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121-528: The Cresta Run is a natural ice track in eastern-Switzerland used for skeleton -toboggan racing. Located in the winter sports town of St. Moritz , the 1.2125 km (0.753 mi) run is one of the few in the world dedicated entirely to skeleton. It was built in 1884 near the hamlet of Cresta in the municipality of Celerina/Schlarigna by the Outdoor Amusement Committee of the Kulm Hotel and

242-498: 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

363-583: A toboggan track between the towns of Davos and Klosters in Switzerland . While toboggan tracks were not uncommon at the time, the added challenge of curves and bends in the Swiss track distinguished it from those of Canada and the United States . The source of the word is debated; some speculate that it comes from the skeleton-like appearance of the original sleds, and others an incorrectly anglicized version of

484-404: 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

605-472: 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

726-813: A Junior World Championships (open to athletes aged 23 and under) which are held annually without regard to the Olympics. One race each World Cup season is also designated the European Championship. The IBSF cooperates with the International Olympic Committee to supervise the skeleton races at the Olympic Winter Games, and the IBSF ranking system is used to determine the National Olympic Committees' athlete quota allocations. On all of

847-433: 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

968-663: A dedicated drink, the "Bullshot". The highlight of the Shuttlecock Club is the yearly Shuttlecock Dinner . The dinner is organised by the Shuttlecock President. Prominent presidents have included Constantin von Liechtenstein , Gianni Agnelli , Gunther Sachs , Sir Dudley Cunliffe-Owen , Rolf Sachs , Lord Dalmeny , Graf Luca Marenzi, Marc M. K. Fischer, Lord Wrottesley , Jonny Seccombe and Sven Ley. The club sponsors more than thirty races each season which generally last from just before Christmas to late February. The track

1089-474: A gateway sport to "train young, aspiring athletes…for their future career in bobsleigh." "The 'toboggans' used in Alpine countries at the end of the 19th century were inspired by Canadian/Indian sleds used for transport". Various additions and redesigning efforts by athletes have led to the skeleton sleds used today. In 1892, L. P. Child introduced the "America", a new metal sled that revolutionized skeleton as

1210-466: A maximum of four. To be eligible to enter a World Cup race, athletes must have safely completed five races on two tracks in the previous two seasons. At the end of the World Cup season, the man and woman with the highest ranking, considering only points earned in World Cup races, are given a trophy known as the "Crystal Globe". One World Cup race a year may be designated as a continental championship for

1331-651: A national federation volunteers to organize the (Senior) World Championships (for both bobsleigh and skeleton), which are open to all athletes meeting the experience requirements that apply to the World Cup and the ICC (including junior athletes). The quota system for the Senior World Championships is the same as for the World Cup, except that all national federations are entitled to send one athlete. The defending Junior World Champion in each discipline also receives an automatic entry. Unlike all other IBSF-sponsored races,

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1452-485: A newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of 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

1573-633: A participant is highly unlikely to be ejected from the track), the Cresta takes place only on the Cresta Run (which is more open, meaning a rider can fall out of the run if he is out of control). Skeleton sleds are steered using torque provided by the head and shoulders. The Cresta toboggan does not have a steering or braking mechanism, though Cresta riders use rakes on their boots in addition to shifting body weight to help steer and brake . The sport of skeleton can be traced to 1882, when English soldiers constructed

1694-685: 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

1815-409: A phenomenon known as "sled head". Multiple suicides of former athletes have been linked to these sports. 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 ,

1936-651: A prior history of breast cancer, and 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

2057-407: 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

2178-514: 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 ,

2299-817: 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

2420-580: A sport. The stripped-down design provided a compact sled with metal runners, and the design caught on quickly. In 1902, Arden Bott added a sliding seat to help athletes shift their weight forward and backward, a feature that is no longer included on modern sleds. In 2010, the FIBT restricted the materials with which skeleton sleds are permitted to be made. Sled frames must be made of steel and may not include steering or braking mechanisms. The base plate, however, may be made of plastics. The handles and bumpers found along

2541-487: A team must have placed at least one athlete in the top 70 (for men) of the overall ranking table (top 55 for women); quotas were loosened for the 2023–24 season to account for the discontinuation of the Intercontinental Cup. Each team receives a number of starting positions equal to the number of athletes from that team who were in the top 70 (for men) or top 55 (for women) in the previous season's overall rankings, to

