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Query: UMLS:C0006142 (breast cancer)
 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Estrogen replacement in menopause should be used for specific symptoms such as ovarian failure, hot flushes, vaginal atrophy, atrophy of the vulva, and atrophic urethritis. The dose should be as low as possible to be effective and perscribed for as short as time as possible, since there are possible risks of uterine cancer, breast cancer, increased blood pressure, gallstones, deep vein thrombosis, and thromboembolism. Estrogens should be administered to provide the maximum benefit with the minimum risk involved. Estrogens should not be given to patients with known contraindications such as: suspected breast or uterine cancer; undiagnosed genital bleeding; Dubin-Johnson syndrome; acute hepatic disease; previous or present thromboembolism; or severe thrombophlebitis. Careful evaluation should be made before administering estrogen to women with uterine myomata, hyperlipidemia, hypercholesterolemia, sevare varicose veins, chronic hepatic dysfunction, diabetes mellitus, porphyria, or severe hypertension.
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PMID:Estrogen replacement in the menopause. 39 Apr 56

From 1985 to 1987 148 patients underwent mastectomy for breast cancer, of whom 91 underwent modified radical mastectomy. Of these patients (median age 60 years (range 31-86 years)), 89 have been assessed for early (< 30 days) and late (> 30 days) non-tumour morbidity and mortality. A total of 41 patients had nodal metastases. Adjunctive therapy used was tamoxifen in 70 patients and radiotherapy in 20. Overall, 47 patients (53%) developed a total of 75 complications, and there was one 30-day mortality. Of the patients, 26 developed one complication, 14 had two complications and 7 three complications. Early complications were lymphocoele/seroma (n = 22), wound infection (n = 9) and cardiopulmonary problems (five deep vein thrombosis, two pulmonary embolus (1 death), one myocardial infarct). Late complications were lymphoedema (n = 10), pectoralis major wasting (n = 6), frozen shoulder (n = 7), intercostobrachial neuralgia (n = 4), and a small number of self-limiting wound problems (n = 9). There were two late deaths (myocardial infarcts). Early complications were not related to nodal status, and late complications were related to neither nodal status nor radiotherapy. Significant morbidity is attached to radical surgery for breast cancer. Most complications are minor and self-limiting, but there are a small number of late complications which may affect quality of life.
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PMID:Non-tumour morbidity and mortality after modified radical mastectomy. 141 1

In 1919, a German scientist placed ovaries from pregnant rabbits under the skin of other female rabbits making them infertile. Later he injected extracts from pregnant cow corpora lutea into rabbits also making them infertile. In 1931, he states that hormonal sterilization is the ideal birth control. Yet, it was another 30 years before the first hormonal contraceptive was available. Estrogenic research led another German scientist to conclude that estrogen inhibits the pituitary gland. This resulted in more steroid research. Many obstacles existed, however; e.g. it took 4000 gallons of urine to extract a minute amount of androsterone and almost a ton of bull testicles and identify progesterone. Schering was able to synthesize it from ox bile, resulting in high-priced monopoly. Marker later synthesized it from a Mexican yam causing the price of progesterone to drop rapidly from dollars to cents per gram. Other scientists struggled to also develop estrogenic substances. By 1940, some physicians used estrogens to suppress ovulation. Despite this evidence, few physicians considered using them for contraceptive purposes because, like abortion, contraception was taboo. Instead political activists (e.g., Margaret Sanger) addressed synthetic hormones' potential for contraception. Their persistence encouraged some researchers to isolate compounds and to conduct clinical trials with oral contraceptives (OCs). The older OCs posed a deep vein thrombosis risk. The lower-dosed OCs no longer carry this risk. There has also been some evidence, albeit inconclusive, that OCs increase, the risk of breast cancer. 30 years later, physicians still are reluctant to address contraception. The Catholic Church and conservative economists are against contraceptives. The economists fear that smaller populations reduce markets. In many developing countries another obstacle to contraceptives is the cultural norm to produce many children.
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PMID:Thirty years of hormonal contraception: an historical perspective. 168 99

The overall risk of oral contraceptive (OC) use is minimal when women over 35 years of age, smokers, and those with multiple risk factors (thromboembolic disorders, cerebrovascular or coronary artery disease, liver tumors, breast cancer, estrogen-dependent neoplasms, undiagnosed abnormal genital bleeding, and congenital hyperlipidemia) are excluded. OC use increases the risk of hypertension by 1-5%, depending on age, parity, and duration of use, but even this small risk is decreased when multiphasic OCs are prescribed. Deep venous thrombosis in the leg is 4 times more prevalent in OC users than nonusers and the risk of superficial thrombosis is doubled. Again, fewer thromboembolic complications occur when the estrogen dosage is low. The risk of myocardial infarction is not believed to increase with OC use as long as other risk factors--smoking, obesity, hypertension, age over 35 years, hypercholesterolemia--are not present. Studies involving the original high-dose OCs revealed a 3-fold increase in the risk of thrombotic stroke and a 2-fold increase in the risk of hemorrhagic stroke, but low-dose OCs appear to have no effect on the potential for stroke. The impact of OC use on breast cancer cannot yet be determined given the very long latency period of this cancer. In terms of benign breast disease, OC users have been shown to be at substantially reduced risk of lesions, fibroadenomas, and fibrocystic changes. OCs also protect women from endometrial and ovarian cancer, although the pill seems to accelerate the progression of cervical dysplasia. Other beneficial effects of OC use include reductions in the incidence of pelvic inflammatory disease, endometriosis, ectopic pregnancy, and ovarian cysts.
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PMID:Oral contraceptive pills. Part II: Potential complications and health benefits. 228 19

