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Breast cancer is a prevalent and life-threatening disease that affects millions of individuals worldwide. It is important to raise awareness about breast cancer, its causes, prevention methods, and treatment options. Writing an essay on breast cancer can help educate others, spread awareness, and provide support to those affected by the disease. To help you get started, here are 117 breast cancer essay topic ideas and examples:

• The history of breast cancer research.
• Understanding breast cancer: Causes, risk factors, and prevention.
• The impact of genetics on breast cancer development.
• Exploring the different types and stages of breast cancer.
• The role of hormonal imbalances in breast cancer.
• Environmental factors and their link to breast cancer.
• The importance of regular breast self-examinations.
• The significance of early detection in breast cancer survival rates.
• The impact of breast cancer on mental health.
• The emotional journey of breast cancer survivors.
• The role of support groups in the breast cancer community.
• Breast cancer in men: Understanding the challenges and misconceptions.
• The importance of mammograms in breast cancer screening.
• The role of lifestyle choices in breast cancer prevention.
• Exploring the various treatment options for breast cancer.
• The impact of chemotherapy on breast cancer patients.
• Radiation therapy: Benefits and side effects.
• Surgical interventions for breast cancer: Mastectomy vs. lumpectomy.
• Breast reconstruction surgery: A personal choice after breast cancer.
• The role of targeted therapies in breast cancer treatment.
• The impact of hormone therapy on breast cancer patients.
• The role of immunotherapy in advanced breast cancer cases.
• The psychological effects of breast cancer on patients' relationships.
• Coping strategies for dealing with the emotional toll of breast cancer.
• The role of nutrition in supporting breast cancer treatment.
• The importance of exercise during and after breast cancer treatment.
• Alternative and complementary therapies for breast cancer patients.
• The financial burden of breast cancer treatment.
• Breast cancer advocacy: The fight for better research and resources.
• The role of technology in advancing breast cancer detection methods.
• Breast cancer awareness campaigns: Their impact on public perception.
• Breast cancer in developing countries: Challenges and solutions.
• The impact of breast cancer on fertility and reproductive choices.
• The role of genetic testing in breast cancer risk assessment.
• The relationship between obesity and breast cancer.
• The impact of race and ethnicity on breast cancer outcomes.
• The importance of early education about breast health.
• Breast cancer in young women: Unique challenges and considerations.
• The role of social media in raising breast cancer awareness.
• Breast cancer and pregnancy: Navigating treatment decisions.
• The impact of breast cancer on sexual health and intimacy.
• The role of survivorship programs in supporting breast cancer patients.
• The impact of breast cancer on workplace dynamics and discrimination.
• Breast cancer and the LGBTQ+ community: Unique experiences and challenges.
• The importance of clinical trials in advancing breast cancer research.
• Breast cancer and the role of epigenetics.
• The impact of stress and emotional trauma on breast cancer outcomes.
• The role of advocacy organizations in supporting breast cancer patients.
• Breast cancer and the role of spirituality in coping.
• The impact of hormone replacement therapy on breast cancer risk.
• The role of patient navigation programs in improving breast cancer outcomes.
• Breast cancer and the impact on body image and self-esteem.
• The significance of breast cancer education in schools and colleges.
• The role of art therapy in supporting breast cancer patients.
• Breast cancer recurrence: Challenges and treatment options.
• The impact of breast cancer on caregivers and their mental health.
• The role of exercise in reducing the risk of breast cancer recurrence.
• Exploring the relationship between breast cancer and autoimmune diseases.
• Breast cancer and the impact on fertility preservation options.
• The role of palliative care in supporting advanced breast cancer patients.
• The impact of breast cancer on survivorship and quality of life.
• The role of community-based organizations in supporting breast cancer patients.
• Breast cancer and the impact on body image in the media.
• The importance of peer support in the breast cancer community.
• Breast cancer and the role of spirituality in healing and recovery.
• The impact of breast cancer on families and children.
• The role of mindfulness-based interventions in supporting breast cancer patients.
• Breast cancer in the elderly population: Challenges and considerations.
• The importance of clinical breast exams in early detection.
• Breast cancer and the impact on sexual orientation and gender identity.
• The role of survivorship care plans in supporting breast cancer survivors.
• Breast cancer and the impact on fertility preservation options for transgender individuals.
• The significance of dietary supplements in breast cancer prevention.
• The impact of breast cancer on body image and self-acceptance.
• Breast cancer and the role of spirituality in coping with treatment side effects.
• The importance of breast cancer education in underserved communities.
• Breast cancer and the impact on mental health in marginalized populations.
• The role of music therapy in supporting breast cancer patients.
• Breast cancer and the impact on access to healthcare in rural areas.
• The significance of breastfeeding in reducing the risk of breast cancer.
• Breast cancer and the role of integrative medicine in treatment.
• The impact of breast cancer on sexual identity and gender dysphoria.
• The role of survivorship clinics in addressing long-term effects of breast cancer treatment.
• Breast cancer and the impact on body image in different cultures.
• The importance of mentorship programs for young breast cancer survivors.
• Breast cancer and the role of spiritual practices in coping with treatment side effects.
• The impact of breast cancer on mental health in refugee populations.
• The significance of art therapy in supporting breast cancer patients during treatment.
• Breast cancer and the impact on healthcare disparities in minority communities.
• The role of laughter therapy in improving the well-being of breast cancer patients.
• Breast cancer and the importance of culturally sensitive healthcare practices.
• The impact of breast cancer on mental health in adolescent survivors.
• The significance of dance therapy in improving physical and emotional well-being of breast cancer patients.
• Breast cancer and the role of mobile health applications in self-management.
• The impact of breast cancer on mental health in immigrant populations.
• The importance of peer mentoring programs for breast cancer survivors.
• Breast cancer and the role of mindfulness meditation in managing treatment side effects.
• The impact of breast cancer on mental health in the LGBTQ+ community.
• The significance of pet therapy in providing emotional support to breast cancer patients.
• Breast cancer and the role of community health workers in improving access to care.
• The impact of breast cancer on mental health in rural populations.
• The importance of gardening therapy in promoting well-being among breast cancer survivors.
• Breast cancer and the impact on mental health in older adults.
• The role of equine therapy in supporting emotional well-being of breast cancer patients.
• The significance of telehealth in improving access to healthcare for breast cancer patients.
• Breast cancer and the impact on mental health in low-income populations.
• The importance of aromatherapy in managing treatment-related symptoms for breast cancer patients.
• The impact of breast cancer on mental health in individuals with disabilities.
• The role of horticultural therapy in promoting emotional healing among breast cancer survivors.
• Breast cancer and the significance of patient navigators in improving health outcomes.
• The impact of breast cancer on mental health in incarcerated populations.
• The importance of acupuncture in managing treatment side effects for breast cancer patients.
• Breast cancer and the impact on mental health in military veterans.
• The role of aquatic therapy in improving physical and emotional well-being of breast cancer patients.
• The significance of technology-based interventions in supporting breast cancer survivors.
• Breast cancer and the impact on mental health in individuals with substance use disorders.
• The importance of laughter yoga in promoting emotional well-being among breast cancer patients.

These essay topic ideas provide a diverse range of perspectives on breast cancer, allowing you to choose a topic that resonates with you. Remember to conduct thorough research, use credible sources, and share compelling stories to make your essay impactful and informative. Together, we can continue to raise awareness and support those affected by breast cancer.

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Breast Cancer - Free Essay Examples And Topic Ideas

Breast cancer is a type of cancer that develops from breast tissue. Essays on this topic could explore the causes, diagnosis, treatment, and prevention of breast cancer. Additionally, discussions might delve into the psychological and social impact of breast cancer on patients and their families, the ongoing research towards finding a cure, and the broader societal awareness and support systems available for those affected. We have collected a large number of free essay examples about Breast Cancer you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Micro Needle Thermocouple for Detection of Breast Cancer

Hundreds and thousands of people are affected by cancer each year; it is one of the most fatal diseases and a leading cause of death and disability for humans (Iranifam 2014). There are several types of cancer than can affect different areas of the body, some being less life-threatening than others. A vast amount of patients suffer from late diagnosis or recurrence of their disease in spite of all the advances in diagnosis and treatment of breast cancer. Modern cancer […]

The Role of Histology in the Breast Cancer

Breast cancer is an uncontrolled growth of breast cell that can be benign, not dangerous, but it can also metastasize and invade different and distant tissues in our body. Breast Cancer is the most common cancer in female of any age and although the risk increases, as you get older, many different factors affect the chance of a woman to get breast cancer. I chose this specific topic because breast cancer is something that I’ve dealt with in my personal […]

Corporate Social Responsibility against Cancer

Abstract As an assistant manager at Kenta Law Firm, based in Monroe, I intend to collaborate with the Susan B. Komen Foundation a non-organization corporation that is interested in reducing issues of breast cancer among women. Kenta law firm has noted that a significant populace of Monroe’s youth especially women and young children specifically those who are homeless are suffering from breast cancer. In this CSR partnership, our law firm will collaborate with the Susan B. Komen Foundation in addressing […]

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Why is Screening for Breast Cancer Important

The impact this disease has, on not only the individual but the people around them, is powerful. Even though the tests show cancer, I am thankful that I had the annual test. It is true that stress, anxiety, and money can be saved by waiting until the age of 50 years old because of misinterpretation and overdiagnosis. However, early detection is the key to success in the battle against breast cancer. There are many different options for detection scans that […]

Breast Cancer: Casuses and Treatment

Cancer is defined as “when the body’s cells begin to divide without stopping and spread into surrounding tissues.” (“What is cancer?”, 2017), caused by mutations that lead to the cell cycle to proceed, regardless if the cell is qualified to. The mutations block the use of the G1, G2, and M checkpoints in the cell cycle. These checkpoints are important in “sensing defects that occur during essential processes, and induce a cell cycle arrest in response until the defects are […]

Breast Reconstruction after Mastectomy

Breast cancer is always personal. As a physician who counsels women at different steps during the healing process, I am acutely aware of this undeniable fact. Every decision she makes from the point at which she is diagnosed with breast cancer will require her focused engagement and a physician who is central to understanding her need for clarity of options. It is an intimate relationship where trust is a requirement and every woman faced with the many unknowns ahead will […]

Breast Cancer History Research Paper

Breast cancer is a disease in which most commonly occurs in all women no matter their size, shape, race, or ethnicity. About one in eight women will be diagnosed with breast cancer every year, a fatal disease if not discovered early. Early detection of breast cancer is key so that cancerous cells found in the breast do not spread through other parts of the body. With an increasing prevalence in breast cancer today, the evolution of technology has been improved […]

New Healthcare Inventions on Breast Cancer

Abstract Background: The Ki67 labeling index (LI) for breast carcinoma is essential for therapy. It is determined by visual assessment under a microscope which is subjective, thus has limitations due to inter-observer variability. A standardized method for evaluating Ki67 LI is necessary to reduce subjectivity and improve precision. Therefore, automated Digital Image Analysis (DIA) has been attempted as a potential method for evaluating the Ki67 index. Materials and Method: We included 48 cases of invasive breast carcinoma in this study. […]

Understanding Breast Cancer

This paper will clarify what Breast Cancer is. It will explain the symptoms, treatment options, and other useful information regarding this disease. The first thing to know about Breast Cancer is understanding what it is. According to the Cancer.org website, breast cancer begins when cells in the bosom begin to spread out of control. The tumor that is formed from these cells may be detected on an x-ray or can be felt as a lump. Malignancy can advance into neighboring […]

Breast Cancer in African American Women

Summary Despite the fact that Caucasian women in the United States have a higher incidence rate of breast cancer than any other racial group, African-Americans succumb notably worse to the disease and record the highest mortality rate. To comprehend the barriers and challenges that predispose African-American women to these disparities, this research was conducted to get a better understanding from the perspective of oncologists. With diverse ethnicity and gender representation, the participation of seven medical, surgical and radiation oncologists that […]

Essential Breast Cancer Screening Techniques and their Complements

It is with great distress that each year a large number of females suffer and die from breast cancer. Medicine practitioners and researchers have been striving to save lives from breast cancer, and how they manage to do this includes two major parts—diagnosis and treatment. What comes first on the stage of diagnosis is the detection of tumor. Thus, the development of breast imaging techniques is at the highest priority for diagnosing breast cancer, and individuals’ focus is on earlier […]

Breast Cancer Prevention and Treatment

The human body is made up of cells. When a cell dies the body automatically replaces it with a new healthy cell, but sometimes the cell is not healthy and grows out of control. These cells group together and form a lump that can be seen on an x-ray. Breast cancer is a tumor in the cells of person’s breast. It can spread throughout the breast to the person’s lymph nodes and other parts of the body. Sometimes it occurs […]

Breast Cancer Diagnosis

I. Executive Summary Breast cancer is concerning a large number of female individuals worldwide. This disease comes from abnormally developed breast tissue, which usually begins in either lobules or ducts of the breast. Generally speaking, breast cancer is divided into two types—non-invasive and invasive. The core criteria to distinguish in between these two types of breast cancers is the location of cancer cells. Cancer cells remain on their initial positions for a non-invasive breast cancer, whereas they grow, or “invade”, […]

Understanding a Breast Cancer Diagnosis

Breast cancer is often known as an aggressive cancer. It forms when cells grow uncontrollably in the tissues of the breast, leading to a tumor. Over 190,000 individuals are diagnosed yearly (Cancer Center). Breast cancer is the second leading cause of death, and the rate increases every year in women, and occasionally in men. Over 12 percent of women in the United States of America will face breast cancer in their lifetime. It is the most common cause of death […]

Breast Cancer in the Era of Precision Medicine

Introduction: Precision medicine is concerned with the diagnosis of patients according to their biological, genetic, and molecular status. As cancer is a genetic disease, its treatment comes among the first medical disciplines as an application of precision medicine. Breast cancer is a highly complex, heterogeneous, and multifactorial disease; it is also one of the most common diseases among women in the world. Usually, there are no clear symptoms, so regular screening is important for early detection. Scientists recently started using […]

Exome Sequencing to Identify Rare Mutations Associated with Breast Cancer Susceptibility

Abstract Background - Breast cancer predisposition has been known to be caused by hereditary factors. New techniques particularly exome sequencing have allowed/ helped us to identify new and novel variants that exhibit a phenotype. Method - In this review we discuss the advantages of exome sequencing and how it could help in understanding the familial breast cancer. In particular, we will discuss about the studies by Noh et al.(1), Thompson et al.(2), and Kiiski et al.(3), on how they have […]

A Novel Therapeutic Strategy for HER2 Breast Cancer by Nanoparticles Combined with Macrophages

Abstract:In recent years, the cell membrane bionic nanoparticles as a new drug delivery system is widely used in small molecule drugs, vaccines and targeted delivery of macromolecular drugs, because of its inherited the specific receptors on the cell membrane and membrane proteins can be used to implement specific targeted delivery, and the tumor showed a good treatment effect on the disease such as model, this topic with a huge bite cell membrane of the role of tumor capture, chemical modification, […]

Essays About Breast Cancer Breast Cancer is one of the most common cancers in women and is a disease by which the cells in the breast area grow out of control. Breast cancer tends to begin in the ducts or lobules of a breast and there are different types of cancer. In the US alone 1 in 8 women will develop breast cancer at some stage in their lives. In many academic fields; from science to medicine the study of breast cancer and essays about breast cancer are required as part of the curriculum. An essay on breast cancer can seem daunting due to the amount of research and several varying scientific approaches used to talk about the topic. We offer essay examples, or research paper guidance and free essay samples.  These can be used to gauge how to approach the topic and are an informative look at all factors that contribute to breast cancer and prevention. We also factor breast cancer awareness into our essay samples and ensure essays for both university and college build a strong foundation to understanding the disease, but also draw criticism when necessary and a strong conclusion on whatever element of breast cancer the focus of the essay is on.

