BREAST CANCER & TCM. DR Fatima Manesh PDF

BREAST CANCER
&
TRADITIONAL CHINESE MEDICINE (TCM)
By Fatima Manesh
Page | 1 Breast Cancer and TCM by Fatima Manesh
Introduction
I chose the topic "Breast Cancer and Traditional Chinese Medicine (TCM)"
for my thesis because I am a breast cancer survivor. As a result of having
had cancer, it became clear to me that my thoughts and emotions were the
starting point of my disease. When I first found out that I had cancer, I felt
that my life was over. The discovery of my disease came about just as the
U.S. Economic Recession was gaining speed. There was little work for
many people, housing and investment concerns abounded, stability was at an
all-time low....and then my cancer.
When I surrendered to my cancer treatment, both with Traditional Chinese
Medicine (TCM) and Western Medicine, I recovered. I accepted my disease,
regained my health, and learned that I could still enjoy life and move on. I
started to appreciate each day, happily communicating with my friends and
family. I never took my recovery for granted.
It is my desire to outline the approaches of both TCM and Western Medicine
in the treatment of breast cancer, and in doing so, make others aware of the
benefits of both.
I hope my experiences with using both types of these treatments, and the
benefits I derived from them, will help other cancer patients to beat the
disease and go on to lead full, healthy, long lives!
Acknowledgment
This paper is dedicated first and foremost to my beloved husband, Saeed

Mohammadi, and my dear sons, Ehsan, Ali, and Atta.
Many thanks are extended to my professors and the friendly staff at
American Liberty University, especially Doctors Kevin Sultani, Monica
Sultani, Shahbaz, Jahroomy and Kim. Above all, I must thank my
oncologist, Dr. Homayena Sanati, who gave me exemplary care.
Special thanks go to my fellow classmates who shared their time and talents
with me, and to Lili Adibi, who frequently helped and motivated me to
continue this work.
A final thank you to Sharon Girulat, a close family friend, who helped me to
finish.
To all those people around the world who are striving to overcome cancer, I
wish you the best success with your treatment, and a return to good health!
Dedication to All Cancer Patients

I am a cancer survivor. I am alive for one reason - to share my life and my
knowledge to help others. There are many cancer patients....some will be
survivors, and some not. I do not have the power to know or help them all. I
do have the power to try and meet and help as many as I possibly can, and
that I plan to do!
Whether through my work with acupuncture and my knowledge of
Traditional Chinese Medicine (TCM), or through lectures, visits with
patients, or other methods, I plan to turn cancer victims into cancer
survivors.
You may or may not ever know me personally, but I feel that someday I
shall make the world a better, more hopeful place for those patients who
battle cancer.
We all need to ACT to prevent and cure this dreaded disease.
Eat Right
Don't Smoke
Don't Drink
Avoid Toxins
I also strongly believe that my faith in a Higher Power, meditation, positive
attitude, and a heart full of love have done much to help me endure and
improve my life.
TABLE OF CONTENTS
CHAPTER 1. Pathology Of Cancer
History of Cancer 6
History of Breast Cancer 7
Ancient Egypt and Greece: Breast Cancer as a Systemic Disease 8
William Halstead and the Radical Mastectomy Paradigm 11
The Eighteenth Century: Breast Cancer as a Localized Disease and the Rise of Surgery
12
A New Beginning: Moving Away from the Halstead Mastectomy 13
New Hope for the Twenty-first Century: Changing Public Perception 14
CHAPTER2. What Is Cancer
What Is Cancer?
Normal cells in the body
How cancer starts
How cancer spreads
How cancers differ
Tumors that are not cancer

How common is cancer?
CHAPTER 3. What Causes Cancer?
What Causes Cancer?

Heredity and Cancer
DNA, genes, and chromosomes
Genes and cancer
When should I worry?
CHAPTER 4. Type Of Cancer
Breast cancer
Colon cancer
Childhood cancers
Cancer Types
CHAPTER 5. Breast Cancer In Western Medicine
Breast Cancer
What is breast cancer?
The normal breast

The lymph (lymphatic) system of the breast
Benign breast lumps

Fibrocystic changes
Other benign breast lumps
General breast cancer terms

Types of breast cancers
Less common types of breast cancer
Special types of invasive breast carcinoma
What are the risk factors for breast cancer?
Risk factors you cannot change
Family history of breast cancer
Personal history of breast cancer
CHAPTER 6. Breast awareness and self exam
Mammograms and Self-Exam

What the doctor looks for on your mammogram
Limitations of mammograms
Clinical breast exam

Breast awareness and self exam
How to examine your breasts
Magnetic resonance imaging (MRI)
CHAPTER 7. How is breast cancer treated in western medicine?
General types of treatment

Local versus systemic therapy
Adjuvant and neoadjuvant therapy
Oncoplastic surgery
Breast reconstruction surgery
Radiation therapy
New chemotherapy drugs
Targeted therapies
Drugs that target HER2:
Anti-angiogenesis drugs:
Other targeted drugs:
Denosumab
Vitamin D
CHAPTER 8. Breast Cancer Statistics
Breast cancer in the United States

Women
Men
Rates of breast cancer over time
Mammography and rates of early detection over time
Race/ethnicity and breast cancer rates over time
Male breast cancer rates over time
Worldwide variation
Variation within the United States
Race/ethnicity and breast cancer rates
Migration to the U.S. and breast cancer rates

African American women
Ashkenazi Jewish women
Asian American and Pacific Islander women
Primary prevention is the answer
Breast cancer: Europe
Breast Cancer in Europe 2006

CHAPTER 9. Cancer And Breast Cancer According To Traditional Chinese

Medicine
The Chinese understanding of cancer
Acupuncture
Acupuncture points for cancer
Herbal medicine
The role of the spirit
Diet
Breast Cancer in traditional Chinese medicine
First is the concept of flow and how it relates to health.
The second missing concept is immunity.
Conclusion
CHAPTER 10 . Diagnosis According to Traditional Chinese Medicine (T.C.M.) A

Guide to Oriental Medicine
1 - Looking Diagnosis
Tongue Diagnosis
2 - Listening Diagnosis
3 - Smelling and tasting Diagnosis
4 - Feeling the pulse (Touching Diagnosis).
Where is the pulse felt?
CHAPTER 11. Chinese Medicine & The Theory of Qi , Blood and the Theory of Yin
Yang
Qi and Blood According to Traditional Chinese Medicine

"Qi is the source of all movement and heat.
Blood is mother to the Qi."
CHAPTER 1. Pathology of Cancer
History of Cancer
Cancer may be one of the oldest known forms of tumors in the human body. The oldest
description of cancer was discovered in Egypt and dates back to approximately 1600 BC.
The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were
treated by cauterization. The writing says about the disease, "There is no treatment."
For centuries, physicians described similar cases in their practices, with the same
conclusion. It was not until doctors achieved greater understanding of the circulatory
system in the 17th century that they could establish a link between breast cancer and the
lymph nodes in the armpit.`
The French surgeon Jean Louis Petit (16741750) and later the Scottish surgeon Benjamin
Bell (17491806) were the first to remove the lymph nodes, breast tissue, and underlying
chest muscle. Their successful work was carried on by William Stewart Halsted who
started performing mastectomies in 1882.
The Halsted radical mastectomy often involved removing both breasts, associated lymph
nodes, and the underlying chest muscles. This often led to long-term pain and disability,
but was seen as necessary in order to prevent the cancer from recurring. Radical
mastectomies remained the standard until the 1970s, when a new understanding
of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and
more sparing procedures were developed that proved equally effective.
History of Breast Cancer

Breast cancer is an ancient disease, and it has been mentioned in almost every period of
recorded history. Physicians have consistently noted that breast cancer is visible to even
the untrained eye, progressing from a small lump to large tumors. Unlike other fatal
diseases (heart conditions and most other cancers), breast cancer announces itself in a
tangible fashion (Leopold 1999). Yet, despite the visibility of the disease and the powerful
reverberations breast cancer has had, for women specifically and society in general, any
discussion of breast cancer was found only in medical journals before the 1970s.
Historically, the breast carries with it many cultural expectations for women, specifically
their nurturing and sexual obligations. Perhaps it is because the breast holds such cultural
power that the disease was considered by many to be a taboo subject and many of its
sufferers often felt ashamed or embarrassed to openly discuss the disease. This previous
void in literature outside medical journals stands in stark contrast to the extremely visible
presence the disease holds in contemporary culture. Today there is no public forum in
which breast cancer is not discussed (Leopold 1999). Since the success of breast cancer
activism in the 1990s, the symbol of breast cancer--the pink ribbon--is ubiquitous in
American culture, and politicians and healthcare officials are acknowledging the role that
political and cultural assumptions play in finding a cure.
Ancient Egypt and Greece: Breast Cancer as a Systemic Disease
Ancient Egyptians were the first to note the disease more than 3,500 years ago. Both the
Edwin Smith and George Ebers papyri contain descriptions of conditions that are
consistent with modern descriptions of breast cancer. For example, one nameless ancient
Egyptian surgeon describes bulging tumors in the breast and states that there is no
cure. In 460 B.C., Hippocrates, the father of Western Medicine, described breast cancer
as a humoral disease. In other words, for Hippocrates, the body consisted of four humors
(blood, phlegm, yellow bile, and black bile), which mirrored the building blocks of nature
(air, fire, earth, and water)--and any imbalance of the system of humors caused sickness
or even death. For Hippocrates, cancer was caused by the excess of black bile, or
melonchole. This logic made sense to Hippocrates because the appearance of an
untreated breast tumor would be black and hard, eventually erupting through the skin with
black fluids. He named the cancerkarkinos, a Greek word for crab, because the tumors
seemed to have tentacles, like the legs of a crab. Hippocrates considered surgery dangerous
because those who had the tumor excised perish quickly; while those who are not excised
lived longer (Olsen 2002).
In A.D. 200, Galen, Hippocrates successor, also describes cancer as excessive black bile
but, unlike Hippocrates, Galen also realized that some tumors were more dangerous than
others. Galen also discusses a wide range of pharmaceutical agents to treat breast cancer,
such as opium, castor oil, licorice, sulpher, and a variety of salves, as well as incantations
to the gods. For humoral physicians, surgery to remove the tumor or entire breast was not
even considered to be an option for a cure since they assumed the cancer would just
reappear near the surgical site or somewhere else in the body. For Galen and physicians
succeeding him over the next 2,000 years, breast cancer was a systemic disease, which
meant it was a disease of the entire body, not just one localized part. The dark bile was
believed to course throughout the entire body--so even if a tumor were removed, the bile
would still remain in the body, ready to create more tumors.
Until the seventeenth century, physicians assumed that Galen had the final word on breast
cancer and that there was nothing left to discover. However, in 1680, French physician
Francois de la Boe Sylvius began to challenge the humoral theory of cancer by arguing
that cancer did not come from an excess of black bile but from a chemical process that
transformed lymphatic fluids from acidic to acrid. In the 1730s, Paris physician ClaudeDeshais Gendron also rejected the humors theory and insisted that cancer developed when
nerve and glandular tissue mixed with lymph vessels (Olson 1999).
The Eighteenth Century: Breast Cancer as a Localized Disease and the Rise of
Surgery
By 1769, the humoral theory had lost much of its currency. To disprove the humoral
theorists, French physician Jean Astruc took a piece of breast cancer tissue along with a
slice of beef and burned them both in an oven and chewed them. Both tasted the same, and
he concluded the tumor tissue did not contain unusual amounts of bile or acid. With the
humoral theory disproved, physicians began to search for a new origin of breast cancer,
and many argued that its origin was sexual. Physicians knew of Bernardino Ramazzini's
1713 hypotheses that the high frequency of breast cancer in nuns was due to lack of sex;
according to Ramazzini, without regular sexual activity, reproductive organs, including
the breast, started to decay and cancer was the result. Friedrich Hoffman of Prussia posited
that women who had regular sex but still developed cancer were practicing vigorous sex
that could result in lymphatic blockage.
But there were other, nonsexual theories also presented. Giovanni Morgagni blamed
curdled milk. Johanes de Gorter in the 1750s claimed that tumors came from pus-filled
inflammations in the breast that mixed with blood, lodged in the milk gland, and dried into
a tumor. Claude-Nicolas Le Cat from Rouen claimed that depression caused cancer by
constricting the blood vessels and trapping coagulated blood. Lorenz Heister placed
childless women at high risk, while others blamed a sedentary lifestyle which slackened
bodily fluids. Though there was no lack of theories, the cause of breast cancer was still as
mysterious to them as it was to the ancients. But unlike the ancients, eighteenth-century
physicians gradually became more certain that breast cancer was a localized disease. This
had enormous implications, because in contrast to humoral theories which considered
mastectomy a tangential treatment due to the systemic nature of cancer, doctors were
rapidly becoming skeptical of anything but surgery (Olson 1999).
In 1757, Henri Le Dran, a leading French physician, argued that surgery could actually
cure breast cancer as long as the infected axillia lymph nodes were removed. Similarly,
Claude-Nicolas Le Cat argued that the scalpel was the only way to cure cancer. Le Cat
would amputate the breast, cutting out the lymph nodes as well as the pectoralis major
muscle. These physicians were convinced that the presence of a tumor did not necessarily
imply a more serious problem, but was a single-site disease that could be surgically
removed locally before it spread. This theory lasted well into the twentieth century and led
to the creation of the radical mastectomy (Hellman 1993).
William Halstead and the Radical Mastectomy Paradigm

