Pathophysiology of breast cancer

Pathophysiology of breast cancer Cancer is a process in which normal cells go through stages that eventually change them to abnormal cells that multiply out of control. Breast cancer is a malignant growth that begins in the tissue of breast. It is most common cancer in women, but it can also appear in men. As per the W.H.O. survey 5, 19,000 deaths happen around the world per year. In 2008, Breast cancer incidence was estimated that 1.38 million folks suffered with breast cancer throughout the world. In 2008, it was estimated that nearly 3, 32,000 in Europe and 1,82,460 in US were registered with new cases. The incidence of breast cancer in India is on the rise and is rapidly becoming the number one cancer in females. One in twenty two women in India is likely to suffer from breast cancer during their lifetime, but this figure is more in developed countries like America and UK (one in eight being victim). In 2005, International Association of Cancer Research survey showed that there will be 2,50,000 of breast cancer patients that will be seen in India by 2015, A net 3% increase per year (80 new cases per 1,00,000 population per year). PATHOPHYSIOLOGY OF BREAST CANCER: Breast cancers arise from a sequence that begins with an increase in the number of breast cells to the emergence of atypical breast cells followed by carcinoma in situ and finally invasive cancer. Breast cancer occurs due to interaction between the environment and a defective gene. When cells became cancerous they lost ability to stop dividing, to attach to other cells and to stay where they belong. Some mutations can cause cancer such as p-53, BRCA1 and BRCA2. These mutations are either inherited or acquired after birth. Other mutations also cause breast cancer which is deterring the P13K/AKT pathway; these are helpful in apoptosis so that the pathway is stuck in the on position and cancer cells do not commit suicide. Breast cancers are many types which are mainly invasive (infiltrating) breast cancer, non-invasive(ductal, lobular), estrogen fueled, inflammatory and metastatic breast cancer, in these types ductal carcinoma and invasive breast cancers are more common types accounting for about 15% and 80% respectively. CLINICAL SYMPTOMS: Lump or swelling in the armpit. Changes in breast size or shape. Dimpling or puckering of the skin thickening and dimpling skin is sometimes called orange peel. Inverted nipple nipple turns inwards. Crusting or scaling on the nipple. THERAPEUTIC APPROACHES FOR BREAST CANCER: In the present era we have different approaches are there to reduce the breast cancer effect in patients. The treatment of breast cancer is merely dependent on stages of breast cancer, prognosis and risk of recurrence. It is usually treated with breast conserving surgery and then may be with radiation or chemotherapy or both. In case of hormone positive cancers are treated with hormone therapy. Surgery is usually the first line of attack against breast cancer and depends on many factors. Lumpectomy, Mastectomy, lymph node removal and breast reconstruction are comes under the surgery. Chemotherapy treatment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body. It is used to treat early stage invasive breast cancer and advanced stage breast cancer, in some cases chemotherapy is give before surgery to shrink the cancer. In many cases a combination of two or more med icines will be used as chemotherapy treatment for breast cancer. Hormone therapy medicine treats either by lowering the amount of the hormone estrogen in the body or by blocking the action of estrogen on breast cancer cells. Hormonal therapy medicines can also be used to reduce the growth of advanced stage or metastic hormone receptor positive breast cancers and early stage hormone receptor positive breast cancers. Hormonal therapy medicines are not effective against hormone receptor negative breast cancers. RISK FACTORS FOR BREAST CANCER: Many factors can influence a womans getting breast cancer but having one or more risk factors does not necessarily mean that a women will get breast cancer. It is important to remember that breast cancer can also occur in women who have no identifiable risk factors. There are many risk factors are responsible for breast cancer, these are classified into three categories Strong risk factors Moderate risk factors Other risk factors Strong risk factors AGE: The primary risk factor for breast cancer in most women is older age. Overall, 85 percent of cases occur in women 50 years of age and older, while only 5 percent of breast cancers develop in women younger than age 40. Family history: Women who have a family history of breast cancer are at a higher risk for breast cancer than those who do not have such a history. Mainly two autosomal dominant genes, BRCA1 and BRCA2 are responsible for breast cancer. Previous breast cancer: If women had breast cancer in one of the breast previously then there is more possibility of developing cancer in the other breast. This is basically due to hereditary mutation of BRCA gene Moderate risk factors Mammographic density: Women whose mammograms showing many dense areas of tissue in the breast have higher risk of acquiring breast cancer than women showing only fat tissue in her mammogram. Biopsy abnormalities: Women whose previous breast biopsy result showed abnormal proliferation like excessive growth of glandular tissue have an increased tendency of acquiring breast cancer than non proliferative benign breast conditions like fibrocystic changes. Radiation: For the treatment of other cancers