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The Impact of Technological Advancements on Early Breast Cancer Detection and Diagnosis

1. Introduction The majority of women who have had breast cancer were diagnosed through screening with annual mammography. Breast cancer screening has been considered the most effective method for early breast cancer detection. Breast cancer, if identified at an early stage, usually allows curative treatment, preserving the breast. The development of digital mammography, particularly the advent of digital mammography systems, has accelerated the refinements and diagnostic capacity of mammograph ...

Evaluación de la efectividad del tratamiento del cáncer de mama en diferentes etapas de la enfermedad

1. Introducción El cáncer es un grupo de enfermedades distinguibles por un crecimiento no controlado y una diseminación de células anormales. Se trata con diferentes métodos, generalmente incluyendo la cirugía, la radioterapia, la quimio o la inmunoterapia. Entre los modelos animales disponibles más recientemente, los ratones transgénicos están siendo frecuentemente utilizados para modelar el progreso y la efectividad molecular de alternativas experimentales. Además, existen varios modelos inmu ...

The Impact of Early Detection and Prevention on the Prognosis of Breast Cancer

1. Introduction Breast cancer is the most common type of cancer affecting women. Its incidence is steadily increasing and spares no age group. Its curability is due to an effective detection program, an increased number of conservative surgical operations that should always be followed by radiation therapy, and especially to a constant promotion of prevention of the malignant transformation of glandular tissue by an optimal diet, the constant use of some drugs, and screening programs based on o ...

The Benefits and Challenges of Breastfeeding for Both Mother and Child

1. Introduction Breastfeeding is the natural way to provide essential nutrients needed for growth and development of infants, with numerous benefits for both the mother and the child. The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for at least 2 years with the introduction of adequate complementary foods from 6 months of age. Despite the widely known benefits, many mothers choose not to breastfeed or face difficulties when b ...

Breast Cancer: Concept Map and Case Study -

1. Introduction Breast cancer is one of the most recognized malignant tumors impacting the female population worldwide. This is a public health issue, since its occurrence and mortality rates have been rising over the past years. The awareness about the disease and the adoption of a healthier life are fundamental for the prevention of this occurrence. Approximately 80% of lumps found in women’s breasts are benign, but they must always be assessed by a physician. According to the National Cancer ...

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Breast Cancer and Its Population Burden Essay

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Introduction

Facts and figures, population impacts, environmental factors, social factors, potential solution to breast cancer.

The overriding objective of this paper is to provide a detailed discussion of the burden of breast cancer. The other objectives that are central to this paper are highlighted below:

• To determine which group is at a high risk of breast cancer
• To elucidate the impact of breast cancer on elderly women and those below the age of 45 years
• To highlight the possible solutions to the burden of breast cancer
• To discuss, in detail, some of the possible causes of breast cancer – environmental and social factors.

Breast cancer (BC) is regarded as the most common type of cancer globally. According to Mascara and Constantinou (2021), “about 2.3 million people are diagnosed with the disease each year” (p. 9). In the U.S., approximately 264000 and 2400 cancer cases are diagnosed each year among women and men, respectively (Mascara and Constantinou (2021, p. 6). African American women have a high mortality rate of breast cancer. The main facts about this condition are that it has a high survival rate, and women are at a higher risk than men for developing it.

While there are several types of cancer, breast cancer is regarded as the second leading cause of death among women. Women above 55 years are at a high risk of being diagnosed with breast cancer. More specifically, it is common after menopause – “longer exposure to estrogen increases a woman’s risk of breast cancer” (Madigan et al., 2020, p. 9). However, there are a few cases of this condition among women below 45 (Madigan et al., 2020, p. 9). In the U.S., for instance, about 9% of all the cases are recorded in women below 45 years

Most older women living with breast cancer are considered underdiagnosed and undertreated. This explains why this population has a low survival rate. According to Madigan et al. (2020), the majority of women who die of breast cancer are above 65 years. In addition to this, screening for this condition in the elderly population is very controversial. In fact, mammography is rarely performed in women between 65 and 70 years old (Madigan et al. (2020). Most of these women delay reporting the signs and symptoms of this condition – it is diagnosed at a more advanced stage.

The one known environmental factor that increases the risk of breast cancer is long exposure to ionizing radiation. According to Burstein et al. (2019), continued exposure to “environmental pollutants and toxic chemicals are possible risk factors for breast cancer.” However, the possibility of developing this condition depends largely on the period and type of exposure. Burstein et al.’s (2019) study focused on women exposed to polybrominated diphenyl ethers and bisphenol A. They noted that most women during the menopausal transition were at a high risk of developing breast cancer.

Social factors contribute a lot to the health and well-being of individuals. Among breast cancer patients, income and education, unemployment, social support, and neighborhood limitations are the main risks for breast cancer. Other social factors include food insecurity, poor housing, and lack of medical trust. Lack of social support, for instance, is associated with an increase in cancer-related deaths (Coughlin, 2019). This happens because most of them are socially isolated – they lack essential instrumental support. Overall, more affluent women, regardless of race, are at a higher risk of developing breast cancer.

The available solutions aim at reducing the risk of developing breast cancer. According to Montagnese et al. (2020), lifestyle changes are crucial to decreasing the risk of BC. The first possible solution requires one to maintain a healthy weight. For instance, healthy adults should strive to achieve at least 150 minutes of aerobic activity combined with up to 75 minutes of vigorous exercises (Montagnese et al., 2020). However, it is important to consult the healthcare provider regarding the available healthy strategies to help them accomplish the same.

Another possible solution to breast cancer, specifically for women below the age of 45 years, is through breastfeeding. More specifically, such women should consider breastfeeding for at least one year. This helps reduce the risk of breast cancer post-menopause. Similarly, hormone therapy in menopause should not be taken for the long term as it increases the risk of breast cancer – “whether estrogen is taken by itself or combined with progestin” (Jelly & Choudhary, 2019, p. 47). This presentation emphasizes that for those women who opt to take hormone therapy, it should be for the short-term.

As evidenced above, breast cancer is the second leading cause of death in women, especially those aged 65 years and above. Based on research, approximately 264000 and 2400 cancer cases are diagnosed each year among women and men, respectively. In addition to this, both environmental and social factors play a critical role in the development of breast cancer. For instance, ionizing radiation is one of the main environmental factors associated with this condition. Scholars recommend lifestyle changes combined with physical activity in an attempt to minimize the risk of being diagnosed with the condition.

Burstein, H. J., Curigliano, G., Loibl, S., Dubsky, P., Gnant, M., Poortmans, P., & Thurlimann, B. (2019). Estimating the benefits of therapy for early-stage breast cancer: The St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019 . Annals of Oncology , 30 (10), 1541-1557. Web.

Coughlin, S. S. (2019). Social determinants of breast cancer risk, stage, and survival . Breast cancer research and treatment , 177 (3), 537-548. Web.

Jelly, P., & Choudhary, S. (2019). Breastfeeding and breast cancer: A risk reduction strategy . Int J Med Paediatr Oncol , 5 (2), 47-50. Web.

Madigan, L. I., Dinh, P., & Graham, J. D. (2020). Neoadjuvant endocrine therapy in locally advanced estrogen or progesterone receptor-positive breast cancer: determining the optimal endocrine agent and treatment duration in postmenopausal women—A literature review and proposed guidelines . Breast Cancer Research , 22 (1), 1-13. Web.

Mascara, M., & Constantinou, C. (2021). Global perceptions of women on breast cancer and barriers to screening . Current Oncology Reports , 23 (7), 1-9. Web.

Montagnese, C., Porciello, G., Vitale, S., Palumbo, E., Crispo, A., Grimaldi, M., & Augustin, L. S. (2020). Quality of life in women diagnosed with breast cancer after a 12-month treatment of lifestyle modifications . Nutrients , 13 (1), 136. Web.

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IvyPanda. (2023, December 28). Breast Cancer and Its Population Burden. https://ivypanda.com/essays/breast-cancer-and-its-population-burden/

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Essays on Breast Cancer

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Breast Cancer - Free Essay Examples and Topic Ideas

Breast cancer is a type of cancer that occurs in breast cells. It can develop in any part of the breast and can spread to other nearby tissues and organs. The two main types of breast cancer are invasive and non-invasive. Symptoms may include a lump or thickening in the breast, changes in the size or shape of the breast, nipple discharge, or a new or persistent pain in the breast or armpit. Early detection through regular mammograms and self-exams can improve the chances of successful treatment. Treatment options may include surgery, radiation therapy, chemotherapy, or hormone therapy.

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How to Write an Expository Essay | Structure, Tips & Examples

Published on July 14, 2020 by Jack Caulfield . Revised on July 23, 2023.

“Expository” means “intended to explain or describe something.” An expository essay provides a clear, focused explanation of a particular topic, process, or set of ideas. It doesn’t set out to prove a point, just to give a balanced view of its subject matter.

Expository essays are usually short assignments intended to test your composition skills or your understanding of a subject. They tend to involve less research and original arguments than argumentative essays .

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Table of contents

When should you write an expository essay, how to approach an expository essay, introducing your essay, writing the body paragraphs, concluding your essay, other interesting articles, frequently asked questions about expository essays.

In school and university, you might have to write expository essays as in-class exercises, exam questions, or coursework assignments.

Sometimes it won’t be directly stated that the assignment is an expository essay, but there are certain keywords that imply expository writing is required. Consider the prompts below.

The word “explain” here is the clue: An essay responding to this prompt should provide an explanation of this historical process—not necessarily an original argument about it.

Sometimes you’ll be asked to define a particular term or concept. This means more than just copying down the dictionary definition; you’ll be expected to explore different ideas surrounding the term, as this prompt emphasizes.

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An expository essay should take an objective approach: It isn’t about your personal opinions or experiences. Instead, your goal is to provide an informative and balanced explanation of your topic. Avoid using the first or second person (“I” or “you”).

The structure of your expository essay will vary according to the scope of your assignment and the demands of your topic. It’s worthwhile to plan out your structure before you start, using an essay outline .

A common structure for a short expository essay consists of five paragraphs: An introduction, three body paragraphs, and a conclusion.

Like all essays, an expository essay begins with an introduction . This serves to hook the reader’s interest, briefly introduce your topic, and provide a thesis statement summarizing what you’re going to say about it.

Hover over different parts of the example below to see how a typical introduction works.

In many ways, the invention of the printing press marked the end of the Middle Ages. The medieval period in Europe is often remembered as a time of intellectual and political stagnation. Prior to the Renaissance, the average person had very limited access to books and was unlikely to be literate. The invention of the printing press in the 15th century allowed for much less restricted circulation of information in Europe, paving the way for the Reformation.

The body of your essay is where you cover your topic in depth. It often consists of three paragraphs, but may be more for a longer essay. This is where you present the details of the process, idea or topic you’re explaining.

It’s important to make sure each paragraph covers its own clearly defined topic, introduced with a topic sentence . Different topics (all related to the overall subject matter of the essay) should be presented in a logical order, with clear transitions between paragraphs.

Hover over different parts of the example paragraph below to see how a body paragraph is constructed.

The invention of the printing press in 1440 changed this situation dramatically. Johannes Gutenberg, who had worked as a goldsmith, used his knowledge of metals in the design of the press. He made his type from an alloy of lead, tin, and antimony, whose durability allowed for the reliable production of high-quality books. This new technology allowed texts to be reproduced and disseminated on a much larger scale than was previously possible. The Gutenberg Bible appeared in the 1450s, and a large number of printing presses sprang up across the continent in the following decades. Gutenberg’s invention rapidly transformed cultural production in Europe; among other things, it would lead to the Protestant Reformation.

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The conclusion of an expository essay serves to summarize the topic under discussion. It should not present any new information or evidence, but should instead focus on reinforcing the points made so far. Essentially, your conclusion is there to round off the essay in an engaging way.

Hover over different parts of the example below to see how a conclusion works.

The invention of the printing press was important not only in terms of its immediate cultural and economic effects, but also in terms of its major impact on politics and religion across Europe. In the century following the invention of the printing press, the relatively stationary intellectual atmosphere of the Middle Ages gave way to the social upheavals of the Reformation and the Renaissance. A single technological innovation had contributed to the total reshaping of the continent.

If you want to know more about AI tools , college essays , or fallacies make sure to check out some of our other articles with explanations and examples or go directly to our tools!

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An expository essay is a broad form that varies in length according to the scope of the assignment.

Expository essays are often assigned as a writing exercise or as part of an exam, in which case a five-paragraph essay of around 800 words may be appropriate.

You’ll usually be given guidelines regarding length; if you’re not sure, ask.

An expository essay is a common assignment in high-school and university composition classes. It might be assigned as coursework, in class, or as part of an exam.

Sometimes you might not be told explicitly to write an expository essay. Look out for prompts containing keywords like “explain” and “define.” An expository essay is usually the right response to these prompts.

An argumentative essay tends to be a longer essay involving independent research, and aims to make an original argument about a topic. Its thesis statement makes a contentious claim that must be supported in an objective, evidence-based way.

An expository essay also aims to be objective, but it doesn’t have to make an original argument. Rather, it aims to explain something (e.g., a process or idea) in a clear, concise way. Expository essays are often shorter assignments and rely less on research.

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Estrogens and the risk of breast cancer: A narrative review of literature

Khayry al-shami.

a Faculty of Medicine, Yarmouk University, P.O Box 566, 21163, Irbid, Jordan

Sajeda Awadi

Almu'atasim khamees.

b Department of General Surgery, King Hussein Cancer Center, Amman, 11941, Jordan

Ahmad Malek Alsheikh

Sumaiya al-sharif, raneem ala’ bereshy, sharaf f. al-eitan, sajedah h. banikhaled, ahmad r. al-qudimat.

c Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, 2713, Qatar

d Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar

Raed M. Al-Zoubi

e Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, 2713, Qatar

f Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan

Mazhar Salim Al Zoubi

Associated data.

Data will be made available on request.

In female mammals, the development and regulation of the reproductive system and non-reproductive system are significantly influenced by estrogens (oestrogens). In addition, lipid metabolism is another physiological role of estrogens. Estrogens act through different types of receptors to introduce signals to the target cell by affecting many estrogen response elements. Breast cancer is considered mostly a hormone-dependent disease. Approximately 70% of breast cancers express progesterone receptors and/or estrogen receptors, and they are a good marker for cancer prognosis. This review will discuss estrogen metabolism and the interaction of estrogen metabolites with breast cancer. The carcinogenic role of estrogen is discussed in light of both conventional and atypical cancers susceptible to hormones, such as prostate, endometrial, and lung cancer, as we examine how estrogen contributes to the formation and activation of breast cancer. In addition, this review will discuss other factors that can be associated with estrogen-driven breast cancer.

1. Introduction

Estrogens also known as oestrogens, are key hormones responsible for the progression and regulation of mammal females’ reproductive system and have an essential role in the non-reproductive system [ 1 , 2 ]. In addition, they are pleiotropic steroids that play a regulatory role in a myriad of physiological processes from reproduction to lipid metabolism [ 3 ]. Estrogens perform their action through two different types of receptors: First, classical nuclear estrogen receptors (ER) with two various isoforms known as (ERα and ERβ) that are encoded by genes on chromosomes 6 and 14, respectively. Second, novel cell surface membrane receptors (GPR30 and ER-X). Both kinds of estrogen receptors are expressed in the brain and periphery with cell and tissue-specific circulations [ 4 , 5 ]. Estrogen receptors are a component of the superfamily of nuclear transcription factors with a classical pathway of estrogen-dependent function. The action of estrogen receptors achieves in the cytoplasm by binding lipophilic hormone molecules and transferring the compound to the nucleus, dimerization, and interaction with suitable response elements in gene promoters region, which initiates transcription after co-activators binding as demonstrated in Fig. 1 [ 6 , 7 ]. Due to the significant role of ER in signaling transduction, the current review aimed to summarize the mechanism of action of estrogen in cancer development, particularly in breast cancer.