By the mid-nineteenth century, most physicians held that because cancer was a localized
disease, surgery was the only hope. The development of antiseptic, anesthesia, blood
transfusion, and cellular biology--as well as increased public trust in the medical field-made radical surgery possible. Gone were the days of pre-anesthesia which necessitated
speed and dexterity with an often resistant patient. Surgeons now had time for deliberate
precision, and William Halstead of New York made radical breast surgery the gold
standard for the next 100 years. Halstead wanted to reduce the recurrences of the disease
which often afflicted patients within a year of their initial surgery and to help even the
most advanced-inflicted patients. Whereas earlier surgeons would remove the breast,
axilla nodes, and pectoralis muscle, that was not enough for Halstead. He knew that cancer
was a cellular disease and worried about his own role in spreading it. He argued that lifting
away the excised breast with surgeon hands probably scattered tumor cells. This led him
to call for a radical mastectomyremoval of the breast, axillary nodes, and both chest
muscles in a single en blocprocedure. He would cut widely around the tumor, removing
all the tissue in one piece.
During the first four decades of the twentieth century, the radical mastectomy dominated
breast cancer treatment. Halstead himself performed hundreds of radical mastectomies and
urged that inflicted women should receive a radical mastectomy before the tumor spread
to regional lymph nodes. While the radical mastectomy may have extended life slightly
and eased the pain of diseased breasts, it was not an unmixed blessing. Some women
avoided the surgery because it would leave them wounded and disfigured for the rest of
their lives. Women had to deal with a deformed chest wall, hollow voids under the collar
bone and the armpit, chronic pain, and lymphedema or swelling in the arm because the
removed underarm lymph nodes could no longer process circulatory fluids efficiently.
Halstead dismissed these effects as necessary evils; besides, the womens average age was
nearly fifty-five years [and t]hey are no longer active members of society (Olson 1999).
Halstead also gave some thought to shoulder amputation. For Halstead and his followers,
cutting away more and more tissue was the only way to treat breast cancer. Jerome Urban,
the architect of the super-radical mastectomy in 1949, would remove the breast, the
axillary nodes, the chest muscles, and internal mammary nodes in a single procedure, often
on patients who had tumors less than one centimeter large.
Twentieth-Century
Surgeries:
Oophorectomy,
Adrenalectomy,
and
Hypophysectomy
In 1895, Scottish surgeon George Beatson discovered that removing the ovaries from one
of his patients shrank her breast tumor. This news spread and soon surgeons were
performing prophylactic oophorectomies, which involved removing both ovaries and
performing a radical mastectomy. The operations were debilitating and the results
unpredictable since the surgeons had no way of determining which tumors possessed
estrogen receptors. Because of this, by 1920 most surgeons employed an oopherectomy
only as a last resort. What modern oncologists now know is that some breast tumors have
estrogen receptors that feed on estrogen. Removing the ovaries in some cases starved the
tumor, at least temporarily. The tumor would always regrow because the body
compensated by secreting estrogen-like substances from the adrenal and pituitary glands.
In 1952, approximately the same time as Urbans super-radical mastectomy, Charles
Huggins began removing a womans adrenal gland (adrenalectomy) in an effort to starve

the tumor of estrogen. Rolf Lefft and Herbert Olivecrona began performing
hypophysectomies, or the removal of the pituitary gland. Side effects included impaired
vision, personality changes, and cognitive difficulties. Even with these extreme surgeries,
the tumors still returned to kill.
A New Beginning: Moving Away from the Halstead Mastectomy
The Halstead mastectomy was based on the premise that breast cancer was a localized
disease that could be treated by surgically removing the diseased part of the body. George
Crile in 1955 began to argue that cancer was not localized but rather is spread throughout
the body. Bernard Fisher also revolutionized cancer treatment by revising metastasis
theory which, like Hippocrates, argued that cancer cells traveled throughout both the
circulatory and lymphatic systems and that surgery could not cure cancer because cancer
cells were floating throughout the body in the circularity system. In 1976, Fisher published
results indicating that simpler breast-conserving surgery followed by radiation or
chemotherapy were just as effective as the radical mastectomy, and usually more so
(Hellman 1993). By advocating a more systemic approach to breast cancer, Fisher and
Crile directly challenged the surgeons role as the primary source of breast cancer
treatment. Yet physicians were reluctant to abandon the Halstead mastectomy until the
sexual revolution and modern feminism.
With the decline of the Halstead radical mastectomy and a revised theory of metastasis,
physicians hypothesized about the origins of breast cancer and, during the 1990s,
everything ranging from diet, chemical pollution, race, delay in having children, and
breastfeeding was up for debate. Despite this uncertainty, there were still advances. After
an in initial increase in breast cancer rates, the number of deaths plateaued in 1995 and
then started to decline. By 1995, less than 10 percent of breast cancer-inflicted women had
a mastectomy. Improvements in chemotherapy, radiation, hormone treatments
(particularly Tamoxifen), mammography, and surgery helped move breast cancer from an
urgent disease to a chronic condition. Significantly, scientists isolated the genes that cause
breast cancer: BRCA2 and ATM. Today, advances in molecular and genetic sciences are
creating novel therapeutic strategies that give both women and men not only hope but also
more choices about their bodies.
New Hope for the Twenty-first Century: Changing Public Perception
The ultimate cure for breast cancer remains elusive. The disease is so complex, diverse,
and so subtly connected to genetic and environmental variables that finding a cure can
often seem remote if not impossible. While a cure has not yet been found, public
perception surrounding breast cancer has changed dramatically. Once a disease that
women felt ashamed to discuss, breast cancer now has lost much of its stigma, providing
the opportunity for politicians and health care officials to acknowledge that economic and
political considerations bear on the success of breast cancer treatment as much as advances
in medical science.
CHAPTER2. What Is Cancer
What Is Cancer?
Cancer is the general name for a group of more than 100 diseases. Although there
are many kinds of cancer, all cancers start because abnormal cells grow out of
control. Untreated cancers can cause serious illness and death.
Normal cells in the body
The body is made up of trillions of living cells. Normal body cells grow, divide, and die in
an orderly fashion. During the early years of a persons life, normal cells divide faster to
allow the person to grow. After the person becomes an adult, most cells divide only to
replace worn-out or dying cells or to repair injuries.
How cancer starts
Cancer starts when cells in a part of the body start to grow out of control. Cancer cell
growth is different from normal cell growth. Instead of dying, cancer cells continue to grow
and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues,
something that normal cells cannot do. Growing out of control and invading other tissues
are what makes a cell a cancer cell.
Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in
every cell and it directs all the cells actions. In a normal cell, when DNA gets damaged
the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not
repaired, and the cell doesnt die like it should. Instead, the cell goes on making new cells
that the body doesnt need. These new cells all have the same abnormal DNA as the first
cell does.
People can inherit abnormal DNA, but most DNA damage is caused by mistakes that
happen while the normal cell is reproducing or by something in the environment.
Sometimes the cause of the DNA damage may be something obvious like cigarette
smoking or sun exposure. But its rare to know exactly what caused any one persons
cancer.
In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form
tumors. Instead, these cancer cells involve the blood and blood-forming organs and
circulate through other tissues where they grow.
How cancer spreads
Cancer cells often travel to other parts of the body where they begin to grow and form new
tumors. This happens when the cancer cells get into the bodys bloodstream or lymph
vessels. Over time, the tumors replace normal tissue. The process of cancer spreading is
called metastasis.
How cancers differ
No matter where a cancer may spread, its always named for the place where it started. For
example, breast cancer that has spread to the liver is called metastatic breast cancer, not
liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic
prostate cancer, not bone cancer.
Different types of cancer can behave very differently. For instance, lung cancer and skin
cancer are very different diseases. They grow at different rates and respond to different
treatments. This is why people with cancer need treatment that is aimed at their kind of
cancer.
Tumors that are not cancer
Not all tumors are cancer. Tumors that arent cancer are called benign. Benign tumors can
cause problems they can grow very large and press on healthy organs and tissues. But
they cannot grow into (invade) other tissues. Because they cant invade, they also cant
spread to other parts of the body (metastasize). These tumors are almost never life
threatening.
How common is cancer?
Half of all men and one-third of all women in the US will develop cancer during their
lifetimes.
Today, millions of people are living with cancer or have had cancer. The risk of developing
many types of cancer can be reduced by changes in a persons lifestyle, for example, by
staying away from tobacco, limiting time in the sun, being physically active and healthy
eating.
There are also screening tests that can be done for some types of cancers so they can be
found as early as possible while they are small and before they have spread. In general,
the earlier a cancer is found and treated, the better the chances are for living for many years.
CHAPTER 3. What Cause Cancer?

What Causes Cancer?

Cancer is a complex group of diseases with many possible causes. In this section you can
learn more about the known causes of cancer, including genetic factors; lifestyle factors
such as tobacco use, diet, and physical activity; certain types of infections; and
environmental exposures to different types of chemicals and radiation.
Heredity and Cancer
Cancer is such a common disease that it is no surprise that many families have at least a
few members who have had cancer. Sometimes, certain types of cancer seem to run in
some families. This can be caused by a number of factors. Often, family members have
certain risk factors in common, such as smoking, which can cause many types of cancer.
But in some cases the cancer is caused by an abnormal gene that is being passed along from
generation to generation. Although this is often referred to as inherited cancer, what is
inherited is the abnormal gene that can lead to cancer, not the cancer itself. Only about 5%
to 10% of all cancers are inherited. This document focuses on those cancers.
DNA, genes, and chromosomes
Cancer is a disease of abnormal gene function. Genes are pieces of DNA (deoxyribonucleic
acid). They contain the instructions on how to make the proteins the body needs to function,
when to destroy damaged cells, and how to keep the cells in balance. Your genes control
things such as hair color, eye color, and height. They also can affect your chance of getting
certain diseases, such as cancer.
An abnormal change in a gene is called a mutation. The 2 types of mutations are inherited
and acquired (somatic).
Inherited gene mutations are passed from parent to child through the egg or sperm. These
mutations are in every cell in the body.
Acquired (somatic) mutations are not present in the egg or sperm. These mutations are
acquired at some point in the person's life, and are more common than inherited
mutations. This type of mutation occurs in one cell, and then is passed on to any new
cells that are the offspring of that cell.
Genes are found on long strands of DNA called chromosomes. Humans have 23 pairs of
chromosomes in each cell. We inherit one set of chromosomes from each parent. Each
chromosome can contain hundreds or thousands of genes that are passed from the parents
to the child. Every cell in your body has all of the genes you were born with. Although all
cells have the same genes and chromosomes, different cells (or types of cells) may use
different genes. For example, muscle cells use a different set of genes than skin cells use.
The genes that the cell doesn't need are turned off and not used. The genes that the cell is
using are activated or turned on.
Genes and cancer
Genes seem to have 2 major roles in cancer: Some called oncogenes, can cause cancer;
others known as tumor suppressor genes, stop cancer from developing or growing. More
information about oncogenes and tumor suppressor genes can be found in our
document, Oncogenes, Tumor Suppressor Genes, and Cancer.
Oncogenes are mutated forms of certain normal genes of the cell called protooncogenes. Proto-oncogenes are often genes that normally control what kind of cell it is
and how often it grows and divides. When a proto-oncogene mutates (changes) into an
oncogene, it turns on or activates when it is not supposed to be. When this occurs, the cell
can grow out of control, leading to cancer.
Tumor suppressor genes are normal genes that slow down cell division, repair DNA
mistakes, or tell cells when to die (a process known as apoptosis or programmed cell
death). When tumor suppressor genes dont work properly, cells can grow out of control,
which can lead to cancer.
A tumor suppressor gene is like the brake pedal on a car. It normally keeps the cell from
dividing too quickly just as a brake keeps a car from going too fast. When something goes
wrong with the gene, such as a mutation, cell division can get out of control.
An important difference between oncogenes and tumor suppressor genes is that oncogenes
result from the activation (turning on) of proto-oncogenes, but tumor suppressor genes
cause cancer when they are inactivated (turned off).
Even if you were born with healthy genes, some of them can become changed (mutated)
over the course of your life. These mutations are known as sporadic or somatic, meaning
they are not inherited. Sporadic mutations cause most cases of cancer. These mutations
may be caused by things that we are exposed to in our environment, including cigarette
smoke, radiation, hormones, and diet (although in many cases there is no obvious cause).
More gene mutations build up as we get older, leading to a higher risk of cancer.
When someone has inherited an abnormal copy of a gene, their cells already start out with
one mutation. This makes it all the easier (and quicker) for enough mutations to build up
for a cell to become cancer. That is why cancers that are inherited tend to occur earlier in
life than cancers of the same type that are not inherited.
When should I worry?

When many cases of cancer occur in a family, it is most often due to chance or because
family members have been exposed to a common toxin, such as cigarette smoking. Less
often, these cancers may be caused by an inherited gene mutation. (These are called family
cancer syndromes.) Certain things make it more likely that an abnormal gene is causing
cancers in a family, such as
Many cases of an uncommon or rare type of cancer (like kidney cancer)
Cancers occurring at younger ages than usual (like colon cancer in a 20 year old)
More than one type of cancer in a single person (like a woman with both breast and
ovarian cancer)
Cancers occurring in both of a pair of organs (both eyes, both kidneys, both breasts)
More than one childhood cancer in a set of siblings (like sarcoma in both a brother and a
sister)
Before you decide that cancer runs in your family, first gather some information. For each
case of cancer, look at:
Who is affected? How are we related?
What type of cancer is it? Is it rare?
How old was this relative when they were diagnosed?
Did this person get more than one type of cancer?
Did they smoke or have other known risk factors?

Cancer in a close relative, like a parent or sibling (brother or sister), is more cause for
concern than cancer in a more distant relative. Even if the cancer was from a gene mutation,
the chance of it passing on to you gets lower with more distant relatives.
It is also important to look at each side of the family separately. Having 2 relatives with
cancer is more concerning if the people are related to each other (meaning that they are
both on the same side of the family). For example, if both relatives are your mother's
brothers it means more than if one was your father's brother and the other was your mother's
brother.
The type of cancer matters, too. More than one case of the same rare cancer is more
worrisome than cases of a more common cancer. And having the same type of cancer in
many relatives is more concerning than if it is several different kinds of cancer. Still, in
some family cancer syndromes, a few types of cancer seem to go together. For example,
breast cancer and ovarian cancer run together in families with hereditary breast and ovarian
cancer syndrome (HBOC). Colon and endometrial cancers tend to go together in a
syndrome called hereditary non-polyposis colorectal cancer (HNPCC), also known as
Lynch syndrome.
The age of the person when the cancer was diagnosed is also important. For example, colon
cancer is rare in people under 30. Having 2 or more cases in close relatives under 30 could
be a sign of an inherited cancer syndrome. On the other hand, prostate cancer is very
common in elderly men, so if both your father and his brother were found to have prostate
cancer when they were in their 80s, it is less likely to be due to an inherited gene change.
When many relatives have the same type of cancer it is important to notice if the cancer
could be related to smoking. For example, lung cancer is commonly caused by smoking,
so many cases of lung cancer in a family of heavy smokers is more likely to be due to
smoking than to an inherited gene change.
CHAPTER 4. Type of Cancer
Types of cancer
Cancer Types
Adrenal Cortical Cancer
Advanced Cancer
Anal Cancer
Aplastic Anemia
Bile Duct Cancer
Bladder Cancer
Bone Cancer
Bone Metastasis
Brain/CNS Tumors In Adults
Brain/CNS Tumors In Children
Breast Cancer
Breast Cancer In Men
Cancer in Children
Cancer of Unknown Primary
Castleman Disease
Cervical Cancer
Colon/Rectum Cancer
Endometrial Cancer
Esophagus Cancer
Ewing Family Of Tumors

Eye Cancer
Gallbladder Cancer
Gastrointestinal Carcinoid Tumors
Gastrointestinal Stromal Tumor (GIST)
Gestational Trophoblastic Disease
Hodgkin Disease
Kaposi Sarcoma
Kidney Cancer
Laryngeal and Hypopharyngeal Cancer
Leukemia - Acute Lymphocytic (ALL) in Adults
Leukemia - Acute Myeloid (AML)
Leukemia - Chronic Lymphocytic (CLL)
Leukemia - Chronic Myeloid (CML)
Leukemia - Chronic Myelomonocytic (CMML)
Leukemia in Children
Liver Cancer
Lung Cancer - Non-Small Cell
Lung Cancer - Small Cell
Lung Carcinoid Tumor
Lymphoma of the Skin
Malignant Mesothelioma
Multiple Myeloma
Myelodysplastic Syndrome
Nasal Cavity and Paranasal Sinus Cancer
Nasopharyngeal Cancer
Neuroblastoma
Non-Hodgkin Lymphoma
Non-Hodgkin Lymphoma In Children
Oral Cavity and Oropharyngeal Cancer
Osteosarcoma
Ovarian Cancer
Pancreatic Cancer
Penile Cancer
Pituitary Tumors
Prostate Cancer
Retinoblastoma
Rhabdomyosarcoma
Salivary Gland Cancer
Sarcoma - Adult Soft Tissue Cancer
Skin Cancer - Basal and Squamous Cell
Skin Cancer - Melanoma
Small Intestine Cancer
Stomach Cancer
Testicular Cancer
Thymus Cancer
Thyroid Cancer
Uterine Sarcoma
Vaginal Cancer
Vulvar Cancer
Waldenstrom Macroglobulinemia
Wilms Tumor
CHAPTER 5.Breast Cancer in Western Medicine

