozole , letrozole , or exemestane ) slightly improves survival, but has more severe side effects. Side effects of estrogen depletion include hot flashes , vaginal discomfort, and muscle and joint pain. Endocrine therapy

4125-443: The lining of the mammary ducts . 10% are lobular carcinoma – derived from the mammary lobes – or mixed ductal/lobular carcinoma. Rarer types include mucinous carcinoma (around 2.5% of cases; surrounded by mucin ), tubular carcinoma (1.5%; full of small tubes of epithelial cells ), medullary carcinoma (1%; resembling "medullary" or middle-layer tissue), and papillary carcinoma (1%; covered in finger-like growths). Oftentimes

4200-421: The mammary lobes) rarely causes a noticeable lump, and is often found incidentally during a biopsy for another reason. It is commonly spread throughout both breasts. Those with lobular carcinoma in situ also have an increased risk of developing breast cancer – around 1% develop breast cancer each year. However, their risk of dying of breast cancer is no higher than the rest of the population. Invasive tumor tissue

4275-441: The mastectomy scar and chest wall. If cancerous cells have spread to nearby lymph nodes, those lymph nodes will be irradiated as well. Radiation is typically given five days per week, for up to seven weeks. Radiotherapy for breast cancer is typically delivered via external beam radiotherapy , where a device focuses radiation beams onto the targeted parts of the body. Instead, some undergo brachytherapy , where radioactive material

4350-677: The most dense breasts (called "extremely dense"). Women with particularly dense breasts can instead be screened by ultrasound , magnetic resonance imaging (MRI), or tomosynthesis , all of which more sensitively detect breast tumors. Regular screening mammography reduces breast cancer deaths by at least 20%. Most medical guidelines recommend annual screening mammograms for women aged 50–70. Screening also reduces breast cancer mortality in women aged 40–49, and some guidelines recommend annual screening in this age group as well. For women at high risk for developing breast cancer, most guidelines recommend adding MRI screening to mammography, to increase

4425-489: The nipple. Some may experience unusual discharge from the breasts, or swelling of the lymph nodes under the arms or along the collar bone . Some less common forms of breast cancer cause distinctive symptoms. Up to 5% of people with breast cancer have inflammatory breast cancer , where cancer cells block the lymph vessels of one breast, causing the breast to substantially swell and redden over three to six months. Up to 3% of people with breast cancer have Paget's disease of

4500-470: The offending lesion. Some experts believe that the single BI-RADS 4 classification does not adequately communicate the risk of cancer to doctors and recommend a subclassification scheme: As of the BI-RADS 5th edition: Automatic parsers have been developed to automatically extract BI-RADS features, categories and breast composition from textual mammography reports. There is also an automatic parser available for BI-RADS final category inference by parsing only

4575-438: The other breast over 20 years. For around 1 in 5 people treated for localized breast cancer, their tumors eventually spread to distant body sites – most commonly the nearby bones (67% of cases), liver (41%), lungs (37%), brain (13%), and peritoneum (10%). Those with metastatic disease can receive further chemotherapy, typically starting with capecitabine, an anthracycline, or a taxane. As one chemotherapy drug fails to control

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4650-452: The other scored characteristics. The management of breast cancer depends on the affected person's health, the cancer case's molecular characteristics, and how far the tumor has spread at the time of diagnosis. Those whose tumors have not spread beyond the breast often undergo surgery to remove the tumor and some surrounding breast tissue. The surgery method is typically chosen to spare as much healthy breast tissue as possible, removing just

4725-663: The protein PIK3CA . PARP inhibitors ( olaparib and talazoparib ) for those with mutations that inactivate BRCA1 or BRCA2 . The immune checkpoint inhibitor antibody atezolizumab for those whose tumors express PD-L1 . And the similar immunotherapy pembrolizumab for those whose tumors have mutations in various DNA repair pathways. Many breast cancer therapies have side effects that can be alleviated with appropriate supportive care. Chemotherapy causes hair loss , nausea , and vomiting in nearly everyone who receives it. Antiemetic drugs can alleviate nausea and vomiting; cooling

4800-518: The quality of life. Physical activity interventions, yoga and meditation may also have beneficial effects on health related quality of life, cognitive impairment, anxiety, fitness and physical activity in women with breast cancer following adjuvant therapy. Breast cancer prognosis varies widely depending on how far the tumor has spread at the time of diagnosis. Overall, 91% of women diagnosed with breast cancer survive at least five years from diagnosis. Those whose tumor(s) are completely confined to