Signaling Pathway of Estrogen Receptor. Estrogen can cross the plasma membrane, where it interacts with intracellular ER and ER to affect DNA directly. The GPER1 and/or ER and ER can interact with estrogen to cause it, to activate intracellular signaling cascades as an alternative. Estrogen-mediated signaling events can be classified as genomic and non-genomic due to differences in the cellular and molecular processes regulating gene expression, in which estrogen-receptor complexes can bind to DNA directly or indirectly. The migration of estrogen-receptor complexes into the cell nucleus and direct contact with chromatin at particular DNA sequences known as estrogen response elements are two examples of genomic impacts (EREs). More than one-third of human genes controlled by estrogen receptors are reported to lack ERE sequence elements, although EREs have been found in multiple gene promoters and regulatory regions. Contrarily, non-genomic impacts entail the indirect control of gene expression via a range of intracellular signaling occasions. Below is a description of the known ways through which estrogens regulate both genomic and non-genomic aspects of gene expression.

BioRender (2021). Estrogen Receptor Signaling. Retrieved from https://app.biorender.com/biorender-templates/t-5db2fd9f9688420082acf5d3-estrogen-receptor-signaling .

2. Estrogen synthesis

In premenopausal women, estrogens are synthesized primarily in theca cells in the ovaries, placenta, and corpus luteum. A noteworthy quantity of estrogens can also be created by non-gonad organs, like the liver, skin, brain, and heart. The synthesis process ends with the conversion of androgens to estrogens in granulosa cells by the aromatase enzyme as illustrated in Fig. 2 A and B [ 8 ]. There are three main endogenous forms of physiological estrogens in women: estrone (E1), estradiol (E2), and estriol (E3). After menopause, E1 has an important role as it is formed in adipose tissue from adrenal dehydroepiandrosterone. While E2 which is also called estradiol, considers the major and most potent product of the estrogen biosynthesis process. E3 form is the least prevalent estrogen and is formed from the E1 or E2 ( Fig. 3 ). Additionally, it plays a larger role during pregnancy when it is produced in large quantities by the placenta [ [9] , [10] , [11] ].

Estrogen synthesis pathway in the ovary and brain. (A) Synthesis of estrogens begins with the production of pregnenolone from cholesterol, catalyzed by the cytochrome P450 side-chain cleavage enzyme (P450scc). The pregnenolone is transformed into progesterone by 3 b-hydroxysteroid dehydrogenase (3 b-HSD) in both thecal and granulosa cells. Progesterone is transformed to androgens by cytochrome P450 17a-hydroxylase (P45017a) and 17 b-hydroxysteroid dehydrogenase (17 b-HSD) in the thecal cells throughout the follicular phase. The transformation of E2 is enhanced by the aromatase enzyme (P450Arom) in granulosa cells. (B) Neurons express all of the mandatory enzymes for the production of estrogen to create brain estrogen [ 12 ].

Estrogen metabolism pathway in humans. The diagram shows the metabolism of estradiol and other natural estrogens such as estrone and estriol. It demonstrates that conjugation (e.g., sulfation and glucuronidation) occurs in the case of estradiol and metabolites of estradiol that have one or more available hydroxyl (–OH) groups. Catechol and quinone formation from estrone is shown and how the derivatives are reacting with DNA to form depurination DNA adducts (adapted from Ref. [ 16 ]).

3. Estrogen metabolism in humans

Estrogens are metabolized via hydroxylation and conjugation. Hydroxylation is achieved by cytochrome P450 enzymes such as CYP1A1 and CYP3A4, while conjugation is performed by estrogen sulfotransferases (sulfation) and UDP-glucuronyltransferases (glucuronidation). Moreover, estradiol is dehydrogenated by 17β-hydroxysteroid dehydrogenase into the less common estrogen estrone as shown in Fig. 3 . These reactions take place primarily in the liver, but also in other tissues [ [13] , [14] , [15] ].

3.1. 2-Hydroxylation pathway

2-hydroxylation is the main hydroxylation pathway. CYP1A1 and CYP1B1; cytochrome P-450 enzymes which are expressed in breast and liver tissues are major phase I enzymes [ 17 ]. C2 hydroxylation for parent estrogens to catechol estrogens is catalyzed by cytochrome P-450 enzymes including CYP1A2 [ 18 ].2-Hydroxylated estrogens have a low binding affinity for the estrogen receptor [ 19 ]. Compared with estradiol these metabolites reduce hormonal potency and are the cause of non-estrogenic and anti-estrogenic activities. Some studies showed that 2-hydroxyestrone and 2-hydroxyestradiol can inhibit cell growth and proliferation [ 20 ]. Also, they have a role in normal cell differentiation and apoptosis [ 21 ]. Therefore, some researchers define 2-hydroxyestrone as a “good estrogen” [ 22 ]. The low potency or non-tumorigenic effect of the 2-hydroxy metabolites can be attributed to the high clearance rate, O-methylation by the COMT enzyme, which may inhibit tumor cell proliferation and angiogenesis [ 19 ]. In addition, it has been demonstrated that when COMT is blocked or when 2-hydroxyestrogens undergo redox cycling, they can cause DNA damage and release free radicals [ 23 ]. Moreover, some studies showed that methoxyestrogens like 2-methoxyestradiol inhibit carcinogenesis through microtubule destabilization [ 24 , 25 ].

3.2. 4-Hydroxylation pathway

In liver microsomes, the 4 hydroxylations of estradiol primary start with the CYP3A4/3A5 enzyme [ 26 ]. 4-Hydroxylated catechol estrogens showed a carcinogenic potential because of their ability to damage the DNA by depurination adducts and oxidative damage that may initiate breast cancer [ 16 , 27 ]. As a biochemical marker, the ratio of 4-/2-hydroxyestradiol is used to differentiate malignant breast tumors because the production of 4-hydroxyestradiol is four times higher than 2-hydroxyestradiol in adenocarcinoma [ 28 ]. Additionally, it has been demonstrated that, as compared to control women, women with breast cancer or at high risk of developing breast cancer had much greater ratios of quinone-estrogen DNA adducts to their parent or conjugated catechol estrogens [ 29 ]. Moreover, some studies showed that the 4-methoxyestrogens prevent the oxidative metabolism of estradiol and oxidative DNA damage [ 30 ]. Although other studies showed that inhibition of the COMT enzyme was linked with higher levels of depurination 4-hydroxyestrone linked with higher levels of depurination 4-OH Estrone/Estradiol-DNA adducts [ 31 ].

3.3. 16-Hydroxylation pathway

In the 16-hydroxylation pathway, 16α-hydroxyestrone is the main product. 16α-hydroxyestrone showed a potential tumor stimulation by catalyzing unprogrammed DNA synthesis and promoting independent growth in mammary epithelial cells [ 32 , 33 ]. Some animal studies showed that urinary concentration of 16α-hydroxyestrone is accompanied by an elevated proliferation of mammary cells and mammary tumor incidence [ 34 , 35 ]. Another study shows that there is a relation between estradiol 16α-hydroxylation and increasing the risk of developing breast cancer in humans, the levels of 16α-hydroxyestrone were eight times higher in the cancerous units of mammary terminal duct lobular in comparison with the nearby mammary fat tissue, which suggests a critical role of 16α-hydroxyestrone production in breast cancer induction [ 36 ].

4. Biological function of estrogen in the human body

Estrogens are found in both males and females; they are usually present at higher levels in women during reproductive age. They control the improvement of women's secondary sexual characteristics, such as breasts, and are elaborated in the thickening of the endometrium and other features of regulating the menstrual cycle. In men, estrogen regulates specific functions of the reproductive system essential to sperm maturation [ 8 , 37 ]. Estrogen receptors are responsible for mediating estrogen actions and functions; a dimeric nuclear protein binds to DNA and has a role in controlling gene expression. Similar to the principle of the other steroid hormones, estrogen moves in passively into the cell and binds to it then activates the ER [ 38 ].

5. Estrogen receptor (positive and negative)

ER-positive tumors overexpress the ER while tumors that contain a small number of receptors and sometimes no receptors are called ER-negative which is directing the treatment options [ 39 ]. Patients with ER-negative have lower survival rates in the first few years and their tumors are usually more aggressive [ 40 , 41 ]. However, 10 years after the initial diagnosis of the tumor without being associated with other health problems, the possibility of relapse is more in patients who have ER-positive [ 42 ]. In addition, other factors affect the life of a breast cancer patient, such as the infiltration of lymphocytes, especially for patients who have the disease before the age of forty, as the presence of a large number of CD8 + T lymphocytes contributes to the high survival rates of the patient, and this shows It is more clearly in patients who have ER-negative compared with patients with ER-positive [ 43 ].

6. Estrogen and estrogen receptors role in cancer development

The α and β isoforms of estrogen receptors exhibit similar structural and functional organization [ 3 ]. Both receptors interact in the same way with endogenous estrogens, mostly with 17β-estradiol (E2) [ 44 ]. E2 plays an essential role in the development and malignant progression of multiple cancers. The oncogenic function of estrogens is considered in both classical and non-classical hormone-sensitive carcinomas such as prostate, breast, endometrial, lung, colon, and ovarian cancers [ [45] , [46] , [47] , [48] ]. The molecular basis of cancer initiation by estrogen has been suggested through the production of aromatic estrogen metabolites (catechol estrogens quinones) that are derived from normally formed catechol estrogens. Chemically, depurinating DNA-adducts are formed by the reaction of 4-OHE 1/2 or 2-OHE 1/2 with Adenine/Guanine bases which leads to DNA mutations ( Fig. 3 ) [ 16 ].

6.1. Endometrial cancer

Tumoral ER expression is mentioned in approximately 30 different kinds of cancer, predominately in hormone-sensitive tumors like ovarian, breast, prostate, and endometrial cancers [ 49 , 50 ]. By utilizing immunohistochemistry (IHC), studies were able to compare ER protein expression with clinicopathological characteristics in tumor tissue and illustrated differential relations to the prognosis of disease based on the localization of cells and cancer type [ 48 ]. Endometrial cancer which is considered the most popular type of uterine cancer, using histopathology, can be subdivided into two types [ 51 ]. Type I endometrial tumors, also called low-grade endometrioid, form most of the endometrial cancer cases around 85%, usually express high levels of α estrogen receptor (αER), and are supposed to be hormonally driven [ 52 ]. Type II tumors contain high-grade endometrioid tumors, clear-cell, serous tumors, carcinosarcomas, and tumors with diverse histology. These tumors are expressing ER at low levels, have a worse prognosis, and have combined molecular features with serous ovarian cancer and triple-negative breast cancer such as a high prevalence of p53 mutations and a high number of copies of a variation [ [53] , [54] , [55] ].

6.2. Ovarian cancer

Extensive research in epidemiology has illustrated that hormonal and reproductive exposures are linked with a high risk of ovarian cancer. However, how these factors impact ovarian carcinogenesis and lead to tumor development is still not fully understood. Epithelial ovarian cancers are heterogeneous in their morphology, gene and protein expression [ [56] , [57] , [58] ]. These variations are mandatory to understand the etiology, prognosis, and treatment of ovarian cancer [ 59 ].

Studies have demonstrated differential associations between the risk factors of ovarian cancer and α-ER and progesterone receptor (PR) status, while no previous research has observed associations of ovarian cancer risk factors with β-ER expression [ 60 , 61 ]. Some reports suggested tumor suppression activity of ERβ in ovarian tissues and showed low expression in malignant transformation; with cell localization pattern [ [62] , [63] , [64] , [65] ]. A study done by De Stefano and colleagues to distinguish between normal and cancer ovarian cells found that; ERβ staining was more likely to be localized in the nucleus in normal ovarian tissue while it was more likely to be localized in the cytoplasm in ovarian cancer cells [ 66 ]. Additionally, higher levels of expression of the ERβ protein have been linked with enhanced progression-free survival, furthermore, the probability of metastasis of lymph nodes has declined in serous tumors [ 67 , 68 ]. A recent study showed alterations in expression and localization of ERβ noticed to be essential for causing ovarian cancer [ 59 ].

6.3. Prostate cancer

It is already known that the estrogen receptor signaling pathway is biologically relevant in prostate cancer but has been relatively under research as a biomarker in prostate tumors. Estrogen has a significant part in physiological hormone signaling, and circulating levels can be distinguished in males [ 69 ]. Presently, it is not fully known if direct signaling through ER has an impact on prostate cancer behavior in models or patients. Estrogen-based treatments were one of the first effective therapy choices for advanced prostate cancer and are still utilized in many countries [ 70 ]. Its therapeutic effects were thought to be the effect of chemical castration which results from negative feedback on the hypothalamic-pituitary-testicular axis [ 71 , 72 ]. By utilizing knockout mice lacking the aromatase enzyme in previous studies, the absence of the production of estrogen prevented prostate cancer progression despite the raised levels of testosterone [ 73 ].

7. Estrogen and estrogen receptors and risk of breast cancer

7.1. estrogen role in breast development.

Breast cancer is the m ost common female cancer with no decline in the incidence, prevalence, or mortality. In 2023, it has been estimated that about 300 000 new cases of BC will appear with more than 43 000 deaths in the USA [ 74 ]. In 2020, breast cancer surpassed lung cancer to become the most frequently diagnosed cancer and ranked fifth among the leading causes of cancer-related fatalities worldwide. During that year, there were approximately 2.3 million reported cases and 685 000 documented deaths attributed to breast cancer [ 75 ]. In combination with growth hormone (GH) and its secretory product insulin-like growth factor 1 (IGF-1), estrogen is important in mediating breast development during puberty and breast maturation during pregnancy to prepare for lactation [ 76 , 77 ]. Estrogen is highly involved in breast development and it is primarily responsible for making the ductal component of the breast as well as for causing growth in fat deposition and connective tissue [ [78] , [79] , [80] ]. Moreover, it is indirectly elaborated in the lobuloalveolar component, via increasing the expression of progesterone receptors in the breasts and by inducing prolactin secretion. After working with estrogen, progesterone, and prolactin together, they can complete the growth of the lobuloalveolar during pregnancy [ 78 , 81 , 82 ].

7.2. Expression and distribution of ER in the breast

The expression of the individual isoforms of ER is regulated differently in the breast epithelium, compared with other tissues [ 83 ]. ERα and ERβ show some distinct expression patterns; ERα is controlled in the luminal epithelial compartment, while ERβ is expressed in myoepithelial cells and luminal, as well as the endothelium of blood vessels and stromal cells [ 84 ]. Interestingly, these isoform-specific expression manners can differ between species, for instance, in the rat mammary gland, the ERβ is expressed throughout all stages of development, while ERα demonstrates fluctuating expression, it increases during puberty and declines during pregnancy, as well as increases during lactation, and decreases again in the post-lactating gland [ 85 ]. On the other hand, in the rhesus monkey, neither ERα nor ERβ could be noticed in the lactating mammary gland, nor was PR detected, this is a confirmation that observations that are noticed in animal models, may not always be prolonged into the human breast [ 86 ]. Therefore, the expression of steroid hormone receptors in normal breast tissue is highly dependent on cell type, the stage of progression, and the exposure to cycling endogenous or exogenous hormone utilization.

7.3. Estrogen and breast cancer

The ovarian hormones of females, estrogen, and progesterone are essential regulators in the development and function of normal breasts, as well as critical in breast cancer. The breast is developmentally infrequent in the fact that the main part of the improvement of the breast happens postnatally, during puberty, and at the onset of pregnancy [ 87 ]. Both estrogen and progesterone are censoriously involved in these normal evolving processes, having highly coordinated functions in the development of the ductal structures and amplification of lobules of the normal epithelium. It looks that these behaviors become undermined in the development of breast cancer, connecting both steroids in the enhancement and progression of cancer [ 83 ].