Breast cancer
Many women are concerned that breast cancer seems to run in their family. A woman who
has a first-degree relative (a mother, sister, or daughter) with breast cancer is about twice
as likely to develop breast cancer as a woman without a family history of this cancer. Still,
most cases of breast cancer, even those in close relatives, are not part of a family cancer
syndrome caused by an inherited gene mutation.
The chance that someone has an inherited form of breast cancer is higher the younger they
are when they get the cancer and the more relatives they have with the disease. Inherited
breast cancer can be caused by several different genes, but the most common
are BRCA1 and BRCA2. Inherited mutations in these genes cause hereditary breast and
ovarian cancer syndrome (HBOC). Along with breast and ovarian cancer, this syndrome
can also lead to male breast cancer, pancreatic cancer, prostate cancer, as well as some
others. This syndrome is more common in women of Ashkenazi Jewish descent than it is
in the general US population.
Women with a strong family history of breast cancer may choose to undergo genetic
counseling to estimate their risk for inherited breast cancer. They then can choose to be
tested to find out if they have a breast cancer gene mutation. If a mutation is present, the
woman has a high risk of developing breast cancer. She may start getting mammograms at
an age younger than 40, have special breast cancer screening tests, or take other measures
to try to reduce her risk of getting breast cancer.
What is breast cancer in western medicine?
Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor
is a group of cancer cells that can grow into (invade) surrounding tissues or spread
(metastasize) to distant areas of the body. The disease occurs almost entirely in women,
but men can get it, too.
To understand breast cancer, it helps to have some basic knowledge about the normal
structure of the breasts, shown in the diagram below.
The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes
that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective
tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).
Most breast cancers begin in the cells that line the ducts (ductal cancers). Some begin in
the cells that line the lobules (lobular cancers), while a small number start in other tissues.
The lymph (lymphatic) system of the breast

The lymph system is important to understand because it is one way breast cancers can
spread. This system has several parts.
Lymph nodes are small, bean-shaped collections of immune system cells (cells that are
important in fighting infections) that are connected by lymphatic vessels. Lymphatic
vessels are like small veins, except that they carry a clear fluid called lymph (instead of
blood) away from the breast. Lymph contains tissue fluid and waste products, as well as
immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in
lymph nodes.
Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary
nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal
mammary
nodes)
and
those
either
above
(supraclavicular orinfraclavicular nodes).
or
below
the
collarbone
If the cancer cells have spread to lymph nodes, there is a higher chance that the cells could
have also gotten into the bloodstream and spread (metastasized) to other sites in the body.
The more lymph nodes that have breast cancer, the more likely it is that the cancer may be
found in other organs as well. Because of this, finding cancer in one or more lymph nodes
often affects the treatment plan. Still, not all women with cancer cells in their lymph nodes
develop metastases, and some women can have no cancer cells in their lymph nodes and
later develop metastases.
Benign breast lumps

Most breast lumps are not cancerous (benign). Still, some may need to be sampled and
viewed under a microscope to prove they are not cancer.
Fibrocystic changes
Most lumps turn out to be fibrocystic changes. The term fibrocystic refers to fibrosis and
cysts. Fibrosis is the formation of scar-like (fibrous) tissue, and cysts are fluid-filled sacs.
Fibrocystic changes can cause breast swelling and pain. This often happens just before a
woman's menstrual period is about to begin. Her breasts may feel lumpy and, sometimes,
she may notice a clear or slightly cloudy nipple discharge.
Other benign breast lumps
Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal
growths, but they are not cancerous and do not spread outside the breast to other organs.
They are not life threatening. Still, some benign breast conditions are important because
women with these conditions have a higher risk of developing breast cancer.
General breast cancer terms
Here are some of the key words used to describe breast cancer.
Carcinoma
This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of
organs like the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas
or lobular carcinomas).
Adenocarcinoma
An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes
and secretes a substance). The ducts and lobules of the breast are glandular tissue (they
make breast milk), so cancers starting in these areas are often called adenocarcinomas.
Carcinoma in situ
This term is used for an early stage of cancer, when it is confined to the layer of cells where
it began. In breast cancer, in situ means that the cancer cells remain confined to ducts
(ductal carcinoma in situ). The cells have not grown into (invaded) deeper tissues in the
breast or spread to other organs in the body. Carcinoma in situ of the breast is sometimes
referred to as non-invasive or pre-invasive breast cancer because it may develop into an
invasive breast cancer if left untreated.
When cancer cells are confined to the lobules it is called lobular carcinoma in situ. This is
not actually a true cancer or pre-cancer.
Invasive (infiltrating) carcinoma
An invasive cancer is one that has already grown beyond the layer of cells where it started
(as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas either
invasive ductal carcinoma or invasive lobular carcinoma.
Sarcoma
Sarcomas are cancers that start in connective tissues such as muscle tissue, fat tissue, or
blood vessels. Sarcomas of the breast are rare.
Types of breast cancers

There are several types of breast cancer, but some of them are quite rare. In some cases a
single breast tumor can be a combination of these types or be a mixture of invasive and in
situ cancer.
Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common
type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts
but have not spread through the walls of the ducts into the surrounding breast tissue.
About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this
early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS
early.
When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from
tissue samples) will look for areas of dead or dying cancer cells, called tumor necrosis,
within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive.
The term comedocarcinoma is often used to describe DCIS with necrosis.
Invasive (or infiltrating) ductal carcinoma
This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma
(IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and
grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize)
to other parts of the body through the lymphatic system and bloodstream. About 8 of 10
invasive breast cancers are infiltrating ductal carcinomas.
Invasive (or infiltrating) lobular carcinoma
Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC,
it can spread (metastasize) to other parts of the body. About 1 in 10 invasive breast cancers
is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than
invasive ductal carcinoma.
Less common types of breast cancer

Inflammatory breast cancer: This uncommon type of invasive breast cancer accounts for
about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead,
inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It
also may give the breast skin a thick, pitted appearance that looks a lot like an orange peel.
Doctors now know that these changes are not caused by inflammation or infection, but by
cancer cells blocking lymph vessels in the skin. The affected breast may become larger or
firmer, tender, or itchy. In its early stages, inflammatory breast cancer is often mistaken for
an infection in the breast (called mastitis). Often this cancer is first treated as an infection
with antibiotics. If the symptoms are caused by cancer, they will not improve, and a biopsy
will find cancer cells. Because there is no actual lump, it may not show up on a
mammogram, which may make it even harder to find it early. This type of breast cancer
tends to have a higher chance of spreading and a worse outlook (prognosis) than typical
invasive ductal or lobular cancer.
Triple-negative breast cancer: This term is used to describe breast cancers (usually
invasive ductal carcinomas) whose cells lack estrogen receptors and progesterone
receptors, and do not have an excess of the HER2 protein on their surfaces. Breast cancers
with these characteristics tend to occur more often in younger women and in AfricanAmerican women. Triple-negative breast cancers tend to grow and spread more quickly
than most other types of breast cancer. Because the tumor cells lack these particular
receptors, neither hormone therapy nor drugs that target HER2 are effective treatments (but
chemotherapy can still be useful if needed).
Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads
to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare,
accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola
often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may
notice burning or itching.
Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue)
of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names
for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are
usually benign but on rare occasions may be malignant.
Benign phyllodes tumors are treated by removing the tumor along with a margin of normal
breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider
margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but these
cancers may not respond as well to the other treatments used for more common breast
cancers. When a malignant phyllodes tumor has spread, it can be treated with the
chemotherapy given for soft-tissue sarcomas.
Angiosarcoma: This is a form of cancer that starts in cells that line blood vessels or lymph
vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication
of previous radiation treatments. This is an extremely rare complication of breast radiation
therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur
in the arms of women who develop lymphedema as a result of lymph node surgery or
radiation therapy to treat breast cancer.
What are the risk factors for breast cancer?
A risk factor is anything that affects your chance of getting a disease, such as cancer.
Different cancers have different risk factors. For example, exposing skin to strong sunlight
is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth,
larynx (voice box), bladder, kidney, and several other organs.
But risk factors don't tell us everything. Having a risk factor, or even several, does not
mean that you will get the disease. Most women who have one or more breast cancer risk
factors never develop the disease, while many women with breast cancer have no apparent
risk factors (other than being a woman and growing older). Even when a woman with risk
factors develops breast cancer, it is hard to know just how much these factors may have
contributed to her cancer.
There are different kinds of risk factors. Some factors, like a person's age or race, can't be
changed. Others are linked to cancer-causing factors in the environment. Still others are
related personal behaviors, such as smoking, drinking, and diet. Some factors influence
risk more than others, and your risk for breast cancer can change over time, due to factors
such as aging or lifestyle.
Risk factors you cannot change
Gender
Simply being a woman is the main risk factor for developing breast cancer. Men can
develop breast cancer, but this disease is about 100 times more common among women
than men. This is likely because men have less of the female hormones estrogen and
progesterone, which can promote breast cancer cell growth
Aging
Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive
breast cancers are found in women younger than 45, while about 2 of 3 invasive breast
cancers are found in women age 55 or older.
Genetic risk factors
About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly
from gene defects (called mutations) inherited from a parent.
BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited
mutation in the BRCA1 and BRCA2genes. In normal cells, these genes help prevent cancer
by making proteins that keep the cells from growing abnormally. If you have inherited a
mutated copy of either gene from a parent, you have a high risk of developing breast cancer
during your lifetime. The risk may be as high as 80% for members of some families
with BRCA mutations. These cancers tend to occur in younger women and more often
affect both breasts than cancers in women who are not born with one of these gene
mutations. Women with these inherited mutations also have an increased risk for
developing other cancers, particularly ovarian cancer.
In the United States BRCA mutations are found most often in Jewish women of Ashkenazi
(Eastern Europe) origin, but they can occur in any racial or ethnic group.
Changes in other genes: Other gene mutations can also lead to inherited breast cancers.
These gene mutations are much rarer and often do not increase the risk of breast cancer as
much as the BRCA genes. They are not frequent causes of inherited breast cancer.
Genetic
testing: Genetic
tests
can
be
done
to
look
for
mutations
in
the BRCA1 and BRCA2 genes (or some other genes linked to breast cancer risk). Although
testing may be helpful in some situations, the pros and cons need to be considered carefully.
Family history of breast cancer
Breast cancer risk is higher among women whose close blood relatives have this disease.
Having one first-degree relative (mother, sister, or daughter) with breast cancer
approximately doubles a woman's risk. Having 2 first-degree relatives increases her risk
about 3-fold.
The exact risk is not known, but women with a family history of breast cancer in a father
or brother also have an increased risk of breast cancer. Altogether, less than 15% of women
with breast cancer have a family member with this disease. This means that most (over
85%) women who get breast cancer do not have a family history of this disease.
Personal history of breast cancer
A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new
cancer in the other breast or in another part of the same breast. This is different from a
recurrence (return) of the first cancer.
Race and ethnicity
Overall, white women are slightly more likely to develop breast cancer than are AfricanAmerican women, but African-American women are more likely to die of this cancer.
However, in women under 45 years of age, breast cancer is more common in AfricanAmerican women. Asian, Hispanic, and Native-American women have a lower risk of
developing and dying from breast cancer.
Dense breast tissue

Women with denser breast tissue (as seen on a mammogram) have more glandular tissue
and less fatty tissue, and have a higher risk of breast cancer. Unfortunately, dense breast
tissue can also make it harder for doctors to spot problems on mammograms.
Certain benign breast conditions
Women diagnosed with certain benign breast conditions may have an increased risk of
breast cancer. Some of these conditions are more closely linked to breast cancer risk than
others. Doctors often divide benign breast conditions into 3 general groups, depending on
how they affect this risk.
Menstrual periods
Women who have had more menstrual cycles because they started menstruating at an early
age (before age 12) and/or went through menopause at a later age (after age 55) have a
slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime
exposure to the hormones estrogen and progesterone.
Previous chest radiation
Women who, as children or young adults, had radiation therapy to the chest area as
treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) have a
significantly increased risk for breast cancer. This varies with the patient's age when they
had radiation. If chemotherapy was also given, it may have stopped ovarian hormone
production for some time, lowering the risk. The risk of developing breast cancer from
chest radiation is highest if the radiation was given during adolescence, when the breasts
were still developing. Radiation treatment after age 40 does not seem to increase breast
cancer risk.
Diethylstilbestrol exposure
From the 1940s through the 1960s some pregnant women were given the drug
diethylstilbestrol (DES) because it was thought to lower their chances of miscarriage
(losing the baby). These women have a slightly increased risk of developing breast cancer.
Women whose mothers took DES during pregnancy may also have a slightly higher risk
of breast cancer.
Lifestyle-related factors and breast cancer risk
Having children
Women who have had no children or who had their first child after age 30 have a slightly
higher breast cancer risk. Having many pregnancies and becoming pregnant at a young age
reduce breast cancer risk. Pregnancy reduces a woman's total number of lifetime menstrual
cycles, which may be the reason for this effect.
Recent oral contraceptive use
Studies have found that women using oral contraceptives (birth control pills) have a slightly
greater risk of breast cancer than women who have never used them. This risk seems to go
back to normal over time once the pills are stopped. Women who stopped using oral
contraceptives more than 10 years ago do not appear to have any increased breast cancer
risk. When thinking about using oral contraceptives, women should discuss their other risk
factors for breast cancer with their health care team.
Hormone therapy after menopause

Hormone therapy with estrogen (often with progesterone) has been used for many years to
help relieve symptoms of menopause and to help prevent osteoporosis (thinning of the
bones). Earlier studies suggested it might have other health benefits as well, but these
benefits have not been found in more recent, better designed studies. This treatment goes
by many names, such as post-menopausal hormone therapy (PHT), hormone replacement
therapy (HRT), and menopausal hormone therapy (MHT).
There are 2 main types of hormone therapy. For women who still have a uterus (womb),
doctors generally prescribe both estrogen and progesterone (known as combined hormone
therapy or HT). Progesterone is needed because estrogen alone can increase the risk of
cancer of the uterus. For women who no longer have a uterus (those who've had a
hysterectomy), estrogen alone can be prescribed. This is commonly known as estrogen
replacement therapy (ERT) or just estrogen therapy (ET).
Combined hormone therapy: Using combined hormone therapy after menopause
increases the risk of getting breast cancer. It may also increase the chances of dying from
breast cancer. This increase in risk can be seen with as little as 2 years of use. Combined
HT also increases the likelihood that the cancer may be found at a more advanced stage.
The increased risk from combined hormone therapy appears to apply only to current and
recent users. A woman's breast cancer risk seems to return to that of the general population
within 5 years of stopping combined treatment.
Breast-feeding
Some studies suggest that breast-feeding may slightly lower breast cancer risk, especially
if breast-feeding is continued for 1 to 2 years. But this has been a difficult area to study,
especially in countries such as the United States, where breast-feeding for this long is
uncommon.
One explanation for this possible effect may be that breast-feeding reduces a woman's total
number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or
going through early menopause).
Alcohol
The use of alcohol is clearly linked to an increased risk of developing breast cancer. The
risk increases with the amount of alcohol consumed. Compared with non-drinkers, women
who consume 1 alcoholic drink a day have a very small increase in risk. Those who have
2 to 5 drinks daily have about 1 times the risk of women who drink no alcohol. Excessive
alcohol use is also known to increase the risk of developing several other types of cancer.
Being overweight or obese
Being overweight or obese has been found to increase breast cancer risk, especially for
women after menopause. Before menopause your ovaries produce most of your estrogen,
and fat tissue produces a small amount of estrogen. After menopause (when the ovaries
stop making estrogen), most of a woman's estrogen comes from fat tissue. Having more fat
tissue after menopause can increase your chance of getting breast cancer by raising
estrogen levels. Also, women who are overweight tend to have higher blood insulin levels.
Higher insulin levels have also been linked to some cancers, including breast cancer.
But the connection between weight and breast cancer risk is complex. For example, the
risk appears to be increased for women who gained weight as an adult but may not be
increased among those who have been overweight since childhood. Also, excess fat in the
waist area may affect risk more than the same amount of fat in the hips and thighs.
Researchers believe that fat cells in various parts of the body have subtle differences that
may explain this.
Physical activity
Evidence is growing that physical activity in the form of exercise reduces breast cancer
risk. The main question is how much exercise is needed. In one study from the Women's
Health Initiative (WHI) as little as 1.25 to 2.5 hours per week of brisk walking reduced a
woman's risk by 18%. Walking 10 hours a week reduced the risk a little more.
Factors with uncertain, controversial, or unproven effect on breast cancer risk

