Introduction
New research puts forward the assumption that as for patients who have gone through a cancer of breast, and for other women, excessive enthusiasm healthy diets cannot increase chances of the person of avoidance of repeated disease by a cancer. Results of research under the name “the Healthy life and a feed of women – randomized research” have shown that diets with the high maintenance of fruit and vegetables actually do not reduce the risk of repeated disease by a cancer of breast. The information in noted clause is only a part of results of the researches spent in the field of the analysis of influence of a diet on a risk level of disease in cancer.
Despite of general opinion that the correct way of a feed can help to overcome a cancer, recent results could not justify fidelity of this statement for hundred percent. Research on a theme of clause which was spent at the Californian university of San Diego, was much more careful, rather than the previous analyses. During work 3088 women by age from 18 up to 70 which have passed successful treatment at the first stages of a cancer of a mammary gland have been invited. Women have been divided into two groups. To the first group was appointed a diet, according to which woman were to eat fruit and vegetables five times a day – this style of a feed is recommended by National institute of a cancer. Women from other group visited special diet consultations – culinary lessons entered into them also – which purpose was to help them to lower consumption of fats on 15 % and to increase regular consumption celullose up to 30 gram a day. They if fruit and vegetables about 12 times a day.
Researchers have tracked the way of feed of women from 1995 to 2000 and have analysed the cases of repeated occurrence up to 2006. By the end of research in both groups of women the identical percent of repeated disease by a cancer and death rates from it was observed. In total 518 cases of returning of illness were totaled, 256 from them were in that group which ate by a principle ” fruit of 5 times in day “, and 262 – in experimentally new group. From 315 death more than 80 % were the result of a cancer. Among them 160 have fallen to “five-single” group, and 155 were at women who actively ate fruit and vegetables. ” The basic conclusion following: the woman in whom have found out a cancer tumour of breast, should not pass to a diet excessively overloaded by vegetables and fruit, – doctor Shiril speaks Fate (Cheryl Rock), one of scientists-researchers and the professor of dietology at the Californian university in San Diego. – but these researches do not cross out our former recommendations – vegetables and fruit it is necessary to eat five times a day”.(Dickson, 1996)
In editorial clause authors doctor Susan Gapstur and doctor Sima Khan have noted restrictions of research “the Healthy life and a feed of women “. In particular they called into question into accuracy of data which gave the woman in groups: that all women have started to type weight during experiment, Khan says, that, should be, inveraciously told about quantity of the consumed calories. If women have lowered quantity of consumed calories they would dump weight. Authors of the analysis also have noted, that group which ate a lot of vegetables, never held out up to 15 % of percent of norm of day time norm of consumption of fat. “In the end of day, the control over strict execution diet instructions can be complicated partially and that supervision over the purposes of research can be complex “.
Two previous researches assume, however, that the certain food can raise risk of occurrence of a cancer. In the publication in July release magazine “Cancer epidemiology, biomarkers and preventive maintenance” researchers analyze the data received from researches of the Shanghai cancer center. According to these information Asian women, being the postclimacteric period which eat a lot of red meat, desserts and sweets – the risk of disease by a cancer of a breast in comparison with those who eats traditional Asian food – vegetables, a soya, a fish twice increases.
In separate research in which 50 000 women of the given age have taken part, published in current number ” the British magazine about a cancer ” to be spoken, that at women who ate a quarter of a grapefruit or more in day on 30 % the risk of disease by a cancer of a breast in comparison with women, which grapefruit not if absolutely increased. But these results are preliminary, and authors speak, that before drawing final conclusions on individual styles of a feed and their influence on risk of disease by a cancer, it is necessary to continue researches. But a diet it not a unique element in business of preventive maintenance of cancer, and in editorial clause of ” Magazine of the American medical association ” Khan calls for the further researches of influence of the general physical style of a life of the woman. ”
Research
The cancer of a mammary gland concerns to highly aggressive malignant tumours owing to its extraordinary high potentiality of the process of dissemination. Metastasises meet in axillary lymph nodes – in 48-73.6 %, then in supraclavicular – in 16-19 % and parasternal – in 2.4-15 % is more often. Two ways of the process of dissemination of cancer of mammary gland are known: the most widespread – lymphogenous and less often widespread hemogenous. One of the major ways of outflow of lymph from mammary gland is axillary, then parasternal. hematogenous metastasises can arise in any body. Most often hematogenous metastasises amaze lungs, pleura, liver, and bones. Cancer of mammary gland is illness of women of an average and advanced age. Symptoms of a cancer of this body are a various degree of expressiveness asymmetry of the mammary glands, involved dummies with serous and sanguinolent discharge and also hyperaemia and a hypostasis of skin above a tumour.