a women who have received high doses of radiation therapy on the chest are more prevalence to breast cancer than women who have not exposed to radiation. Other risk factors Hormones: Throughout a womens life breast tissue remain sensitive to hormonal changes that includes during each menstrual cycle, pregnancy and lactation. Increased exposure of estrogen is more porn to breast cancer in women because estrogen stimulates glandular proliferation in breast. Pregnancy and breast feeding: Women who gives child birth at or after the age of 30 have double the chances and women who never given birth have triple the chances of getting breast cancers. Hormone replacement therapy: women aging 50 to 79 who undergo hormone replacement therapy, a combination of estorogen and progesterone for approximately 5 years have increased risk of breast cancer development. Alchol: A women who drink alcohol of two units per day have 8% chances of developing breast cancer than women consuming one unit per day. Increased alcohol consumption increases estrogen levels causing breast cancer. Miscellaneous factors: It may include women of high socio economic status, women working in night shifts exposing to light, race or different ethnic groups like black women and women who smoke have increased tendency of acquiring breast cancer. Women who have other diagnosed cancers of endometrium, ovary or colon have increased chances of getting breast cancer. DIAGNOSTIC TOOLS FOR BREAST CANCER: Evaluation of breast complaints and screening for breast cancer accounts for a significant part of primary care. These screening techniques are useful in determining the possibility of cancer. Generally triple test is used to diagnose the breast cancer; it means clinical breast examination, mammography and fine needle aspiration cytology. Other techniques for evaluation of breast cancer are ultrasonopgraphy, core needle biopsy and genetic tests to evaluate the BRCA mutagenic genes. There are many biomarkers are there to evaluate the breast cancer most of them are useful for early detection some are useful to assess the prognosis of the disease. Risk biomarkers are those associated with increased cancer risk and include mammographic abnormalities, proliferative breast disease with or without atypia, and inherited germ line abnormalities. Prognostic biomarkers provide information regarding outcome irrespective of therapy, while predictive biomarkers give evidence regarding response to therapy. Mammography: It is performed to evaluate the breast lumps or as a screening tool. It is usually recommended as part of the evaluation in women older than 35 years who have a breast mass to help evaluate the mass and to search for other lesions. Mammographic findings propose cancer include increased density, irregular border, speculation, and clustered irregular microcalcification. There have been eight major trials of mammography screening. The observed change in breast cancer mortality has varied widely among these studies but the difference is only in randomization techniques, quality of mammograms, and duration of follow-up and evolving treatments during the trial. To assess the Mammographic density is allied with risk of breast cancer and portrays the effects of different reading conditions on the detection of changes in mammographic features. The subjects were recruited from who were participated in NBSS(National Breast Screening Study) program. The trial was randomized into two groups and subjects were allocated based on age, menopause conditions. i.e. one group contains who had undergone menopause after entry (n=202) and called it as prepostmenopausal group and another group contains who had not (n=202), called it as premenopausal group. By using a computer assisted method they obtained memmogram in each individual. Through the one year they collected mammographs in four reading methods of randomization. They assessed mammographic measures of total, dense and non-dense areas, percent density and associated variance to evaluate the mean effect of the menopause. The result of trial shows mehod-1 gave the largest mean period difference; method -4 gave the least mean period among the four mammographic measures. Finally the result shows that mammographic density is the most reliable and sensitive method for the detection of changes. There is variation in the composition of tissue and also radiographic properties of fat, stroma and epithelium in the breasts of the radiographic appearance from one woman to the other. Literature studies have shown more density of breast is associated with increased breast cancers. Wolfe explained the relativity between variation of mammographic density and the risk of breast cancer. Women have four to six times higher risk of getting breast cancer with more than 75% of density. An extended mammographic density may make difficult to detect breast cancer by mammography. During screen tests it will increase the risk of development of cancer. The reason for the study was to relate mammographic density in base line mammogram and the increased development of breast cancer. The NBSS conducted a screening test with mammography and physical examination. The SMPBC with mammography and OBSP with mammography and physical examination. A cause control study in which the subjects who had histolog ically verified breast cancer were included and subjects whose diagnose of the breast cancer with less than 12 months were excluded. Through radiologist and computer assisted method the mammographic density was examined. The image of unaffected breast of case patient with image of control subjects were examined in a multiviewer in a set of 100 images. The statistical result showed that women with 10% of mammogram density had lesser risk of developing breast cancer than women with 75% of density. Increased risk of breast cancer persisted for minimum of 8 years either detected by screening or other methods. It was less in older women than in younger. 