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
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PMID:Oral contraceptives. 650 52

In a randomized study, 63 postmenopausal patients with advanced breast cancer were treated with ethinyl estradiol (EE2) or the antiestrogen tamoxifen to compare the efficacy and side effects of both drugs. EE2 was always given in combination with chlorothiazide to prevent fluid retention. Pretreatment characteristics of the patients of both groups did not differ significantly. Objective remissions were achieved in 31% of the EE2-treated patients and in 33% of the tamoxifen-treated patients. The median duration of remission was 12 months (range, 5-32) for the EE2 group and 11 months (range, 5-26) for the tamoxifen group (P greater than 0.1), and the estimated median survival times from the start of treatment were 31 and 25 months, respectively (P greater than 0.1). The best treatment results in both groups were obtained in patients with estradiol receptor-positive tumors and less advanced disease. After therapy was stopped, objective withdrawal responses were observed in EE2- but not in tamoxifen-treated patients. Two patients receiving EE2 had to discontinue treatment because of drug-related liver function impairment. Both patients had cholelithiasis. Two patients in the tamoxifen-treated group discontinued therapy because of nausea. Deep venous thrombosis occurred in one patient receiving EE2, whereas two patients receiving tamoxifen developed superficial thrombophlebitis. Other side effects in both groups of patients, including initial hypercalcemia, were mild. It is concluded that both treatment regimens, EE2 or tamoxifen, are equally effective with respect to induction and duration of remission in postmenopausal patients with advanced breast cancer. Side effects of EE2 therapy appeared to be more serious than those of tamoxifen treatment.
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PMID:Tamoxifen versus ethinyl estradiol in the treatment of postmenopausal women with advanced breast cancer. 723 48

Often called in to give his opinion on lymphoedema of the upper limb after radiosurgical treatment for breast cancer, the angiologist should be familiar with the anatomic lesions induced by the treatment. The surgical procedure varies from simple tumourectomy to complete mammectomy. Complications include infection followed by fibrosis and occlusion of the collecting lymphatic vessels. Axillary venous thrombosis is exceptional. Dissection of the lymph nodes interrupts lymph drainage of the homolateral limb leading to lymphoedema which is worsened by fibrosis, venous stasis and damage to the plexus. Ionization therapy causes multiple organ damage to viscera (lungs, pleura), skeleton (ribs, clavicle), myocardium and coronary arteries, mediastinal brachial plexus, skin fibrosis, arterial obliteration and venous narrowing and thrombosis. Chemotherapy causes thrombosis of the superficial veins after perfusion. Deep vein thrombosis is rare. These lesions rarely occur alone. The clinical course of the associated lesions is part of a major psychological context which must be taken into account. The angiologist should perform a careful clinical examination, detect and document possible recurrence, explore the vascular axes with echo-Doppler or plethysmography when needed in order to detect the venous lesions which occur in 50% of the cases. Lymphatic involvement in lymphoedema is clinically obvious and may not require further explorations. Treatment is difficult in cases with associated venous involvement. Strapping with or without pressure, manual lymphatic drainage, active mobilisation and elastic sleave after reduction are used. When detected early venous thrombosis is managed as other deep vein thrombosis. Arterial damage may appear late (delay more than 3 years) in rare cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Management by the angiologist of sequellae of radiosurgical treatment of breast cancer]. 765 Apr 44

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

Oral contraceptive (OC) pills have a very high rate of acceptability among Danish women in spite of the possible risks associated with their use referred to in the daily press. Every fourth woman prefers OCs. Half of the women under 25 use OCs as well as every tenth one over 35. There is hardly any doubt that the use of OCs can increase the risk of blood clot in the heart, and the more cigarettes are smoked the higher the risk. Today increasing doses of gestagens are used with minor effect on the lipid system. The risk of deep venous thrombosis of the lower extremities and the risk of cerebral thrombosis or embolism is elevated even with low-dose OCs, but regarding cerebral thrombosis, research is inconclusive. The risk of cerebral thrombosis is very low among young women and it increases with age. Considering that masses of young women use OCs, and increased incidence of breast cancer has been found under 45 years of age among those who had used OCs before the birth of their first child, a risk that seems to correspond to perhaps a higher number of breast cancer cases in the following years. This can be explained by the fact that OC users do not have an increased risk of breast cancer, but may undergo checkups more often than others, giving a higher chance of early diagnosis of this disease. Based on this it would be unwise to advise against OCs for women under 25, but the issue has to be examined in the context of the risks of other contraceptive methods and AIDS. It is reasonable to restrict OC use in women over 35-40 who smoke more than 5-10 cigarettes daily, or who have other known risk factors for cardiovascular disease.
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PMID:[Use of oral contraceptives and smoking among Danish women]. 823 73

A 74-year-old female with lung metastasis of breast cancer was treated with chemo-endocrine therapy (intravenous administration of epirubicin at 30 mg/2w, oral administration of UFT at 400 mg/day, alternate oral administration of medroxyprogesterone acetate at 800 mg/day and tamoxifen at 40 mg/day) and immuno-therapy (intravenous administration of lentinan at 2 mg/w). Lung tumors decreased in size and number. At the same time, deep vein thrombosis of the lower extremities occurred, which caused multiple pulmonary embolization. In this case, several factors were suggested to cause thrombosis in the advanced or recurrent breast cancer patient.
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PMID:[A case of breast cancer with thrombosis during treatment of lung metastasis]. 845 90


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