During the palpation the various sizes of tumour can be defined; in the form it can be a knotty and non-uniform consistence, but with precise enough borders.
Most often there are the forms of cancer of a mammary gland which are central and infiltrative. There are also infiltratively edematic and ulcer forms. Seldom met form is cancer of Pedget which begins with change of nipple: its forms, occurrence of redness and condensation of skin, formation of squama, becoming wet crusts. Later under the nipple in a tissue of the glad the tumoral unit can be found. There are eczemoidea, ulcer and tumoral forms of cancer of Pedget.
The great value in diagnostics of cancer of a mammary gland was received with a radiological method of research – contrastless mammography. Last is carried out with the purpose of specification of the sizes, character of growth of tumour, revealing infiltrative component of cancer. Mammography is necessary also for the reception of the information on a condition of the second mammary gland by the way of revealing palpated tumours (Dickson, 1996).
From additional techniques in some cases, under corresponding indications, it is used contrast mammography (pneumomammography, pneumocystography, ductography). Needle biopsy has a great diagnostic informative value. Last time accuracy of cytologic diagnostics has considerably increased, up to 98 % of cases of right answers with the characteristic of a degree of a differentiation of a malignant tumour. The techniques of biopsy of thick needle or parenanbiopsy have even greater diagnostic opportunities. However it is necessary to remember, that these techniques are applied after an irradiation of a mammary gland, especially at infiltrative the form of a cancer with the purpose of prevention of possible dissimination cancer process.
For scheduling treatment and the forecast of disease the information on condition regional lymph nodes is needed. Besides palpation and biopsy of anatomic areas the straight line of lymphography is applied, allowing revealing increased axillary, less often above – and subclavian units.
These researches especially are neede for stout women when it is impossible to define palpusly. In some cases there can be certain indirect isotope lymphography with radioactive gold – 198 Au, allowing in comparison to a straight line lymphography to receive the data on prevalence of the process in this group of lymph nodes. To definition of condition parasternal lymph nodes it is applied through-breast phlebography and indirect radionuclide lymphography 198 Au though phlebography is more informative.
The researches dealing with specifying condition of lung, bone systems, liver do not have smaller value. Frequency secretly proceeding metastasises, as is known, is high enough: Almost at 1/3 sick women revealed by scanning asymptomatic proceeding metastasises in bones, in the further prove to be true clinical and radiological data.
Four stages of classification of mammary gland cancer according to S.A. Halldane.
There are also other classifications of malignant neoplasms of mammary gland, such as TNM-classification (Dickson, 1996).
The classification of tumors according to TNM.
A very important characteristic of the tumor process is the description of regional lymph nodes and some metastasis.
The characteristic of N-regional lymph nodes.
Long-term metastasis.
The choice of a way of influence on a tumour is caused by an individual deviation in current of disease, large number of pathological forms of a cancer, biological features of an organism of women. Now medical tactics is reduced to liquidation of the pathological center by local intervention – removals or destructions of a tumour and possible or defined metastasises in regional lymph nodes (operation, beam therapy) and the subsequent general influence of chemotherapy and hormonal preparations. The basic type of operative treatment of a cancer of a mammary gland is radical Hallsted’s mastectomy. Limited radical Pate’s mastectomy provides preservation of the big chest muscle.