26% breast cancer and 50% of cancers detected in less than 12 months after negative screening test in women younger than age of 56. The study concluded increased risk of breast cancer is seen with higher mammographic density detected by screening or between screening tests. CONCLUSION: The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their homes, food habbits, life styles and shorter duration of breast feeding and late age at first childbirth. Early detection of breast cancer has possibility to save the lives. Weve different biomarkers to detect breast cancer. Mammography is not generally useful in women younger than 35 years who present with a lump. It is performed as an adjunct to the physical examination in evaluating as a screening tool in breast cancer. Mammography is not sufficient to exclude cancer in the evaluation of a palpable mass. Ultrasonography is very useful for evaluating breast lumps and in further defining mammographic abnormalities. It is especially useful in women younger than 35 years.

All the Pretty Horses Essay

The book All the Pretty Horses is a western drama about teenage cowboys as they transition from adolescence into manhood. The author, Cormac McCarthy, structures the book using echo words and parallel structure that links dialogue exchanges and makes the scenes flow smoothly. McCarthy is a master of this sort of repetition and uses this structure throughout the entire book. There are many examples of this used throughout the book, but the author primarily focuses on the interpersonal relationships, diversity, and change. There are many different types of relationships based on a very vast scale. John Grady Cole has many complicated and some not-so-complicated relationships with his friends and family members. In book 1, McCarthy informs the audience that John Grady’s parents are divorced and in book 4, John Grady’s wife, Alejandra, leaves him. When John Grady flees Texas in book 1, he has the expectations that any sixteen year old cowboy might have. It is ironic that he ends up experiencing events and overcoming obstacles he never thought would occur, including falling in love and then getting his heart broken by his wife. John Grady Cole’s relationships with the leading women in the novel are also peculiar in the way that the women discipline him. In book 1 it was his mother and the servants in the house, and in book 4 Duena Alfonsa definitely gets her way with him. Alfonsa warns John Grady when he is about to cross the line with Alejandra, and then later in the book when she bails him out of jail. In a way, John Grady has to rely on the women which is comforting since he is on a journey of growing up, yet he still falls back on others to guide him. Another parallel relationship occurs in book 1 when John Grady meets with his father who tells him to forgive his mother. In book 4, John Grady seeks the judge for advice and to confess a crime he committed; the judge tells him he should forgive himself. John Grady has a good heart, tries to do the right thing, and reassures himself by going to others for advice. John Grady’s choice in his friendships and choices effect who he has strong relationships with throughout the book and he maintains his strategy through both book 1 and book 4. Another key parallel theme in the book revolves around diversity between John Grady’s homeland-the United States- and his new home in Mexico. On page 25 of book 1 it says, â€Å"The last thing his father said was that the country would never be the same† which relates to book 4 in many ways. One relation occurs on page 299 which states, â€Å"I don’t know, said John Grady†¦I don’t know what happens to a county. In this scene he is reflecting on how things have changed and how there are many differences between events on his homeland in Texas and the events that occur in Mexico. A more direct relation is in book 1 when the boys (John Grady, Rawlins, and Blevins) cross the Rio Grande naked and then in book 4 when John Grady crosses Rio Grande naked-heading back to Texas. The sense of home and the countries boarder really affects John Grady and how he makes decisions based on where he is. The last key theme in the book concerns how John Grady changes during the course of the novel. In book 1 John Grady is ignorant to reality and is just looking for an adventure. On page 5 of book 1 it states, â€Å"He stood like a man come to the end of something. † This quote is ironic because it saying that John Grady is posing as a man at the end of something which is silly since it’s just the beginning of the story. The parallel event that corresponds to this occurs on page 254 of book 4 which states, he â€Å"saw clearly how his life led to this moment. This simple phrase shows that John Grady really observed and reflected on how he accomplished the transition into manhood, and by doing this, changed emotionally and spiritually into a more well-rounded human being. McCarthy really is an outstanding author by being able to use parallel events and echoed sentences between book 1 and book 4. He really accomplished his themes and getting his audience to understand the importance of parallel events that have to do with relationships, diversity, and change.

