An anticancer drug that is used to treat certain forms of breast cancer, and, sometimes, to treat some typesof infertility. It may cause nausea, vomiting, hot flushes, swollen ankles, and irregular vaginal bleeding.
Tamoxifen is also used to treat INFERTILITY, being taken on certain days of the menstrual cycle (see MENSTRUATION).
Affects women more than men by 10:1 especially after menopause, whether this is natural or due to destruction or removal of ovaries in early adult life.
By means of a calcium-rich diet after 35 years it is a preventable disease. Like so many degenerative diseases a common cause is widespread consumptions of refined, processed, chemicalised foods. It is possible that dental caries is in reality osteoporosis.
In men, alcohol is the chief cause. It wreaks its greatest havoc in women 10-15 years after the menopause. Increased calcium will not restore tissue already lost by wasting. Emphasis is therefore on prevention. It is estimated that a quarter of women over 50 in the West suffer bone loss after the menopause when reduced oestrogen speeds loss of calcium with possible bone damage to wrist, spine and especially hip. The chances of such fractures in women reaching seventy are one in two.
Vitamin D deficiency predisposes, as also does over-prescription of thyroxine for hypothyroid cases. Fat-free diets can break bones.
In menopausal women, increased bone loss is associated with disorders of the ovaries, which organs should receive treatment. Specially at risk are anorexic women with absence of periods. Secondary causes: hyperthyroidism, long-term use of steroids, liver disease, drugs (Tamoxifen, Antacids).
Common fractures are those of hips, spine and wrist. Wrist bone mineral content and grip strength are related. Squeezing a tennis ball hard three times each morning and evening reduces risk of fractures of the wrist.
Drinking of Lemon juice contributes to brittle bones. The habit of daily drinking of the juice causes enamel of teeth to crumble and the removal of calcium from the bones.
Cod Liver oil (chief of the iodised oils) reaches and nourishes cartilage, imparting increased elasticity which prevents degeneration.
Coffee. Two or more cups of coffee a day significantly reduces bone mineral density in women, but drinking milk each day can counter it.
Alternatives. Alfalfa, Black Cohosh, Chamomile, Clivers, Fennel, Dong quai, Fenugreek, Liquorice, Meadowsweet, Mullein, Pimpernel, Helonias, Plantain, Rest Harrow, Shepherd’s Purse, Silverweed, Toadflax, Unicorn root. Nettle tea.
Tea. Equal parts. Alfalfa, Comfrey leaves, Nettles. Mix. 2 teaspoons to each cup boiling water; infuse 5- 15 minutes; 1 cup thrice daily.
Decoction. Equal parts: Comfrey root, Irish Moss (for minerals), Horsetail. Mix. 3 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: 1 cup thrice daily.
Tablets/capsules. Bamboo gum, Helonias, Iceland Moss, Irish Moss for minerals, Kelp, Prickly Ash. Formula. Horsetail 2; Alfalfa 2; Helonias 1. Mix. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action is enhanced by taking in a cup of Fenugreek tea.
Comfrey decoction. 1 heaped teaspoon to cup water gently simmered 5 minutes. Strain when cold. Dose: 1 cup, to which is added 10 drops Tincture Helonias, morning and evening. Fenugreek seeds may be used as an alternative to Comfrey root. Comfrey and Fenugreek are osteo-protectives. For this condition the potential benefit of Comfrey outweighs possible risk.
Propolis. Regeneration of bone tissue.
Dr John Christopher. Mix powders: Horsetail 6, de-husked Oats 3; Comfrey root 4; Lobelia 4. Dose: quarter to half a teaspoon 2-3 times daily.
Diet. Fresh raw fruit and green vegetables. Consumption of raw bran (which contains calcium-binding phytic acid) and wholemeal bread should be suspended until recovery is advanced. Natural spring water. Fish and fish oils. Reject high salt intake which aggravates bone loss and places the skeleton at risk by creating increasing loss of calcium and phosphorus through the kidneys. Avoid soft drinks, alcohol. Heavy meat meals inhibit calcium metabolism. Incidence of the disease is lower in vegetarians. High protein. Supplements. Daily. Vitamin A, Vitamin B12 (50mcg); Vitamin C (500mg); Vitamin D, Vitamin E, Folic acid 200mcg; Vitamin B6 (50mg); Calcium citrate 1g; Magnesium citrate 500mg. Boron and Vitamin D. Zinc 15mg.
