Here once more to deliver information you might on treatment removal for kidney cancer.

This reaserch was done for you out of love and to give the best information out there.

If you have found this info interensting you might be interested in reading more about the cancer remover program

Staging

To plan the best treatment, the doctor needs to know the stage (extent) of the disease. The stage is based on the size of the tumor, whether the cancer has spread and, if so, to what parts of the body.

Staging may involve imaging tests such as an ultrasound or a CT scan. The doctor also may use an MRI. For this test, a powerful magnet linked to a computer makes detailed pictures of organs and blood vessels.

Doctors describe kidney cancer by the following stages:

• Stage I is an early stage of kidney cancer. The tumor measures up to 2 3/4 inches (7 centimeters). It is no bigger than a tennis ball. The cancer cells are found only in the kidney.

• Stage II is also an early stage of kidney cancer, but the tumor measures more than 2 3/4 inches. The cancer cells are found only in the kidney.

• Stage III is one of the following: The tumor does not extend beyond the kidney, but cancer cells have spread through the lymphatic system to one nearby lymph node; or The tumor has invaded the adrenal gland or the layers of fat and fibrous tissue that surround the kidney, but cancer cells have not spread beyond the fibrous tissue. Cancer cells may be found in one nearby lymph node; or The cancer cells have spread from the kidney to a nearby large blood vessel. Cancer cells may be found in one nearby lymph node.

• Stage IV is one of the following: The tumor extends beyond the fibrous tissue that surrounds the kidney; or Cancer cells are found in more than one nearby lymph node; or The cancer has spread to other places in the body such as the lungs.

• Recurrent cancer is cancer that has come back (recurred) after treatment. It may come back in the kidney or in another part of the body.

Treatment

Many people with kidney cancer want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, people may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor-to take part in the discussion, to take notes, or just to listen.

The doctor may refer the patient to a specialist, or the patient may ask for a referral. Specialists who can give the best treatment removal for kidney cancer include doctors who specialize in diseases of the urinary system (urologists) and doctors who specialize in cancer (medical oncologists and radiation oncologists).

Thanks again for taking time and reading, and remember there is always hope.

All the best.

Bone cancers are rare forms of cancer that can affect any bone in the body. Two types of bone cancer are multiple myeloma and bone sarcomas. Bone cancers can also happen when tumors that start in other organs, such as breasts, lung, and prostate, metastasize (spread) to the bone. Multiple myeloma is the most common type of bone cancer. Basic information about Bone cancer symptoms and treatment.

Blood tests, X-rays, CT scans, MIRs and ultrasound can all be used in the diagnosis of bone cancer and cancer of the bone marrow. Ultimately however, only a bone biopsy can provide a definitive diagnosis. By examining a sample of tissue, a Pathologist can determine whether cancer is present and how fast it’s growing, crucial information in determining the best course of treatment.

Types of Bone Cancer: Osteosarcoma is the most common bone cancer. It rarely occurs in adults older than 25 years old. Osteosarcoma is usually found in the bones of the arms, legs and pelvis, and in bones that grow rapidly, such as the shoulders and knees.

Ewing’s sarcoma is commonly found in children ages 4 to 15, and is rare in adults older than 30. It is an aggressive cancer typically found in the center of the long bones of the arms and legs.

Chondrosarcoma is found in cartilage cells and accounts for about 25 percent of bone tumors, making it the second most common type. Unlike most other bone cancers, it is most common in people older than 40. It is typically found in the large bones of the hips and pelvis.

Bone Cancer Symptoms:

• Pain
• Swelling or tenderness of the joints
• Fractures
• Fatigue, fever, weight loss, anemia
• Bone dysplasia with medullary fibrosarcoma
• Eosinophilic granuloma
• Multiple Myeloma

The symptoms of bone cancer vary from one person to another according to the location and size of the bone cancer. Pain is one of the most common bone cancer symptoms. Generally, there is a gradual increase in the severity of the symptoms with time. At first, the pain may only be felt with activity or at night.

These are common types of Bone Cancer Treatment:

Surgery

How bone cancer is treated depends on the type of tumor, how aggressive it is, the location of the tumor and whether or not the cancer has spread to other areas of the body. Options include surgery, radiation and chemotherapy, or a combination of the three.
Risks include infection, damage to surrounding muscles, nerves and blood vessels, and recurrence of the cancer. Patients are often prescribed a course of physical therapy after surgery to help them regain full use and strength in the limb where the tumor was removed.

Chemotherapy

Chemotherapy is administered by an oncologist, and comprises a series of powerful intravenous drug treatments aimed at stopping and reversing the growth of cancer cells. Chemotherapy is often used before surgery to shrink the tumor, making surgery less invasive. After surgery, it is used as a safeguard to kill any remaining cancer cells. The drugs kill cancer cells, but also affect hair, digestive tract cells and blood-forming cells. Loss of hair, nausea, loss of appetite, anemia and low energy are common side effects of chemotherapy. These side effects usually go away quickly after chemotherapy stops. Chemotherapy patients are sometimes referred to nutritionists to help with the anemia and loss of appetite.

Radiation Therapy

Radiation therapy is administered by a radiation oncologist, and comprises a series of high-energy X-rays aimed at the site of the tumor. This treatment is given in small doses over several days, sometimes months. The most common side effects are loss of appetite, fatigue and damage to the skin and other soft tissue at the site of the treatment. Patients who undergo surgery near the site of radiation therapy sometimes are slow to heal because of damage to the blood vessels at the site. Most side effects go away quickly after radiation therapy is over, but problems with slow healing may persist.