Successes beam and the chemotherapy, proved an opportunity of full destruction of a primary tumour of a mammary gland and metastasises, force researchers to reconsider volume of operative intervention(Dickson, 1996).
The combined and complex treatment is conventional by virtue of its big efficiency. To preoperative beam therapy patients with tumours in diameter more than 5 see and more, especially during the infiltrative to the form of a cancer with presence of metastasises in axillary lymph nodes.
A preoperative irradiation spend usually on the areas which are a subject surgical intervention. Namely on lymphatic glands, axillary and subclavian zones. After operation depending on localization of a tumour and the histologic conclusion irradiate underclavian and parastenal lymph nodes.
The irradiation of mammary glands is carried out by means of two tangential fields at horizontal position of the patient on one side. Borders of fields are defined by distance, not less than 5 sm from edge of a tumour. Dosimetric researches thus show, that cortical layer of a pulmonary tissue receives 25 % from a doze in a tumour; edges – 25-30 %; a doze in a nipple above a doze in the center on 25-30 % that it is necessary to consider admissible in view of the tendency of growth of a tumour to periphery.
The greatest difficulty is represented with an irradiation auxiliary subclavian areas. Calculation of a doze in targets is carried out in view of their depth. So, the group underclavian lymph nodes together with lymph nodes together with lymph nodes the bottom half of neck is irradiated from one forward field which bottom border passes on the top edge of collar bone; top – on the middle of a neck; internal – on edge of a trachea; external – on a lateral surface of a neck. Foci doze pays off on 80 % to value of isodose curve.
The irradiation of parasteral lymph nodes is carried out from one forward field grasping space of first six edges. Calculation of foci dozes is conducted on value of 80 % isodoze by a curve. At localization of a tumour near to a brest or defeat parasteral lymph nodes the opposite party all is exposed to beam processing breast space.
Till now irrespective of a stage of process and its biological features the preoperative irradiation is spent by a technique usual fractionation of dozes. The single doze in the center makes 2gr., the total doze is possible till 45-50 gr. Duration of a rate of an irradiation and an interval following it about 2 weeks and more before operation do this technique from oncological positions not irreproachable by way of development for the period of beam treatment of the remote metastasises. The rate of the concentrated irradiation provides processing a tumour and region LU a single daily doze 4-5 gr., leading up a total doze till 20-25 gr. (An average fractionation of dozes). And present time is more and more applied a technique large fractionation of dozes – two-or a unitary irradiation by dozes accordingly 6-7gr. Or 10 gr. With the subsequent operation in a day in the first and this very day in the second variant of an irradiation. In order to prevent beam complications from lungs and heart it is expedient parasteral and underclavian areas to irradiate on 10 – 12 day after operation by a usual technique of doze fractionation.
The concentrated beam therapy of a cancer of a mammary gland by radiations of the accelerator approaches a technique of an irradiation to optimum whereas character of spatial distribution of dozes of brake radiation of the accelerator allows spending a preoperative irradiation of the chosen volume of tissue at the minimal number of fields(Link, 2003).
The saved up experience of a preoperative irradiation of a cancer of a mammary gland allows defining indications to application of a technique of the concentrated irradiation. So, it is established, that use of short rates of an irradiation is expedient at the small sizes of a tumour. T1-2 and at individual metastasises in subclavianlymph nodes. Studying beam pathomorphism has shown that at the concentrated irradiation quantitative and qualitative character of damage of the primary center does not differ from those at an irradiation of a tumour in a mode usual fractionation of dozes. During too time an established fact full (up to 18 % of cases distinct destructions in cells of a cancer) damaging action of radiation on metastasises of a tumour in lymph nodes. Greater sizes of a tumour of mammary gland T3-4, infiltrative – edematic forms of a cancer, presence of great number of metastasises in axillary and parastenal lymph nodes which are preoperative irradiation by a technique classical fractionation dozes.