Diet and vitamin intake
Many studies have looked for a link between what women eat and breast cancer risk, but
so far the results have been conflicting. Some studies have indicated that diet may play a
role, while others found no evidence that diet influences breast cancer risk. Studies have
looked at the amount of fat in the diet, intake of fruits and vegetables, and intake of meat.
No clear link to breast cancer risk was found.
Studies have also looked at vitamin levels, again with inconsistent results. Some studies
actually found an increased risk of breast cancer in women with higher levels of certain
nutrients. So far, no study has shown that taking vitamins reduces breast cancer risk. This
is not to say that there is no point in eating a healthy diet. A diet low in fat, low in red meat
and processed meat, and high in fruits and vegetables may have other health benefits.
Most studies have found that breast cancer is less common in countries where the typical
diet is low in total fat, low in polyunsaturated fat, and low in saturated fat. But many studies
of women in the United States have not found breast cancer risk to be related to dietary fat
intake. Researchers are still not sure how to explain this apparent disagreement. It may be
at least partly due to the effect of diet on body weight (see below). Also, studies comparing
diet and breast cancer risk in different countries are complicated by other differences (like
activity level, intake of other nutrients, and genetic factors) that might also change breast
cancer risk.
More research is needed to understand the effect of the types of fat eaten on breast cancer
risk. But it is clear that calories do count, and fat is a major source of these. High-fat diets
can lead to being overweight or obese, which is a breast cancer risk factor. A diet high in
fat has also been shown to influence the risk of developing several other types of cancer,
and intake of certain types of fat is clearly related to heart disease risk.
Bras
Internet e-mail rumors and at least one book have suggested that bras cause breast cancer
by obstructing lymph flow. There is no good scientific or clinical basis for this claim.
Women who do not wear bras regularly are more likely to be thinner or have less dense
breasts, which would probably contribute to any perceived difference in risk.
Induced abortion
Several studies have provided very strong data that neither induced abortions nor
spontaneous abortions (miscarriages) have an overall effect on the risk of breast cancer.
Breast implants
Several studies have found that breast implants do not increase breast cancer risk, although
silicone breast implants can cause scar tissue to form in the breast. Implants make it harder
to see breast tissue on standard mammograms, but additional x-ray pictures called implant
displacement views can be used to examine the breast tissue more completely.
Chemicals in the environment
A great deal of research has been reported and more is being done to understand possible
environmental influences on breast cancer risk.
Of special interest are compounds in the environment that studies in lab animals have found
to have estrogen-like properties. These could in theory affect breast cancer risk. For
example, substances found in some plastics, certain cosmetics and personal care products,
pesticides (such as DDE), and PCBs (polychlorinated biphenyls) seem to have such
properties.
Tobacco smoke
For a long time, studies found no link between cigarette smoking and breast cancer. In
recent years though, some studies have found that smoking may increase the risk of breast
cancer. The increased risk seems to affect certain groups, such as women who started
smoking when they were young. In 2009, the International Agency for Research on Cancer
concluded that there is limited evidence that tobacco smoking causes breast cancer.
An active focus of research is whether secondhand smoke increases the risk of breast
cancer. Both mainstream and secondhand smoke contain chemicals that, in high
concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast
tissue and are found in breast milk.
The evidence on secondhand smoke and breast cancer risk in human studies is
controversial, at least in part because smokers have not been shown to be at increased risk.
One possible explanation for this is that tobacco smoke may have different effects on breast
cancer risk in smokers and in those who are just exposed to smoke.
Night work
Several studies have suggested that women who work at night for example, nurses on a
night shift may have an increased risk of developing breast cancer. This is a fairly recent
finding, and more studies are looking at this issue. Some researchers think the effect may
be due to changes in levels of melatonin, a hormone whose production is affected by the
body's exposure to light, but other hormones are also being studied.
CHAPTER 6. Mammograms and Self-Exam
Mammograms and Self-Exam

A mammogram is an x-ray of the breast. A diagnostic mammogram is used to diagnose
breast disease in women who have breast symptoms or an abnormal result on a screening
mammogram. Screening mammograms are used to look for breast disease in women who
are asymptomatic; that is, they appear to have no breast problems. Screening mammograms
usually take 2 views (x-ray pictures taken from different angles) of each breast. For some
patients, such as women with breast implants, more pictures may be needed to include as
much breast tissue as possible. Women who are breast-feeding can still get mammograms,
but these are probably not quite as accurate because the breast tissue tends to be dense.
What the doctor looks for on your mammogram
The doctor reading the mammogram will look for several types of changes:
Calcifications are tiny mineral deposits within the breast tissue, which look like small white
spots on the films. They may or may not be caused by cancer. There are 2 types of
calcifications:
Macrocalcifications are coarse (larger) calcium deposits that are most likely changes in
the breasts caused by aging of the breast arteries, old injuries, or inflammation. These
deposits are related to non-cancerous conditions and do not require a biopsy.
Macrocalcifications are found in about half the women over 50, and in about 1 of 10
women under 50.
Microcalcifications are tiny specks of calcium in the breast. They may appear alone or in
clusters. Microcalcifications seen on a mammogram are of more concern, but still usually
do not mean that cancer is present. The shape and layout of microcalcifications help the
radiologist judge how likely it is that cancer is present. If the calcifications look
suspicious for cancer, a biopsy will be done.
A mass, which may occur with or without calcifications, is another important change seen
on a mammogram. Masses can be many things, including cysts (non-cancerous, fluid-filled
sacs) and non-cancerous solid tumors (such as fibroadenomas), but they could also be
cancer.
Cysts can be simple fluid-filled sacs (known as simple cysts) or can be partially solid
(known as complex cysts). Simple cysts are benign and dont need to be biopsied. Any
other type of mass (such as a complex cyst or a solid tumor) might need to be biopsied to
be sure it isnt cancer.
A cyst and a tumor can feel alike on a physical exam. They can also look the same on a
mammogram. To confirm that a mass is really a cyst, a breast ultrasound is often done.
Another option is to remove (aspirate) the fluid from the cyst with a thin, hollow needle.
If a mass is not a simple cyst (that is, if it is at least partly solid), then you may need to
have more imaging tests. Some masses can be watched with periodic mammograms,
while others may need a biopsy. The size, shape, and margins (edges) of the mass help
the radiologist determine if cancer is present.
Limitations of mammograms
A mammogram cannot prove that an abnormal area is cancer. To confirm whether cancer
is present, a small amount of tissue must be removed and looked at under a microscope.
This procedure, called a biopsy.
Clinical breast exam
A clinical breast exam (CBE) is an exam of your breasts by a health care professional, such
as a doctor, nurse practitioner, nurse, or doctor's assistant. For this exam, you undress from
the waist up. The health care professional will first look at your breasts for abnormalities
in size or shape, or changes in the skin of the breasts or nipple. Then, using the pads of the
fingers, the examiner will gently feel (palpate) your breasts.
Special attention will be given to the shape and texture of the breasts, location of any lumps,
and whether such lumps are attached to the skin or to deeper tissues. The area under both
arms will also be examined.
The CBE is a good time for women who don't know how to examine their breasts to learn
the proper technique from their health care professionals. Ask your doctor or nurse to teach
you and watch your technique.
Breast awareness and self exam

Beginning in their 20s, women should be told about the benefits and limitations of breast
self-exam (BSE). Women should know how their breasts normally look and feel and report
any new breast changes to a health professional as soon as they are found. Finding a breast
change does not necessarily mean there is a cancer.
A woman can notice changes by being aware of how her breasts normally look and feel
and by feeling her breasts for changes (breast awareness), or by choosing to use a step-bystep approach (see below) and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step approach for the exam.
The best time for a woman to examine her breasts is when the breasts are not tender or
swollen. Women who examine their breasts should have their technique reviewed during
their periodic health exams by their health care professional.
How to examine your breasts
Lie down and place your right arm behind your head. The exam is done while lying down,
not standing up. This is because when lying down the breast tissue spreads evenly over
the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right
breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast
tissue.
Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to
feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm
pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in
the lower curve of each breast, but you should tell your doctor if you feel anything else
out of the ordinary. If you're not sure how hard to press, talk with your doctor or nurse.
Use each pressure level to feel the breast tissue before moving on to the next spot.
Move around the breast in an up and down pattern starting at an imaginary line drawn
straight down your side from the underarm and moving across the breast to the middle
of the chest bone (sternum or breastbone). Be sure to check the entire breast area going
down until you feel only ribs and up to the neck or collar bone (clavicle).
There is some evidence to suggest that the up-and-down pattern (sometimes called the
vertical pattern) is the most effective pattern for covering the entire breast, without
missing any breast tissue.
Repeat the exam on your left breast, putting your left arm behind your head and using
the finger pads of your right hand to do the exam.
While standing in front of a mirror with your hands pressing firmly down on your hips,
look at your breasts for any changes of size, shape, contour, or dimpling, or redness or
scaliness of the nipple or breast skin. (The pressing down on the hips position contracts
the chest wall muscles and enhances any breast changes.)
Examine each underarm while sitting up or standing and with your arm only slightly
raised so you can easily feel in this area. Raising your arm straight up tightens the tissue
in this area and makes it harder to examine.
This procedure for doing breast self exam is different from previous recommendations.
These changes represent an extensive review of the medical literature and input from an
expert advisory group. There is evidence that this position (lying down), the area felt,
pattern of coverage of the breast, and use of different amounts of pressure increase a
woman's ability to find abnormal areas.
Magnetic resonance imaging (MRI)

For certain women at high risk for breast cancer, screening MRI is recommended along
with a yearly mammogram. It is not generally recommended as a screening tool by itself,
because although it is a sensitive test, it may still miss some cancers that mammograms
would detect.
MRI scans use magnets and radio waves (instead of x-rays) to produce very detailed, crosssectional images of the body. The most useful MRI exams for breast imaging use a contrast
material (gadolinium) that is injected into a vein in the arm before or during the exam. This
improves the ability of the MRI to clearly show breast tissue details.
MRI is more sensitive in detecting cancers than mammograms, but it is more likely to find
something that turns out not to be cancer (called a false positive).These false positive
findings have to be checked out to know that cancer isnt present, which means coming
back for further tests and/or biopsies. This is why MRI is not recommended as a screening
test for women at average risk of breast cancer, as it would result in unneeded biopsies and
other tests in a large portion of these women.
CHAPTER 7. How is breast cancer treated in western medicine?
General types of treatment

Treatments can be classified into broad groups, based on how they work and when they are
used.
Local versus systemic therapy
Local therapy is intended to treat a tumor at the site without affecting the rest of the body.
Surgery and radiation therapy are examples of local therapies.
Systemic therapy refers to drugs which can be given by mouth or directly into the
bloodstream to reach cancer cells anywhere in the body. Chemotherapy, hormone therapy,
and targeted therapy are systemic therapies.
Adjuvant and neoadjuvant therapy
Patients who have no detectable cancer after surgery are often given additional treatment
to help keep the cancer from coming back. This is known as adjuvant therapy. Doctors
believe that even in the early stages of breast cancer, cancer cells may break away from the
primary breast tumor and begin to spread. These cells can't be felt on a physical exam or
seen on x-rays or other imaging tests, and they cause no symptoms. But they can go on to
become new tumors in nearby tissues, other organs, and bones. The goal of adjuvant
therapy is to kill these hidden cells. Both systemic therapy (like chemotherapy, hormone
therapy, and targeted therapy) and radiation can be used as adjuvant therapy.
Not every patient needs adjuvant therapy. Whether or not you are likely to benefit from
adjuvant therapy depends on the stage and characteristics of your cancer and what type of
surgery you had. Generally speaking, if the tumor is larger or the cancer has spread to
lymph nodes, it is more likely to have spread through the bloodstream, and you are more
likely to see a benefit. But there are other features, some of which have been previously
discussed, that may determine if a patient should get adjuvant therapy. Recommendations
about adjuvant therapy are discussed in the sections on these treatments and in the section
on treatment by stage.
Some
patients
are
given
treatment,
such
as
chemotherapy
or
hormone
therapy, before surgery. The goal of this treatment is to shrink the tumor in the hope it will
allow a less extensive operation to be done. This is called neoadjuvant therapy.
Oncoplastic surgery
Breast-conserving therapy (lumpectomy or partial mastectomy) can often be used for earlystage breast cancers. But in some women, it can result in breasts of different sizes and/or
shapes. For larger tumors, it might not even be possible, and a mastectomy might be needed
instead. Some doctors address this problem by combining cancer surgery and plastic
surgery techniques, known as oncoplastic surgery. This typically involves reshaping the
breast at the time of the initial breast-conserving surgery, and may mean operating on the
other breast as well to make them more symmetrical. This approach is still fairly new, and
not all doctors are comfortable with it.
Breast reconstruction surgery

The number of women with breast cancer choosing breast conservation therapy has been
steadily increasing, but there are some women who, for medical or personal reasons,
choose mastectomy. Some of them also choose to have reconstructive surgery to restore
the breast's appearance.
For several years, concern over a possible link between breast implants and immune system
diseases has discouraged some women from choosing implants as a method of breast
reconstruction.
Recent studies have found that although implants can cause some side effects (such as firm
or hard scar tissue formation), women with implants do not have any greater risk for
immune system diseases than women who have not had this surgery. Similarly, the concern
that breast implants increase the risk of breast cancer recurrence or formation of new
cancers is not supported by current evidence.
Radiation therapy
For women who need radiation after breast-conserving surgery, newer techniques such as
hypofractionated radiation or accelerated partial breast irradiation may be as effective
while offering a more convenient way to receive it (as opposed to the standard daily
radiation treatments that take several weeks to complete).
These techniques are being studied to see if they are as effective as standard radiation in
helping prevent cancer recurrences.
New chemotherapy drugs