Breast cancer is considered mostly a hormone-dependent disease [ 88 , 89 ]. Approximately 70–80% of breast cancers express progesterone receptors and/or estrogen receptors, and if they are found in a tumor, are a good mark as a promising prognostic biomarker [ 89 , 90 ]. In addition, their expression in malignant cells is mostly associated with other tumor characteristics. The positive association between PR, ER, and prognosis has been identified with the progress of multi-gene prognostic processes that categorize breast cancers into clinically relevant groups, with PR and ER segregating into the better distinguished luminal cancer subtypes as demonstrated in Fig. 4 [ 91 , 92 ]. For managing ER + breast cancer, using agents targeting the signaling pathway of estrogen is still the most effective treatment [ 83 ].

The five main subtypes of breast cancer; are where the best prognosis is when the ER is positive, while the worst is a triple-negative case when ER is negative. BioRender (2021). Intrinsic and Molecular Subtypes of Breast Cancer. Retrieved from https://app.biorender.com/biorender-templates/t-5f872409fb2c3900a82e109e-intrinsic-and-molecular-subtypes-of-breast-cancer .

An abundance of clinical and experimental data in various studies has illustrated that estrogen is critical in the progression and proliferation of breast cancer [ 93 , 94 ]. In different malignant breast cells, the function of an ER signaling pathway is to promote unequal rates of cell proliferation and apoptosis, with pro-survival and proliferation signals devastating pro-death and quiescence signals [ 95 ]. Dependable on a pro-proliferative role, there is in vitro proof that estrogen can inhibit apoptosis in breast cancer cells by up-regulation of Bcl-2, an anti-apoptotic proto-oncogene. As a result of its part in the proliferation and growth of tumors in breast cancer cells, the ER signaling network has been considered an attractive agent for the development of therapeutic targets [ 96 ].

8. Factors affecting breast cancer

8.1. obstetric and gynecological factors, 8.1.1. menstrual cycle.

The menstrual cycle is a physiological process that starts in females at ages ranging from 8.5 to 13 years old, and it repeats in a cycle-like pattern that varies in length from 25 to 34 days until they finally stop experiencing it for one year entering a stage called menopause at an average age of 51 years old [ 97 ]. The cycle alternates between two phases as it happens each time, a follicular phase that ranges from 10 to 16 days, and a luteal phase that is usually the same in all women that is 14 days. This makes the follicular part of the cycle the usual reason for its length difference between women, what mainly regulates this process are hormones secreted from the hypothalamus, the pituitary gland, and the ovaries like estrogen and progesterone [ 98 ], which induce different changes in the reproductive organs leading to the capability of fertility [ 99 ]. Accordingly, there is variability in the menstrual cycle's age of onset, length, and age of termination between different individuals, but does that have any role in increasing the risk of developing breast cancer in women? And does estrogen play a role in that risk?

Understanding the relationship between the menstrual cycle and breast cancer could be beneficial in diagnosing and treating breast cancer since the aggression and poor prognosis characteristics of breast cancer in premenopausal women could be due to the fact of the influence of menstrual cycles on estrogen receptor-positive subtypes of breast cancer, which are the most common in that age group.

8.1.1.1. Age of menarche and menopause

The age of menarche and time of menopause seem to affect the risk of developing breast cancer, due to their role in the time and amount of exposure to hormones like estrogen and progesterone. An earlier age of menarche induces a rise in breast cancer risk since it causes earlier exposure to the hormonal changes that induce the beginning of menstrual cycles. As well as, a rise in estrogen levels in the first couple of years following early menarche that can remain throughout their fertile years [ 100 ]. This risk is limited to hormone receptor-positive subtypes of breast cancer [ 101 ]. Moreover, the same concept of increased estrogen exposure is related to the increase of breast cancer risk related to a late age of menopause, due to more exposure to menstrual cycles and their hormones, although the increase in that risk may be not evident up until 10–20 years after menopause [ 100 ].

8.1.1.2. Menstrual cycle length and regularity

The regularity and length of the menstrual cycle both have an association with breast cancer risk, a short length, and a regular cycle are associated with breast cancer occurrence since more menstrual cycles result in a shorter follicular phase and therefore more dominant exposure to progesterone and an increased division of epithelial cells in the fixed luteal phase each cycle [ 102 ]. Despite some data suggesting no relation between menstrual cycle irregularity and breast cancer with an exception of a precise group of women aged 30–34 years old with a high level of irregularity [ 103 ]. Likewise, no relation between irregularity and increased length of menstrual cycles and breast cancer risk again with the exception of longer menstrual cycle length during the age of 18–20 years old decreasing the risk of breast cancer in women younger than 40 years old [ 104 ].

8.1.2. Pregnancy

Breast cancer that is diagnosed during pregnancy or after it the post-partum period has a poor degree of prognosis [ 105 , 106 ]. Many factors related to pregnancy are thought to influence breast cancer risk. The first one is the age of the woman when she had her first pregnancy, or “age at first pregnancy”. In general, women who first conceive at an older age have a higher risk of developing breast cancer, while younger women have a decreased risk of developing breast cancer. The mechanism behind that is that older women will go through more menstrual cycles and therefore be more exposed to substances like estrogen that can promote the carcinogenesis of breast tissue. Other than that, some changes occur in pregnancy that protective against breast cancer, like the hormonal changes that happen in early pregnancies that secure a gene called p53, which helps in the cessation of the cell cycle, therefore, stopping cell growth, another hormone change is the production of human chorionic gonadotropin, a hormone that differentiates breast cells and makes them less prone to a response by carcinogens [ 107 ]. However, age at first pregnancy doesn't affect all breast cancer subtypes in the same way, for example, triple negative and human epidermal growth factor receptor 2 (HER2) subtypes of breast cancer are not affected by it, while the luminal subtype of breast cancer has more prevalence among women who are older than 24 years old when they have their first birth [ 108 ]. The second factor is the number of pregnancies that the woman had regardless of whether it resulted in an abortion, stillbirth, successful childbirth, or “parity”. Parity has a protective effect against breast cancer, this could be due to the hormonal changes occurring during multiple pregnancies like decreasing estrogen levels and increasing progesterone levels, as well as increasing the differentiation of mammary tissue while decreasing the activation of its stem cells [ 109 ]. Nevertheless, the effect on breast cancer varies according to subtype, as it decreases the risk of developing hormone-receptor-positive subtypes of breast cancer mainly the HR+ and Ki-67 subtypes [ 110 ]. The time length between each birth can also play a role in breast cancer risk. Although shorter intervals between each childbirth (excluding stillbirths and abortions) showed a protective effect against the lobular breast cancer subtype being effective up to the fifth childbirth, a longer interval between the first and second childbirth provides protection specifically in premenopausal women against the ductal subtype of breast cancer [ 111 ].

The hormone levels during pregnancy, the length of the pregnancy, and the gender of the fetus have been suggested to be related to the development of BC. The hormone levels that decrease breast cancer risk when elevated are the human chorionic gonadotropin hormone (beta-HCG) decreasing it by 30% and the Alpha-fetoprotein hormone (AFP) decreasing it by 50%, while the hormone that increases breast cancer risk while elevated is the estrone hormone increasing it by 2.5 times [ 112 ]. Secondly, full-term pregnancy is associated with a lower risk of breast cancer in the long term but a higher one immediately following the birth after the full-term pregnancy is compensated with breastfeeding [ 113 ]. Lastly, the sex of the fetus has no relation to the breast cancer risk [ 114 ], however, in certain cases like hypertension induced in pregnancy also called “preeclampsia” a male fetus has an impactful decrease in the risk of developing breast cancer for the mother [ 115 ].

8.1.3. Breastfeeding

Previous studies showed that breastfeeding per se has an overall reduction in breast cancer risk [ 116 ] with more impact on young women [ 117 ]. It may have different influences on the development of different subtypes of breast cancer. A systematic review, and meta-analysis by Lambertini M, Santoro L, Del Mastro L et al., reported a protective effect of breastfeeding against the chance of developing the luminal and triple-negative subtypes of breast cancer, whereas it does not affect the development of the HER2 subtype of breast cancer [ 108 ]. However, its effect on positive receptor subtypes of breast cancer is still unclear and needs more data to be determined. Breastfeeding can also have different effects depending on different BRCA gene mutation carriers, having a protective effect against breast cancer in the BRCA1 gene mutation carriers and no effect on the BRCA2 gene mutation carriers [ 118 ].

Studies demonstrated that longer breastfeeding duration and protects against breast cancer [ 119 ] [ 120 ]. For instance, breast cancer risk reduction by 26% and 37% if the duration exceeds a year [ 121 ]. Although this protection may only be limited only to postmenopausal women [ 122 ]. The mechanism behind this protection that the longer duration of breastfeeding provides is due to the breast cells differentiating after pregnancy to be able to lactate which decreases its responsiveness to substances like estrogen that can stimulate breast cells to become cancerous. Another way is the mechanical flushing of carcinogens and exfoliated DNA-damaged cells and insulin through breast milk, which reduces insulin levels in the blood and prevents the anti-apoptosis effects that insulin can have by increasing the level of substances like insulin-like growth factor [ 123 ]. Nevertheless, a recent review proposed there was still an unclarity of the definitive relationship between breastfeeding and breast cancer risk [ 124 ].

8.1.4. Polycystic ovary syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is the most common metabolic disease occurring in women at the age of reproduction. Women with the condition are more prone to cardiovascular manifestations as well as insulin resistance, but it also affects fertility, hormone balance, and ovulation [ 125 ]. PCOS doesn't have a clear association with an increased breast cancer risk [ [126] , [127] , [128] , [129] ], despite it causing changes in the body that can lead to breast cancer like the high androgen levels in the blood that results in the absence of ovulation and therefore longer exposure to estrogen [ 130 ]. The high levels of insulin that it causes in the blood, as well as having an intersection with a gene that is also present in breast cancer [ 131 ]. Also, it produces high levels of anti -Mullerian hormone (AMH) which could suggest PCOS is the original factor responsible for the increased breast cancer risk occurring in women with high levels of (AMH), not the increase in the hormone itself [ 131 , 132 ]. There are also some data like a population-based case-control study by Kim J, Mersereau JE, Khankari N et al., that does suggest it has a positive relationship with an increased risk of breast cancer occurrence specifically in premenopausal women [ 133 ].

8.2. Ethnicity and diet

Breast cancer is the most common malignancy among women regardless of their ethnic groups with a considerable difference in the incidence between populations [ 134 ]. For instance, the breast cancer risk among Asian American women is lower than it is in Caucasian American women with a small exception related to age and state [ 135 ]. This difference could be due to differences in lifestyles between them, like the diet rich in soybean content [ 136 ]. Another diet that has contents of foods lowering breast cancer incidence is the Mediterranean diet as opposed to a Western diet style, which increases that risk [ 137 ]. Other examples of foods associated with a higher risk of breast cancer are foods like Ultra-processed foods [ 138 ], red meats, higher than 450 g of milk intake per day [ 139 ], saturated fats [ 140 ], and alcohol [ 141 , 142 ]. However, fruits, vegetables, fatty fish [ 143 ], soybean [ 144 ], food containing β-carotenoids [ 145 ], mushrooms [ 146 ], and olive oil [ 147 ] are associated with lowering breast cancer risk. Fruits and vegetables specifically reduce the risk of postmenopausal breast cancer as well as estrogen, progesterone positive, and negative breast cancers [ 148 ].

8.3. Obesity

Weight and body mass index (BMI) can affect breast cancer by the high amounts of aromatase enzymes due to the high content of adipose tissue [ 149 ]. It has different effects on different breast cancer subtypes, increasing the incidence of triple-negative breast cancer in premenopausal women and decreasing the incidence of the luminal A subtype of breast cancer [ 150 ], but has a weaker effect on increasing breast cancer in postmenopausal women [ 151 ].

8.4. Microbiota and breast cancer

Dysbiosis was found to make an impact on the effectiveness of chemotherapy drugs and prefer the environment of tumor development, suggesting an association between gut dysbiosis and the progression of cancers, autoimmune disorders of the gut, or inflammatory diseases. Even with the presence of some skeptical concerns about whether breast cancer development is due to this dysbiosis or the natural selection of microorganisms that can survive in a carcinogenic environment with special nutritional requirements [ 152 ], a diversity of lipid types suggest lipid signatures for the bacterial growth species in breast cancer compared to healthy breast tissue [ 153 ]. Breast cancer environment was reached in higher numbers of Phylum Proteobacteria , families Micrococcaceae, Caulobacteraceae, Rhodobacteraceae, Nocordioidaceae , and Methylobacteriaceae, and genus Propionicimonas compared to benign healthy breast tissue, even with different types of breast cancer like HER2, Luminal A, Luminal B, ER+ the type of microbiome was diverse and different [ 154 ]. A shifting of microorganism types was estimated from the healthy breast tissue and cancerous including the presence of microorganisms that will raise the local breast estrogen exposure level by glucuronidation like S . pyogenes [ 155 ]. To support the role of breast microbiota in breast cancer either as an inducer or consequence of the disease, a study has been done at St. Joseph's Hospital in London, Ontario, Canada by collecting samples from women, aged between 19 and 90 with healthy breasts or with breast cancer. These women underwent breast surgery and the researchers found that breast cancer microbiota was made up of collocation of bacteria that end up with DNA damage and breaks in Vitro including Bacillus, Enterobacteriaceae, Staphylococcus , and Escherichia coli (a member of the Enterobacteriaceae family) and Staphylococcus epidermidis rising [ 156 ]. Fernández et al. support the relationship between the gut microbiota and breast cancer development in many ways. The gut contains many glucuronidase bacteria, including the Clostridium leptum cluster and the Clostridium coccoides cluster, which are members of the Firmicutes phylum. The first method, which included deconjugation of contacted estrogen, came from an endogenous source or even an exogenous source of estrogen through the bile pathway. This deconjugation process will be aided by the Proteobacteria phylum's Escherichia/Shigella bacterial group, which increases the blood level of estrogen. Additionally, the second method involves the function of Firmicutes and Bacteroidetes bacteria of the gut, which are in charge of processing the colon. These bacteria discovered that nutrients were present in much higher ratios among obese women, knowing that obesity is an indirect link between breast cancer and the gut microbiome [ 157 ]. The gut microbiome, which is thought to play a role in the development of breast cancer, should be the first thing to be targeted during breast cancer treatment or even prevention because there is a clear indication that there is a difference between microbial patterns in healthy breast tissue and women with breast cancer where many DNA breakers are found. Additionally, researchers should discover a means of preventing dysbiosis so that the microbiome balance in breast tissue remains constant and does not change [ 158 , 159 ]. The favorable effects of probiotic therapy on the treatment of breast cancer contradict the idea of the negative effects of microbiota and its function in breast cancer given that this bacterium also contributes to the metabolism of cytotoxic medicines [ 160 ]. Another study confirmed the beneficial effects of probiotics in preventing the growth and even genesis of breast cancer. By avoiding dysbiosis, we can improve the balance of the gut's metabolic activity and lower obesity, which is known to increase the risk of breast cancer [ 161 ]. Many bacteria found in breast cancer patients have an inverse relationship to the prognosis of breast cancer, a point that should be taken into consideration in the future of breast cancer treatment strategies. These bacteria may affect body weight, chemotherapy agents, and even the potential of neurological side effects [ 162 ].

8.5. Smoking

Breast cancer in active or passive smokers can't be negligible knowing that this tobacco smoke included a lot of carcinogens of breast tissue, especially mammary cells. The enzyme N-acetyltransferase 2 (NAT2) was found to play a role in the detoxification and eradication of tobacco smoke chemicals so genetic polymorphisms of this enzyme gene will play a role to determine whether you are a fast or slow acetylators. Moreover, being a slow acetylators with a long history of smoking increases the risk for breast cancer development two times. The onset of smoking was found to increase the risk, like young age or long history of smoking before the first term of pregnancy [ 163 ]. Jones et al. reported in their cohort study that the risk of breast cancer and smoking was potentially supported, especially if the onset of smoking was even before the menarche in young girls with a family history of breast cancer [ 164 ]. Breast cancer at early stages before lymph node metastasis or organ spread was found to begin at higher rates among smokers of younger age [ 165 ]. Another study found that smoking plays a significant role in the prognosis of breast cancer with higher rates of mortality before or after the diagnosis of breast cancer [ 166 ].