Mesothelioma surgery does not cure mesothelioma and is not even suitable for everyone. The main focus of mesothelioma surgery is on keeping the illness limited, under control and prolonging good health. Usually mesothelioma surgery is not done alone but is a part of a combination followed or led by radiotherapy and chemotherapy. According to the researchers, this is the best way of limiting mesothelioma.

The reason why mesothelioma surgery is not solely effective is because mesothelioma is diagnosed very late usually. If pleural mesothelioma is diagnosed in its early stages then the patient can opt for an extrapleural pneumonectomy. However, if the cancer has only spread, which is usually the case, then a pleurecomy can be helpful to control the symptoms. However, this treatment would not cure your mesothelioma and will not prolong your life under mesotheliomic conditions.

Mesothelioma surgery is helpful for people with peritoneal mesothelioma only if the cancer is diagnosed at its early stages.

There are various types of mesothelioma surgeries related to the different types of mesothelioma.

- Extrapleural pneumonecomy (EPP):
This one is a major mesothelioma surgery in which the affected side of the lung is removed. Also, some other areas namely the pleura, diaphragm and covering of the heart are also eliminated.

This type of mesothelioma surgery is not suitable for everyone. As it is a major surgery, therefore it requires proper health conditions determined and certified by a physician.

Pleurectomy:
Pleurectomy is another form of mesothelioma surgery which is meant to control symptoms. It helps control the fluid build up and can relieve chest pain.

Mesothelioma surgery for peritoneal mesothelioma:
mesothelioma surgery for peritoneal mesothelioma is not possible for everyone. There are a number of factors such as the age, health and others that determine whether or not a person is fit for operation. In this mesothelioma surgery, the lining of the peritoneum is removed.

Russia, the world’s leading producer of asbestos, protested as an international forum in Moscow urged a global ban on the use of the material because of health risks.

“It’s just a PR campaign when they say that asbestos can kill,” said Viktor Ivanov, head of the Chrysotile Association, an industry group based in the Russian town of Asbestos in the Ural mountains region.

Yevgeny Kovalevsky, a forum delegate from the Russian Academy of Medical Sciences, said: “For the general population, there aren’t significant risks… I haven’t seen a single scientific study that shows the need for a ban.”

Meanwhile, international public health experts at the first World Social Security Forum in the Russian capital urged a global ban, saying that up to 100,000 people die every year of asbestos-related diseases.

This issue is a commentary by Russian Chrysotile Association to the XVIII World Congress on Safety and Health at Work and the International Safety and Health Exhibition (KISS-2008) held in Seoul, South Korea, on June 29 – July 02, 2008.

The Russian chrysotile industry continues the information campaign “A Big Lie of “Ban Asbestos”, which goal is to inform the public about true reasons of the anti-asbestos campaign, about the falsity of objectives of its promoters.
The information campaign is usually in the form of answers to your questions, but this issue is a commentary to the XVIII World Congress on Safety and Health at Work and the International Safety and Health Exhibition (KISS-2008) held in Seoul, South Korea, on June 29 – July 02, 2008.
read more details

LINKS:
Mesothelioma Cancer Org

You received a diagnosis of cancer.  Where to go now?  Because of our own experiences with this dreaded disease, my wife, Nancy, and I have some suggestions to share with you.

Nancy, my wife and my hero, and I will celebrate our 40th wedding anniversary this September 25.  It has only been over the last 10 years that I have come to appreciate and admire her heroic qualities brought to fruition through tremendous personal adversity.  To accomplish this it is imperative that the doctors and hospital chosen possess unique skills and procedural methods to make the cancer victim’s survival possible.

Many know me as the author of the “Managing My Fibromyalgia” Website and Forum in which I describe my life dealing with the effects of what is now termed fibromyalgia, for more than 30 years.  My life has been challenging and I find myself now permanently disabled due to this chronic pain and fatigue disorder.  What I have had to face with my illness pales in comparison to what Nancy has dealt with successfully over the past 10 years. 

Nancy was diagnosed with the dreaded big “C” in 1999.  It was both colon and pancreatic cancers.  She was initially devastated.  This was something she feared since 1973 when she found out she had a condition called familial polyposis.  Until that point, Nancy thought her rectal bleeding was due to hemorrhoids as her doctors had told her since she was in her teens.  She had thousands of polyps in her colon, too many to be removed.

[Familial polyposis or familial adenomatous polyposis [FAP) is a premalignant disease.  This means that a person with FAP, if left untreated, will invariably develop cancer.  Individuals with this disorder grow hundreds of polyps throughout their large intestines.  The polyps, also called adenomas, commonly develop just after puberty.  Approximately half of all FAP patients will have polyps by age 14.  Ninety percent will have detectable polyps by age 25.  Usually by age 35-40, one or more of these polyps will become cancerous.]*

[FAP is a rare disease.  One in 8,000 people in the United States have FAP.  However, it may be very common in affected families.  FAP is inherited in an autosomal dominant pattern.  This means that a person with FAP has a 50% chance of passing the condition down to each of their children.  [Our son Gregg inherited this abnormal gene and had his colon removed by the time he was 22].  FAP can also develop in someone with no family history of the disorder, due to a new genetic mutation in that individual.  It is thought that approximately one percent of all colorectal cancers in the United States can be attributed to FAP.]*

Nancy had surgery back in 1973 to remove her colon.  The doctors created what they term a “J-pouch” out of her intestine to replace her colon and to restore normal bowl function.  It was now necessary for her to be monitored for the rest of her life.  Any new polyps that developed, while in a precancerous state, required removal and testing.

This treatment worked for many years.  Since moving to Virginia, however, she became uncomfortable with the doctors she met.  Nancy became remiss on going for her checkup appointments, even after my protests that she not neglect her follow-ups.  This is what undoubtedly led to her developing colon and pancreatic cancer in 1999.