Advanced breast cancers are often hard to treat, so researchers are always looking for newer
drugs.
A drug class has been developed that targets cancers caused by BRCA mutations. This
class of drugs is called PARP inhibitors and they have shown promise in clinical trials
treating breast, ovarian, and prostate cancers that had spread and were resistant to other
treatments.
Targeted therapies
Targeted therapies are a group of newer drugs that specifically take advantage of gene
changes in cells that cause cancer.
Drugs that target HER2: There are 2 drugs approved for use that target excess HER2
protein, trastuzumab (Herceptin) and lapatinib (Tykerb). Studies continue to see which of
these is best for treating early breast cancer. Other drugs that target the HER2 protein are
being tested in clinical trials, including TDM-1, pertuzumab and neratinib. Researchers are
also looking at using a vaccine to target the HER2 protein.
Anti-angiogenesis drugs: In order for cancers to grow, blood vessels must develop to
nourish the cancer cells. This process is called angiogenesis. Looking at angiogenesis in
breast cancer specimens can help predict prognosis. Some studies have found that breast
cancers surrounded by many new, small blood vessels are likely to be more aggressive.
More research is needed to confirm this.
Bevacizumab (Avastin) is an example of anti-angiogenesis drug. Although bevacizumab
turned out to not be very helpful in the treatment of breast cancer, this approach still may
prove useful in breast cancer treatment. Several other anti-angiogenesis drugs are being
tested in clinical trials.
Drugs that target EGFR: The epidermal growth factor receptor (EGFR) is another
protein found in high amounts on the surfaces of some cancer cells. Some drugs that target
EGFR, such as cetuximab (Erbitux) and erlotinib (Tarceva), are already used to treat
other types of cancers, while other anti-EGFR drugs are still considered experimental.
Studies are now under way to see if these drugs might be effective against breast cancers.
Other targeted drugs: Everolimus (Afinitor) is a targeted therapy drug that is approved
to treat kidney cancer. In one study, letrozole plus everolimus worked better than letrozole
alone in shrinking breast tumors before surgery. More studies using this drug are planned.
Many other potential targets for new breast cancer drugs have been identified in recent
years. Drugs based on these targets are now being studied, but most are still in the early
stages of clinical trials.
Bisphosphonates
Bisphosphonates are drugs that are used to help strengthen and reduce the risk of fractures
in bones that have been weakened by metastatic breast cancer. Examples include
pamidronate (Aredia) and zoledronic acid (Zometa).
Some studies have suggested that zoledronic acid may help other systemic therapies, like
hormone treatment and chemo) work better. In one study, the women getting zolendric acid
with chemo had their tumors shrink more than the women treated with chemo alone. In
other studies, giving zoledronic acid with other adjuvant treatment reduced the risk of the
cancer coming back. Some more recent studies have not shown a benefit of giving this drug
with adjuvant chemo. More studies are needed to determine if bisphosphonates should
become part of standard therapy for early-stage breast cancer.
Denosumab
Denosumab (Xgeva, Prolia) can also be used to help strengthen and reduce the risk of
fractures in bones that have been weakened by metastatic breast cancer. It is being studied
to see if it can help adjuvant treatments work better.
Vitamin D
A recent study found that women with early-stage breast cancer who were vitamin D
deficient were more likely to have their cancer recur in a distant part of the body and had
a poorer outlook. More research is needed to confirm this finding, and it is not yet clear if
taking vitamin D supplements would be helpful. Still, you may want to talk to your doctor
about testing your vitamin D level to see if it is in the healthy range.
CHAPTER 8.Breast Cancer Statistics

Rates of breast cancer vary depending on who you are and where you live. Rates vary
between women and men and among people of different ethnicities and ages. They vary
around the world and across the United States. This section provides an overview of breast
cancer statistics among many different populations.
Breast cancer in the United States
Women
In 2012, it is estimated that among U.S. women [31]:
There will be 226,870 new cases of invasive breast cancer (includes new cases of
primary breast cancer among survivors, but not recurrence of original breast cancer
among survivors).
There will be 63,300 new cases of in situ breast cancer (includes ductal carcinoma
in situ (DCIS) and lobular carcinoma in situ (LCIS), of those, about 85 percent were
DCIS). DCIS is a non-invasive breast cancer and LCIS is a risk factor that increases
the risk of invasive breast cancer. Learn more about DCIS and breast cancer risk.
Learn more about LCIS and breast cancer risk.
There will be 39,510 breast cancer deaths.
Rates of breast cancer among women vary by:
Age
Race/ethnicity
o
African American
Ashkenazi Jewish
Asian American and Pacific Islander
Hispanic/Latina
Native
American
Specific populations
o
Lesbian women
Transgender people
Pregnant women
Men
Breast cancer in men is rare, but it does happen. In 2012, it is estimated that among U.S.
men [31]:
There will be 2,190 new cases of breast cancer.
There will be 410 breast cancer deaths.
Rates of breast cancer incidence (new cases, including new cases of primary breast cancer
among survivors, but not recurrence of original breast cancer among survivors) and
mortality (the rate of death) are much lower among men than among women [31]. For
example, in 2009 (most recent data available) [32]:
Incidence
Men
Women
1.2 per 100,000
125.7 per 100,000

Survival rates for men are
(new cases)
about the same as for
Mortality
0.3 per 100,000
22.2 per 100,000
(deaths)
women with the same

stage of cancer at the time
of diagnosis. However,
men are usually diagnosed at a later stage because they are less likely to report symptoms.
Learn more about the symptoms of male breast cancer.
Treatment for men is the same as treatment for women and usually includes a combination
of surgery, radiation, chemotherapy, hormone therapy and/or targeted therapy.
Rates of breast cancer over time
From the 1940s until the 1980s, the rate of new cases of breast cancer (called incidence) in
the United States increased by a little over one percent a year. In the 1980s, incidence rose
dramatically (likely due to increased mammography screening), then leveled off during the
1990s.
The incidence of breast cancer declined in the early 2000s [31,33]. Although
mammography screening rates fell somewhat over this same time period, studies show
these changes were not likely related to the decline in breast cancer rates [34-35]. The
decline appears to be related to the drop in use of postmenopausal hormones that occurred
after the Women's Health Initiative study showed their use increased risk of breast cancer
and heart disease [33-36]. Since 2003, the incidence of breast cancer has remained stable
[31].
Mammography and rates of early detection over time

As mammography screening rates have increased, more cases of breast cancer are found at
earlier stages, when they are more easily and successfully treated. During the 1980s and
1990s, diagnoses of early-stage breast cancer, including ductal carcinoma in situ (DCIS),
and conditions such as lobular carcinoma in situ (LCIS) increased greatly. Since the late
1990s, these rates have remained steady. At the same time, diagnoses of advanced stage
(metastatic) breast cancer have remained stable or dropped slightly [31].
Race/ethnicity and breast cancer rates over time
Since 1975, the incidence of breast cancer has increased among both white women than
black women. However, during this same time period, mortality rates have decreased for
white women, but increased somewhat for black women [32]. Figure 1.2 (below) shows
this trend.
Figure 1.2
Age-adjusted
to
the
2000
U.S.
standard
Source: SEER Cancer Statistics Review, 1975-2008, 2011 [32]
Male breast cancer rates over time

Rates of male breast cancer have changed little over the past 30 years [31].
population.
Geographic variation in breast cancer rates

Worldwide variation
Breast cancer is the most common cancer in women worldwide. It is estimated that more
than 1.6 million new cases of breast cancer occurred among women worldwide in 2010
[71]. Rates of breast cancer around the world vary a great deal. In general, developed
countries have higher rates than developing countries (see Figure 1.3 below). And, women
who live in developed countries tend to have a higher lifetime risk of breast cancer than
women who live in developing countries (see Figure 1.4 below). Although we dont know
all the factors that make up these differences, lifestyle and reproductive factors likely play
a large role. Low screening rates and incomplete reporting can make rates of breast cancer
in developing countries look lower than they truly are and may also explain some of the
difference.
Figure
1.3:
Breast Cancer Incidence Worldwide

Figure
1.4:
Lifetime Risk of Breast Cancer Worldwide

Variation within the United States
Rates of breast cancer vary across the United States. Figure 1.5 (below) shows the
incidence of breast cancer for each of the 50 states and Washington D.C.
Figure 1.5: Estimated New Cancers among Women by

State, 2004-2008
State
Rate
of State
Rate
Invasive
Invasive
Breast
Breast
Cancer
Cancer
(per
(per
100,000
100,000
women)
women)
Alabama
117
Montana
120
Alaska
130
Nebraska
125
Arizona
107
Nevada
112
Arkansas
109
New
132
Hampshire
California
122
New Jersey
130
Colorado
122
New Mexico
111
Connecticut
136
New York
124
of
Delaware
127
North
123
Carolina
Dist.
of 127
North Dakota
124
Columbia
Florida
114
Ohio
120
Georgia
119
Oklahoma
126
Hawaii
122
Oregon
130
Idaho
117
Pennsylvania
125
Illinois
124
Rhode Island
133
Indiana
115
South
120
Carolina
Iowa
123
South Dakota
117
Kansas
124
Tennessee
117
Kentucky
121
Texas
114
Louisiana
118
Utah
110
Maine
129
Vermont
130
Maryland
123
Virginia
124
Massachusetts
133
Washington
130
Michigan
120
West Virginia 113
Minnesota
126
Wisconsin
123
Mississippi
113
Wyoming
115
Missouri
121
United States
121
Source: American Cancer Society, 2012 [31]
Race/ethnicity and breast cancer rates

Within the United States, breast cancer rates among women vary by race and ethnicity.
Figure 1.6
Source: American Cancer Society, 2011 [36]

White women have the highest incidence, while Asian American and Pacific Islander
women have the lowest [36]. More about breast cancer rates among women of different
races/ethnicities:
African Americans
Asian Americans and Pacific Islanders
Hispanics/Latinas
Native Americans
Migration to the U.S. and breast cancer rates

Immigrants in the United States usually have breast cancer rates similar to those in their
home country. Over generations however, the daughters and granddaughters of immigrants
take on a risk similar to U.S. women.
African American women
Breast cancer is the most common cancer among African American women. It is also the
second leading cause of cancer death among African American women, exceeded only by
lung cancer. In 2011, an estimated 26,840 new cases of breast cancer and 6,040 deaths are
expected to occur among African American women [38].
Breast cancer incidence in African American women is lower than in Caucasian women.
Breast cancer mortality, however, is 39 percent higher [38]. Although breast cancer
survival in African American women has increased in recent decades, survival rates remain
lower than among Caucasian women. From 1999-2006, the five-year relative survival rate
for breast cancer among African American women was 78 percent compared to 90 percent
among Caucasian women [38]. There are many possible reasons for this difference in
survival. Factors that may all play a role include:
Biologic and genetic differences in tumors
Presence of risk factors
Barriers to health care access
Health behaviors
Later stage of breast cancer at diagnosis
Breast cancer screening rates among African American women are similar to those among
white women [39].
Breast and ovarian cancer are somewhat more common among women of Ashkenazi
Jewish descent (ancestors who came from Central or Eastern Europe). This is likely due to
the high prevalence of mutations in the Breast Cancer 1 and Breast Cancer 2
(BRCA1 andBRCA2,
respectively)
genes
in
these
women.
Everyone
has BRCA1 and BRCA2 genes, but those who have an inherited mutation in either of these
genes are at higher risk for breast and ovarian cancer [40-44].
While BRCA1 and BRCA2 mutations are rare in the general population, between eight and
10 percent of Ashkenazi Jewish women carry one of these mutations [40, 45-47]. The most
common BRCA mutations in these women are 185delAG and 5382insC in BRCA1 and
6174delT in BRCA2 [45, 47-50].
Learn more about BRCA1 and BRCA2 mutations and breast cancer risk.
Learn about genetic testing for BRCA1 and BRCA2 mutations.
Asian American and Pacific Islander women

The most recent estimated breast cancer incidence (2004 to 2008) and mortality (2003 to
2007) rates were lower for Among Asian American and Pacific Islander women than for
non-Hispanic white and African American women [36].
Asian
White
African
American
(non-
American
and
Pacific Hispanic)
Islander
women
women
women
Incidence
84.9 per
125.4
(new cases)
100,000
100,000
Mortality
12.2
(deaths)
100,000
per 23.9
100,000
per 116.1
per
100,000
per 32.4
per
100,000
Breast cancer is the most common cancer in Korean, Chinese, Filipino and Japanese
women in the U.S. [51]. Among Asian American and Pacific Islander women, Native
Hawaiian and Japanese women have the highest rates of breast cancer. Native Hawaiian
and Samoan women have the highest rates of breast cancer death, exceeding even those in
white women [51].
Korean Chinese Filipino Samoan Japanese Native

women women women women
women
Hawaiian
women
Incidence 53.5 per 77.6 per 100.4

(new
126.5 per 175.8 per
per
100,000
100,000 100,000 per
102.4
cases)
100,000
100,000 100,000
Mortality 7.8 per 12.3 per 17.2 per 36.2 per 15.1 per 33.2
(deaths)
100,000 100,000 100,000 100,000 100,000
per
100,000
Asian Americans who are new immigrants have lower rates of breast cancer than those
who have lived in the U.S. for many years. For those born in the U.S., breast cancer risk is
similar to that of non-Hispanic white women (60 percent higher than women born in Asia)
[52].
Breast cancer is one of the leading causes of cancer death in most Asian American and
Pacific Islander women (lung cancer is the major cause of cancer death among most of
these women).
Mammography screening rates among Asian American and Pacific Islander women are
similar to those among white women [39].
Hispanic/Latina women
Breast cancer is the most common cancer among Hispanic/Latina women. The most recent
estimated incidence (2004 to 2008) and mortality rates (2003 to 2007) for Hispanic/Latina
women were lower than for non-Hispanic white women and African American
women [36].
Hispanic/Latina White
African
women
(non-
American
Hispanic)
women
women
Incidence
91.0 per 100,000 125.4
(new cases)
Mortality
100,000
15.3 per 100,000 23.9
(deaths)
100,000
per 116.1
per
100,000
per 32.4
per
100,000
Screening mammography rates among Hispanic/Latina women are now similar to rates
among non-Hispanic white women [39]. However, in the past, Hispanic/Latina women
were less likely to have regular screening and to get prompt follow-up for an abnormal
mammogram [32, 39, and 53].
Native American women
A century ago, breast cancer in Native Americans was rare. However, the last two decades
have seen major increases in both incidence and mortality rates for American Indian and
Alaskan Native women. However, rates of both incidence and mortality remain lower than
among white or African American women. The most recent estimate of incidence (2004 to
2008) for American Indian and Alaskan Natives was 89.2 per 100,000 women and
mortality (2003 to 2007) was to 17.6 per 100,000 [36]. Both incidence and mortality vary
according to where women live. Women who live in Alaska have the highest incidence
rates (similar to non-Hispanic white women) and women who live in the Southwest have
the lowest incidence rates [54].
Mammography screening rates are lower among American Indian and Alaskan Native
women compared to women of other ethnicities [39].
Lesbians and women who partner with women
Lesbians and women who partner with women have a greater risk of breast cancer than
other women, but this is not because of their sexual orientation. Rather, it is linked to risk
factors for breast cancer that tend to be more common in these women such as never having
children or having them later in life [55-57]. Lesbian women also tend to have higher rates
of obesity and alcohol use, both of which can increase breast cancer risk [55-57].
Age and breast cancer
All women are at risk for breast cancer. The two most important risk factors for breast
cancer are:
Being female
Getting older
The risk of getting breast cancer increases as you age. Most breast cancers and breast cancer
deaths occur in women aged 50 and older. Until more is known about preventing breast
cancer, early detection and effective treatment offer the best defense against breast cancer
mortality.
No matter your age, you should become familiar with how your breasts look and feel. If
you notice any changes, see your health care provider right away.
Younger women
Although rare, younger women can also get breast cancer. Just five percent of all breast
cancers occur in women under age 40 [36].
While risk is generally much lower among younger women, certain genetic factors can put
some women at a higher risk of breast cancer. Women who are diagnosed at younger ages
may have a BRCA1 or BRCA2 genetic mutation. Women who carry one of these gene
mutations have an increased risk of both breast and ovarian cancers.
Pregnant women
Breast cancer is the most common cancer in pregnant and postpartum women. About 1.3
cases are diagnosed per 10,000 pregnancies [60]. When women are pregnant or lactating,
their breasts are naturally more tender and enlarged. This may make it harder to find a lump
or notice other changes.
View the map below to see how your country is impacted by breast cancer (pink being the
highest per capita):
The World Health Organization has suggested that two components of early detection have
been shown to improve cancer mortality:
Educationto help people recognize early signs of cancer and seek prompt
medical attention for symptoms.
Screening programsto identify early cancer or pre-cancer before signs are
recognizable, including mammography for breast cancer.
In the UK and US, effective education and screening could save between 12 to 37 lives
per day, respectively:
Lives that could have
New Cases of Breast Cancer
been saved through
CountryBreast Cancer Deaths
early
(per day)
detection
(per day)
(per day)
USA
527
110
37
UK
125
35
12
The most common breast cancer statistic you have probably heard is that 1 in 8 women
will develop breast cancer in their lifetime. What it should really read is If everyone lived
beyond the age of 70, 1 in 8 of those women would get or have had breast cancer. This
statistic is based on everyone in the population living beyond the age of 70. Since your
breast cancer risk increases as you age, your lifetime risk changes depending on your age:
Age
20-29:
Age
30-39:
Age
40-49:
in
68
Age
50-59:
in
37
Age
60-69:
in
26
Ever:
in
2,000
in
in
229
According to estimates of lifetime risk by the U.S. National Cancer Institute, about 13.2%
of women in the U.S. will develop breast cancerwhich is the same as saying 1 in 7.57
people. And since there is no such thing as .57 of a person, the common phrase is 1 in 8.
Primary prevention is the answer
Breast cancer: Europe
Information on this webpage is drawn from our 2008 report: Breast Cancer - an
This graph shows the estimated incidence and mortality rates per 100,000 of the population
using age-standardized rates (ASRs). ASR allows the comparison of rates in populations
that have different age structures and over different periods of time.
Breast Cancer in Europe 2006
Within the European Union, every 2.5 minutes a woman is diagnosed with breast cancer.
Every
7.5
minutes
woman
dies
from
the
disease.
We have strong scientific evidence about toxic chemicals in the environment that mimic
female sex hormones and overload a woman's hormonal system, a known cause of breast
cancer. We know how pesticides, industrial pollutants, radiation and other factors are
linked - part of the social context of breast cancer. Yet, neither government agencies nor
societies responsible for dealing with breast cancer acknowledge this context. WHY?
Professor Ross Hume Hall 'Female Biology, Toxic Chemicals and Preventing Breast
Cancer: A Path Not Taken' International Conference on Breast Cancer and the
Environment Ontario
Canada November
1995
CHAPTER 9.CancerAnd Breast Cancer According To Traditional Chinese Medicine