Propaganda, Recruitment and Resistance Essay

When war broke out, the British army was professional but small. The government desperately needed a lot more troops, and they turned their heads straight to recruitment. Britain was very different to its allies in recruitment; they started the war recruiting volunteers. The Government believed that as tradition, they should not force any men into conflict; they had never done, and believed they never would. Volunteering was a British thing to do; using posters, and leaflets, they thought would get enough soldiers to volunteer. The Government assumed that many soldiers would come forward as patriots and out of honour, for generations men’s predecessors had fought in civil war, Lord Kitchener and the PM Asquith supposed men had to maintain the loyalty. Those who wanted to join the army, joined out of excitement, the thrill of killing, and a break from normal life. They thought that the war was going to be a short, easy war which they would not be a major part of, as they had been reassured that the Naval power would wipe out supplies of food, and arms. These troops would have been highly motivated and ready for whatever was to come at them (or so they thought). Propaganda was a factor in men volunteering; a number of the male citizens were genuinely persuaded by the propaganda and believed what it told them. The Government realised that all men who volunteered were going to train harder, and in the long term where going to be superior soldiers, even if there was a smaller number of them. Women, older men (who had fought in civil wars before them) pressured young men who had not enlisted, also their friends, and relatives were joining. In theatres, actresses interrupted performances to call men up onto the stage and sign up. Those men who were watching the play felt embarrassed, also as if everyone was watching them and urging them to sign up. The Government encouraged this in homes, and although it was an illegitimate way of getting men to join, it was very useful, and many of those who were put under such pressure, crumbled and enlisted. The figures of unemployed men in Britain were rising, and the amount of jobs for these men was decreasing, as they didn’t have the necessary skills to acquire a job that paid good money. Prime Minister Asquith seized upon this opportunity to give these unemployed a ‘future’ in the army. The unemployed had to accept the opportunity, as it paid good money, it was an exciting experience and that they simply they had no where else to go. The men were happy to receive this break away from their dirty, shabby lifestyle. Asquith, and Kitchener exaggerated this prospect, and the unemployed believed that this was easy money, and a gateway to a new life. Men who volunteered into the army where grouped in accordance of what area they came from. Theoretically this was a good idea, but in practice demonstrated a fatal blunder. ‘Pals Battalions’ as these neighbouring units were named, were awfully effective in making each soldier feel at home, and able to settle in to army life. At the front though it was a different story, as each Pals Battalion went ‘over the top’ it was usually on the first day of a major battle, which resulted in 70% or more of their men killed or seriously wounded. Local areas in England wit a small population lost many of its younger men in a short space of time. The rest of the male population who did not volunteer chose not to for various reasons. Some men decided not to enlist on occupational grounds. Men who worked in vital industries such as mining felt it was there duty to stay home and continue their essential job. However, this was not the only reason on work-related grounds that people did not volunteer. Some men did not want to fight because they had a well paid job and good career prospects, whilst others left the rest of the population to volunteer because they thought that the war would not last long. They assumed that if they joined the army they would die, they were scared of dying and losing everything that they had worked for. This fear of dying was made a great deal worse when rumours of the conditions on the front line filtered through to the public. They were told of the huge numbers of deaths and casualties that the British were taking. Other chose not to volunteer on the moral or religious grounds. The Quakers did not volunteer because they did not believe the war was the answer. Many other men refused to ‘play God’, ad take away another mans life. Some men refused to volunteer because they had people at home depending on them, and they were the main breadwinner of the family, for example children and wives or elderly relatives. The Government thought that the war would be over by Christmas, and this small army would do fine, because the Navy would be the major battle point in the war, where the ships would create blockages, and starve them to surrender. Conscription being introduced from 1914 would have caused pandemonium in Britain, for the fact that the public would have realised that this war was going to be a long and drawn out war. Asquith did not want to cause any panic, and wanted to carry out ‘business as usual’, one of his idea’s to keep Britain an active and calm country to live in still, although the war was only overseas, but