Nancy’s initial reaction to her diagnosis was immediate devastation.  It lasted until she met her new doctors at the Sloan Kettering Memorial Cancer Hospital in New York City.  She saw the doctors at Sloane after getting the recommendations of family and friend based on their experience with the hospital. 

After talking to the doctors and meeting other patients with the same condition, her feelings of devastation became one of hope and steadfastness in the face of cancer, an attitude she has strongly maintained until the present.

Since 1999, Nancy was treated and had surgery and several related procedures for colon, pancreatic, and lung cancer.  Through it all, she is now cancer free.

The past two years, polyps where found developing in Nancy’s stomach.  They were removed, tested, and found to be showing mild dysplasia.  At the time, it was thought that they could be controlled this way, which was until the polyps became more and more numerous.

After several consultations and much consideration on Nancy’s part, to prevent any cancer of her stomach developing to threaten her life, she opted for a total gastrectomy [surgical removal of the stomach and the connecting of her intestine directly to her esophagus] on Oct 7, 2008.  This radical surgery would extend her life and assure that the polyps in her stomach would not turn to cancer.  Her surgeon told us that she should expect to be in the hospital for 5 to 10 day, possibly a week, after having her surgery.

As it turned out, this was not the case.  From Oct 7, 2008 till when she returned home December 9, 2008, she spent a total of 8.5 weeks in the hospital with only a couple of short stays at her sister’s home in New Jersey.  There were complications due to leaks in her new digestive tract, slow healing, abscesses filled with fluid in her torso and related infections.  In fact, Nancy returned home to Virginia with two drains still in place. 

The doctors in New York City gave us the name of a surgeon in Winter Park Florida.  Dr. Timothy Childers, was going to follow up on her case.  We moved from Virginia to Chuluota Florida to live at my sister’s home on December 13, 2008.  We gave up our apartment in Lorton, Virginia due to financial reasons; going to stay at my sister’s home in Florida would give us extra hands to help in Nancy’s recovery. 

Within several days of seeing Dr. Childers for the first time and before having her drain apparatus removed, Nancy ended up once again in the hospital [Florida Hospital Orlando South] for another week.  She had developed fever and it was determined to be an on going infection from a previously undetected abscess filling with fluid.  She finally left the hospital on December 27, 2008.

It is now January 6, 2009 and we are thanking God that Nancy is making slow but steady progress [some days better with occasional set backs] in achieving some sort of normalcy.  She will never be able to eat the same way as before, but many times a day in much smaller portions and will probably need supplements to reach the goal of 2000 calories a day.

This last surgery turned out to be the hardest on Nancy that I have witnessed.  It took a toll on her emotions and determination, but I know in my heart that her steadfast resolve to live will make the difference again and she will continue to be cancer free.

Nancy’s surviving cancer has come at a financial cost.  Even with her good insurance coverage from her employer, we have been financially devastated over these past 10 years.  We gave up our home in Stafford Virginia in 2005, used up my entire 401k plan from my once employer, over extended my credit on my main credit card to pay medical bills and are at a point of considering declaring bankruptcy [although it goes against everything I believe in].  We now realize we may never get to travel during our retirement as we had planned, nor have a place of our own nor live our remaining years together without tremendous financial stress and pressure.

I am not complaining though.  We look to God for comfort with thanksgiving.  Even if I knew back then, what I know now, I would, without hesitation, do it all over again and ask Nancy to be my wife. 

After nearly 40 years of marriage, I love and cherish my hero wife even more than before.  I would truly be lost in this world without her.

Based on Nancy’s experience with her cancer and my own experience with prostate cancer, that was treated successfully this past year, there are several things that are important if one is to successfully fight the cancer battle:

1.    Early detection through regular examinations and testing is essential.
2.    Know your risks [family history, etc].
3.    Learn everything you can about your particular cancer.
4.    Always obtain a second or third opinion.
5.    If you do not feel comfortable with a doctor, move on to another; if you do not have any confidence in your cancer doctor, find a new one.
6.    Research cancer doctors and cancer hospitals.
7.    Ask friends and professionals for their recommendations on same.
8.    When declared cancer free, do not become complacent.  Continue regular examinations and tests to detect any reoccurrence early.

*Gale Encyclopedia of Medicine, Published December 2002 by the Gale Group.  The Essay Author is Ellen S. Weber, MSN.

Uterine Cancer is one of the deadliest cancers, which actually start in the lining of the cells in the uterus. The womb or the uterus is a vital part of the reproductive system in a woman.

Type of Uterine Cancer

Uterine cancer may denote various types of cancers, which occur in a woman’s uterus. Uterine sarcomas, commonly known to be leiomyosarcomas are a type of uterine cancer, which occurs in the muscular layer of a uterus. Endometrial cancer is another type of uterine cancer, which originates from the cells that are located in the glands of the uterine lining or the endometrium. Cervical cancer is a different type of uterine cancer, which is known to arise from the lower portion of a uterus. It extends to the transitional zone of a woman’s cervix and connecting to the upper part of her vagina.

Symptoms of Uterine Cancer

A woman having uterine cancer can notice some common symptoms. However, they may differ from person to person depending upon the disease in consideration. Commons symptoms include painful or difficult urination, unusual discharge or vagina bleeding, extreme pain during the time of having sexual intercourse, a typical pelvic lump, abnormal weight loss, pain in the pelvic region and having never breast-fed. In fact, uterine cancer occurs rarely before menopause, during which a woman have regular menstrual periods.

It generally occurs during the time when the regular menstruation cycle stops. If a woman notices reappearance of bleeding at this stage of her life, she should immediately bring it to the attention of her general physician, as there may be a possibility of uterine cancer.