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2662-597: 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

2783-403: 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

2904-498: A time became known as 'Cresta' racing. The Cresta Run and the SMTC were founded by devotees of sledding (tobogganing in English) who adopted a head-first (prone) technique of racing down an icy run, as opposed to the feet-first (supine) and somewhat faster luge race. Both evolving sports were natural extensions of the invention of steerable sleds during the early 1870s by British guests of

3025-412: A two-thirds majority to allow women to ride the Cresta Run again and to become members. Whilst the Cresta Run is often considered to be the birthplace of modern day skeleton and acted as the course for Skeleton events in the 1928 and 1948 Winter Olympics, Cresta riding is notably different from modern day Skeleton sliding . Cresta Riding requires significant movement on the toboggan in order to navigate

3146-463: 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

3267-567: Is German Magnus Eger (40.94 in 2017). Marcel Melcher was the youngest ever winner (aged 19, in 1979) of the Grand National. Wing Commander Andy Green is the RAF's team captain for the Cresta Run. Green is an established driver of land speed record cars, and holds the current land speed record which he achieved in Thrust SSC . He also drives the 1,000 mph car Bloodhound SSC . Baron Raunchy

3388-412: 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

3509-412: 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

3630-401: 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

3751-796: 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

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3872-643: 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

3993-462: 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

4114-509: 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

4235-783: 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

4356-424: Is generally referred to as 'The Cresta Run'. The course has two entrances known as 'Top' and 'Junction' respectively, with two banks, known as 'Upper' 'and 'Lower'. The entrance at Junction is adjacent to the SMTC clubhouse and is about a third of the way down from Top along the run. Similarly, the exit is simply called 'Finish' and given a typical average speed of more than 50 mph, an experienced rider will exit

4477-425: 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

4598-442: 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

4719-413: 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)

4840-424: 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

4961-479: Is not shared with bobsled , unlike the original half-pipe sledding track built by hotelier Caspar Badrutt for his guests. Most of it is located within the contour of a steep ravine and is recreated each winter using the rocky ravine and banks of earth as a buttress for the pack ice . The run is owned and operated, created in 1885 by British military officers with the official name of the St. Moritz Tobogganing Club (SMTC) , but

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5082-486: 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

5203-469: Is opened as soon as it is seasonally possible to do so, and is kept open as long as natural weather conditions permit. Some notably good riders from the membership of the past were Nino Bibbia , Italy; Giorgio Jegher , Jack Heaton , USA; and Billy Fiske , USA (the first American pilot killed in World War II as a volunteer in the "Millionaire Squadron" ). In 1955 the then 71-year-old Lord Brabazon won

5324-400: 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

5445-462: 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

5566-526: 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

5687-401: 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

5808-471: Is the slowest of the three sliding sports, as skeleton's face-down, head-first riding position is less aerodynamic than luge's face-up, feet-first ride. Previously, skeleton appeared in the Olympic program in St. Moritz , Switzerland , in 1928 and again in 1948 . It was added permanently to the Olympic program for the 2002 Winter Olympics , at which stage a women's race was added. During elite racing

5929-411: 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

6050-581: The Austrian championship held the following year. In 1908 and 1910, skeleton competitions were held in the Semmering Pass . As the popularity of the sport grew, skeleton evolved into the sport recognized today. In 1892, the sled was transformed by L. P. Child, an Englishman, to incorporate a more bare-bones design. In 1923, the Federation Internationale de Bobsleigh et de Tobogganing (FIBT)

6171-492: 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

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6292-590: The Cresta Run , the first tobogganing track of its kind in St. Moritz. The track ran three-quarters of a mile from St. Moritz to Celerina and contained ten turns still used today. When the Winter Olympic Games were held at St. Moritz in 1928 and 1948 , the Cresta Run was included in the program, marking the only two times skeleton was included as an Olympic event before its permanent addition in 2002 to