4875-422: The question they are attempting to answer. The quality of each study is carefully assessed using predefined criteria and evidence of weak methodology or the possibility that a study may have been affected by bias is reported in the review. Cochrane researchers then apply statistical analysis to compare the data of the trials. This creates a review of studies, or systematic review , giving a comprehensive view of

4950-425: 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. Around 10% of those with breast cancer have a family history of the disease or genetic factors that put them at higher risk. Women who have had a first-degree relative (mother or sister) diagnosed with breast cancer are at

5025-605: The risk of breast cancer. Autoimmune diseases such as lupus erythematosus seem also to increase the risk for the acquisition of breast cancer. Women whose breasts have been exposed to substantial radiation doses before the age of 30 – typically due to repeated chest fluoroscopies or treatment for Hodgkin lymphoma – are at increased risk for developing breast cancer. Radioactive iodine therapy (used to treat thyroid disease) and radiation exposures after age 30 are not associated with breast cancer risk. Cochrane review The Cochrane Library (named after Archie Cochrane )

5100-866: The scalp with a cold cap during chemotherapy treatments may reduce hair loss. Many complain of cognitive issues during chemotherapy treatment . These usually resolve within a few months of the end of chemotherapy treatment. Those on endocrine therapy often experience hot flashes , muscle and joint pain, and vaginal dryness/discomfort that can lead to issues having sex. Around half of women have their hot flashes alleviated by taking antidepressants ; pain can be treated with physical therapy and nonsteroidal anti-inflammatory drugs ; counseling and use of personal lubricants can improve sexual issues. In women with non-metastatic breast cancer, psychological interventions such as cognitive behavioral therapy can have positive effects on outcomes such as cognitive impairment, anxiety, depression and mood disturbance, and can also improve

5175-460: The semi-formatted finding section of the textual mammography report. Breast cancer This is an accepted version of this page Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection , fluid coming from the nipple , a newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of

5250-514: The skin ( jaundice ). Those with lung metastases experience chest pain , shortness of breath, and regular coughing . Metastases in the brain can cause persistent headache , seizures , nausea, vomiting, and disruptions to the affected person's speech, vision, memory, and regular behavior. Breast cancer screening refers to testing otherwise-healthy women for breast cancer in an attempt to diagnose breast tumors early when treatments are more successful. The most common screening test for breast cancer

5325-865: The three scores. Combined scores of 3, 4, or 5 represent grade 1, a slower-growing cancer. Scores of 6 or 7 represent grade 2. Scores of 8 or 9 represent grade 3, a faster-growing, more aggressive cancer. In addition to grading, tumor biopsy samples are tested by immunohistochemistry to determine if the tissue contains the proteins estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2). Tumors containing either ER or PR are called "hormone receptor-positive" and can be treated with hormone therapies. Around 15 to 20% of tumors contain HER2; these can be treated with HER2-targeted therapies. The remainder that do not contain ER, PR, or HER2 are called "triple-negative" tumors, and tend to grow more quickly than other breast cancer types. After

5400-431: The time of diagnosis; their tumor is detected by a breast cancer screening test. For those who do have symptoms, a new lump in the breast is most common. Most breast lumps are not cancer, though lumps that are painless, hard, and with irregular edges are more likely to be cancerous. Other symptoms include swelling or pain in the breast; dimpling, thickening, redness, or dryness of the breast skin; and pain, or inversion of

5475-628: The top of the page. The Collaboration has a procedure for the event of serious error, an event which has only occurred once in its history. Annual colloquia have been conducted by Cochrane since 1993. From 1994 onwards, Cochrane has maintained a database of posters and presentations of past colloquia. From 2009 onwards, Cochrane published the abstracts of those colloquia as supplements to the Cochrane Database of Systematic Reviews . From 2010 to 2016, an annual newsletter related to Cochrane methodology called Cochrane Methods ( ISSN   2044-4702 ),

5550-434: The tumor ( lumpectomy ) or a larger part of the breast (partial mastectomy ). Those with large or multiple tumors, high genetic risk of subsequent cancers, or who are unable to receive radiation therapy may instead opt for full removal of the affected breast(s) (full mastectomy). To reduce the risk of cancer spreading, women will often have the nearest lymph node removed in a procedure called sentinel lymph node biopsy. Dye

5625-547: The tumor is evaluated, the breast cancer case is staged using the American Joint Committee on Cancer and Union for International Cancer Control 's TNM staging system . Scores are assigned based on characteristics of the tumor (T), lymph nodes (N), and any metastases (M). T scores are determine by the size and extent of the tumor. Tumors less than 2  centimeters (cm) across are designated T1. Tumors 2–5 cm across are T2. A tumor greater than 5 cm across

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