The most common symptom of uterine cancer is abnormal bleeding from a woman’s uterus after her menopause. The bleeding may be in the form of a blood streaked, watery discharge containing more blood. In some cases, a woman may experience lower abdominal pain too.

Causes behind Uterine Cancer

There are different causes of uterine cancer, which have been discovered till date. Diabetes, obesity, polycystic ovaries having prolonged anovulation, nulliparity or having borne not a single child, lack of menstruation, extended usage of tamoxifen for the treatment of breast cancers and taking unopposed estrogen without progestin are some of the valid causes of uterine cancer.

Diagnosing the Disease

Uterine cancer can be diagnosed by endometrial and endocervical sampling. Apart from these techniques, vaginal ultrasonography is also used to detect the thickness of the endometrium because increased thickness of the uterus may determine some serious cancerous change. Apart from this, the Pap test can also be an accurate way detecting uterine cancer but cannot be termed as a reliable source.

Treatment of Uterine Cancer

The treatment of uterine cancer is performed on the basis of grade and stage of the cancer. Abdominal hysterectomy is a standard therapy, which involves in the surgical removal of the woman’s uterus along with both the ovaries and fallopian tubes, washing of the abdominal cavity to determine malignant cells and the selective removal of the aortic and pelvic lymph nodes. Many doctors prefer usage of hormone therapy that removes the possibility of metastatic cancer. Again, women also opt for radiation therapy for the treatment of their uterine cancer.

Although treatment is a possibility for Uterine Cancer, still you should take immediate action after noticing the symptoms. Don’t let it reach a level from where it cannot be cured!

To Your Health!

Determining the breast cancer stages is important since it enables the patient and doctor to identify the treatment necessary for one’s condition. Also, it is essential in assessing the risk of the given condition and what lifestyle changes the patient can do to improve their health.

Identifying A Breast Cancer’s Stage

When talking about breast cancer stages, it is aimed at describing the extent of the cancer in the body. So, if you ask how a breast cancer is staged, doctors often start to classify whether it is invasive or non-invasive. Other factors considered are the tumor size, number of nymph modes involved, and what other parts of the body it has managed to affect.

Determining a cancer’s stage is helpful during prognosis and deciding on a treatment option.

To determine the stage, a few standard procedures are done by the doctor on a patient. They undergo physical exam and biopsy to acquire the data needed by the doctor for the diagnosis.

If needed, further tests are also conducted such as imaging tests that include x-ray, bone scans, mammograms for the breasts, CT scans, positron emission tomography (PET), and magentic resonance imaging.

What Are the Breast Cancer Stages?

Now that the importance of determining the different breast cancer stages have been clarified, as well as the methods used to identify them, it is now time to move on to discussing each of the stages. Take note of the features and extent of the cancer in each of the stages:

Breast Cancer Stage 0

This stage renders the case of breast cancer to be non-invasive. At this point of the breast cancer, cancer or non-cancerous cells cannot be detected yet.

The abnormal cells are still at the stage wherein they try to spread out within the specific part of the breast where the cells are rooted. Also, they can try to expand on the neighboring tissues as the cancerous cells continue to grow.

Breast Cancer Stage I

Once the breast cancer enters this stage, it is now categorized as an invasive type of breast cancer. Meaning, the cancer cells have now worked their way towards the neighboring tissues. Stage I breast cancer also exhibit the following characteristics:

•    The cancerous tumor has reached the size of 2 centimeters.
•    No lymph modes are affected.

Breast Cancer Stage II

For this particular stage of breast cancer, it is also known as an invasive type of cancer and is broken down into two more categories:

1) Stage IIA

Even in this particular stage, the conditions can be different:

•    A tumor does not exist in the breast but cancerous cells are detected in the lymph nodes.
•    A tumor could exist but measures less than 2 centimeters;
•    The tumor has expanded beyond 2 centimeters but less than 5 centimeters without reaching the lymph nodes.

2) Stage IIB

This invasive level of the cancer are recognized as either one of the following:

•    The tumor exceeds 2 centimeters in size but less than 5 centimeters, while also reaching the lymph nodes.
•    The tumor is more than 5 centimeters in size but has not yet reached the axillary lymph nodes.

Breast Cancer Stage III

1) Stage IIIA

In this stage, the tumor could either be detected or not. Aside from the axillary lymph nodes, cancer can also stick to other structures outside of the lymph nodes and become clumped together.

2) Stage IIIB

In this stage, the tumor can grow in size and affect other areas of the body outside of the actual breast, whether th chest wall or skin of the breast. This is the stage wherein inflammatory breast cancer takes place.

3) Stage IIIC

In some cases, sign of breast cancer might not be detectable yet. However, the tumor could already be spreading towards the breast skin, chest wall, and below your collarbone.

Breast Cancer Stage IV

In this level, the cancerous cells have managed to spread to various organs of the body. Therefore, the cancer is no longer restricted on the breast and lymph nodes, which signifies the initial diagnosis of breast cancer. The reason why diagnosis is done only during this stage is because cancerous cells were not detected while still within the breast.

Recognizing breast cancer stages does more than just identifying treatment options, but also enables doctors and patients to understand the developmental pattern of the disease.

Using known risk factors for breast cancer, mathematical models can be developed to help answer important questions.  These mathematical models are useful tools for researchers and for patients as follows:

• 1. Research on risk factors – The Claus risk assessment model was used to discover the subpopulation of people who had an autosomal dominant genetic allele that increased their risk from 10% to 92%. This led to the discovery of the BRCA genes associated with breast, ovarian, and prostate cancer.
• 2. Clinical trial eligibility – The Gail risk assessment model was developed to help researchers determine who to enroll in the NSAPB Breast Cancer Prevention Trials

where chemoprevention was shown to reduce breast cancer risk.