6413-484: 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

6534-499: The Norwegian word for toboggan, "Kjelke". Approximately 30 km (20 mi) away in the winter sports town of St. Moritz, British men had long enjoyed racing one another down the busy, winding streets of the town, causing an uproar among citizens because of the danger to pedestrians and visiting tourists. In 1884, Major William Bulpett, with the backing of winter sports pioneer and Kulm hotel owner Caspar Badrutt , constructed

6655-601: The Virgin Islands have become involved with the sport in recent years. The IBSF operates a support program for "emerging nations", which provides travel, coaching, and equipment funding assistance to countries which have neither a track nor three qualified pilots in three IBSF disciplines; in 2017, 20 national federations qualified for financial support in men's skeleton, and 11 qualified in women's skeleton. The IBSF organizes three competitive circuits for international skeleton competition, in two tiers: two Continental Cups, and

6776-454: The 1870s. It also allowed higher speeds on the longer runs. Local views varied, but eventually complaints grew louder and Kulm hotel owner Caspar Badrutt built the first natural ice run for his guests, as part of his efforts to popularize wintering in the mountain resort, while careful not to lose customers to boredom, nor his workforce to injury from errant sleds on the streets. The committee members were Major William Henry Bulpett (founder of

6897-576: The 2017/18 season. The Junior World Championships are held every year, but are scheduled to avoid conflict with the Olympics and the Senior World Championships. Junior athletes are those who are under 23 years of age, or who turn 23 at some point during the competitive season. All countries are entitled to send up to three athletes to the Junior World Championships, subject to the requirement that each entrant must have finished at least three IBSF sanctioned competitions on at least two tracks in

7018-502: The Cresta Run Coronation Cup at an average speed of 71 km/h (44 mph). Among the best riders in recent years: eight times Grand National winner was Swiss Franco Gansser , fifteen times Grand National winner Lord Wrottesley finished fourth at the 2002 Olympic Winter Games and was the top record holder (49.92 in 2015), former Junction record holder Johannes Badrutt (41.02 in 1999), and current Junction record holder

7139-415: The Cresta Run from Top since the ban on women riders was lifted in 2018. Towards the end of the season, there is a Ladies Event in which women compete from Junction by invitation only. Skeleton (sport) Skeleton is a winter sliding sport in which a person rides a small sled , known as a skeleton bobsled (or bobsleigh), down a frozen track while lying face down and head-first . The sport and

7260-420: The Cresta by Reto Gansser (brother of 8-time Grand National Winner Franco Gansser) in the 1960s and became the basis for modern day skeleton sleds. Flat-Tops are characterised by either a steel or carbon fibre base with removable runners. Modern-day are much more akin to Skeleton sleds, with some manufacturers providing Sleds to Olympic Skeleton teams and amateur Cresta Riders alike. Unlike the traditional toboggan,

7381-635: The FIBT was renamed the International Bobsleigh & Skeleton Federation (IBSF), and the Congress of the IBSF adopted its current governing statutes in 2016. Popularity in the sport has grown since the 2002 Winter Olympics and now includes participation by some countries that either do not or cannot have a track because of climate, terrain or monetary limitations. Athletes from such countries as Australia , New Zealand , Bermuda , South Africa , Argentina , Iraq , Israel , Mexico , Brazil , and even

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7502-464: The Flat-Top lacks a moving seat, and is more sensitive and faster. As a result, the secretariat requires riders to achieve consistent rides of 48 seconds from Junction on a Traditional in order to convert to a flat-top. Converts are then taught by their Flat-Top Guru, an experienced flat top rider who is given permission by the secretariat to tutor the converts in Flat-Top riding. It is up to Tower and

7623-483: The IBSF and using the IBSF ranking system to determine qualification; 20 women and 30 men competed at the 2018 Winter Olympics in Pyeongchang, Korea, with one automatic quota going to the host country (Korea) for each gender. For men, three countries received three quota spots each, six were allocated two spots, and five got one; for women, two countries received three spots, four got two, and two got one. The ranking of

7744-475: The Kulm hotel in St. Moritz. The initial crude sleds were developed almost accidentally—as bored well-to-do gentlemen naturally took to intramural competition in the streets and byways of mountainous downtown St. Moritz posing a risk to each other and pedestrians alike. This gave impetus to steering the sleds, and soon runners and a primitive mechanism evolved to allow some steerage along the longer curving streets of