Calcium helps reduce risk of fracture particularly in menopausal women who may increase their daily intake to 800mg – Calcium citrate malate being more effective than the carbonate. Dried skimmed milk can supply up to 60 per cent of the recommended daily amount of Calcium.
Stop smoking.
Information. National Osteoporosis Society, PO Box 10, Radstock, Bath BA3 3YB, UK. Send SAE. ... osteoporosis
Benign disease is much more common than cancer, particularly in young women, and includes acute in?ammation of the breast (mastitis); abscess formation; and benign breast lumps, which may be ?broadenosis – di?use lumpiness also called chronic mastitis or ?brocystic disease – in which one or more ?uid-?lled sacs (cysts) develop.
Women who are breast feeding are particularly prone to mastitis, as infection may enter the breast via the nipple. The process may be arrested before a breast abscess forms by prompt treatment with antibiotics. Non-bacterial in?ammation may result from mammary duct ectasia (dilatation), in which abnormal or
blocked ducts may over?ow. Initial treatments should be with antibiotics, but if an abscess does form it should be surgically drained.
Duct ectasia, with or without local mastitis, is the usual benign cause of various nipple complaints, with common symptoms being nipple retraction, discharge and skin change.
Breast lumps form the chief potential danger and may be either solid or cystic. Simple examination may fail to distinguish the two types, but aspiration of a benign cyst usually results in its disappearance. If the ?uid is bloodstained, or if a lump still remains, malignancy is possible, and all solid lumps need histological (tissue examination) or cytological (cell examination) assessment. As well as having their medical and family history taken, any women with a breast lump should undergo triple assessment: a combination of clinical examination, imaging
– mammography for the over-35s and ultrasonagraphy for the under-35s – and ?ne-needle aspiration. The medical history should include details of any previous lumps, family history (up to 10 per cent of breast cancer in western countries is due to genetic disposition), pain, nipple discharge, change in size related to menstrual cycle and parous state, and any drugs being taken by the patient. Breasts should be inspected with the arms up and down, noting position, size, consistency, mobility, ?xity, and local lymphadenopathy (glandular swelling). Nipples should be examined for the presence of inversion or discharge. Skin involvement (peau d’orange) should be noted, and, in particular, how long changes have been present. Fine-needle aspiration and cytological examination of the ?uid are essential with ULTRASOUND, MAMMOGRAPHY and possible BIOPSY being considered, depending on the patient’s age and the extent of clinical suspicion that cancer may be present.
The commonest solid benign lump is a ?broadenoma, particularly in women of childbearing age, and is a painless, mobile lump. If small, it is usually safe to leave it alone, provided that the patient is warned to seek medical advice if its size or character changes or if the lump becomes painful. Fibroadenosis (di?use lumpiness often in the upper, outer quadrant) is a common (benign) lump. Others include periductal mastitis, fat NECROSIS, GALACTOCELE, ABSCESS, and non-breast-tissue lumps – for example, a LIPOMA (fatty tissue) or SEBACEOUS CYST. A woman with breast discharge should have a mammograph, ductograph, or total duct excision until the cause of any underlying duct ectasia is known. Appropriate treatment should then be given.
Malignant disease most commonly – but not exclusively – occurs in post-menopausal women, classically presenting as a slowly growing, painless, ?rm lump. A bloodstained nipple discharge or eczematous skin change may also be suggestive of cancer.
The most commonly used classi?cation of invasive cancers has split them into two types, ductal and lobular, but this is no longer suitable. There are also weaknesses in the tumour node metastases (TNM) system and the International Union Against Cancer (UICC) classi?cation.