• 3. Guidelines for doing BRCA testing – BRCA testing is very expensive and practically worthless if done on everyone (because it is so rare to be homozygous for BRCA1 or BRCA2). Mathematical models such as the BRCAPRO, BOADICEA, and Tyrer-Cuzick models can help determine what patients should undergo BRCA testing. The decision for testing is usually made when one of these models predicts a 10% or greater chance that there is a mutation of the BRCA1, BRCA2, or both genes.
• 4. Guidelines for doing MRI screening for breast cancer - MRI screening for breast cancer is not a cost effective screening test for the general population, but in specific groups, there are clear cut reasons to do so. In general, screening MRI is recommended for women with 20-25% or greater lifetime risk of breast cancer. The BRCAPRO and Tyrer-Cuzick models have been used to help make clinical decisions about ordering MRIs for breast cancer screening.
• 5. Guidelines for breast cancer therapy - The Gail model is used clinically to help

determine who should be put on tamoxifen or raloxifene for chemoprevention.  Other models have been used to help make decisions about breast cancer risk reduction with prophylactic mastectomy.

For these reasons, it is important to understand these models.  These models are collectively refered to as “risk assessment tools”.  The following paragraphs summarize the most popular and most widely used risk assessment tools.  Keep in mind that none of these risk assessment tools apply to breast cancer survivors.  No mathematical model has been widely accepted to determine cancer risk in cancer survivors. 

General Risk Assessment Tools

Gail Model:  The Gail model is a validated risk-assessment model that focuses primarily on nonhereditary risk factors, with limited information on family history.  It was developed by scientists at the National Cancer Institute and the National Surgical Adjuvant Breast and Bowel Project (NSABP) to assist health care providers in discussing breast cancer risk to determine their eligibility for the Breast Cancer Prevention Trial.  The tool allows one to project a woman’s individual estimate of breast cancer risk over a five-year period of time and over her lifetime.  It also compares the woman’s risk calculation with the average risk for a woman of the same age.  The Gail Model is an on-line quiz that has 13 questions and is interactive.  This calculator is based on published risk statistics and methods gathered from peer-reviewed journals, and has been extensively tested for its validity. 

The major limitation of the Gail model is the inclusion of only first-degree relatives, which results in underestimating risk in the 50% of families with cancer in the paternal lineage and also takes no account of the age of onset of breast cancer.  It may underestimate risk in certain groups, such as obese patients.

National Cancer Institute Model:  The NCI risk assessment tool is essentially a simplified Gail Model that also factors in race.  Race is a factor in determining breast cancer risk but is excluded when determining eligibility for clinical trials.  This tool is probably the most popular risk assessment tool available to the public as an on-line, interactive risk calculator.  The on-line quiz is a shorter, nine-point questionnaire that includes multiple factors, giving a woman her future five-year risk of breast cancer and her lifetime risk of breast cancer.

The NCI tool does not account for a lot of risk factors that can be modified.  For this reason, it is difficult to use this test as a motivation tool to show people how lifestyle can alter their risk of breast cancer.  It also cannot be used in breast cancer survivors, in patients with DCIS, LCIS, or people who carry one of the BRCA genes.

BRCAPRO model:  This is a statistical model available as a computer program that uses two different algorithms to evaluate family history and helps a doctor determine the likelihood of finding either a BRCA1 mutation or a BRCA2 mutation in a family.  The results of this can be used to determine if BRCA testing is indicated.  This is very useful in light of the high cost of BRCA testing ($3,000).  None of the nonhereditary risk factors can yet be incorporated into the model, however.  In a comparison of four different methods for estimating breast cancer risk in patients with a family history of breast cancer, the BRCAPRO model was the least accurate.  It predicted only 49% of the breast cancers that actually occurred in the screened group of patients with a family history of breast cancer.

Harvard Center for Cancer Prevention Risk Assessment Tool:  This is another breast cancer risk assessment tool that includes more lifestyle factors than the NCI or Gail Model tools.  It has not been studied as extensively as the Gail Model or the simplified NCI model, but it is promising in that it includes many lifestyle factors that people can do to modify their risk of developing cancer.  It is also an on-line questionnaire that can be used by both women and men to estimate their breast cancer risk.

Making all this practical

          Now after a thorough and confusing discussion of all these statistical models, it’s time to make all this information practical.  What is the best way to help a patient accurately assess her risk of breast cancer and if possible, show her what positive factors are reducing her risk and what negative factors can be changed to reduce her risk?  If possible, it would also be great to show the patient the value and indications for testing, imaging, chemoprevention, and in some cases surgery.  A discussion of the practical aspect of each of these is addressed in a Q & A format below:

Q: What (free) online programs can be used to help a patient assess their risk of breast cancer?

A: Several of the risk assessment tools mentioned above can be accessed for free by the public. Here are the tests and their websites:

• 1. Your Disease Risk – English version: http://www.diseaseriskindex.harvard.edu

This is a great interactive questionnaire that calculates five-year and lifetime risk of breast cancer developed by the Harvard Center for Cancer Prevention and made public online in 2000.  In 2005, they launched the Spanish version of the site, “Cuidar de su Salud”.  The risk calculator includes lifestyle factors such as weight, dietary vegetables, alcohol intake, as well as Jewish ethnicity.  It does not include other ethnicities, however, and is not accurate for BRCA mutation carriers or breast cancer survivors.  Despite these issues, this is by far the best free online risk calculator since it is very interactive and gives you a personalized description of your risk in the form of a colored bar graph, which they can electronically manipulate to experience “virtual” risk reduction.  The bar graph is a seven-level scale that compares users to a typical man or woman your age.  Users learn where to focus their prevention efforts and how to make lifestyle changes by “clicking on” personalized strategies.  With each click, the bar graph shrinks, and the user watches his/her predicted risk drop.  This is a great concept to motivate people to participate and comply with lifestyle modification measures.