7865-618: The Secretariat to determine whether they are a sufficiently skilled and safe rider to continue riding on a flat-top. The primary purpose of the 1300 member club founded in 1887 is "…the conduct of races and practice on the Cresta Run and the encouragement of tobogganing generally". While not snobbish, the Cresta Club gathers well-to-do gentlemen and is totally amateur. There are many more luge and bobsled runs world-wide, but only one Cresta devoted to head first sledding. The club asserts that most of

7986-431: The St. Moritz Tobogganing Club), George Robertson, Charles Digby Jones (Robertson and Digby Jones planned the proposed course), C. Metcalfe, and J. Biddulph. The head (top) of the run is located under the remains of a 12th Century church, demolished in 1890, known as the 'Leaning Tower'. The overall drop is 157 m (515 ft) and the gradient varies from 2.8 to 1 to 8.7 to 1 (length to drop). The modern Cresta track

8107-581: The Winter Games. In the 1887 Grand National competition in St. Moritz, a Mr. Cornish introduced the now-traditional head-first position, a trend that was in full force by the 1890 Grand National. Skeleton was practiced mainly in Switzerland; however, in 1905, Styria held its first skeleton competition in Mürzzuschlag , Austria . This opened the door to other national skeleton competitions including

8228-561: The World Championships and Winter Olympics) heat, the competitors start in reverse order of their ranking after the previous heat. (At four-heat races, start order in heats two and three is in ascending order of combined time from the prior heats.) In addition to the four race series, the IBSF also organizes World Championships, which are held at the end of every sliding season except when the Olympic Winter Games are held, and

8349-487: The World Championships use a two-day, four-heat format, with rankings determined by total time for all four heats. The 2016/17 World Championships were held at Königssee bobsleigh, luge, and skeleton track in Bavaria , 24–26 February 2017. Martins Dukurs of Latvia won the men's competition and Jacqueline Lölling of Germany won the women's competition. Because 2018 was an Olympic year, no World Championships were held for

8470-594: The World Cup. In addition, teams are limited to four athletes on their home continent and two athletes on the other continent. (For the purposes of this restriction, African teams are considered to be home on the Europe Cup and Asian, Oceanian, and South American teams are home on the North American Cup.) As the bottom level of international skeleton competition, race results in the Continental Cups are assigned

8591-536: 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

8712-409: The back of the runners than their modern-day skeleton counterparts. This is in order to achieve greater grip, as unlike in modern Skeleton which takes place on Bob-Runs, one can exit the Cresta Run at numerous points if they are going too fast or are out of control. Toboggans used by the Cresta Run are broadly separated into two primary categories: Traditionals and Flat-Tops. Traditional toboggans are

8833-553: 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

8954-431: 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

9075-444: 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

9196-671: 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

9317-406: 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,

9438-516: 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

9559-788: 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

9680-423: The catalyst for its upswing in popularity. Most notably, Nino Bibbia , a fruit and vegetable merchant from St. Moritz , Switzerland, took Olympic gold at the 1948 event. With the advent of the first artificially refrigerated track in 1969 at Königssee / Berchtesgaden , Germany , athletes are currently able to practice the sport regardless of weather conditions. The sport is also promoted by skeleton officials as

9801-427: 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

9922-532: The continent on which it is held. This championship is a "paper" race, based only on the times in the regularly scheduled World Cup event, with the athletes representing a different continent excluded. Currently, this is done only in Europe; the 2017/18 European Championship races were the World Cup races held on 15 December 2017 at Innsbruck , Austria . The current European champions are Martins Dukurs of Latvia and Elena Nikitina of Russia. In non-Olympic years,

10043-399: The countries for quota assignment was based on their third-highest, second-highest, or highest ranked athlete in total IBSF ranking over the qualification period. In addition, three quota spots are reserved for countries whose continent did not receive any representation based on this assignment procedure. National Olympic Committees may send athletes other than the ones whose rankings earned

10164-626: The course at more than 80 mph when riding from Top. The track was used for the skeleton event in both the 1928 and the 1948 Winter Olympics . These were the only Olympics with skeleton until 2002 . The exclusion of women from the course, which was enforced until December 2018, dates from the late 1920s and was instituted because of injuries to female racers and the wholly incorrect belief that excessive sledding caused breast cancer . It came into effect in 1929, though women had been banned from competitive events several years earlier. In late 2018, St Moritz Tobogganing Club meeting members voted by