as many exports and imports happened overseas, and where transported into foreign countries, ‘business as usual’ could not happen. Also the government didn’t introduce compulsory military service because they trusted the public to volunteer, as it was a change, it was supposedly ‘exciting’, and the thought of becoming a hero was a chance to be loved by your friends, but most importantly, the whole country. Lord Kitchener and Asquith were spot on; by the end of August in 1914 300,000 more soldiers had enlisted. In September of 1914, 462,901 out of 600,000 volunteers stepped up to support the war efforts. The aim for the end of December was an army of 4 million (which even for the ‘Supreme British’, I believe was a long shot). Conscription would have faced a battering by civil rights activists if introduced in 1914, as conscription was anti-liberal, and a breach of civil rights and individual freedom. In hindsight, with all the protesters, volunteering was an easier way of recruiting without hassle. Another aggravation of conscription was the cost of it. It was considered that conscription would be a waste of needed money and resources. All of the eligible men must be registered in a system, not all men would turn up to register, resulting in wasted time, which could be used to produce posters to round up troops for volunteering. However by 1915 not enough soldiers were being recruited, and drastic measures hadto be taken to gather enough soldiers to compete with the large German army. In 1916 there was a change in Government. Lloyd George became the new Prime Minister, he was determined to win this war, and his practical mind led to the introduction of conscription. The Government primarily thought that they would recruit enough soldiers without moving to conscription, but they were very wrong. The German land forces were huge, and the previous Prime Minister (Asquith) believed this war would be won by Britain’s naval supremacy. Again, they were wrong, the trenches was where the major fighting was taking place, thousands of deaths happened each day at the front. As the war dragged on and on, fewer and fewer amounts of men were enlisting to fight, this was mainly due to leaks from the front of the poor conditions, and high amount of deaths were published by the media. As the numbers of deaths on the front grew, the Government started to ban the lists of deaths. This was due to ‘over the top’ tactics’ as men were old to walk in lines, shooting to gain breach the trenches of the German’s. As the deaths increased men became more wary of what was really happening in the war, and some men began to see through the lies of propaganda. But deaths were not the only reason why men weren’t signing up; the wages at home were increasing while unemployment was decreasing, resulting in men taking the chance of staying at home rather than fighting for the army, which at that time had very low pay. The army was made up of lots of previously unemployed men, but as many of those had already enlisted, there was a shortage of men that wanted to sign up. As volunteers piled through in the early months of the war, the Government believed the army was going to have enough men to win this war, on foot and on sea. But as the number of volunteers each month declined, women of husbands who had volunteered, and the general public (except most younger men) began to complain that it was unfair that some men had volunteered and others had not. There had to be a fairer system, those who had not volunteered were getting away lightly. The only way to improve this system was to introduce conscription. Not only were there thousands of deaths occurring on the front every day, but men did not receive the right, or enough ammunition to compete with the constant bombardment of shells, and the onslaught of machine gun bullets ripping through the British defence, it s men. This was called the Shell Scandal. The reason for the shortage of ammunition was due to the amount of workers that had joined up to the army from indispensable war industries. Factories that made shells, bullets, and armour where literally deserted. The pay was substantially higher in the army, it was an exciting prospect and a change for the men that work the same shift, producing the same goods all day. The press began campaigning to introduce conscription, because they knew the real deaths that were taking place at the front, given that the government banned them from publishing the amount of deceased. Bearing in mind that the newspapers had a major influence over the public then, (and still do now) it started to persuade (using propaganda) the public that conscription was acceptable, and the right way forward. The general public began to succumb to the idea, and by the end of the campaigning the national Service league (NSL) demanded the change from the new government. Lloyd George, as a practical man realised that this was the only way to win the war. Conscription commenced in January 1916, but a long time before that there was talk on how the government would assemble all of the eligible men for active military service, and the restrictions they would put on those that could be exempt from military service. They started the process by creating a National Register, which collected together every citizens details