Abstract
The treatment of breast cancer involves multiple disciplines, and current recommendations are
based on modern tenets of biology and pharmacology along with a growing body of evidence-based
literature. Despite advances in screening, surgery, adjuvant radiation, and systemic therapy, as well
as novel biologically targeted therapies, there are limitations to their benefits, especially in
advanced disease. Complementary therapies including Oriental medicine have enjoyed a growing
popularity as a less intensive and more "natural" approach to achieving health or improving quality
of life. However, definitive literature in this area is scant and therefore has not been integrated into
the mainstream medical community. Traditional Chinese medicine (TCM) may serve as a useful
model for scientific inquiry since there is a standardized system of diagnostics and therapies, and
this discipline is practiced worldwide. Still, the holistic and individualized nature of TCM presents
challenges to rigorous clinical testing, and as a result, most published work in this field is in the
form of anecdotal reports or uncontrolled series. Among the components of TCM, herbal or
botanical agents possess complex biological activities that could affect many aspects of
carcinogenesis such as cell growth and proliferation, apoptosis, host-tumor interactions, and
immune function and differentiation. Despite a fairly extensive series of laboratory studies detailing
many biological effects of botanical agents, few clinical trials have been completed to test specific
hypotheses regarding the mode of action of TCM. Most TCM therapies have been empirically
applied in a series of patients, with descriptive results provided. The summaries of a few studies
highlighted in this review can provide some evidence of safety but generally do not possess the
design and results to verify clinical effectiveness. Nevertheless, the theory of TCM coupled with
laboratory studies and safety information can serve as a basis for the design of more definitive trials
of TCM for specific indications in breast cancer. There are increasing interest and growing
opportunities for investigative approaches that could ultimately verify or reject TCM and specific
botanical agents. Some of these initiatives in the area of breast cancer prevention and treatment are
outlined.
Related Terms in TCM
Acupressure, acupuncture, acustimulation, acutherapy, Asian bodywork, auricular

acupuncture, chi kung, Chinese herbal medicine, Chinese herbs, Chinese nutrition therapy,
Chinese patent remedies, classical acupuncture, coining, cupping, eclectic Chinese
medicine, electroacupuncture, ethnic Chinese traditional medicine, feng shui, five element
acupuncture, I Ching, Japanese acupuncture, medical acupuncture, moxibustion (moxa),
qigong, Reiki, scraping, shiatsu, tai chi, taoism, tiji, ting sha, TCM, traditional acupuncture,
tui na.
Background
Chinese medicine is a broad term encompassing many different modalities and traditions of
healing. They share a common heritage of technique and theory rooted in ancient Chinese
philosophy (Taoism), elements of which are believed to date back over 5,000 years. The
first recorded use of TCM is said to have been around 2,000 years ago. The phrase
traditional Chinese medicine (TCM) is actually a recent development with a specific
meaning in the long history of Chinese medicine. In the 1940s and 1950s, the Chinese
government undertook an effort to combine many diverse forms of Chinese medicine into
a unified system to be officially defined as traditional Chinese medicine. The intent was to
integrate the country's large workforce of traditional practitioners into an organized health
service delivery system. This would aid in providing care for a large population by using
familiar and inexpensive methods.
Because TCM and Western medicine are used side by side in modern China, China is
relatively advanced compared to Western countries in using the concept of "integrative
medicine." TCM figures are prominently in treatment and planning of services -- including
for major illnesses such as cancer and heart disease. According to the World Health
Organization (WHO), TCM is fully integrated into the Chinese health system with 95% of
Chinese hospitals practicing it. As an example of such integration, it is common that
children being treated with intravenous antibiotics are simultaneously treated with Chinese
herbs in order to counteract the side effects of the antibiotic and boost the child's immune
system.
TCM places strong emphasis on herbal medicine since herbs can be taken every day. TCM
regards acupuncture as more of a supportive treatment, although the two are used together
when feasible for the patient. Herbs are usually given in the form of manufactured or
processed pills, extracts, capsules, tinctures, or powders. This contrasts with the raw and
dried form used in the more informal and older forms of practice. There are more than 2,000
different kinds of herbs of which about 400 are commonly used.
TCM has herbal regimens for use with major illnesses, such as cancer and heart disease.
Herbal combinations are commonly used to reduce the side effects of chemotherapy and
improve immune functioning in cancer and to improve cardiovascular health in heart and
circulatory diseases. Other herbal combinations are used in diabetes, infections, and other
conditions.
Cupping is a therapeutic method in TCM that refers to the application of a heated cup over
an area of the body. As the air inside cools, its volume decreases thus creating a slight
suction on the area that stimulates blood circulation.
Moxibustion is a therapeutic method in TCM in which an herb, usually mugwort (Artemisia

vulgaris), is burned above the skin or on the acupuncture points to introduce heat into an
acupuncture point and alleviate symptoms. The herb may be applied in the form of a cone,
stick, or loose herb or it may be placed on the head of an acupuncture needle to manipulate
the temperature gradient of the needle.
TCM practitioners may call upon a wide range of other modalities as well, from meditation
and martial arts to feng shui.
In the West, TCM offers a popular alternative to conventional medicine. Despite this
growing popularity, there is debate as to the evidence of its effectiveness. The modality
within TCM with the largest body of evidence is acupuncture. Few well-designed trials of
TCM herbal formulas are available. Establishing and applying stronger clinical trial
methodologies in TCM is imperative for integrating it with modern medicine and achieving
the end goal of creating evidence-based options for patient care.
Theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly
tested in humans, and safety and effectiveness have not always been proven. Some of these
conditions are potentially serious and should be evaluated by a qualified health care professional.
The ancient Chinese philosophy of Taoism provided the basis for the development of
Chinese medical theory. Taoist principles as described below are present throughout the
literature and teachings of the many forms of Chinese medicine.
Nature and the laws that govern the on-going, harmonious flow of life energy through the
natural world are used to understand the body and health. The person is viewed as an
ecosystem that is embedded in, and related to, the larger ecosystem of nature and subject to
the same laws.
The life force, chi (qi), circulates through the body and enlivens it. Health is a function of a
balanced, harmonious flow of chi and illness results when there is a blockage or an
imbalance in the flow of chi. Yin and yang are opposite and complementary qualities of life
energy (chi). Yin is regarded as the feminine principle and yang the masculine principle.
The human being has a system of pathways called "meridians" (also sometimes called
"channels") through which the chi flows. The body has been mapped with these meridians
that pass through all its organs, and specific meridians correspond with specific organs or
organ systems ("organ networks," below). Health is an ongoing process of maintaining
balance and harmony of the circulation of chi through all of the organs and systems of the
body.
Symptoms are regarded as signals of impaired flow or circulation of chi through the body.
Symptoms are considered as part of a larger picture or pattern affecting the whole person.
The practitioner seeks to connect seemingly unrelated symptoms and develop a unifying
explanation of what is going on with the person's chi overall.
Most modern diseases are considered "chi deficiency" diseases, caused by not maintaining
or supporting a harmonious internal ecology. Harmony and disharmony are understood in
two main conceptual frameworks: the eight principles and the five elements, described
below.
The eight principles are actually four pairs of complementary opposites describing patterns
of disharmony within the person. Briefly the principles are interior/exterior, referring to the
location of the disharmony in the body (internal organs vs. skin or bones); hot/cold, referring
to qualities of the disease pattern, such as fever or thirst vs. chilliness or desire to drink
warm liquids; full/empty, referring to whether the condition is acute or chronic and whether
the body's responses are strong or weak; and the balance of yin/yang, which adds further to
the description of the other six principles. The eight principles are the theoretical basis of
the TCM approach.
The five elements are fire, earth, metal, water, and wood. These terms do not refer to basic
constituents of matter, but are dynamic qualities of nature. They are used to describe the
changing qualities of chi energy as it circulates through the person. Five element theory is
the basis of traditional acupuncture (also referred to as classical or five element
acupuncture), which does not use herbs. However, some TCM practitioners also use the
concept of the five elements.
The body has five organ networks, each corresponding with a particular element:
heart/small intestine with fire, spleen/stomach with earth, lungs/large intestine with metal,
kidneys/bladder with water, and liver/gall bladder with wood. The organ networks are
named for the common meridian that circulates through and connects the organs, as it
circulates chi throughout the larger, body-wide, meridian system. The practitioner's efforts
to harmonize the five elements promote greater harmony in the functioning of all the organ
networks.
Can Chinese Herbal Medicine Treat Cancer?

The Research Says Yes
A large scale review of research by Australia and Chinese University scientists has proved with
thousands of studies using hundreds of thousands of cancer patients that Chinese herbal medicine
offers significant treatment for most types of cancers - including breast cancer.
The research comes from Australia's University of Western Sydney and the Beijing University of
Chinese Medicine. The researchers analyzed and reviewed 2,964 human clinical studies that
involved 253,434 cancer patients. Among these were 2,385 randomized controlled studies and
579 non-randomized controlled studies.
These studies covered most of the cancer types, but the cancers most studied were lung cancer,
liver cancer, stomach cancer, breast cancer, esophageal cancer, colorectal cancer and
nasopharyngeal (throat and sinus) cancer. Yes, breast cancer was the fourth most-studied type of
cancer among these thousands of clinical studies.
The researchers discovered that the overwhelming majority of studies 90% of the clinical
studies - utilized herbal medicine.
The researchers found that 72% of these studies applied Traditional Chinese Medicine alongside
conventional treatment, but a full 28% applied Traditional Chinese Medicine separately to
experimental groups.
In terms of cancer patients, about 64% were given both TCM and conventional medical
treatments. The rest were given TCM therapy alone, but a little over half of them did not qualify
whether the patient was given conventional treatment at some point in the past.
Because of the large number of studies, there were different types of results, depending upon the
type of study, the type of treatment, and the outcome measures tested. Still, in a full 1,015 studies
or 85% of those that reported on symptoms, TCM treatment resulted in improvement of cancer
symptoms with many of those reporting reduced pain. Another 883 studies 70% showed
increased survival rates. Another 38% showed reduced tumor size, and 28% showed increased
quality of life. Another 19% showed lower relapse rates and another 7% showed reduced
complications.
The researchers also found that only a few studies tested TCM acupuncture treatment in cancer
therapy. In their discussion they qualified that acupuncture treatment in cancer therapy to alleviate
pain is quite popular in the U.S., but in Chinese cancer studies, herbal medicine therapy is the
leading type of holistic treatment for cancer.
This study follows another extensive review of research published in 2012 on TCM cancer
treatment. This study comes from Norway's National Research Center in Complementary and
Alternative Medicine and the University of Troms, Norway, also with collaboration with the
Beijing University of Chinese Medicine.
This earlier study reviewed significantly fewer studies, compiling 716 trials that included 1,198
cancer patients with either leukemia, stomach cancer, liver cancer or esophageal cancer.
Among these studies, 98.5% used herbal medicine, and again, acupuncture therapy was rare. In
this study, symptom improvement was achieved in 85% of the patients that used the TCM
therapy.
In yet another study - this one much larger than the second - 1,217 clinical studies between 1958
and 2011, involving 92,945 patients were analyzed and reviewed by researchers from the Beijing
University of Chinese Medicine. Among these studies, 66% of the patients were treated with
TCM therapy alone, while 34% of the patients were treated with a combination of TCM and
conventional cancer therapy. Also, 82% of the patients were given herbal medicines orally.
Only 5% of the patients were given more than one type of TCM therapy. This means that 95%
were treated with only one type of TCM therapy - typically with a precise combination of herbs.
This study found that among the studies treating cancer, symptom relief was the prominent result
among 88% of the studies and among 88% of the patients tested with TCM therapy. Increased
survival rates resulted in 73% of patients. Among all the rest of the studies, 96% of the trials
resulted in symptom relief and 92% of the patients reported cancer symptom relief.
Chinese medicine has recognized the existence of cancer (liu) since around 1600
BC. Detailed descriptions of various types of cancer were recorded from around 200
BC. Since that time, various medical strategies have been evolved to manage cancer,
including surgical operations, herbal medicine, acupuncture, massage, exercises and
dietary therapy.
In modern Chinese hospitals, cancer patients are offered treatments such as herbal medicine and
acupuncture, alongside radiotherapy, chemotherapy and surgery. This integrated approach means
that, as well as attacking the cancer directly, the patients overall health and vitality are largely
maintained. Attention is given to ensuring that the digestive system, liver function, kidney
function, immune function and emotional state are maintained at optimum levels, in order to
strengthen the person in their fight against cancer. Often these systems are weakened by
chemotherapy and radiotherapy, so it is the task of the traditional Chinese medicine therapist to
deal with, and even pre-empt, the side effects of these interventions. The deeper reasons why the
cancer developed are also explored, and an attempt is made to address these causes or issues, in
order to try and minimize the risk of recurrence.
Chinese medicine views the human person differently from orthodox western medicine. Disease
is always seen as part of an imbalance of the whole person, not just an isolated event. Cancer
cannot simply be cut out, allowing the person just to carry on exactly as before. Disease is seen in
the context of the persons relationships with the wider world: other people, food, the home, the
workplace, the environment. Cancer must be seen in the context of the wider problems which
western civilization is encountering, whether ecological, spiritual or psychological.
Chinese medicine looks at cancer in the following manner:
The Chinese understanding of cancer
In order to understand the Chinese approach, we need to know about qi. This word can be
translated as vital force or energy. If one has strong qi, one is healthy but if ones qi is weak, one
gets ill. One of the main tasks of the Chinese medicine therapist is to strengthen the
qi. Underlying most cancers is a weakness of qi.
When the qi is weak, it leads to blood stagnation. This can correspond to what western doctors
call sticky blood, or to various types of circulatory problems. In this situation, nutrients do not get
into the body cells, and toxins are not released properly. This causes the cells to become
weakened and toxins to accumulate. This can eventually contribute to the development of cancer.
Prolonged emotional problems, such as stress, anxiety, anger, grief and depression can also cause
the qi to become weakened, thus contributing to the development of some cancers.
Another problem is poor diet. Research has shown that some foods promote cancer and others
help prevent it. In terms of Chinese medicine, when we take in a lot of poor quality food, it cannot
be digested properly and it breaks down into what Chinese medicine calls phlegm. This can
correspond, for example, to high cholesterol or other fatty deposits. This blocks the proper flow of
nutrients into and the release of toxins out of the cells. This can
contribute to the development of cancer. In the fight against cancer,
dietary changes are crucial.
Acupuncture
Acupuncture involves the insertion of tiny needles into key points