The TNM system – which classi?es the lump by size, ?xity and presence of affected axillary glands and wider metastatic spread – is best combined with a pathological classi?cation, when assessing the seriousness of a possibly cancerous lump. Risk factors for cancer include nulliparity (see NULLIPARA), ?rst pregnancy over the age of 30 years, early MENARCHE, late MENOPAUSE and positive family history. The danger should be considered in women who are not breast feeding or with previous breast cancer, and must be carefully excluded if the woman is taking any contraceptive steroids or is on hormone-replacement therapy (see under MENOPAUSE).
Screening programmes involving mammography are well established, the aim being to detect more tumours at an early and curable stage. Pick-up rate is ?ve per 1,000 healthy women over 50 years. Yearly two-view mammograms could reduce mortality by 40 per cent but may cause alarm because there are ten false positive mammograms for each true positive result. In premenopausal women, breasts are denser, making mammograms harder to interpret, and screening appears not to save lives. About a quarter of women with a palpable breast lump turn out to have cancer.
Treatment This remains controversial, and all options should be carefully discussed with the patient and, where appropriate, with her partner. Locally contained disease may be treated by local excision of the lump, but sampling of the glands of the armpit of the same side should be performed to check for additional spread of the disease, and hence the need for CHEMOTHERAPY or RADIOTHERAPY. Depending on the extent of spread, simple mastectomy or modi?ed radical mastectomy (which removes the lymph nodes draining the breast) may be required. Follow-up chemotherapy, for example, with TAMOXIFEN (an oestrogen antagonist), much improves survival (it saves 12 lives over 100 women treated), though it may occasionally cause endometrial carcinoma. Analysis in the mid-1990s of large-scale international studies of breast-cancer treatments showed wide variations in their e?ectiveness. As a result the NHS has encouraged hospitals to set up breast-treatment teams containing all the relevant health professional experts and to use those treatments shown to be most e?ective.
As well as the physical treatments provided, women with suspected or proven breast cancer should be o?ered psychological support because up to 30 per cent of affected women develop an anxiety state or depressive illness within a year of diagnosis. Problems over body image and sexual diffculties occur in and around one-quarter of patients. Breast conservation and reconstructive surgery can improve the physical effects of mastectomy, and women should be advised on the prostheses and specially designed brassieres that are available. Specialist nurses and self-help groups are invaluable in supporting affected women and their partners with the problems caused by breast cancer and its treatment. Breast Cancer Care, British Association of Cancer United Patients (BACUP), Cancerlink, and Cancer Relief Macmillan Fund are among voluntary organisations providing support.... breasts, diseases of
Most anticancer drugs are cytotoxic (kill or damage rapidly dividing cells), but some act by slowing the growth of hormone-sensitive tumours. Anticancer drugs are often prescribed in combination to maximize their effects.
Treatment with cytotoxic drugs is often given by injection in short courses repeated at intervals. Some drugs cause nausea and vomiting and may result in hair loss and increased susceptibility to infection. Others, such as tamoxifen, which is used for breast cancer, are given continuously by mouth for months or years and cause few side effects.... anticancer drugs
A mastectomy involves the removal of all of the breast tissue and usually some or all of the lymph nodes in the armpit. Cells from the lymph nodes are examined to determine whether cancerous cells may have spread. The operation is performed under general anaesthesia and usually requires a stay in hospital of several days. Plastic surgery to reconstruct the breast may be carried out at the same time as the mastectomy or at a later time (see mammoplasty).
Treatment with radiotherapy is often given after surgery, especially if the cancer has spread to lymph nodes. It usually starts a month after surgery and is continued for 6 weeks. Drug treatment with tamoxifen or chemotherapy may also be given.... mastectomy
The classic sign is a lump in the breast, usually painless; bleeding or discharge from the nipple may occur infrequently. Sometimes the first thing to be noticed is a lump in the axilla (armpit), which is caused by spread of the cancer to the drainage lymph nodes. The tumour may also spread to the bones, lungs, and liver. Current treatment of a localized tumour is usually by surgery (see lumpectomy; mastectomy), with or without radiotherapy; cytotoxic drugs and hormone therapy are used as *adjuvant therapy and *neoadjuvant chemotherapy and for widespread (metastatic) disease. Anti-oestrogenic agents used include *tamoxifen and (more recently) *aromatase inhibitors and *trastuzumab (Herceptin).... breast cancer
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