8.6. Oral contraceptive

Several reviews support the idea that oral contraceptives increase BC risk especially, in up five years of use or before the first pregnancy [ 167 , 168 ]. A similar study suggests that from first pregnancy and up the breast becomes well-differentiated and the carcinogenic effect is negligible of oral contraceptives on breast tissue especially mammary cells of the breast, compared to the established risk of oral contraceptives and breast cancer at the age before menarche even during the prenatal period [ 169 ]. The data is still not enough to powerfully support the relationship between the oral contraceptive in breast cancer and the variable impact of oral contraceptives on different breast tissue receptors, which are the main players in breast cancer development like estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) [ 170 ]. A Cohort study found that women with positive BRCA1 and BRCA2 mutations developed a significant risk of breast cancer but only in the short term, while lifelong combined oral contraceptives (estrogen and progesterone) reduced the cancer risk, but some drugs like hormonal replacement therapy were found to interfere with this protective long term positive impact of this combined oral contraceptive [ 171 ]. Many mechanisms like the disruption of endocrine system balance or provoking breast cancerous cells or even promoting metastasis for present cancerous cells in the tissue of the breast, was found to be strongly related to the onset of the use of oral contraceptive despite the other relations like the combination with progesterone or long-term effect of oral contraceptive drugs [ 172 ]. Ovarian and endometrial cancer in oral contraceptive women users was found to protect against them compared with limited risk for breast cancer development [ 173 ].

8.7. Tamoxifen and aromatase inhibitors

Most women with breast cancer are in a premenopausal state and a wide range of patients are hormone receptor-positive. Therefore, the use of blockers for this hormonal receptor was the way of treatment for a long time like Tamoxifen, but in the last years with the appearance of aromatase inhibitors, the directions are more toward using aromatase inhibitors, especially with gonadotropin-releasing hormone (GnRH) agonists showed to have a promising effect on the treatment of hormone receptor-positive particularly in premenopausal women [ 174 ]. The adjuvant and neoadjuvant hormonal therapies with aromatase inhibitors with or without combination with tamoxifen showed different impacts on the effectiveness of the treatment and management of breast cancer. In neoadjuvant therapy, trials showed that aromatase inhibitors like (anastrozole, letrozole, and exemestane) are more effective than tamoxifen. Compared to conflicting outcomes in adjuvant therapy, the main component of which is tamoxifen. However, we can't deny the combination with aromatase inhibitors showed a powerful impact on breast cancer treatment despite the different regimens and duration of treatment in adjuvant therapy of breast cancer. Also, the risk of osteoporosis and thromboembolism should be kept in mind when dealing with the different toxic effects of each drug [ 175 ]. With the documented side effects of some breast cancer therapy even if they are not that common, we can overcome them with other medications like bisphosphonates for bone fracture with aromatase inhibitors. The use of aromatase inhibitors in premenopausal women with early-stage of estrogen receptor-positive (ER+) is not that effective compared to postmenopausal women to reduce the mortality rate, except if we use ovarian suppression agents by then the therapy may show the promising result in premenopausal women. So, in premenopausal women, tamoxifen will preserve its significant impact on mortality as indicated many years ago compared to aromatase inhibitors [ 176 ]. The recommendations from the American Society of Clinical Oncology (ASCO) panel to use an aromatase inhibitor in postmenopausal women especially the third generation of them including anastrozole, letrozole, and exemestane in estrogen-positive breast cancer with or without tumor metastasis i.e. as adjuvant therapy was more effective even before the tamoxifen therapy initiated [ 177 ]. In the reduction and even absence of estrogen source from ovaries in postmenopausal women, the adipose tissue represents the core fuel for estrogen receptor-positive breast cancer in postmenopausal women a process needed aromatase to catalyze the final and rate-limiting step in the biosynthesis of estrogen. Accordingly, using aromatase inhibitors in hormone receptor-positive breast cancer in postmenopausal women is still the gold standard treatment. Also, the availability of MEK inhibitors, Raf inhibitors, PI3K inhibitors, mTOR inhibitors, and Akt inhibitors support the guidelines to continue in the same rhythm of management of cancer in postmenopausal women despite the resistance issue of aromatase inhibitors by them [ 178 ]. Consequently, the resistance issue for estrogen-positive breast cancer that is treated with the hormonal therapy pathway is the main boundary against hormonal therapy. However, the addition of inhibitors for many of these resistant pathways along with hormonal therapy may represent the way of overcoming this challenge in estrogen-positive breast cancer treatment [ 179 ]. The treatment is not always the case, the directions even support the prevention and development of breast cancer by using hormonal agents like tamoxifen, especially in women with a family profile of breast cancer [ 180 ]. With the wide spread of nonsteroidal anti-inflammatory drugs (NSAIDs) finding a relation between using them and the risk or even prevention of breast cancer represent a matter of interest. A recent study published in 2020 reported that using nonsteroidal anti-inflammatory drugs (NSAIDs) after using Proton pump inhibitors showed to reduce the risk of breast cancer. This is a promising result that needs further investigations and studies to generalize the results [ 181 ]. Likewise, statins for a long time, used for controlling elevated cholesterol levels and maintenance of the prognosis of ischemic artery diseases, even approved using them as tumor-killing medication with an established role of them in decreasing the mortality and the recurrence of breast cancer have been found in the patients. On the other hand, poor data about using statins for targeted therapy for breast cancer particularly with local or metastasis conditions or even in the wide diversity of breast cancer types [ 182 ].

8.8. Local hormone therapy

One of the postmenopausal complications in women is the complaining of genital changes like vaginal atrophy and symptoms of hot flashes due to changes in the hormonal balance mainly of estrogen in their body at that period of their life. Accordingly, the availability of synthetic topical estragon analog to relieve genital symptoms only showed no link to increases in the risk of heart disease or cancer risk in general [ 183 ]. So the effectiveness of topical estrogen for the treatment of genital and even urological symptoms as well in postmenopausal women can't be denied, but we should be aware of the risk of recurrence of breast cancer secondary to estrogen medications for those purposes [ 184 ]. In diagnosed breast cancer patients who are on therapies like aromatase inhibitors, it showed its effect on the genitalia of the women ranging from simple dryness to petechial bleeding and painful intercourse. Therefore, using topical estrogen may relieve these symptoms, and even though it should be used with caution, the patient must understand that using this topical estrogen that will relieve the genital symptoms may increase the recurrence rate of breast cancer that she already had [ 185 ]. Nevertheless, insufficient statistical evidence was estimated for the risk of breast cancer recurrence for patients who were treated with aromatase inhibitors and using a topical hormonal treatment for vaginal symptoms like dryness at the same time. However, patients who were treated with tamoxifen showed no elevated risk of recurrence compared with aromatase inhibitor-treated patients [ 186 ]. Another study suggests that the postmenopausal women who were treated with aromatase inhibitors and took topical estrogen treatment for the vaginal symptoms secondary to aromatase inhibitors showed poor systematic uptake indicating an indirect to decrease the suspicion of using this topical hormonal therapy and breast cancer recurrence [ 187 ]. The alternatives like selective estrogen receptor modulators (SERM) e.g. ospemifene and others like promestriene are better compared to the risky treatment by vaginal estrogen at least for short-term therapy for vaginal symptoms [ 188 ].

8.9. Hormone replacement therapy

Hormonal replacement therapy showed effective outcomes in the treatment of menopausal symptoms in women like hot flashes [ 189 ]. A Nested case-control study concluded that breast cancer risk, especially lobular type, was increased by a long period of using hormonal replacement therapy [ 190 ]. Women with the famous breast cancer mutations BRCA1 and BRCA 2 who did prophylactic salpingo-oophorectomy (RRSO) followed the use of hormonal replacement therapy showed no effect on the breast cancer risk at least for estrogen formulation alone of hormonal replacement therapy [ 191 ]. Topical forms of hormonal replacement therapy or progesterone alone hormonal replacement therapy were reflected in opposite to estrogen or combined estrogen-progesterone hormonal therapy to not linked with elevating the risk of breast cancer. Other factors like body weight play a role in directing the risk, which shows slim women with higher risk compared to obese ones who used hormonal replacement therapy [ 192 ].

9. Prenatal estrogen exposure and the risk of breast cancer

The variety of estrogen concentrations during pregnancy among pregnant women is explained by the impact of numerous exogenous variables on estrogen levels in the intrauterine period. In comparison to estrogen during the intrauterine period, when levels are ten times higher, the adult lifetime estrogen level is often significantly lower. Furthermore, estrogen is one of the key players in the development of breast cancer. Trichopoulos put up a theory that claims that the risk of breast cancer starts even before conception, or in utero [ 193 , 194 ].

To calculate the chance of getting breast cancer later in life, many studies employed indirect indicators of estrogen levels during pregnancy. Some of these indicated factors, such as greater mother age and having twins, have been linked to an increased risk of breast cancer after pregnancy, while others, such as maternal smoking, have been linked to a decreased chance of developing breast cancer in later life [ 195 ]. Even the chance of acquiring breast cancer varies amongst twins, according to a study, with dizygotic twins exposed to more estrogen having a higher risk than monozygotic twins [ 196 ]. Diethylstilbestrol (DES), an exogenous estrogen analog, was used by women to stabilize pregnancies and lower the chance of several pregnancy problems, including abortion [ 197 ]. It was discovered to contribute to the later development of breast cancer in their daughters, which was explained by its influence on DNA methylation by raising DNA methyltransferases (DNMTs) levels, which in turn affected the genes of the mammary gland in the breast that are responsive to estrogen [ 198 , 199 ].

However, other research revealed that conditions including pre-preeclampsia and twins will secrete less potent forms of estrogen-like E3 and E4, and even in rare cases, may lower intrauterine estrogen [ 200 ]. For the first three months of pregnancy, when an increase in several hormone levels, including estrogen, may indicate that a protective factor has not been triggered, birth weight and its relationship to hormonal levels during pregnancy are not a particularly promising indicator for the risk of breast cancer [ 201 ]. Given that most left-handed people are at a lesser risk for breast cancer, an interesting study discovered that early life androgen, specifically testosterone in comparison to estrogens, is proposed as preventive against the disease [ 202 ]. The Digit ratio, which not only predicts the probability of getting breast cancer but also the onset of it, is another promising study of predicting breast cancer risk using non-invasive techniques. Which is how it depicts the prenatal testosterone level that may be linked to a lower risk of breast cancer [ 203 ].

10. Fibroadenoma

Fibroadenoma of the breast is common among all ages with a peak incidence during the second and third decades occurring in 25% of females [ 189 , 204 ]. Histologically, the fibroadenoma is a biphasic tumor consisting of an epithelial and a stromal component. The epithelial component of it is similar to normal breast epithelium [ 205 ]. However, the incidence of carcinoma in situ and invasive carcinoma originating from fibroadenoma is 0.3% [ 205 ]. Moreover, the classification of fibroadenomas is based on their histology and size. Simple fibroadenomas are the most common type and can occasionally manifest as a smooth movable mass up to 3 cm in diameter. Giant fibroadenomas are less common but can appear throughout adolescence [ 206 ].

The clinical assessment of fibroadenomas involves clinical examination (history, physical examination) imaging, and non-surgical tissue biopsy (triple test) [ 207 ]. It is usually present as an encapsulated, mobile, rubbery, non-tender mass [ 208 ]. Ultrasound is used in younger women while mammography is combined with ultrasound in older women for the diagnosis of fibroadenoma. Notwithstanding, the most accurate way to confirm the diagnosis is tissue biopsy, which is performed by either fine-needle aspiration or core biopsy [ 207 ]. Fibroadenomas are accounting for ≤50% of all breast biopsies in Tokyo, New York, and Nigeria [ 189 ]. Asymptomatic fibroadenomas are managed conservatively while symptomatic fibroadenomas are managed by surgical excision [ 207 ].

As mentioned earlier, the fibroadenoma is a biphasic breast lesion in which both epithelial and stromal components of the terminal ductal unit proliferate [ 205 ]. The primary event is usually thought to be stromal cell proliferation, followed by epithelial cell proliferation. Furthermore, as women age, the stroma becomes less cellular and more hyalinized [ 209 ]. Although these findings occur in young women and sclerotic involution in the elderly, the fibroadenoma is hormonally dependent [ 210 ]. A recent discovery of higher plasma levels of estradiol in patients with fibroadenoma supports this hypothesis [ 211 ].

The estrogen receptor (ER)-α is the traditional mediator of the response to estradiol. Although ER-α is mostly expressed by epithelial cells in fibroadenoma, its expression by stromal cells remains controversial. According to a recent investigation, only the ER-β isoforms were detected in the stromal cells of adult human mammary glands. Recent studies revealed that ER-β activates a heterogeneous fibroblast population with different lifespans in the stroma of fibroadenomas. In fibroadenomas, ER-β-related myofibroblastic differentiation of fibroblasts may influence matrix remodeling and inhibition of the sclerotic involution [ 211 ].

In young premenopausal women, the incidence and development of fibroadenoma are dependent on their reproductive history and the presence of ovarian hormones. In addition, environmental factors may affect endogenous estrogen levels and cause hormonal dysfunction, and menstrual fluctuations, which may increase the risk of fibroadenoma, and some lifestyle factors with antiestrogenic effects may reduce the risk of fibroadenoma. Also, early pregnancy appears to prepare the breast for lactation, while estrogens and other circulating hormones stimulate the fast proliferation of epithelial breast tissue, followed by hormonally driven mammary epithelium differentiation. This early differentiation could prevent epithelial cells from developing fibroadenoma, which is caused by estrogen-dependent hyperplasic processes. Even while the preventive effects of OCPs containing >50 mcg estrogen (but not for progestogen-only OCPs) were suggested, the current studies showed that the incidence of fibroadenoma is not higher in women who use oral contraceptives for longer periods. Likewise, severe stress, which can raise endogenous estrogen levels, was considered another possibility in this aspect. However, further research is needed to determine the involvement of psychological illnesses in the occurrence of fibroadenoma [ 212 ].

11. Fibrocystic breast disease (FBD)

11.1. pathophysiology of fbd.

Fibrocystic changes refer to several clinical and histological abnormalities in the female mammary gland. Some of these should be viewed as a disorder of physiological development, maturation, and involution rather than a disease. Moreover, fibrocystic changes are common in around 50% of all women over the age of 30  204 . This disease progresses with premenopausal age and is most noticeable in women in their forties. While fibrocystic changes regress during the postmenopausal period. The pathophysiology of fibrocystic changes is determined by estrogen dominance and progesterone deficiency, which results in connective tissue hyperproliferation and fibrosis and is followed by facultative epithelial proliferation. Likewise, the risk of breast cancer is increased two to fourfold in these patients [ 213 ]. Proliferative and non-proliferative fibrocystic changes are classified according to their risk [ 204 ].

One of the key pathophysiological issues in fibrocystic breast diseases is the prevalence of elevated estrogen concentration throughout the menstrual cycle [ 214 ]. Likewise, changes in the concentration of steroid receptors and their affinity for estradiol may cause hormonal imbalance, which leads to the interlobular connective tissue to accumulates mucosal edema under the influence of estrogen, resulting in swelling and hyalinization. All of these factors could have an impact on the appearance of mastopathy and sclero-cystic changes. Estrogen stimulates the synthesis of DNA, mitotic activity, differentiation, and proliferation of breast cells and connective tissue at the cellular level [ 215 ].