on the skin. It does not generally hurt if done
properly. Acupuncture is very effective at restoring the proper flow
of qi. Acupuncture offers many benefits to those with cancer.
Acupuncture is effective at reducing pain, which can be caused by the cancer or by medical
interventions. Best results are usually obtained using electro acupuncture, where small electrodes
are placed on the acupuncture needles and a tiny current passed through the area of pain. At
certain electrical frequencies the body releases chemicals called endorphins, which help to reduce
pain and to promote the healing of damaged body tissue. Some studies have shown that a
frequency of 2Hz has a mild anti tumor effect.
Chemotherapy can kill the bodys immune cells and sometimes the treatment has to be stopped
because this can reach dangerous levels. Some studies have shown that acupuncture can help
maintain immune function.
Chemotherapy commonly induces nausea, but this is usually greatly improved by acupuncture.
Radiotherapy to the neck can destroy all or part of the salivary gland, causing severe dryness of
the mouth (a condition known as xerostomia).Using an acupuncture protocol developed by the US
Navy. Several hospitals in the South West of England now routinely use this protocol, and report
that around 80 per cent of patients have some improvement to the condition.
Acupuncture points for cancer
Table 1.
Adverse Effects of Cancer Therapies
Mucositis-inflammation of the
gastrointestinal mucous membranes
Nausea and vomiting
Anorexia
Mouth ulcers
Diarrhea
Constipation
Myelosuppression/immunosuppression
o
Leukocytopenia
Thrombocytopenia
Anemia
Susceptibility to infections
Hair loss
Fatigue
Mutagenesis/carcinogenesis
Table 2. Acupuncture for Chemotherapy-Induced Nausea and Vomiting

Electro-
Treatment
Technique
Regimen
Reference(s)
1-6 in 3 days
8,9,11,12
13
acupuncture Duration
Unilateral PC 6
10 Hz
Unilateral PC 6, PC 6
10 min
20 min
None
press needle
24 hours
14
Table 3. Acupuncture-Related Therapies for Chemotherapy-Induced

Nausea and Vomiting
Technique
Treatment
Reference(s)
During chemotherapy
18
Continuous for 7 days
19
Acupressure wristbands,
bilateral PC 6
Acupressure wristbands,
bilateral PC 6
Finger acupressure,
3 min, as needed for nausea, for 10
PC 6 and ST 36
days
Transcutaneous electrical
10-15 Hz, 5 minutes every 2 hours,
20
22,23
stimulation, PC 6 and LI 4 for 5 days
During and for 2 hours after
Magnet, unilateral at PC 6
24
chemotherapy
Table 4. Treatment of Therapy-Induced Myelosuppression

Technique
Points
Reference(s)
PC 6, ST 36, points based on

TCM acupuncture
16
symptoms
Microwave acupuncture
ST 36, SP 6
56
Microwave acupuncture
SP 10, BL 17
57
Acupuncture
LI 11, LI 4, ST 36, SP 6
TCM acupuncture
ST 36, SP 6, points based on
with electroacupuncture
symptoms
Acupuncture with
ST 36, SP 6
58
ST 36
60
ST 36
moxibustion
Acupuncture point
injection
Acupuncture point
injection
GV 14, LI 4, ST 36, SP 6, BL 17,

Moxibustion
1
BL 20, BL 21, BL 23
BL 17, BL 20, BL 21, BL 23, GV

Moxibustion
1
14
3 Points from CV 8, GV 14, SP 6,

Moxibustion
1
BL 17, BL 20, BL 21, BL 23
Moxibustion
ST 36, SP 6
Herbal medicine
In Chinese hospitals herbal medicine is routinely given

alongside chemotherapy in order to enhance its effectiveness
and to maintain liver, kidney and immune function. Several US
studies have suggested that the herb astragalus may increase the life expectancy of those receiving
platinum based chemotherapy. The herb helps boost the production of certain white blood cells,
thus boosting immunity. It also helps identify the rogue cells to be attacked. It is crucial to
maintain a strong immune system in the fight against cancer; There are many types of white cells
some of which are called natural killer cells. These actually bore holes in and kill cancer
cells. Rather than just relying on attacking the cancer directly, Chinese medicine always tries to
help the body become stronger so it can fight the cancer itself.
Many herbs have been identified as possessing anti tumor activity, and some are being
synthesized into new drugs to fight cancer. For example, an herb known as Poria has been shown
to cause cancer cells to commit suicide (a process known as (apoptosis). Unlike chemotherapy,
these herbs (if prescribed by a properly qualified therapist) do not harm normal cells and can be
taken long term to help prevent recurrence of cancer once it has been treated with conventional
methods.
Most liver cancers arise in patients with liver cirrhosis, in whom its incidence is high. Japanese
researchers conducted a trial of 260 patients with cirrhosis. Half of the patients were given an
herbal formula and half were given a placebo. After five years, the incidence of liver cancer was
statistically less in the group taking the herbs, which also had higher survival rates.
Of course, the definition of herbs is wide and can include such items as medicinal mushrooms
which have immune boosting, cancer cell killing and tumor restricting properties in clinical
trials.
The role of the spirit
Emotions have a profound effect on the flow of qi. While the emotions are part of a healthy,
normal, life, they can get out of hand and become over dominant. For example, one can be
consumed by anger, so that the rest of ones personality is under-developed. Or, one could be
consumed by grief, fear, or anxiety, unable to function normally. When emotions become over
dominant, they can cause physical illness. In Chinese medicine, each emotion influences a certain
organ. For example, anger damages the liver, grief harms the lungs, and worry harms the
digestive system. Acupuncture can be very helpful in normalizing emotional function. However,
it works so much better if the person can bring their emotions under control.
Where people are part of a religion, they can use the traditional methods of prayer, fasting and
other means to develop the spirit. All the great religions have such practices if one looks hard
enough. For example, forgiveness may be cultivated in order to overcome anger. Or prayerfulness
may be cultivated in order to overcome fear. The cancer can even be seen as a tool to help one
grow: many patients have told me that cancer has been a good thing for them, as it has helped
their spirit to grow. Cancer has actually helped many people to find a deep level of healing, and
for some this has become more important than whether they survive or not. For the Taoists who
developed Chinese medicine, healing of the spirit was the highest goal.
For those of a non religious persuasion, counseling or other forms of therapy may be used to
address emotional issues. Usually patients who address issues of the spirit do much better than
those who do not.
Diet
Some foods feed cancer, and some foods help heal it. The distinctive aspect of the Chinese
approach is that ones ideal diet depends totally on ones diagnosis. For example, if a patient is
liver blood deficient, they must consume foods to tonify the blood, such as dried fruit, nuts, seeds,
and perhaps some animal products. On the other hand, a patient whose cancer is caused by
phlegm will need to cut out animal products, reduce phlegm-forming foods such as dairy, wheat
and fried foods and introduce more drying foods, such as barley and oats. With Chinese dietary
approach, there is no one size fits all: the diet is tailored for each individual person.
Breast Cancer in traditional Chinese medicine
Commonly, there are at least three causes that underlie most breast cancers. Stagnation, damp
accumulation, and toxicity. In the West, we are familiar with the toxic causes of
cancer. Thousands of substances have been documented to "cause" cancer. What is missing from
our modern-day understanding are several traditional Chinese concepts listed below:
First is the concept of flow and how it relates to health.

Good health depends on normal flows of fluid and energy (blood and qi). These flows are
responsible for nourishment and discharge. Flows are effected by physical, mental, and
environmental influences. Poor flow (stagnation) can lead to accumulations (tumors, cysts,
etc.). Cancer can occur when poor flow causes prolonged exposure to toxicity. These toxic
carcinogens can come from outside or inside the body. Our bodies are chemical factories,
capable of generating toxic waste. When elimination of this waste is impeded by stagnation,
stress is placed upon the cells. Cancer is one possible outcome.
The second missing concept is immunity.
In the West, we are beginning to recognize our immune system and what its role might be in the
cause and cure of many diseases, including cancer.
TCM has recognized the immune concept for several thousand years. In that time, many ways
have been devised to enhance the protective qi.
Conclusion
Chinese medicine understands cancer to be part of an imbalance of the whole person, and of the
wider society we live in. It offers many tried and tested means to help those with cancer fight the
illness at the levels of both body and spirit.
CHINESE HERBAL MEDICINES USED TO TREAT BREAST CANCER
Single herbs are rarely used. Herbs are always combined into formulas. These formulae will vary
from person to person and according to changing conditions in each person. Formulas usually
contain herbs for several different purposes. Herbs to move qi, anti-cancer herbs, immune
building herbs, herbs to neutralize toxins, are combined with herbs that correct underlying
imbalances.
Several herbal products may be even more helpful, because they are tablets, easier to take and to
persevere with. They are available without prescription:
SOME HERBS USED TO TREAT CANCER

VITALIZE BLOOD
ANTI-CANCER
STRENGTHENING OTHER
AND/OR
HERBS
HERBS
HERBS
QI HERBS
Chih Ko
Rei Shi
Astragalus
Yi Yi Ren
Aurantium
and various
Huang Qi
Coix
mushrooms
E Zhu
Lu Feng Fang
Xi Yang Shen
LuGen
Curcuma Zedoaria
Hornet Nest
American Ginseng
Phragmites
Tao Ren
Long Kui
Shu Di Huang
Bai Mao Gen
Persicae Semen
Solanum
Chinese Foxglove
Imperata
Root
Hong Hua
Ban Zhi Lian
Gan Cao
Mu Li - Oyster Shell
Carthami Tinctori
Scutellaria
Chinese Licorice
and other shells
Root
San Leng
Dong Ling Cao
Dang Gui
Pu Gong Yin
Sparganii Rhizoma
Rabdosime
Angelica Sinensis
Taraxacum
Rubescentis
Wu Ling Shi
Bai Hua She She Cao
Bie Jia
Ji Xue Teng
Trogopterori Pteromi
Oldenlandia
Turtle shell
Millettia
HERBS USED TO TREAT THE SIDE EFFECTS OF CHEMOTHERAPY & CANCER

RADIATION THERAPY
The side effects of chemotherapy and radiation therapy are not the same for
everyone. Different chemicals, different people, different disease mean that each case
must be assessed separately. The following information is for those with no recourse to
professional help.
Nausea - Acupuncture is useful, so are Dr. Shen's Stomach Curing Pills
Fatigue - A good general tonic are Shen Clinic's Golden Book Pills
Lowered Immunity - Jade Shield Pills
Dryness - Mai Wei di Huang Wan
Radiation Burns - Burn Cream(spring wind)
Flu-like symptoms (tidal fever, scratchy throat) - Zhi Bai Di Huang Wan
For burns and dry skin caused by cancer radiation therapy, one can apply Spring Wind
Burn Cream
CHAPTER 11. Chinese Medicine & The Theory of Qi , Blood and

the theory of Yin Yang
"The
body
is
visible,
but
Qi
is
invisible."
an old Chinese Medicine saying. "To know the body, study nature"
Qi and Blood According to Traditional Chinese Medicine
"Qi is the source of all movement and heat.

Blood is mother to the Qi."
Chinese Medicine Precept
Chinese medicine is about qi. Some think of qi as vital energy. We study where it comes
from, where it goes, and how it flows. Your body is nourished by, cleansed by, and
dependent on flows. Think of your qi as all your body's energies, electrical, chemical,
magnetic, and radiant.
Matter and energy, (flesh and qi), are governed by natural law. Natural forces such as
gravity, time, inertia, friction, yin, and yang, all affect us, inside and out.
Qi must flow. Movement shows that qi exists. Warmth shows that qi is present.
Qi and blood nourish the body. Qi moves the blood, and blood is mother of the qi.
Normal flows of qi and blood are the basics of good health. When they are abundant and
flowing, we are well.
When blood or qi is weak or stuck, we become ill. "To know the body, study nature"
Yin / Yang describe change.
Yin and Yang refer to the sides of a mountain.

In the morning, one side is in shade, the other in sunlight.
Later in the day, the sides have reversed.
Dark becomes light and light becomes dark.
Nature is like this, forever changing, undulating. In time,
Yang turns to Yin. Yin predictably becomes Yang.
Change is certain, a basic law of nature you can count on, like gravity.
Yang and Yin support one another as they oppose each other.
There is always yin within yang and yang within yin. You simply cannot have one
without the other.
We see the body and its disharmonies in changing shades of Yin and Yang.
This helps to understand where events come from and where they are going to.
This helps to understand the disease and the patient.
Two most important Diagnosis According to Traditional Chinese Medicine (T.C.M.)

