Anglais médical – Tout sur le cancer du sein

Before you start, review the following terms

Breast cancers are now thought to be not one but ten different diseases. A recent study funded by Cancer Research UK has identified ten different categories of breast cancer called IntClust one to 10. The reclassification of breast cancers is hoped to lead to better targeted therapy and longer survival rates. The majority of breast cancers are diagnosed in women with a small number of breast cancers diagnosed in men.

Breast cancers usually develop in the milk-producing glands and ducts that carry milk from the glands to the nipple. Cancers develop as a result of damaged cells, which can grow uncontrollably to form a lump or thickening called a tumour.

Many different factors contribute to the development of breast cancer and hormones such as oestrogen often play an important role. Breast cancer cells may form metastases or ‘secondaries’ in other parts of the body if untreated or if treatment fails. The lymph nodes in the axilla are a common place for secondary tumours.
Currently, breast cancers are classified by their appearance under a microscope and the presence or absence of tumour markers. More than 70% of tumours respond to hormone therapies such as tamoxifen for tumours with "oestrogen receptors" and Hercetin for tumours with a "Her2 receptor".

Before undergoing a mastectomy, a biopsy or removal of cells for examination is undertaken. A common type of biopsy is called the needle biopsy which is performed by inserting a needle into the breast tissue and withdrawing some fluid which is examined by a pathologist who checks for abnormal breast cells. If a larger sample of tissue is needed, an excisional biopsy is performed to remove a lump or large area of breast tissue. Biopsies are useful to exclude fibrocystic breast changes which are benign and therefore do not require mastectomy.

Should it be necessary to remove part or all of the breast , several types of surgery are available. The least radical is breast-conserving surgery. This includes lumpectomy or removal of a breast lump, quadrantectomy or removal of a quadrant of the breast and segmental mastectomy. Segmental mastectomy removes the tumour, some of the surrounding tissue and also some of the lining of the chest muscle .

Removal of the breast is called mastectomy . There are different types of mastectomy depending on the status of the tumour and whether lymph nodes are involved. Tumours which have not spread at all are called carcinoma in situ meaning ‘tumour in its place’. Surgery which removes the entire breast but leaves the pectoral muscles is called modified radical mastectomy . By leaving the chest muscle intact, breast reconstructive surgery can be attempted later. Reconstructive surgery such as tissue flap reconstruction moves a flap of tissue from another part of the body to the chest so that a breast mound can be formed. Sometimes a nipple flap can also be done or, if this is not possible, nipple tattooing approximates the shape and colour of a nipple for a better aesthetic effect.

Before you start, review these terms

Mastectomy drug trial tests begin at the Royal Cornwall Hospital

New treatment for breast cancer patients could be rolled out nationwide if a study in Cornwall proves successful. The Royal Cornwall Hospital in Truro has been given £250,000 to trial a new technique, known as the "painbuster".
The procedure, which takes place in the first 48 hours after a mastectomy is being tested on 160 women from Cornwall and Devon. Morphine will be replaced with a local anaesthetic stored in a small gadget.
'Simple technique'
The gadget, which is worn on the patient's nightgown, slowly releases the anaesthetic directly to the area where the surgery has been carried out. Iain Brown, a consultant oncoplastic surgeon at the Royal Cornwall Hospital, said: "We know morphine is not a great thing to have in your system when you're trying to get over a big operation.
"We want our patients to wake up, sit up in bed, brush their hair and put their make-up on. If they can do that from the beginning it makes them feel great psychologically."
The hospital has been given the funding from the National Institute of Health Research to carry out the study. Those carrying out the trial hope it will reduce the amount of time it takes women to recover from a mastectomy. Roger Langford, a consultant anaesthetist at the hospital, said: "What we're hoping is the results are positive and this technique is beneficial. Then other centres can see what is a relatively simple technique, will be easy to take on and benefit their patients as well."

The text is taken from BBC Health at www.bbc.co.uk

Read the following article taken from www.biomedcentral.com.

An investigation of the apparent breast cancer epidemic in France : screening and incidence trends in birth cohorts

Bernard Junod ¹, Per-Henrik Zahl ², Robert M Kaplan ³, Jørn Olsen ⁴ and Sander Greenland ^{4, 5}

Abstract

Background
Official descriptive data from France showed a strong increase in breast-cancer incidence between 1980 to 2005 without a corresponding change in breast-cancer mortality. This study quantifies the part of incidence increase due to secular changes in risk factor exposure and in overdiagnosis due to organised or opportunistic screening. Overdiagnosis was defined as non progressive tumours diagnosed as cancer at histology or progressive cancer that would remain asymptomatic until time of death for another cause.

Methods

Comparison between age-matched cohorts from 1980 to 2005. All women residing in France and born 1911-1915, 1926-1930 and 1941-1945 are included. Sources are official data sets and published French reports on screening by mammography, age and time specific breast-cancer incidence and mortality, hormone replacement therapy, alcohol and obesity. Outcome measures include breast-cancer incidence differences adjusted for changes in risk factor distributions between pairs of age-matched cohorts who had experienced different levels of screening intensity.

Results

There was an 8-fold increase in the number of mammography machines operating in France between 1980 and 2000. Opportunistic and organised screening increased over time. In comparison to age-matched cohorts born 15 years earlier, recent cohorts had adjusted incidence proportion over 11 years that were 76% higher [95% confidence limits (CL) 67%, 85%] for women aged 50 to 64 years and 23% higher [95% CL 15%, 31%] for women aged 65 to 79 years. Given that mortality did not change correspondingly, this increase in adjusted 11 year incidence proportion was considered as an estimate of overdiagnosis.

Conclusions

Breast cancer may be overdiagnosed because screening increases diagnosis of slowly progressing non-life threatening cancer and increases misdiagnosis among women without progressive cancer. We suggest that these effects could largely explain the reported "epidemic" of breast cancer in France. Better predictive classification of tumours is needed in order to avoid unnecessary cancer diagnoses and subsequent procedures.

Notes

Corresponding author: Bernard Junod Junod.bernard@wanadoo.fr
Author Affiliations :

1. FORMINDEP, Roubaix, France. Previous position: Department of Epidemiology, Ecole des Hautes Etudes en Sante Publique Rennes, France
2. Norwegian Institute of Public Health, Oslo, Norway
3. UCLA Schools of Public Health and Medicine, Los Angeles, USA
4. Department of Epidemiology, UCLA School of Public Health, Los Angeles, USA
5. Department of Statistics, UCLA College of Letters and Science, Los Angeles, USA

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BMC Cancer 2011, 11:401 doi:10.1186/1471-2407-11-401