11.2. Clinical assessment of FBD

The clinical assessment of fibrocystic changes involves clinical examination (history, physical examination) imaging, and fine-needle aspiration [ 207 ]. Benign cysts are rubber-like in texture and move about within the glandular breast tissue, chest wall, and skin. Except for inflammatory cysts, a patient's discomfort and tenderness are either absent or mild [ 216 ]. Upon additional clinical and diagnostic investigation, the majority of patients present with multiple cysts. These cysts are seen as well-circumscribed, oval to circular, anechoic, or hypoechoic foci of varied sizes on ultrasonography. On the other hand, simple cysts must be distinguished on ultrasonography from complex cysts. Only large lesions that induce persistent symptoms require aspiration. The color and viscosity of cyst fluid can range from a clear, thin content to a whitish, opaque secretion to a dirty-green, bluish, or gray secretion. Notwithstanding, the color has no diagnostic value [ 204 ].

11.3. Risk factors of FBD

Gallicchio et al. showed weakly relationship between breast cancer and ESR1 variations and one of the four ESR2 variants investigated in 1438 Caucasian women with benign breast disease [ 217 ]. Obesity and excess body fat, according to current knowledge, are the causes of increased estradiol and estriol production (product of estradiol transformation) suggesting that a higher BMI may have an indirect effect on the development of FBD (through hyperestrogenemia) [ 214 ].

12. Ductal pathology

12.1. ductal hyperplasia.

The terminal duct lobular unit (TDLU) is formed when normal breast ducts come to an end. The duct terminates in lobules made up of acini, which are tiny glandular structures. Inner luminal epithelial cells and outer luminal myoepithelial cells make up the bilayer that lines the ductal-lobular systems [ 218 ]. The TDLU is where the majority of breast lesions (both benign and malignant) occur. Atypical ductal hyperplasia (ADH) is clonal epithelial cell proliferation within the duct. The TDLU or the interlobular ducts are involved in ADH. ADH has small, spherical, monomorphic, non-overlapping cells with homogeneous nuclei, uncommon mitosis, and inconspicuous nucleoli, as well as other atypical histological characteristics [ 219 ].

In breast tissue, atypical ductal hyperplasia is a pathogenic condition. Atypical Ductal Hyperplasia (ADH) is generally discovered by chance on needle biopsy specimens taken in response to aberrant mammography findings. Because atypical ductal hyperplasia is associated with an increased risk of breast cancer, it is classified as a "high-risk" lesion rather than a "precursor" lesion. The difference is that breast cancer associated with ADH can occur anywhere in the breasts, not just in the ADH area. The true incidence of ADH is unknown because most cases are discovered by chance. Once discovered, it is known to raise the risk of breast cancer by about fivefold [ 220 ]. It is critical to address risk reduction techniques if atypical ductal hyperplasia has been diagnosed and breast cancer has been ruled out. Moreover, the use of tamoxifen as a treatment option for these women is one such measure [ 221 ]. If a core needle biopsy reveals breast cancer, a more comprehensive excisional biopsy is required to rule out the disease. If on excisional biopsy, only ADH is discovered, the patient is surgically complete. This includes cases with positive margins. There is no need for node sampling or mastectomy because ADH is not a malignancy [ 222 ].

12.1.1. Role of estrogen in ADH

Estrogen is thought to play a role in the pathophysiology of breast cancer by promoting normal growth of the breast epithelium through the estrogen receptor's mechanism of absorption into the cell [ 223 ]. As mentioned earlier, ER expression is found in both normal and malignant breast epithelium to a greater extent [ 224 ]. In both normal breast epithelium and ductal hyperplasia of the usual type, ER expression appears to increase with age, considering ER expression is generally low in the normal ductal epithelium and higher in proliferative breast disease, particularly when linked with atypia and carcinoma in situ [ 225 ]. Increased ER expression in normal ductal hyperplasia has also been linked to breast cancer risk in one case-control study [ 226 ]. However, no studies have looked at the impact of ER expression on breast cancer risk in women with atypical hyperplasia, which is a known higher-risk group [ 227 ]. Moreover, long-term follow-up of the NSABP P-1 study, one of the largest prospective breast cancer prevention trials, has revealed a risk decrease of breast cancer in women with past atypical hyperplasia taking tamoxifen, presumably through the ER [ 221 ].

These clinical findings, along with previous research on ER expression in other benign breast epitheliums, suggest that ER expression in atypical hyperplasia could be a predictor of breast cancer risk in the future. The researchers wanted to look at ER expression in atypical hyperplasia and see if there were any links to age at biopsy, the reason for biopsy, type of atypia, number of atypical foci, involution status, and family history, as well as see if there was any link between ER expression in atypia and subsequent breast cancer risk [ 221 ]. A large cohort of women with atypical hyperplasia was studied, and it was discovered that ER expression is higher in atypical ductal hyperplasia than in atypical lobular hyperplasia. In contrast to previous research, they discovered that ER expression increased with age at the time of diagnosis of atypical hyperplasia. Despite evidence that estrogen exposure is linked to an increased risk of breast cancer and that atypical hyperplasia has more ER expression than normal breast epithelium, the degree of ER expression in atypical hyperplasia does not correlate with the risk of breast cancer [ 228 ].

12.2. Carcinoma In Situ (CIS)

Carcinoma In Situ (CIS) of the breast is a heterogeneous collection of lesions that covers a broad range of clinical and histological changes. Biologically; CIS can range from biologically aggressive lesions with a high chance of progressing to invasive carcinoma to lesions with very low malignant potential. There are two forms of CIS, ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). CIS is common, and it is expected that roughly 20% to almost a third of all women will get it during their lives [ 229 ].

12.2.1. Ductal Carcinoma In Situ (DCIS)

DCIS is an early, localized stage of breast cancer [ 230 ]. It accounts for up to 15% of newly diagnosed breast tumors, and microcalcifications are usually used to detect them [ 231 ]. Moreover, a considerable majority of these tumors will progress to invasive carcinoma if left untreated. DCIS, on the other hand, has a favorable prognosis when properly treated [ 230 ]. In individuals with non-palpable, mammographically discovered DCIS, mammographically guided wire biopsy remains the gold standard for achieving a histological diagnosis [ 232 ]. The optimal management of DCIS remains controversial. The goal of DCIS treatment is to keep the disease localized and prevent it from progressing to invasive carcinoma [ 230 ]. Mastectomy, local excision with radiation therapy, and local excision alone are all possible treatment choices [ 232 ]. Total mastectomy was the treatment of choice for DCIS for decades, and it should still be considered the gold standard against which more conservative treatments must be measured. Additionally, mastectomy is related to a 1% chance of chest wall recurrence, and axillary lymph node dissection is not routinely recommended. On the other hand, mastectomy is likely overtreatment in a significant number of patients, particularly those with minor, mammographically diagnosed lesions. Moreover, local excision alone has been recommended in carefully selected individuals, whereas the rest of the patients undergoing breast-conservation surgery should get breast irradiation. There is evidence that breast-conservation therapy is an effective alternative in the management of selected DCIS patients. The use of radiotherapy after lumpectomy reduces the risk of recurrence significantly. The most common predictors of recurrence include nuclear grade, comedo necrosis, and margin involvement. Adjuvant chemotherapy has no role in the treatment of this disease. Although tamoxifen's significance in the treatment of DCIS is unclear, it should only be used in patients who are participating in clinical trials. Approximately half of all tumors relapse as invasive cancer after breast conservation therapy. The majority of patients with recurrent disease can be properly treated, usually with a salvage mastectomy, but in certain cases with breast-conservation therapy [ 231 ].

12.2.2. Lobular Carcinoma In Situ (LCIS)

This form of breast cancer starts in lobules and terminal ducts and is more common and more frequent than this incident would seem to suggest. When the tumor invades, it often does so in an odd way that enables one to recognize the likelihood of such an origin even though it is hard to trace it after some experience. Furthermore, it is frequently possible to find peripheral areas where lobular carcinomatosis in situ is still clearly visible in the completely infiltrative form. Thus, out of these same 300 examples, 5 had a very distinct pattern, 2 had one that was only moderately developed, and 5 had one that was certainly there but was insufficient [ 233 ].

12.3. Invasive ductal carcinoma (IDC)

Invasive ductal carcinoma (IDC) is a highly malignant subtype of breast cancer that belongs to the classification of epithelial tumors. It is the general designation for nonspecific invasive carcinoma that belongs to the epithelial tumors classification group. IDC is the most frequent kind of breast cancer in women, and it is also the main cause of cancer-related death [ 234 ]. The most dramatic transcriptome alteration occurs at the normal to DCIS transition, while others have found that different stages of breast cancer (ADH, DCIS, and IDC) are highly similar at the transcriptome level [ 235 ].

13. Estrogen-secreting tumors in developing breast cancer

Granulosa cell tumors (GCT) and thecoma are called estrogen-producing tumors. Researchers found that there is a relationship between these tumors and an increased risk of breast cancer [ 236 ]. With the Danish female population as a benchmark, the team of Hammer Anne discovered evidence of a markedly higher incidence of breast cancer in women with GCT. Only a few papers on the likelihood of breast cancer in women with GCT were found by them. Ohel et al. discovered a 6.4% incidence of breast cancer in 172 women during a 15-year follow-up study carried out in 1983, which is similar to the data of Hammer Anne et al. study [ [236] , [237] , [238] , [239] ]. 200 women with GCT or theca cell tumors had a 5.5% incidence of breast cancer, according to Evans et al. study. Three women were diagnosed with breast cancer before the GCT diagnosis, and eight other women received the diagnosis. In the study by Björkholm et al., 936 women who had been diagnosed with either a GCT or a theca cell tumor had a 2% incidence of breast cancer. Four women received diagnoses concurrent with GCT diagnoses, while 15 women received diagnoses post-GCT diagnoses. In addition, reports of an increased incidence of thyroid cancer, endometrial carcinoma, lymphoma, and colon cancer were made [ 237 , 238 ]. In these investigations, there was no distinction made regarding the incidence of breast cancer between women with GCT and those with theca cells. Therefore, it is unknown what the actual incidence of breast cancer is among women with GCT. However, Björkholm reported a 3.3% incidence of breast cancer among 153 GCT women in different research. Björkholm also discovered that GCT women had a considerably higher risk of cardiovascular disease in this investigation. Although the hormonal balance being disturbed was proposed as a potential cause, this has not been supported by other research [ 239 ].

14. Role of estrogen in breast cancer in males

Male breast cancer is a rare type of cancer that accounts for fewer than 1% of all malignancies in men and 1% of all breast cancers. However, the incidence of the disease is increasing, reaching 15% in some patient groups throughout their lives [ 240 ]. It is most common in people over the age of 60  241 . There are already identifiable risk factors such as constitutional, environmental, hormonal (abnormalities in estrogen/androgen balance), and genetic (positive family history, Klinefelter syndrome, mutations in BRCA1 and especially BRCA2) factors. In 75% of cases, the clinical manifestation is a painless hard and fixed nodule in the subareolar region, with nipple commitment occurring earlier than in women [ 242 ]. The most common type of male breast cancer is infiltrating ductal carcinoma which represents around 70–90%. Only 7% of cases of in situ but non-invasive cancer are ductal [ 241 ]. Clinical examination, combined with a confirming biopsy, is still the most important step in evaluating men with breast lesions [ 242 ]. The conventional basic treatment is Patey's mastectomy, which is a modified radical mastectomy with the removal of certain lymph nodes [ 241 ]. Hormone metabolic abnormalities linked to high estrogen or prolactin levels appear to be the causative mechanism. Progesterone and estrogen receptors are found in tumors in men more commonly than in women. According to immunohistochemistry and the vast majority of cases are estrogen receptor alpha (ER) positive. This indicates that this steroid hormone receptor plays a role in tumor formation and progression [ 243 ]. Also, about 75% of all tumors express estrogen and progesterone receptors, which become more positive as the patient gets older [ 244 ].

15. Conclusion

Estrogen homeostasis and tissue-specific exposure to estrogen and its metabolites are influenced by genetic and environmental variables. Uncertainty exists regarding the relative impact of the changing serum estrogen levels linked to the menstrual cycle in premenopausal women and the more constant levels in postmenopausal women on the total lifetime exposure to estrogen. When considered collectively, the body of evidence is consistent with the idea that estrogen and its metabolites are connected to both the beginning and advancement of breast cancer, albeit these connections are complicated. Recent findings from sizable clinical trials of selective estrogen receptor modulators provide more proof of the link between estrogen and the risk of breast cancer. Tamoxifen's antiestrogenic impact lowered the incidence of breast cancer in healthy premenopausal and postmenopausal women who were at higher risk for the condition, while raloxifene did the same for postmenopausal women who had osteoporosis. Although a link between estrogen exposure and the risk of breast cancer has been shown in some populations of women, the risk for a given woman cannot be precisely predicted. Breast density on mammography, serum estrogen concentrations, and bone mineral density are a few clinical indicators of estrogen exposure that may help determine a woman's risk of breast cancer. Composite risk assessments based on these and other risk variables, such as family and reproductive histories, may help us better understand the role of estrogen in the pathogenesis of breast cancer and provide a more accurate evaluation of risk for specific women.

Author contribution

Conceptualization: MSA and RMA. Study design, data collection, and data analysis: KA, SA and AK. Writing-Original draft preparation: KA, AK, SA, AMA, SAS, RAB, SFA, AMA, and SHB. Writing- Reviewing and Editing the final manuscript: RMZ and MSA. All authors reviewed, contributed, and approved the final manuscript version.

Implications and contribution

Many of the factors highlighted in the review should be considered by researchers studying the impact of estrogens on breast cancer disease (BCa).

Data availability statement

Declaration of competing interest.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgement

The publication of this article was funded by the Qatar National Library.

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• Breast Cancer Research Paper

A GUIDE TO WRITING A BREAST CANCER RESEARCH PAPER

Table of contents, how to write a breast cancer research paper, your breast cancer research paper thesis, breast cancer outline for research paper, introduction for breast cancer research paper, breast cancer research paper body paragraphs, breast cancer research paper conclusion, breast cancer research paper example and other help.

Breast cancer is a serious public health issue that impacts people from every walk of life. There are very few people who will not have their lives impacted in some way by this disease. Because it is so prevalent, there is much research that has been done and much research that is currently in progress. As a result, breast cancer is a popular topic for students in the medical and healthcare fields. In addition to this, breast cancer is also an appropriate topic for courses in political science, education, even business. This guide will provide you with important advice on writing a research paper on this serious disease.

Once you’ve chosen your topic, and conducted the appropriate research, you’ll need to construct a thesis. This is the statement that you will support in your research paper.

Sample Breast Cancer Research Paper

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Now that your topic and thesis are in hand, you can begin the process of creating an outline. Think of this as a foundation for your completed paper. It will help you decide on the structure of your paper, and choose the most important points to support your research paper.

Your introduction paragraph should contain the following elements:

• A hook such as an interesting fact about breast cancer
• A few sentences to introduce the specific topic of your paper
• Your thesis

Best breast cancer research paper topics

• The Impact of Pinkwashing on Breast Cancer Research
• The Prevalence of Breast Cancer in Men
• Are Natural Treatments Ever Appropriate for Breast Cancer?
• What is the Role of CBD in Breast Cancer Treatment?
• How to Tell if a Breast Cancer Charity is Legitimate
• Providing Emotional Support to Loved Ones with Breast Cancer
• Breast Cancer in Film and Literature
• New Research in Breast Cancer Immunotherapy
• New Treatment Options for Metastatic Breast Cancer
• Problems with Current Approaches to Breast Cancer Research
• Treatment Options for Patients Who Cannot Receive Chemotherapy

The body paragraphs are the ‘meat’ of your research paper. This is where you will present facts to your readers. Remember to cite your sources , and to rely on data and academic studies to present your case.

Your concluding paragraph should summarize the points made in your research paper. Show the readers how your research comes together to prove your thesis to be correct.

If you need assistance with a research paper on breast cancer, we recommend looking at an example paper. We are happy to provide such a paper to you, or assistance with writing your own research paper on the subject of breast cancer. We have writers, editors, and customer support reps who are available to help you 7 days per week.

