48. Risk factors for breast cancer Benign proliferative changes with atypia Noninvasive carcinoma( ductal or lobular carcinoma in situ) Personal history of contralateral breast cancer Low dose radiation Family history(mother, sister, or daughter with premenopausal or bilateral breast cancer Late nenopause(after age 50) Age older Early menarche(<12) Gender (female>male) ninor major

49. If diagnosed at an early stage, breast cancer has an encouraging cure rate: up to 97% of women diagnosed with localized breast cancer will survive five years after their diagnosis. Even if the cancer is found at a more advanced stage, new therapies have enabled many people with breast cancer to experience the same quality of life as before their diagnosis. About 90% of all breast cancers originate in the ducts or lobes. Almost 75% of all breast cancers begin in the cells lining the milk ducts and are called ductal carcinomas. Cancers that begin in the lobules are called lobular carcinoma. Lobular carcinoma has a higher chance of occurring in the contralateral (the other) breast either at the time of diagnosis or in the future.

61. The inflammatory changes often mistaken for an infection process, are caused by carcinoma invasion of the dermal lymphatics, with resulting edema,and hyperemia, if the physicin suspects infection but the lesion does not respond rapidly( 1-2 weeks) to antibiotics, biopsy examination must be performed. Metastases tend to occur early and widely, and for this reason inflammatory carcinoma is rarely curable. Mastectomy is seldome, if ever, indicated. Radiation, hormone therapy, and antcancer chemotherapy are the measures more likely to be of value.

77. A blue dye in lumpectomy site B axillary lymph nodes: levels I C axillary lymph nodes: levels II D axillary lymph nodes: levels III E large lymphatic channels F small lymphatic channels G sentinel lymph nodes taking up dye

84. Radiation therapy is given regularly for a number of weeks following a lumpectomy or partial mastectomy in order to eliminate remaining cancer cells near the tumor site. Radiation therapy is also recommended for many women after a mastectomy depending upon the size of their tumor, number of involved lymph nodes under the arm, and width of the margin of resection obtained by the surgeon. Sometimes radiation therapy is given before surgery to shrink a large tumor and make it easier to remove.

95. Aromatase inhibitors decrease the production of estrogen and are effective in postmenopausal women. They work by blocking the aromatase enzyme, which is necessary for production of estrogen. They are emerging as the preferred treatment for women with hormone-sensitive cancers. Several of these drugs include anastrozole, letrozole, and exemestane.