from the age of 15 to 65 e.g. name, age, marital status, occupation and skills. All of the data was collected together. It allowed the government to calculate how many men were of military age, and those who would be in the future, but also those who were in reserved occupations, which means those jobs that are essential to the war effort e.g. industry and agriculture. The National register not only provided the government with information, but also opened the door for new ideas. One of these ideas was the Derby Recruiting Scheme. It was named after Lord Derby the Director of Recruiting, as he was the one who manipulated the information from the National Register to his advantage. He asked all British men aged between 18 and 41 if they would be disposed to serve in the army. Although you may have thought like the propaganda posters, the personal, frontal approach would have worked, it didn’t. The results were disappointing. Firstly, those who were not in reserved occupation did not like the idea of fighting in the war, those would did want to fight were summoned with two weeks notice and secondly, a plus can be drawn from this, this was the first time an actual system had been put in place for conscription, so things could only get better. After the poor response from all those who were not exempt from the war, there was only one way to get men to fight, that was to force them. Four months after The Derby Recruiting scheme the conscription came in form of the Military Service Act, which required all unmarried men, and widowers without children or dependents e.g. sick mother, between the age of 18 and 41 to join the army. Unmarried men in reserved occupations were exempt from duty, as well as those who were breadwinners or sole supporters in their household, those who had medical disabilities and finally conscientious objectors. But as the National Register was unreliable, needed soldiers were not raced. The change from total volunteering to conscription happened in a short space of time, only four months. Compulsion did not just stop at exempting men, it became universal, on May 3rd 1916 all men despite any circumstances between 18 and 41 were forced into battle. Universal Conscription was now introduced and there was no going back. As soldiers died and needed soldiers were untraceable due to poor organisation, the government looked overseas to all British born people, and for Allied citizens living over here to fight for their natural country. This was another Military Service Act to boost friendship with their Allies. It gave each side more men to fight but mustn’t have gone down well with those who tried to flee the country. In two years the British public had gone from hating the idea of conscription to deeming it as acceptable. The newspaper’s had much to do with bringing the country round to believing the Government, but the Government wanted everyone involved. In November 1917, the Ministry of National Service was formed; the power given to them was unbelievable. They could cancel all exemptions on occupational grounds; almost playing God with people’s lives, as they well knew that 70% of these men would die or become seriously injured, before the war had ended. The government began to keep on rising the age limits, and the limits on who should fight, they were becoming desperate; the age limit was raised to 50, and if deaths were on high occurrence then it would be a staggering 56! Even Ireland was made to abide by the same rules of compulsion that was already in place in England. The British Army wanted to out number the Germans, but in the end they had a lot of soldiers at the front unwilling to fight, even those who had volunteered were becoming reluctant to fight. By the end of the war the British realised that they no longer needed so many men, as they were slowing crushing Germany, and the Minimum age of exemption was 23. Men under that age were considered too weak. Slowly but surely the Government extended the restrictions on compulsion. If there hadn’t been a change in government then I believe compulsion would have been introduced at a much later stage, because Asquith was against the idea of forcing men to fight; it was a breach of civil rights.

Social Networking Is Really Big, Especially For Teens Essay

In this era social networking is really big, especially for teens. According to Suren Ramasubbu, 75 percent of teenagers use social networks. They can use facebook, twitter, instagram, snap chat, and more. Teens live off of social networks, they use it to communicate, see what others are doing, or what they are planning to do. Most teens spend most of their day looking at their social networks. However, social networks can be good and/or bad depending on how you use it. It can be good because you can make new friends online, job opportunities, and news. Some bad things are stalkers, not a lot of privacy, bullying, and sexting. There are also some that will fall into both bad and good, such as education and communications. I believe that social networking is changing the way teens interact and be resourceful. Teens can use social networks to make new friends online. They don’t even need to be next to them or see them to get along; all they have to do is add him or her. 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