External links

• Breast Cancer Research Papers - Academia.edu . (n.d.). Www.Academia.Edu. Retrieved February 19, 2020, from http://www.academia.edu/Documents/in/Breast_Cancer
• Breast Cancer Research Articles . (2019, May 23). National Cancer Institute; Cancer.gov. https://www.cancer.gov/types/breast/research/articles

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• Breast Cancer Research Paper

View sample cancer research paper on breast cancer. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Breast cancer is one of the major public health problems. Every year some 1.2 million new cases of breast cancer are diagnosed and some 400 000 women die from it. Worldwide, some 50 million women are living after a previous breast cancer experience. Approximately 200 000 deaths from breast cancer occur in developed countries and 200 000 in developing countries. In Europe, there were an estimated 370 000 new cases and 130 000 deaths in 2004. Mortality rates rose from 1951 to about 1990 but have fallen since then in most European countries, noticeably in the UK (Figure 1(a)), but mortality rates in Central and Eastern European countries have been rising (Figure 1(b)). Although rates in Hong Kong and Japan have been lower than those in Europe, they have also been increasing (Figure 1(b)). Rates in North and South America have been similar to those in Western Europe (Figure 1(c)).

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The decline in mortality rates in Western Europe, Australia, and the Americas may be due to widespread mammographic screening, good diagnosis, and increased numbers of women receiving the best treatment, including hormonal drugs (Ferlay et al., 2004).

Causes of Breast Cancer

Family history.

In countries where breast cancer is common, the lifetime excess incidence of breast cancer is 5.5% for women with one first-degree relative who has had breast cancer and 13.3% for women with two. Eight out of nine women who develop the disease do not have an affected mother, sister, or daughter, however. Only 3–4% of women with breast carcinoma have a genetic mutation (BRCA1 or BRCA2), although these are the most strongly associated risk factors: Affected women have a 50–70% risk of developing breast carcinoma during their lifetime.

Pregnancy-Related And Hormone-Related Factors

Women who have their first full-term birth at an early age have a lifetime reduction in risk. Increased parity is associated with a long-term risk reduction, even when the age at first birth is controlled for; the additional, long-lasting protective effect of a young age at subsequent full-term pregnancies is not as strong as that for the first full-term pregnancy; a nulliparous woman has roughly the same risk as a woman who has her first full-term birth aged about 30 years; the risk is transiently increased after a full-term pregnancy. Long duration of lactation confers a small, additional reduction in risk after the age at pregnancy and the number of full-term pregnancies is controlled for. Breast cancer risk factors are set out in Table 1.

The decision not to breastfeed or a very short lifetime duration of breastfeeding, typical of women in developed countries, contributes substantially to the high incidence of breast cancer in these areas. The risk is significantly reduced by breastfeeding, in addition to the reduction for every birth. Breastfeeding practices can be modified and promoted usefully as a strategy to prevent breast cancer.

There is no pronounced excess risk of diagnosis in women 10 or more years after the cessation of oral contraceptive use. The cancers diagnosed in women who have used combined oral contraceptives tend to be less advanced clinically than those diagnosed in women who have never used them. The risk of breast cancer is raised in women using hormone-replacement therapy and increases with duration of use. This effect declines after cessation of hormone-replacement therapy and largely disappears after about 5 years; the benefits and risks associated with this hormone treatment should be taken into account.

After adjustment for known risk factors, induced abortion is not associated with an increased risk of breast cancer. Pregnancies that end as a spontaneous or induced abortion have been shown not to increase a woman’s risk of developing breast cancer (Veronesi et al., 2005).

Anthropometric Indices And Physical Activity

With pooled data from seven prospective studies (337 819 women and 4385 incident breast cancer cases in total) and after adjustment for reproductive, dietary, and other risk factors, the pooled relative risk of breast cancer per height increment of 5 cm was 1.02 (95% CI 0.96–1.10) in premenopausal women and 1.07 (1.03–1.12) in postmenopausal women. The body mass index showed substantial inverse and positive associations with the disease in premenopausal and postmenopausal women, respectively. Height is an independent risk factor for breast cancer after menopause but not in premenopausal women.

In postmenopausal women not taking exogenous hormones, general obesity is an important predictor of breast cancer. In premenopausal women, weight and body mass index showed nonsignificant inverse associations with breast cancer.

Increased physical activity seems to be inversely related to the risk of breast cancer, although the findings are inconsistent. Physical activity and weight control can be recommended at present, although further research may highlight additional benefits.

Dietary Factors

A pooled analysis of eight prospective studies showed relative risks for an increment of 5% of energy intake were 1.09 for saturated fat, 0.93 for monounsaturated fat, and 1.05 for polyunsaturated fat, compared with equivalent energy intake from carbohydrates.

The Nurses’ Health Study II (Cho et al., 2003) showed that intake of animal fat, mainly from red meat, before menopause, was associated with an increased risk of breast cancer. To assess the risk of invasive breast cancer associated with total and beverage-specific alcohol consumption and to establish whether dietary and nondietary factors change such an association, data from six prospective studies were examined. Alcohol consumption correlated with breast cancer incidence in women. A reduction of consumption among women who drink alcohol regularly could reduce their risk of breast cancer. Cigarette smoking, frequently analyzed with alcohol consumption in etiological studies, does not seem to be related to risk.

Environmental Exposures

An increased risk of breast cancer in women exposed to ionizing radiation, particularly during puberty, has been widely accepted even with low-dose exposure. Environmental exposure to organochlorines has been examined as a potential risk factor for breast cancer. Based on current evidence, the association between risk and exposure to organochlorine pesticides and their residues seems to be small, if it exists at all. The combined evidence from five large U.S. studies that assessed the link between breast cancer risk and concentrations of 1,1-dichloro-2,2-bis (p-chlorophenyl) ethylene and polychlorinated biphenyls in blood plasma does not support such an association (Cuzick et al., 2003).

Possibilities Of Chemoprevention

The pharmacological prevention of cancer represents a comparatively novel field in clinical oncology, but it offers a very promising approach to reducing the burden of cancer and its incidence. In cardiology, it is common practice to treat subjects at higher risk for cardiovascular disease long before clinical evidence of the disease can be detected. This has made a definite contribution to lower mortality. A similar strategy could be adopted for cancer prevention in subjects ‘at higher risk’ (Hong and Sporn, 1997).

The peculiarity of carcinogenesis is that it is a multistep, multipath, and multifocal process, involving a series of genetic and epigenetic alterations that develop from genomic instability all the way to the final development of cancer. This is the key notion lying behind the rationale for intervention in the initial steps of the process, by employing natural or synthetic agents capable of delaying, arresting, or even reversing the pathogenesis of cancer. Since the process is generally very long (10–20 years, sometimes more), there is potentially a great deal of time to assess the true risk and intervene with nutrients and/or pharmacological agents that may interrupt the chain of molecular events long before the onset of clinical symptoms. This may prove of particular use where solid tumors are concerned, since they are often characterized by multifocality and metachronous growth. Recently, a number of compounds have been shown to be clinically effective in breast carcinoma, covering all three settings into which prevention may be typically divided. In primary prevention, the goal is to prevent the onset of the disease, selecting healthy cohorts who are at high risk because of their environment, lifestyle, or familial/ genetic factors. Secondary prevention (screening) is aimed at detecting and treating persons with a premalignant condition or an in situ malignancy, thus blocking its evolution to an invasive cancer. Tertiary prevention is a term that can be applied to the protection of individuals who have previously been treated for cancer from developing a second primary tumor (Figures 2 and 3; Table 2).

Pathogenesis of Breast Cancer

Progression from healthy tissue to invasive carcinoma.

In contrast to the position for adenocarcinoma of the colon, no definitive model of progression from the common benign proliferative lesions of the breast to invasive malignancy has been identified. Cytological or architectural dysplastic changes can be identified in various nonmalignant breast diseases, such as florid and columnar duct hyperplasia, adenosis, and papilloma, but their true precancerous potential remains undefined.

Atypical duct hyperplasia has been regarded as the missing link between healthy duct hyperplasia and low-grade, ductal neoplasia in situ (DIN). Morphological features of atypical duct hyperplasia, which are intermediates of those in healthy and malignant tissues, and the substantially raised risk for subsequent carcinoma in affected women, have been claimed as sufficient proof of a precancerous nature. However, genetic changes in atypical duct hyperplasia are identical to changes in fully developed DIN, which raises questions about whether atypical duct hyperplasia is a distinct entity from low-grade intraductal neoplasia.

Novel approaches such as gene-expression profiling will increasingly be used to ascertain the occurrence of true preneoplastic lesions in the breast. Precise identification of these precursor lesions will be vital for planning interventions in women at high risk of breast cancer and to assess the effectiveness of prevention trials.

Ductal lavage is currently undergoing investigation. In this procedure, luminal cells from the ductal tree are obtained by cannulation of the lactiferous ducts and gentle massage of the breast. Harvested cells can then be examined not only for morphological changes but also for the expression of early markers of cell transformation that will eventually be identified. This procedure is being tested for validation as an additional research instrument to identify patients at high risk of developing breast carcinoma (O’Shaughnessy et al., 2002).

In view of the uncertainty of the occurrence of true preneoplastic lesions of the breast, the morphologically identifiable initial phases of neoplastic transformation remain in situ neoplasia, either ductal or lobular. However, this encompasses various lesions, ranging from low-grade to high-grade neoplasms, with remarkably different modes of presentation, histopathological features, genetic alterations, risk of relapse and of progression to invasive carcinoma.

To emphasize the non-life-threatening nature of in situ lesions and reduce any psychological effect caused by the use of carcinoma as a description, the term ductal intraepithelial neoplasia has been suggested to define these cell masses. This has been revised to encompass candidate preneoplastic lesions: Flat epithelial atypia and atypical duct hyperplasia (Tavassoli and Devilee, 2003). The same procedure has been done for noninvasive lobular neoplasms (atypical lobular hyperplasia and lobular carcinoma in situ), which have been classified into a three-tiered system of lobular intraepithelial neoplasia.

Invasion and metastasis are the hallmarks of fully developed breast carcinoma. Extensive histopathological examination of axillary sentinel lymph nodes by complete and serial sectioning at very close cutting intervals (e.g., at least 60 serial sections at 50-mm intervals, as used at the European Institute of Oncology, Milan, Italy) has greatly improved the detection rate of axillary lymphnode association (Veronesi et al., 2003). Detection is strongly associated with the definitive features of the primary breast cancer, such as tumor size and type, occurrence of peritumoral vascular invasion, and multifocality.

Randomized trials (Veronesi et al., 2003) have shown that the recorded number of patients with clinically overt axillary progression of breast cancer is much lower than expected, based on the false-negative rate of the sentinel lymph-node biopsy. This difference suggests that metastatic cells may not progress to clinical disease in all patients and that only some cells are able to sustain tumor progression, which is consistent with the hypothesis that the growth, progression, and clinical outcome of a cancer depend on the activation of tumorigenic stem/ progenitor cells.

This redefinition of the malignancy of breast cancer is recognized in the new pTNM classification, whereby minimum nodal invasion (1 mm or less) is classed as pT1mic (indicating microinvasive cancer) and isolated tumor cells or tumor-cell clusters (0.2 mm or less) in the regional lymph node are no longer regarded as metastatic, and qualify as pN0(iþ). These new classifications are designed to prevent overstaging of the disease and hence overtreatment for the patient.

Systemic adjuvant therapy is currently offered to patients according to selected clinicopathological features of the primary tumor, which include the status of estrogen and progesterone receptors and expression of human epidermal-growth-factor receptor 2 (HER2/neu); such treatment is undertaken independently of the axillary node status, with an equivalent survival benefit.

Quantification of tumor cells circulating in the blood of patients with breast cancer may also be a predictor of the duration of survival.

Gene-expression profiling of breast carcinoma has already shown that differential expression of specific genes is a more powerful prognostic indicator than traditional determinants such as tumor size and lymph-node status. These molecular assays now await clinical validation by prospective randomized trials before being introduced into routine clinical practice.

Breast Cancer Diagnosis and Staging

Organized screening, education programs, and improved consciousness of the female population have substantially changed the type of patients seen nowadays compared with those a few decades ago. The revolution in diagnostic imaging over the past 20 years has also profoundly modified diagnostic strategies in breast cancer.

Diagnostic Procedures

Procedures commonly used for the diagnosis of breast cancer include mammography, ultrasonography, MRI (magnetic resonance imaging), and PET (positron emission tomography). Physical examination of the breast remains important, however, because a substantial minority (11%) of breast cancers are not seen on mammography.

Mammography remains the most important diagnostic tool in women whose breast tissue is not dense. After menopause, mammography is generally the best method to discover tiny, nonpalpable lesions. By contrast, ultrasonography is the most effective procedure to diagnose small tumors in women with dense breast tissue and to differentiate solid lesions from cystic lesions. Although mammography can identify suspicious microcalcifications, it is not good at distinguishing between breast densities and has difficulty in identifying certain lobular invasive carcinomas, Paget’s disease of the nipple, inflammatory carcinoma, and particularly peripheral, small carcinomas.

MRI is mainly used as a problem-solving method after conventional diagnostic procedures. It is highly sensitive and is used mainly to screen high-risk, BRCA-positive patients. In dynamic, contrast-enhanced MRI, images are acquired before and after patients are given a substance to improve contrast when imaging the lesion. Malignant lesions are generally highly permeable, with rapid uptake and elimination of contrast, whereas benign lesions have slow-rising, persistent-enhancement kinetics. Although MRI has good diagnostic accuracy, the false-positive detection rate is still high and MRI findings should not be the sole indication for breast surgery.

PET is currently used to detect metastatic foci in any distant organ or to assess the status of axillary nodes in preoperative staging. However, PET may fail to identify low-grade lesions and tumors smaller than 5 mm.

The use of imaging techniques to detect unknown breast cancers in women who had no symptoms (i.e., screening) was inaugurated by the Health Insurance Plan of New York in the 1960s. In many randomized studies and population studies, mammography has been confirmed as the only screening test that can reduce breast cancer mortality if a large proportion of the population uses the procedure.

However, ultrasonography seems promising for women with dense breast tissue, such as those before menopause, and MRI has been valuable in the screening of women at high risk of breast cancer who are younger than 50 years.

The TNM (tumor-nodes-metastasis) system defines the extent of disease. It is the language used to compare different cases from various centers. With respect to the primary carcinoma (T), T1 can be divided into three subgroups (T1a, T1b, T1c), depending on the size of the primary lesion. However, with new subdivisions, most instances arise in one subcategory (e.g., T1c). In the era of computerized data analysis, classification is thought to be less necessary, whereas precise description of specific cases is regarded as essential and functional to the different needs of statisticians. Therefore, the T classification will probably be determined by a continuous metric description of the size (cm) of the carcinoma (e.g., T0.9, T2.4). The same system could apply to nodes (N) in which the numbers of involved and examined nodes will define the patient’s condition (e.g., N2/18 for two lymph nodes with tumor out of 18 sampled).

Finally, we believe that the TNM system should rely more on biological characteristics (e.g., hormonal receptors, proliferation rates) and biomolecular aspects (e.g., gene expression profile) of tumors. The present biometric, anatomical description will probably be replaced by molecular staging.

Breast Cancer Surgery

Once a diagnostic procedure indicates a tumor in the breast, cytological or histological confirmation is vital before further treatment is given. Cytology is effective in solid lesions, especially if sonographically guided. The histology of the lesion, which can be obtained by a core biopsy, is most useful for surgeons. This is the simplest method for palpable lesions that are easily reached, whereas a vacuum-assisted needle biopsy can obtain enough material for a good histological diagnosis in nonpalpable or deep lesions (Burbank et al., 1996). Excision biopsy a few days before definitive surgery is no longer done, because it creates a local anatomical distortion that makes conservative treatment difficult.