• 2. The NCI Risk Assessment Tool -regular web: http://www.cancer.gov/bcrisktool

     This is the easy to use, on-line questionnaire based on a modified Gail model that also includes ethnicity.  It does not factor in a personal history of breast cancer, DCIS, or LCIS.  It does not account for other factors such as BRCA status, hormonal replacement therapy, lifestyle factors, breast feeding, menopause, or mammographic density.  Despite these issues, it is a very useful tool that gives a woman her five-year and lifetime risk of breast cancer.  It is the only risk assessment tool that can be used via mobile handheld devices (any type).  A version of this can be downloaded for PDAs with Windows Pocket PC operating system as well.

Q:  What programs can be used to help a doctor make decisions about ordering a breast MRI?

A:  The American Cancer Society has developed some very good guidelines for breast cancer screening with MRI.  It should be emphasized that MRI is an adjunct to mammography, not a replacement.  

• 1. A Cancer Journal for Clinicians – http://caonline.amcancersoc.org/cgi/content/full/57/2/75

• 2. BRCPRO - ver.4.3 available @ http://www4.utsouthwestern.edu/breasthealth/cagene/default.asp

Breast cancer is the most common cancer and the second leading cause of cancer deaths in women in the United States.  In 2008, approximately 184,450 patients were estimated to be diagnosed with invasive breast cancer, and an estimated 40,930 were estimated to die of this disease.   Furthermore, over 50,000 female carcinoma in situ breast cases would have been diagnosed.  The etiology of breast cancer is poorly understood with multiple genetic and environmental factors involved in the initiation and progression of cancer. 

Scandinavian Twin Study:  For years, there has been a hot debate as to whether the cause of breast cancer is genetic or environmental.  Then in 2000, Lichtenstein and his colleagues at the Karolinska Institute in Sweden published their study of 44,788 pairs of twins from the Swedish, Danish, and Finnish twin registries.  In this study, they looked at cancer risk with 28 different types of cancers and did statistical modeling of genetic and hereditary contributions in eleven different cancer types.  For breast cancer, they clearly showed that only 27% of breast cancers were due to genetic factors.  This was an even lower hereditary component than other common cancers such as prostate and colorectal.  This study and others have confirmed the fact that over 70% of breast cancers are influenced by environmental factors.

BRCA genes:  Although much attention has been made about hereditary breast cancer, only two genes are commonly tested for breast cancer risk assessment.  These two genes are tumor suppressor genes named “BRCA1″ and “BRCA2″ that are involved with DNA repair.  These two genes only account for about 5% of all breast cancers.  Because of the Scandinavian twin study, most experts believed that there are other yet to be discovered genes involved with breast cancer.  Because the chance of having a BRCA mutation in the general population is so low, genetic testing is not indicated in most patients.  However, if a patient has a family history of breast cancer, then a mathematical model can be used to determine if BRCA testing is indicated.  The likelihood of being a BRCA carrier increases with the number of relatives who had cancer and if the cancers occurred earlier in life.  For example, in families with four or more cases of breast or ovarian cancer under the age of 60, over 80% are found to have a damaged version of BRCA1 or BRCA2.  If a patient is a carrier of one or both of the BRCA1 and BRCA2 genes, her risk of breast cancer dramatically increases.  According to estimates of lifetime risk, about 13.2% (132 out of 1,000 individuals) of women in the general population will develop breast cancer, compared with estimates of 36-85% (360-850 out of 1,000) of women with an altered BRCA1 or BRCA2 gene.  In other words, women with an altered BRCA1 and/or BRCA2 gene are up to eight times more likely to develop breast cancer than women without alterations in those genes.  The BRCA1 mutation confers a higher risk than a BRCA2 mutation.  Women who inherit a damaged BRCA1 gene have a 60-85% chance of developing breast cancer at some stage in their lives and a 20-40% chance of developing ovarian cancer.  For BRCA2, the risks are 40-60% and 10-20%, respectively.  

Family History and Breast Cancer:  Although the spotlight in hereditary breast cancer has been directed on the BRCA genes, the majority of patients with a family history of breast cancer are BRCA1 and BRCA2 negative.  Even in these BRCA negative patients, however, there is an increased risk of developing cancer with a family history of breast cancer.   Six factors (unrelated to BRCA genes) have been studied in patients with a family history of breast cancer.  They are as follows:

1.  Degree of relationship:  If the family member with a history of cancer is a first degree relative, the increased risk is much greater than for second degree relatives. 

2.  Number of relatives who have had breast cancer:  People with two or more family members who have had breast cancer are at higher risk than those with only one affected relative.

3.  Age of onset of cancer:  If the relative developed breast cancer at an early age (pre-menopausal), the risk is higher than if the relative developed post menopausal breast cancer.

4.  Bilateral breast cancer:  If the relative has a history of bilateral breast cancer, the risk is greater than having a relative with unilateral breast cancer.

5.  Gender of the relative:  If the family member with breast cancer is a man, the risk is higher.

6.  Other related early onset tumors:  If there is a family history of early onset ovarian cancer, this incurs an increased risk for a person.