10285-835: 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

10406-443: 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

10527-418: The list before an athlete's ordinal ranking is determined This had the effect of allowing continental representatives for Africa into the 2018 games, as they would otherwise have been too low on the ranking list to qualify (notably, Nigerian slider Simidele Adeagbo was ranked 74th before cleaning, but was in the top 45 after application of rule 4.1). The accessibility of skeleton to amateurs may have been

10648-470: The lower half of the course. Vera Barclay rode the Cresta Run from Top. She was followed by a young American, Charles Lowe Boorum, Jnr., who said, "See you at the finish". Boorum started too fast and slid into Church Leap at such a speed that he crashed at the Shuttlecock, was hit by his toboggan and died from a fractured skull that evening. In 2019 Carina Evans, of Britain, became the first woman to descend

10769-510: The lowest point values for ranking, with a first-place finish being with 75 points (compared to 225 points for the World Cup). Only the top 30 athletes receive ranking points; 30th place is worth 1 point. However, two races are generally held in each discipline on a single race weekend, allowing consistently competitive athletes to earn a higher ranking than if they went to a single World Cup race and finished poorly. The Intercontinental Cup (ICC)

10890-421: 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

11011-441: 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

11132-677: 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

11253-489: 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

11374-438: 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

11495-452: 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

11616-469: The other sledding sports are dominated by professionals and is one of the last bastions of the genuine amateur in sport. As in many social clubs, members are elected from a list of qualifiers called the Supplementary List. The course is open to anyone who meets the three criteria for joining the list, and need not be English. It has a lot of club rites such as the "Firework", the "Shuttlecock Club" and

11737-416: The overall rankings of their individual athletes during the previous season, but are free to send any qualified athlete to a competition in which they have available quota. However, individual athletes' discipline rankings are used to determine the start order for the first heat of each race: the track becomes less smooth after each successive run, so earlier starts are more desirable. In the second (fourth at

11858-470: The people of St. Moritz. It has continued as a partnership to this day between the St. Moritz Tobogganing Club (SMTC), founded in 1887, and the people of St. Moritz. The sport of intramural sled racing originated in winter resort activities at the Kulm Hotel St. Moritz during the early 1870s. SMTC members still congregate for lunch in the 'Sunny Bar' at the Kulm. In the early days of competitive sledding,

11979-476: The predominant style was luge -style racing, lying on one's back, but the invention of the flexible runner sled ( Flexible Flyer ) in 1887, known colloquially as 'the America', led to one Mr. Cornish using the head-first style in the 1887 Grand National. He finished fourteenth due to some erratic rides but established a trend, and by the 1890 Grand National all competitors were riding head-first. The head-first style for

12100-533: The previous two years. The 2017–18 Junior World Championships were held on 25 January 2018 in St. Moritz , Switzerland , and the winners were Anna Fernstädt of Germany and Nikita Tregubov of Russia. The skeleton event in the Winter Olympics uses the same two-day, four-heat format as the World Championships, but team quotas are significantly smaller. The International Olympic Committee assigns athlete quotas to national Olympic committees in cooperation with

12221-663: 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

12342-518: 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

12463-403: The quota spot, but the athletes chosen must be ranked in the top 60 (for men) or top 45 (for women) on the IBSF list and meet similar experience requirements to those that apply to the World Cup. However, IBSF rule 4.1 provides that, for the purposes of determining the top 60 (or top 45) qualification, lower-ranking athletes from countries which have already received a full quota are "cleaned" from

12584-425: 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

12705-413: The regular competitive circuits, the race days are preceded by three or four days of pre-race training to allow athletes to learn the intricacies of each track, and each athlete must complete a certain number of successful training runs to be eligible to compete. Normally, if the same competition also includes bobsleigh races, the skeleton races will be held first, as the heavier bobsleighs do more damage to