A
Guide to Oriental Medicine
The doctor of Traditional Chinese medicine observes the patient and looks
carefully at the tongue. The heart revealed at the tip, the kidneys at the root. The
color and appearance of the tongue and tongue coating show what may be hidden;
revealing hot from cold, damp from dry; and true from false.
Tongue Diagnosis
Feeling the pulse (Touching Diagnosis).
Feeling the pulse is a skill that is perfected over a lifetime of diagnostic practice. The doctor
will feel the pulse on both wrists. Besides noting its rate, rhythm, and overall strength,
doctor may note the type of pulse. Texts classify the pulse into at least twenty-eight types.
Some of the common types are wiry (feels tense, like a wire), thready (feels thin, like a
thread), deep (strong pressure required to feel it), short (slow and irregular), slippery (feels
like a bubble moving). By touching the patient in this way, the doctor senses something of
the internal condition of the patient.
Where is the pulse felt?
Using three fingers, the doctor feels the pulse at three positions at each wrist along the
radial artery, front (at wrist crease) relates to the heart and lungs, the middle (just medial
to radial styloid process) relates to the middle organs such as the liver and spleen, and just
behind that is the proximal or rear position helping to diagnose the kidneys. By using finger
pressure, the pulse is felt at three depths, superficial, middle and deep. The practitioner of
Chinese medicine also notes the pulse rate. A normal pulse rate is 4-5 beats per breath. A
slow pulse can lead to a diagnosis of internal cold or inactivity. Though athletes can also
present with a slow pulse. A rapid pulse indicates heat or hyperactivity in the body.
The patient may not tell the whole truth, but the pulse never lies. The doctor may also touch
the body. Local sensitivity can reveal what needs attention. The doctor feels for tone,
temperature, sensitivity, accumulations, or other signs of abnormality
CHAPTER 12. REDUCE CANCER RISK

Theres no magic bullet to preventing cancer, but research has shown that up to two-thirds
of cancer deaths are caused by smoking, physical inactivity and poor diet choices. In other
words, they are preventable. Starting today, you can help reduce your familys risk for
cancer by taking the proper steps to lead a longer, healthier life.
Ways to Reduce Your Risk

There are four primary habits that everyone should adopt. Its never too late to make
simple
lifestyle
changes
that
can
save
your
life.
WAYS TO REDUCE RISK

Below are four primary habits that everyone should adopt. These steps are more than a call
to action they are the keys to leading a longer, healthier life. Integrate these steps into
your daily life gradually, share them with family, support friends in the midst of these life
changes its never too late to make simple, yet lifesaving, lifestyle changes.
Eat Healthy
Be Active
Dont Smoke
Get Screened
Of course, the four lifestyle choices above are not the only ways to prevent cancer. To learn
more, visit the Prevent Cancer Foundation Blog that provides regular information related
to cancer prevention. For a more detailed list of risk reduction measures click 10 Ways To
Reduce Your Risk.
EAT HEALTHY
Reduce your risk for cancer by improving your diet.

New research shows that as many as one-third of all cancer deaths are linked to diet and
physical activity.
You have the power to change your eating habits.

Start by reducing dietary fat intake, especially animal fat. Make your diet rich in fruits,
vegetables, nuts, beans and whole grains.
Start small.
No one can overhaul their food habits quickly. Add a few servings of fruits and vegetables
to your diet each day to reduce your cancer risk. Mix some dark, leafy greens like spinach
in with your salad. Eat a peach, or other brightly colored fruit, for a snack.
Limit alcohol.
Alcohol consumption is linked to increased risk of mouth, esophagus, pharynx, larynx,
liver and breast cancers. If you drink alcohol, men should try to drink no more than two
drinks a day and women should try to drink no more than one drink a day.
Eat less red meat and cut out processed meat.

Eating too much red meat can increase your cancer risk. Skip processed meats like bacon,
ham, pastrami, salami, sausage, hot dogs and pepperoni. Choose fish, poultry, or beans
instead of beef, pork or lamb. When you eat meat, choose lean cuts and eat smaller portions.
Prepare meat by baking, broiling, or poaching at lower temperatures, rather than by frying
in fat or broiling/grilling at excessively high temperatures.
BE ACTIVE
Moderate exercise at least three days a week can make a big

difference in your health and well-being. Research has shown that physical activity reduces
risk of colon cancer by about 50 percent, and it plays a role in lowering risk of other
cancers. Small steps count take the stairs instead of the elevator, park farther from your
destination or walk or ride your bike to work. No more excuses!
Get
Bring
Started
a
Energize
yourself
Stay
Build
Use
friend
motivated
new
skills
available
resources
Dont let the weather stop you
Get started
Add physical activity to your daily routine. Walk or ride your bike to work,
organize school activities around physical activity, walk the dog with your children,
exercise while you watch television.
Make time for physical activity. Walk, jog or swim during your lunch hour, or take
fitness breaks instead of coffee breaks. Try doing something active after dinner with
your family, especially on weekends. Choose activities requiring minimal time,
such as walking, jogging or stair climbing.
Bring a friend
Ask friends and family to exercise with you, and plan social activities involving
exercise. Plan a party with physically active games and activities for your family
and your childrens friends.
Develop new friendships with physically active people. Join a group, such as the
YMCA or a hiking or running club.
Energize yourself
Schedule physical activity for times in the day or week when you have the most
energy.
Pay attention to how you feel after physical activity. Youll be surprised by how
long a short exercise can sustain your energy levels.
Stay motivated
Plan ahead. Make physical activity a regular part of your familys daily or weekly
schedule and write it on a family activity calendar. Keep track of your progress with
this exercise chart.
Pick activities requiring no new skills, such as walking, climbing stairs or jogging.
Exercise with friends who are at the same skill level as you, and create opportunities
for your children to be active with friends.
Build new skills
Find a friend who is willing to teach you some new skills.
Take a class to develop new skills and enroll your children in classes, such as
swimming, gymnastics or tennis.
Use available resources
Select activities that require minimal facilities or equipment, such as walking,

jogging, jumping rope or stretching and strengthening movements.
Identify inexpensive, convenient resources available in your community, such

as education, park and recreation and work site programs.
Dont let the weather stop you
Pick activities that dont depend on the weather indoor cycling, aerobic dance,
indoor swimming, stretching
and strengthening, stair climbing, jumping rope, walking in the mall or dancing.
DONT SMOKE
Tobacco use is one of the worst things you can do to your health.
It is deadly and causes cancers of the lung, throat, mouth and esophagus, in addition to
causing heart disease, emphysema and many other smoking-related health problems.
Nearly one-third of cancer deaths are attributed to smoking.

Smoking is the cause of more than 80 percent of all lung cancer cases and the cause of 30
percent of all cancer deaths. Non-smokers who are exposed to second-hand smoke are at
risk for lung cancer and other respiratory problems. Even third-hand smoke[1] toxic
residue left behind on hair, clothes, furniture and carpets long after second-hand smoke has
cleared is reported to present serious health risks to people who come in to contact with
it.
HOW DID I DEAL WITH BREAST CANCER?!(My case study)

Breast cancer scared me.
Breast cancer, not understanding all of the words, phrases,
diagnoses and instructions overwhelmed me. My family was similarly confused and
concerned. I was devastated and ready to run away to try any treatment, anywhere I could,
to save me from what my life had created. The more I felt helpless and hurried to act, the
less I felt confident that I would survive.
Once I found different way in TCM, everything started to settle down. I became less
afraid when I started , to meditate,pray and using traditional chines medicinan,and my
family: an advocate. My family and I also began the journey laid out by my insurance
and doctors, finding all of the best doctors within 100 miles of our home. Much of it was
right in our own city. As my treatment options and confidence increased, I became
aware of my ability to contribute to my own well-being. Together with my doctors,
family and friends, we walked the journey to recovery
.
I started chemotherapy and began to lose my hair. My beautiful, long, dark brown hair!
I knew I could bring it back using TCM and acupuncture!
My beautiful family cared for me, kept me smiling and well, and made sure I knew there
were many good things awaiting me in their lives, too. Everyday my husband or sons would
remind me of all the good being done, and more for me to do.
It didnt hurt me because I knew it was temporary!!
My adoring husband, Saeed, received a support hair cut. We became bald together, then
grew out together.
My husband always brought me lots of love and energy! His days were long and difficult,
and our trials many. But he remained strong and adoring, and above all, he was there, held
me, protected me and continued to search for the ways to restore my health.
He always was with me!
Family and friends did not abandon me. Many wonderful people spent time, invited me
to events with them; all to keep my spirits active and high.
My family always supported me. A photo from a family affair; then, and more later.
Seeing another person also suffering from cancer brooks my heart. Here I am with my
sister.
If only you knew the joy my sons brought me. Ehsan, with his Visionary abstract paintings,
depicting people in varying states of chaos.that was ME! But he surrounded them all
with a frame of unity.as they surrounded me with the love of family. And Ali, with his
graduation and marriage, joyous times which lifted my pride and spirits. What blessings
had been bestowed on us. And beloved Ata, our amazing and talented youngest boy, who
has been nurtured by his brothers, blessed with the mind and heart of wise ones. He was
troubled, for so long, knowing something was wrong, but not what. He became very strong,
very independent, very quickly, as everyone was struggling to make sure the family was
protected, in tact, and able to move forward through these most difficult times.
My 3 lovely boys always with me and keep me full of love, hope and life.
Conclusion
My first approach to dealing with my cancer was through TCM. I thought I
could heal myself because of all the experience I had with the study of herbs,
acupuncture, diet, etc. at South Baylo University. I had learned so much, and
thought that it would empower me to win my battle over cancer. I continued
with this for three months after the initial discovery of my breast tumor.
I did have an oncologist, who told me that my tumors had shrunk, and my
blood work results were good, so I had achieved some benefits from the
TCM methods of treatment. He still felt, however, that if I did not also have
treatment with Western Medicine techniques, there was a risk of a
recurrence of cancer in the future.
At his suggestion. I began those treatments, but that was not the only reason.
I was finding it difficult to continue with the rigorous demands of TCM on a
daily basis. The needs of my family, which include my husband and my
three sons, keeping myself on a strict diet that required special foods and
special preparation, and the balancing of all this were proving too much for
me to bear.
I began a course of treatments that included surgery, chemotherapy,
radiation, and hormone therapy. My dread was overwhelming when my
oncologist told me all the possible side effects of these approaches that I
would have to endure. I was so frightened that I didn't know if I could
tolerate it all.
When I began my chemotherapy, I was also having acupuncture treatments,
which are part of TCM. It was a surprise to me that many fellow patients in
chemotherapy were very ill, and had many side effects which I was not
experiencing. I wondered if my acupuncture treatments were helping me to
deal better with the effects of the chemotherapy , and I asked my oncologist
about this. He felt that I was correct in continuing my TCM treatment, and
suggested that when my course of cancer treatment with Western Medicine
was complete, that I come and share my positive experiences with other
cancer patients at his hospital.
At present, he is waiting for me to complete my degree, so that I may begin
work at Memorial Coast Hospital, which is where he practices. I am excited
about having the opportunity to help patients better tolerate their treatment
by using a combination of both types of medicine to battle their disease!
I hope that I can help many people to understand that there are benefits and
also shortcomings in using only Western Medicine or TCM. In my
experience, both treatments present challenges. TCM takes a complete
change of lifestyle, diligence, and much time to show results. On the other
hand, Western Medicine has quicker results, but a host of possible side
effects which can be very debilitating, and limit a persons' ability to continue
with the tasks of daily life.
This is why I believe that a combination of both approaches to treating
cancer can be more beneficial, both in terms of results, and quality of life
while a patient strives to regain his/her health.
I have provided articles to give my reader an overview of both TCM and
Western Medicine, as it is applied to the treatment of breast cancer. It is my
hope that breast cancer patients may become aware of all their options in
meeting and defeating the challenge of this disease.
With more knowledge about ones options comes greater strength, and the
greater likelihood of success!
REFERENCES:
http://www.randomhistory.com/1-50/029cancer.html
Sourcehttp://www.worldwidebreastcancer.com/riskform/
American Cancer Society Breast Cancer Facts & Figures, 2005-2006.
(Source: Cancer Research UK Breast Cancer Incidence statistics page accessed online
May, 2008)
Stella Kyriakides, President of Europa Donna, the European Breast Cancer Coalition. Sue
Claridge, in 'The Beacon' (Breast Cancer Network Australia's magazine) Issue 29, Summer
2004 p10
a campaign of Breast Cancer UK reg. charity number: 1138866 in England & Wales; reg.
company
number:
7348408|
Reg. address: Breast Cancer UK Ltd, Solva, Southwick Road, Denmead, Waterlooville,
Hants. American Acupuncture Center, Berkeley, CA, USA.
PO7 6LA UK | last updated: 5/10/2006
Dr Shen's: Free & Easy Pills

http://www.drshen.com/chinesemedicineqiandblood.htm
[1]http://www.nytimes.com/2009/01/03/health/research/03smoke.html?_r=3
Semin Oncol. 2002 Dec;29(6):563-74.
Instead of resisting to changes, surrender. Let life be with

you, not against you. If you think "My life will be upside
down" don't worry. How do you know down is not better
than upside?
~ Shams Tabrizi
Sometimes love wants to do us a great favor: turn us upside
down and shake all the nonsense out!
~ Hafez

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BREAST CANCER

Page | 1 Breast Cancer and TCM by Fatima Manesh

Page | 2 Breast Cancer and TCM by Fatima Manesh

This paper is dedicated first and foremost to my beloved husband, Saeed

Page | 3 Breast Cancer and TCM by Fatima Manesh

Dedication to All Cancer Patients

Page | 4 Breast Cancer and TCM by Fatima Manesh

CHAPTER 1. Pathology Of Cancer

CHAPTER2. What Is Cancer

Tumors that are not cancer

CHAPTER 3. What Causes Cancer?

What Causes Cancer?

CHAPTER 4. Type Of Cancer

CHAPTER 5. Breast Cancer In Western Medicine

Page | 6 Breast Cancer and TCM by Fatima Manesh

The normal breast

Benign breast lumps

General breast cancer terms

Page | 7 Breast Cancer and TCM by Fatima Manesh

Mammograms and Self-Exam

Clinical breast exam

Magnetic resonance imaging (MRI)

CHAPTER 7. How is breast cancer treated in western medicine?

General types of treatment

Page | 8 Breast Cancer and TCM by Fatima Manesh

Page | 9 Breast Cancer and TCM by Fatima Manesh

CHAPTER 8. Breast Cancer Statistics

Breast cancer in the United States

Race/ethnicity and breast cancer rates

Migration to the U.S. and breast cancer rates

Breast cancer: Europe

Breast Cancer in Europe 2006

CHAPTER 9. Cancer And Breast Cancer According To Traditional Chinese

The Chinese understanding of cancer

The role of the spirit

CHAPTER 10 . Diagnosis According to Traditional Chinese Medicine (T.C.M.) A

Page | 11 Breast Cancer and TCM by Fatima Manesh

Qi and Blood According to Traditional Chinese Medicine

Page | 12 Breast Cancer and TCM by Fatima Manesh

CHAPTER 1. Pathology of Cancer

History of Breast Cancer

Page | 14 Breast Cancer and TCM by Fatima Manesh

Page | 16 Breast Cancer and TCM by Fatima Manesh

Page | 17 Breast Cancer and TCM by Fatima Manesh

William Halstead and the Radical Mastectomy Paradigm

Page | 19 Breast Cancer and TCM by Fatima Manesh

Huggins began removing a womans adrenal gland (adrenalectomy) in an effort to starve

Page | 20 Breast Cancer and TCM by Fatima Manesh

Page | 21 Breast Cancer and TCM by Fatima Manesh

CHAPTER2. What Is Cancer

CHAPTER 3. What Cause Cancer?

What Causes Cancer?

Page | 26 Breast Cancer and TCM by Fatima Manesh

Page | 27 Breast Cancer and TCM by Fatima Manesh

When should I worry?

Many cases of an uncommon or rare type of cancer (like kidney cancer)

Who is affected? How are we related?

What type of cancer is it? Is it rare?

How old was this relative when they were diagnosed?

Did this person get more than one type of cancer?

Did they smoke or have other known risk factors?

Page | 29 Breast Cancer and TCM by Fatima Manesh

CHAPTER 4. Type of Cancer