How to decide whether you need the BRCA gene test

The following is an excerpt from the American Society of Breast Surgeons:

1.  Early onset breast cancer (diagnosed before age 50)

2.  Two primary breast cancers, either bilateral or ipsilateral
3.  A family history of early onset breast cancer
4.  Male breast cancer
5.  A personal or family history of ovarian cancer
6.  Ashkenazi (Eastern European) Jewish heritage
7.  A previously identified BRCA1 or BRCA2 mutation in the family

Any one of these features alone indicates a risk for harboring a BRCA1 or BRCA2 mutation.  The presence of more than one of these features raises that risk to greater than 10%, the traditional cutoff for recommending a BRCA test. Such patients should have access to BRCA testing.  A simple risk-calculation model based on the prevalence of mutations seen among women tested for BRCA mutations is available at http://www.brcacalculator.com.

Reduce Your Risk

Consider this number: 10 million. That’s how many cases of cancer are diagnosed worldwide each year. Now consider this number: 15 million. That’s how many cases of cancer the World Health Organization estimates will be diagnosed in the year 2020 — a 50 percent increase — if we don’t get our act together.

Most cancers don’t develop overnight or out of nowhere. Cancer is largely predictable, the end result of a decades-long process, but just a few simple changes in your daily life can significantly reduce your risk. Here are 31 great tips.

1. Serve sauerkraut at your next picnic. A Finnish study found that the fermentation process involved in making sauerkraut produces several other cancer-fighting compounds, including ITCs, indoles, and sulforaphane. To reduce the sodium content, rinse canned or jarred sauerkraut before eating. 2. Eat your fill of broccoli, but steam it rather than microwaving it. Broccoli is a cancer-preventing superfood, one you should eat frequently. But take note: A Spanish study found that microwaving broccoli destroys 97 percent of the vegetable’s cancer-protective flavonoids. So steam it, eat it raw as a snack, or add it to soups and salads.

3. Toast some Brazil nuts and sprinkle over your salad. They’re a rich form of selenium, a trace mineral that convinces cancer cells to commit suicide and helps cells repair their DNA. A Harvard study of more than 1,000 men with prostate cancer found those with the highest blood levels of selenium were 48 percent less likely to develop advanced disease over 13 years than men with the lowest levels. And a dramatic five-year study conducted at Cornell University and the University of Arizona showed that 200 micrograms of selenium daily — the amount in two unshelled Brazil nuts — resulted in 63 percent fewer prostate tumors, 58 percent fewer colorectal cancers, 46 percent fewer lung malignancies, and a 39 percent overall decrease in cancer deaths.

4. Pop a calcium supplement with vitamin D. A study out of Dartmouth Medical School suggests that the supplements reduce colon polyps (a risk factor for colon cancer) in people susceptible to the growths. 5. Add garlic to everything you eat. Garlic contains sulfur compounds that may stimulate the immune system’s natural defenses against cancer, and may have the potential to reduce tumor growth. Studies suggest that garlic can reduce the incidence of stomach cancer by as much as a factor of 12! 6. Sauté two cloves of crushed garlic in 2 tablespoons of olive oil. then mix in a can of low-sodium, diced tomatoes. Stir gently until heated and serve over whole wheat pasta. We already mentioned the benefits of garlic. The lycopene in the tomatoes protects against colon, prostate, and bladder cancers; the olive oil helps your body absorb the lycopene; and the fiber-filled pasta reduces your risk of colon cancer. As for the benefits of all of these ingredients together: They taste great!

7. Every week, buy a cantaloupe at the grocery store and cut it up after you put away your groceries. Store it in a container and eat several pieces every morning. Cantaloupe is a great source of carotenoids, plant chemicals shown to significantly reduce the risk of lung cancer.

The Power of Antioxidants

8. Mix half a cup of blueberries into your morning cereal. Blueberries rank number one in terms of their antioxidant power. Antioxidants neutralize free radicals, which are unstable compounds that can damage cells and lead to diseases including cancer.

9. Learn to eat artichokes tonight. Artichokes are a great source of silymarin, an antioxidant that may help prevent skin cancer. To eat these delicious veggies, peel off the tough outer leaves on the bottom, slice the bottom, and cut off the spiky top. Then boil or steam until tender, about 30-45 minutes. Drain. Dip each leaf in a vinaigrette or garlic mayonnaise, then gently tear the fibrous covering off with your front teeth, working your way inward to the tender heart. Once there, gently scoop the bristles from the middle of the heart, dip in a little butter or lemon juice, and enjoy! 10. Coat barbecue food with a thick sauce. Grilling meat can create a variety of cancer-causing chemicals. But researchers from the American Institute for Cancer Research found that coating the meat with a thick marinade and thereby preventing direct contact with the charring flames reduced the amount of such chemicals created. Another tip: Precook your meat in the oven and then throw it on the grill to finish.

11. Every time you go to the bathroom, stop by the kitchen or water cooler for a glass of water. A major study published in The New England Journal of Medicine in 1996 found that men who drank six 8-ounce glasses of water every day slashed their risk of bladder cancer in half. Another study linked the amount of water women drank to their risk of colon cancer, with heavy water drinkers reducing their risk up to 45 percent.