The sophisticated technique of sentinel lymph node biopsy provides knowledge about the condition of the axillary nodes without the need for dissection, when lymph nodes are not affected. Internal mammary nodes can also be easily reached during surgery, to complete the staging procedure. With respect to distant, occult metastases, PET will help identify occult foci of cancer cells anywhere in the body.

Breast conservation is the most popular treatment because most carcinomas have a restricted size and large primary tumors can be reduced in size by primary (neoadjuvant) chemotherapy before surgery. In most breast cancer centers, conservative surgery (lumpectomy) accounts for 75–85% of all operations. Total removal of the mammary gland (mastectomy) is required for multicentric invasive carcinoma, extensive intraduct carcinoma, inflammatory carcinoma, and large primary carcinomas that have not been sufficiently shrunk by neoadjuvant chemotherapy. Early recurrences or even a second ipsilateral carcinoma of restricted size can also be treated with conservative surgery.

Several options are available for reconstruction of the breast, from simple positioning of an expander to the use of musculocutaneous flaps (such as the thoracodorsal or abdominal flap, TRAM). One method becoming widely used is the skin-sparing mastectomy that conserves an extensive section of skin, as well as the more recent skin and nipple-sparing mastectomy, which preserves the nipple-areolar complex.

Identical 5-year survival has been recorded in women with axillary dissection and in women who underwent axillary dissection only if the sentinel lymph node was affected by tumor, although other clinical trials of the long-term effect on survival are ongoing. The histological diagnosis of the sentinel node should be immediately available. The traditional frozen-section procedure (which takes three or four sections of the node) often fails to detect micrometastases. As a consequence, surgeons should completely and definitively examine the sentinel node during surgery, and accurately section the node (up to 60–80 sections) to avoid missing even very small micrometastases. In about 85% of cases in which a micrometastatic sentinel node is found, other axillary nodes are not implicated. Therefore, many surgeons now consider the option of simply monitoring patients carefully with ultrasonography and PET.

In situ lesions are mainly treated with mammary resection. Since axillary metastases are rare, both lymph node dissection and biopsy are optional.

In situ neoplasia should not be incorporated in the TNM classification. Instead, it should be described with the new ductal-intraepithelial-neoplasia system proposed by Tavassoli (Tavassoli et al., 2003).

Radiotherapy in Breast Cancer

Radiotherapy in breast conservation.

The current standard of care for patients with early-stage breast cancer consists of breast-conserving surgery, followed by 5–6 weeks’ postoperative radiotherapy. The need for radiotherapy in breast conservation is still debated. Some subgroups of patients may be expected to have a low risk of local recurrence, and radiotherapy could therefore be avoided. Attempts have been made to identify these populations, which might include individuals with small, low-grade tumors that are estrogenrecept-or-positive, or elderly patients resected with wide tumor-free margins, but no subgroup has been identified that would be adequately treated by breast-conserving surgery alone.

Radiotherapy is used on the whole breast. Some data support the effectiveness of an additional dose applied to the tumor bed (i.e., boost irradiation) to reduce local recurrence. The EORTC study results suggest that the patients deemed to receive the greatest absolute benefit from boost doses are those younger than 50 years and at higher risk of local recurrence (large tumor size or positive or small tumor-free margins in the surgical specimen).

Different radiation treatment schedules with rapid fractionation have been used for years in centers in the UK and Canada. Results from a randomized trial support delivery of a reduced total dose in a shortened schedule (42.5 Gy in 16 fractions for 22 days) in patients with lymph-node-negative breast cancer treated by lumpectomy. A short schedule (20 fractions) with concurrent use of the boost dose is currently used at the European Institute of Oncology Milan after quadrantectomy. In patients younger than 48 years who receive an intraoperative boost dose of 12 Gy, a rapid course of external radiotherapy is used (13 fractions of 2.85 Gy each).

Partial Breast Irradiation

The rationale for partial breast irradiation (restricted to the excision site and adjacent tissues) instead of the conventional approach is based on the finding that most recurrences arise near the primary tumor location. Partial breast irradiation can be delivered by different techniques, such as low or high-dose-rate brachytherapy (delivered interstitially or with an intracavitary balloon), conformal external-beam irradiation (including intensity-modulated radiotherapy), and intraoperative radiotherapy.

Intraoperative Radiotherapy

ELIOT (ELectron Intra Operative Therapy) refers to the application of a high dose of radiation during surgical intervention, after removal of the tumor.

ELIOT is currently used in early-stage breast cancer as the only treatment at the European Institute of Oncology, and a prospective randomized trial is ongoing. Two miniaturized mobile-linear accelerators producing a variable range of electron energies are available. Apart from low costs, ELIOT is advantageous because it potentially overcomes problems related to the accessibility of radiotherapy centers after surgery and has a beneficial impact on the patient’s quality of life. ELIOT does not irradiate the skin or the other breast, and irradiation to the lung and the heart is greatly reduced. ELIOT can also be used to give boost doses: One boost of 10–15Gy in an intraoperative session will extend surgery by just 10–20 min and reduces the time for external treatment by 2 weeks. The TARGIT (TARGeted Intraoperative radio-Therapy) trial is based on the use of a low-energy radiography source to compare one fraction of radiotherapy with a conventional postoperative approach.

Radiotherapy For Ductal Carcinoma In Situ

The role of radiotherapy in ductal carcinoma in situ (DCIS) managed with conservative treatment has been defined by results from three randomized trials. Addition of radiotherapy reduced the local recurrence rate by about 50%, with no effect on survival, and women with positive margins benefited the most. Despite these positive data, the best management of DCIS is still controversial. In fact, according to an analysis of a database of more than 25 000 patients treated between 1992 and 1999, almost half the women did not undergo postoperative radiotherapy after breast-conserving surgery.

Development In Radiation Techniques

Nowadays, the target volume can be tailored to individuals, which reduces the dose to the lung on the same side as the affected breast, and to the heart, the other breast, and surrounding soft tissue. Intensity-modulated beam arrangement ensures a more homogeneous dose delivery. The increasing use of optic or electronic devices (or both) to monitor organ motion and daily setup variations guarantees the accuracy and safety of the delivery system.

Radiotherapy In Locally Advanced Carcinoma

Breast-conserving surgery followed by radiotherapy can be offered to patients with locally advanced disease who respond to induction chemotherapy. A study of 340 patients given this combined treatment had a total locoregional recurrence rate of only 9% at 5-year follow-up. Breast reconstruction after mastectomy has become a standard procedure, and postmastectomy radiotherapy might represent an obstacle to good aesthetic results because of radiation-related fibrosis. The use of radiotherapy after mastectomy is still controversial.

Radiotherapy Of Metastases

With metastases in the skeleton, short courses of irradiation can palliate symptoms and prevent fractures. Radiotherapy and diphosphonates can improve the efficacy of the treatment. Brain metastases or carcinomatous meningitis can be treated successfully: Radiotherapy after complete surgical resection can substantially improve control. Patients with one brain metastasis who can be treated with more aggressive therapies, including surgery and high-precision radiotherapy, are especially challenging. Stereotactic radiotherapy is also used in other secondary tumor sites such as the liver, lung, and soft tissues.

Systemic Treatment of Breast Cancer

Treatment of locally advanced disease.

The presence of estrogen and progesterone receptors in tumor cells shown by immunohistochemical staining is a good predictor of endocrine-responsiveness. Staining for either receptor indicates a response to endocrine therapies. Chemotherapy is also effective in endocrineresponsive disease, but the chances of more extensive cell killing are lower for these tumors than for tumors that are unresponsive.

The distinction between disease lacking expression of steroid-hormone receptors and disease showing some presence of these receptors is associated with gene-expression profiling and with the clinical course. Recognition of such a distinction will require a fundamental shift away from reporting whether the receptor status is positive or negative, which is current practice in many laboratories, to the quantitative reporting of receptor determinations.

Overexpression of the epithelial growth factor receptor HER2/neu on tumor-cell membranes is a strong predictor for response to trastuzumab (Tripathy et al., 2004). Overexpression of both steroid-hormone receptors and HER2/neu has been postulated as a condition for selective resistance to tamoxifen, but less so to aromatase inhibitors in postmenopausal women, and not to tamoxifen combined with suppression of ovarian endocrine function.

Adjuvant Treatments

Adjuvant systemic therapy is given to attempt eradication of micrometastatic disease, which may still be present in all patients with invasive breast cancer. It aims to reduce relapse and increase survival. Postoperative adjuvant therapies cannot be checked for efficacy except with respect to long-term outcomes in a randomized trial. In contrast, the efficacy of systemic treatment given either before surgery (i.e., primary treatments for operable or locally advanced breast cancer) or for metastases, should enable evaluation of the effect of treatment after short-term treatment.

Adjuvant systemic treatments are usually offered to reduce the risk of relapse. An expected 10-year survival below 90% would justify the use of adjuvant chemotherapy. The major concern about adjuvant cytotoxic treatments is that they are offered to a large proportion of patients who are either cured by local treatments or who might have their small risk of relapse reduced by endocrine drugs alone.

Selection of adjuvant treatments is based on the distinction between endocrine-unresponsive and endocrineresponsive breast cancer.

Patients with endocrine-responsive disease are offered adjuvant systemic therapy based on endocrine treatments. High risk of relapse (with metastatic lymph nodes in the operated axilla or vascular invasion) can justify some chemotherapy being given before endocrine treatment in adjuvant therapy.

Premenopausal women with endocrine-responsive disease are usually offered tamoxifen, with or without suppression of ovarian function. Use of cytotoxic drugs before endocrine therapy is recommended only if the risk of relapse is very high. However, the role of both ovarian function suppression and chemotherapy is still uncertain for many of these patients, and trials are in progress. Aromatase inhibitors, which need ovarian function suppression, represent an additional treatment choice.

Women with endocrine-responsive disease after menopause are usually offered endocrine therapy with tamoxifen and increasingly with aromatase inhibitors. Efficacy in reduction of recurrence and mortality well beyond 5 years’ treatment (carryover effect) is the reason for its standard use. When prescribed, chemotherapy should be given before the start of tamoxifen treatment.

New alternatives for tamoxifen are available to treat postmenopausal women with endocrine-responsive disease after surgery, after 2–3 years of tamoxifen to complete standard duration, or after 5 years to further reduce risk of relapse (especially for patients at high risk of relapse) (Coombes et al., 2004). These alternatives include nonsteroidal (anastrozole and letrozole) and steroidal (exemestane) aromatase inhibitors. The IBCSG (International Breast Cancer Study Group) trial 18–98 or BIG 1–98, which compares tamoxifen and letrozole alone or in the two possible sequences, recently provided data on greatly improved disease-free survival for postmenopausal patients with endocrine-responsive disease who received letrozole compared with those who received tamoxifen.

Neoadjuvant (Primary) Systemic Treatments of Breast Cancer

Systemic primary treatment is usually offered to patients with large primary tumors and aims to reduce tumor size for breast-conserving surgery. With such treatment, physicians can also induce regression of axillary node metastases and obtain knowledge on the responsiveness of the disease to treatment.

Endocrine therapies for patients with endocrineresponsive disease showed an improved outcome for aromatase inhibitors compared with that for tamoxifen.

Endocrine-unresponsive disease and high proliferation rates (e.g., Ki67 expressed in 20% of tumor cells) are important predictors of complete pathological response to six courses of primary chemotherapy. Disease-free survival is substantially longer for patients with endocrineresponsive disease than for patients who do not express steroid-hormone receptors, even though patients with endocrine-unresponsive disease are at least four times more likely to obtain a pathological complete remission after primary chemotherapy (Colleoni et al., 2004).

Anthracyclines and taxanes are usually used for patients with both operable and locally advanced disease (Nowak et al., 2004). Anthracycline-based primary chemotherapy has been reported to yield a large proportion of responses in small-sized tumors with a high proliferation index (Ki67) or grade, and with simultaneous overexpression of HER-2/neu and topoisomerase II, whereas mutation of p53 has been associated with a reduced response rate to chemotherapy. Chemotherapy regimens that do not contain anthracycline (that have vinorelbine, platinum, and fluorouracil) were also reported to be effective, especially for patients with endocrine-unresponsive disease, with or without inflammatory features.

Conclusions

Breast cancer is the most common type of tumor in women in most parts of the world. Although stabilized in Western countries, its incidence is increasing in other continents. Prevention of breast cancer is difficult because the causes are not well known. We know of many risk factors such as nulliparity, late age at first pregnancy, little or no breastfeeding, which, however, are linked to the historic development of human society. On the contrary, a great effort is needed to improve early detection of the tumor. Screening programs among the female population should therefore be implemented. The early discovery of a small breast carcinoma leads to a very high rate of curability and entails very mild types of treatment, with preservation of the body image. Treatments are improving, but a strict interdisciplinary approach is essential. It is conceivable that in all countries specialized centers or units for breast cancer management should be set up.

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The 15 Best Argumentative Essay Topics About Breast Cancer

What is argumentative essay.

Before beginning with the details one must be quite clarified with the type and formats of writing. If you are not aware of that then you can never come up with a nice essay even having a great knowledge about the topic. Each format of essay has its own beauty and one must know how to observe that beauty and come up with a great description. There are several formats of essays like compare and contrast, persuasive, definition, argumentative etc. All these have their own technique and quality of writing. You should not mix up.

The argumentative format of writing is the one where the author has to have a stern writing technique. Without a strong and persuasive approach one can never incept anything in the mind of the reader. The ways of persuasion should be extremely strong and you should have a biased opinion about what you think and that is the only right thing. You have to make people understand that.

15 best argumentative essay topics about breast cancer

• Breast cancer should be considered as the new epidemic for the modern era.
• Are women becoming too casual about the growing rates of breast cancer?
• Is the society becoming too casual about the approach to take strict action for curing breast cancer?
• Curing breast cancer might lead to loosing of breast- is that a taboo?
• There should be a convention on breast cancer in WHO every month to reduce the growing risk.
• The third world countries are the most affected in breast cancer diseases due to lack of knowledge about the disease.
• There should be classes of how to reduce the risk of breast cancer in the society.
• Detecting breast cancer with the help of machines like MRI increases the rate of Mastectomy- do you believe in the notion?
• There should be many local breast cancer hot spot s that people could go and have check-ups often.
• Breast cancer is due to the susceptibility of the genes BRCA1 and BRCA 2.
• Breast cancer is curable and is a form of malignant tumour- should this be the new notion of the era.
• Women are still ashamed of having breast cancer- How to avoid it?
• Representation of breast cancer in to the society should be done in a much simpler way so that everyone can understand.
• Educate people about men breast cancer.
• Breast cancer should be treated with extra care and what are the measures taken by government about it?

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Home — Essay Samples — Nursing & Health — Breast Cancer — The Ways of Raising Awareness about Breast Cancer

The Ways of Raising Awareness About Breast Cancer

• Categories: Awareness Breast Cancer

About this sample

Words: 1131 |

Published: Dec 5, 2018

Words: 1131 | Pages: 2 | 6 min read

Table of contents

Breast cancer speech outline, breast cancer speech example, introduction.

• Brief overview of breast cancer awareness and its goals

Breast Cancer Advocacy and Awareness

• Role of breast cancer advocates in raising funds and lobbying for better care
• The cultural aspect of breast cancer advocacy and pink ribbon culture
• The significance of the pink ribbon symbol and National Breast Cancer Awareness Month

Support Groups

• Types of support groups (informational, emotional)
• The role of support groups in the recovery process
• Differences between formal and informal support groups

Support Group Variability

• Tailoring support groups to specific needs (age, stage of diagnosis)
• The availability of online support groups
• Unique challenges and needs of men with breast cancer

Impact of Support Groups

• Effectiveness of support groups in reducing stress and anxiety
• No proven impact on long-term survival
• Importance of social support from networks and its potential effect on survival

Available Resources

• Free resources for connecting with breast cancer support groups (online and in-person)

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