12826-522: The rider experiences accelerations up to 5   g and reaches speeds over 130 km/h (81 mph). The skeleton originated in St. Moritz , Switzerland , as a spinoff of the tobogganing sport pioneered by the British on the Cresta Run . Although skeleton "sliders" use equipment similar to that of Cresta "riders", the two sports are different: while skeleton is run on the same tracks used by bobsleds and luge (which are sufficiently 'closed' that

12947-866: 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

13068-1009: The sides of the sled help secure the athlete during a run. Further specifications are included in the FIBT ruling regarding sled dimensions: Some athletes opt to attach ballasts if the combined weight of athlete and sled falls below the maximum combined weight. These ballasts may only be added to the sled, not the rider. Current Olympic champion: [REDACTED] [REDACTED]   South Korea   (KOR) Yun Sung-bin [REDACTED] [REDACTED]   Olympic Athletes from Russia   (OAR) Nikita Tregubov [REDACTED] [REDACTED]   Great Britain   (GBR) Dominic Parsons Current Olympic champion: [REDACTED] [REDACTED]   Great Britain   (GBR) Lizzy Yarnold [REDACTED] [REDACTED]   Germany   (GER) Jacqueline Lölling [REDACTED] [REDACTED]   Great Britain   (GBR) Laura Deas Both skeleton and its sister sport, bobsledding, have been associated with traumatic brain injury,

13189-514: 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

13310-415: The sled may have been named from the bony appearance of the sled. Unlike other sliding sports of bobsleigh and luge , the race always involves single riders. Like bobsleigh, but unlike luge, the race begins with a running start from the opening gate at the top of the course. The skeleton sled is thinner and heavier than the luge sled, and skeleton gives the rider more precise control of the sled. Skeleton

13431-865: 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

13552-431: 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

13673-454: The toboggans that every Cresta Rider initially starts on, and have been used since the 1900s; as an evolution of the earlier Americas toboggan. Traditionals are characterised by a prominent sliding seat and having the runners integrated into the frame. The sliding seat allows riders to move back on the toboggan prior to entry of Shuttlecock to place more weight on the knives, therefore gaining greater control and grip. Flat-Tops were introduced to

13794-422: The top level World Cup . Each athlete receives points based on their results and the level of the competition, which are used to determine both their rankings on each circuit they race in and also an overall ranking across all circuits. An intermediate tier, the Intercontinental Cup, was discontinued after the 2022–23 season. National federations are assigned athlete quota spots in the higher levels according to

13915-425: The track. The two Continental Cup series are the Europe Cup (also called "Europa Cup" and "European Cup") and the North American Cup. Both series are open to athletes from all participating nations, but with some restrictions: the top 15 athletes in combined ranking are not permitted to race in the Continental Cups, and athletes are not permitted to race unless their team has filled all of its assigned quota sports in

14036-443: The track. Such movement includes riders moving their position back and forwards on the toboggan, and actively pushing the toboggan with your right hand in order to manoeuvre through Shuttlecock and Thoma. On the other hand, modern Skeleton sliding requires much less movement on the toboggan, and the sleds are generally speaking more flexible and sensitive than those for the Cresta. Cresta Toboggans possess longer, more prominent knives on

14157-434: 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

14278-547: 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

14399-566: Was established as the governing body of the sport. Soon afterward, in 1926, the International Olympic Committee declared bobsleigh and skeleton as Olympic sports and adopted the rules of the St. Moritz run as the officially recognized Olympic rules. It was not until 2002, however, that skeleton returned to the Olympic Winter Games after a 54-year absence, with the 2002 Winter Olympics in Salt Lake City , Utah . In 2015,

14520-475: Was introduced as an intermediate level between the Continental Cups and the World Cup; a first-place finish was worth 120 points in the IBSF ranking (vs. 225 points for a World Cup win). The ICC was discontinued after the 2022–23 season to increase the number of athletes participating on the World Cup. The World Cup is the top level of international skeleton competition, and has the most stringent team quotas, with no teams receiving an automatic entry. To qualify,

14641-403: Was reported to have had the slowest ride from Junction, with a time of 380 seconds. Although since 1929 until December 2018 rules forbade women riders, it was not always so. For example, T. A. Cook records that, in 1895, various trials were made by women on the Cresta, testing different riding positions and different styles of toboggan—although at that time women riders were encouraged to use only

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