12. Take up a tea habit. The healing powers of green tea have been valued in Asia for thousands of years. In the West, new research reveals that it protects against a variety of cancers as well as heart disease. Some scientists believe that a chemical in green tea called EGCG could be one of the most powerful anticancer compounds ever discovered. 13. Have a beer tonight. Beer protects against the bacterium Helicobacter pylori, known to cause ulcers and possibly linked to stomach cancer. But don’t overdo it. Drinking more than one or two alcoholic drinks a day may increase your risk of mouth, throat, esophageal, liver, and breast cancer. 14. Throw some salmon on the grill tonight. Australian researchers studying Canadians (go figure) found those who ate four or more servings of fish per week were nearly one-third less likely to develop the blood cancers leukemia, myeloma, and non-Hodgkin’s lymphoma. Other studies show a link between eating fatty fish (salmon, mackerel, halibut, sardines, and tuna, as well as shrimp and scallops) with a reduced risk of endometrial cancer in women. Ah, those amazing omega-3s at it again! 15. Take a multivitamin every morning. Many studies suggest getting the ideal levels of vitamins and minerals can improve your immune system function and help prevent a variety of cancers. 16. Get about 15 minutes of sunlight on your skin each day. You’ve heard of the sunshine vitamin, vitamin D haven’t you? Turns out we’ve been so good at heeding advice to slather on sun lotion and avoid the sun’s rays that many of us aren’t getting enough of this valuable nutrient. Researchers find that getting too little vitamin D may increase your risk of multiple cancers, including breast, colon, prostate, ovarian, and stomach, as well as osteoporosis, diabetes, multiple sclerosis, and high blood pressure. The best source? Exposure to UVB rays found in natural and artificial sunlight. About 15 minutes a day ought to do it. Avoid overexposure, of course. That can increase your risk for cancers of the skin. You can also get vitamin D in your calcium supplement if you choose a supplement that contains both. 17. Carry a shot glass in your beach bag. Then fill it with sunscreen and rub it all over your body. A shot glass holds about 1.5 ounces, which is how much sunscreen dermatologists estimate you need to protect yourself from the cancer-causing UV rays of the sun. Repeat every two hours. 18. Cut a kiwifruit in half, then scoop out the flesh with a spoon. Now eat! Kiwi is a little hand grenade of cancer-fighting antioxidants, including vitamin C, vitamin E, lutein, and copper. You can also rub a couple of cut kiwifruit on a low-fat cut of meat as a tenderizer. 19. Use a condom and stick to one partner. The more sexual partners a woman has, the greater her risk of contracting human papillomavirus, or HPV, which causes cervical cancer. Having an unfaithful husband also increases her risk. 20. Cut out high-fat animal protein. A Yale study found that women who ate the most animal protein had a 70 percent higher risk of developing non-Hodgkin’s lymphoma, while those who ate diets high in saturated fat increased their risk 90 percent. So switch to low-fat or nonfat dairy, have poultry or fish instead of beef or pork, and use olive oil instead of butter.

21. Have your partner feed you grapes. They’re great sources of resveratrol, the cancer-protecting compound found in wine, but don’t have the alcohol of wine, which can increase the risk of breast cancer in women. Plus, the closeness such an activity engenders (we hope) strengthens your immune system.

22. Sprinkle scallions over your salad. A diet high in onions may reduce the risk of prostate cancer 50 percent. But the effects are strongest when they’re eaten raw or lightly cooked. So try scallions, Vidalia onions, shallots, or chives for a milder taste. 23. Make a batch of fresh lemonade or limeade. A daily dose of citrus fruits may cut the risk of mouth, throat, and stomach cancers by half, Australian researchers found. Unecessary Chemicals

24. Take a 30-minute walk every evening after dinner. That’s all it takes to reduce your breast cancer risk, according to a study from the Fred Hutchinson Cancer Research Center in Seattle. Turns out that moderate exercise reduces levels of estrogen, a hormone that contributes to breast cancer. When 170 overweight, couch potato women ages 50-75 did some form of moderate exercise for about three hours a week, levels of circulating estrogen dropped significantly after three months. After a year, those who lost at least 2 percent of their body fat had even greater decreases in estrogen. Another study linked four hours a week of walking or hiking with cutting the risk of pancreatic cancer in half. The benefits are probably related to improved insulin metabolism due to the exercise.

25. Buy organic foods. They’re grown without added pesticides or hormones, both of which can cause cellular damage that may eventually lead to cancer.

26. Learn to love dandelions. Using commercial pesticides on your lawn may increase your risk of cancer, since most contain pesticides such as 2,4-D (linked to non-Hodgkin’s lymphoma) and MCPP (associated with soft-tissue cancers). Plus, pesticides used solely on lawns don’t have to go through the same rigorous testing for long-term health effects as those used on food. And, as E/The Environmental Magazine noted in a 2004 article, no federal studies have assessed the safety of lawn-care chemicals in combination, the way most are sold.

27. Buy clothes that don’t need to be dry-cleaned. Many dry cleaners still use a chemical called perc (perchloroethylene), found to cause kidney and liver damage and cancer in animals repeatedly exposed through inhalation. Buying clothes that don’t require dry cleaning, or hand washing them yourself, can reduce your exposure to this chemical. If you must dry-clean your clothes, take them out of the plastic bag and air them outside or in another room before wearing.

28. Choose cucumbers over pickles, fresh salmon over lox. Studies find that smoked and pickled foods contain various carcinogens.

29. Switch from french fries and potato chips to mashed potatoes and pretzels. A potential cancer-causing compound called acrylamide forms as a result of the chemical changes that occur in foods when they’re baked, fried, or roasted. Not surprisingly, many foods with the greatest amounts of acrylamide are also some of the worst-for-you foods, such as french fries, potato chips, and baked sweets. Although the results aren’t final yet, Michael Jacobson, Ph.D., executive director of the Center for Science in the Public Interest, estimates acrylamide causes between 1,000 and 25,000 cancers per year. His agency has petitioned the Food and Drug Administration to set limits on the amount of acrylamide foods can contain. The FDA is studying the issue.

30. Go for a spray-on tan. They’re available in most tanning salons these days and, unlike tanning beds, there’s no evidence that they increase your risk of skin cancer.

31. Call up your bowling pal and hit the lanes. A study from the State University of New York at Stony Brook found that men with high levels of stress and those with less satisfying contacts with friends and family members had higher levels of prostate-specific antigen (PSA) in their blood, a marker for the development of prostate cancer.

Fight Cancer With Anti Aging