The primary goals of a postoperative irradiation of zones of regional metastasis is reduction of frequency of metastasises in remained regional lymph nodes and by that improvement of the remote results. Postoperative irradiations appoint to 12-14 day after mastectomy. Beam therapy is spend by a technique of usual fractionation of dozes. The single doze in the center makes 2 gr., total – in zones regional metastasis to be lead up to 45 gr. On an irradiation postoperative cicatrix use from 45 up to 60 gr., depending on the histologic form of a cancer. Postoperative cicatrix irradiate from the direct or tangential fields distributed on distance of 1-2 sm from borders of the next fields of an irradiation, in avoidance of “hot” zones. The greatest anesthetizing and medical effect beam therapy possesses at metastasises in bones. Recently for achievement of palliative effect in deadlines it is used large fractionation dozes., Spent in the form of two irradiations on 6.5 or 8.5 gr. With an interval at 48 o’clock. This technique is especially shown at treatment at treatment of heavy patients in a phase generalizated metastasis. As a result of an irradiation of bone metastasises the growth inhibition of a tumour, restoration of bone structure on a place of destructive process is quite often observed(Dickson, 1996).
Beam therapy can promote stabilization of process and at so-called armour-clad forms of a metastatic cancer. In these cases depending on the sizes of defeat an irradiation spend from two-three fields daily dozes 2-3 gr. Up to total 25-30 gr. The irradiation is spent on accelerators, scale-therapeutic installations from 2 temporal fields in the size 3X3 sm in a mode usual fractionation up to a total doze 60-80 gr.
Meta-analysis
The purpose
By means of the meta-analysis to estimate, as observance of a recommended diet influences risk factors of such chronic diseases, as ischemic illness of heart and a cancer of a mammary gland.
Sources of the information
Computer and manual search in databases, magazines and materials of conferences (since 1993).
Selection of researches
Randomized controllable tests spent in out-patient conditions among adult volunteers during 3 months if the basic purpose was primary preventive maintenance (before inclusion in test <25 % of participants received treatment in occasion of studied diseases) and if in group of intervention participants received recommendations on change of quantity of consumed fats, sodium and cellulose. Criteria of exception: distinctions between groups of intervention and the control which concerned not only recommendations on change of a diet; use of food additives and specially delivered products; studying at once several interventions; cross character of test.
Choice of data
The Characteristic and the number of patients, character of intervention, place of carrying out of test, the purpose of purpose of a diet, level of arterial pressure, the general cholesterol in blood and sodium in urine, the maintenance of fats in food.
The basic results
All it is revealed 17 tests included 6893 participants (51 % of woman); from them into groups of intervention entered 3736 (54 %) the person. In 3817 (55 %) cases randomization was spent on an individual basis, and in 3076 (45 %) – depending on a place. The recommended diet has helped to lower systolic pressure on the average on 1,3 mm hg at 95 % a confidential interval from 0,3 up to 2,4 mm hg (Ñ€=0,01) in 8 tests proceeded from 3 up to 6 months, and for 1,9 mm hg (from 0,8 up to 3,0 mm hg; Ñ€ <0,001) in 5 tests by duration from 9 up to 18 months diastolic pressure has decreased on 0,7 mm hg (from 0,0 up to 1,5 mm hg; Ñ€=0,06) in 8 tests by duration from 3 up to 6 months, the tendency to its decrease (diastolic pressure has decreased on 1,2 mm hg at from-0,2 up to 2,6 mm hg; Ñ€=0,09) it is noted in 5 tests proceeded from 9 up to 18 month Observance of the recommended diet has led to decrease in the general level of cholesterol in blood on 0,28 millimole /½ ( from 0,15 up to 0,42 millimole /½) in 8 tests by duration from 3 up to 6 months and on 0,22 millimole /½ ( from 0,05 up to 0,39 millimole /½) in 5 tests by duration from 9 up to 18 months Observance of a diet was accompanied by decrease daily excraction sodium with urine on 45 millimole (from 32,8 up to 57,1 millimole) in 3 tests by duration from 9 up to 18 months After exception of the analysis of all tests, devoted to preventive maintenance of a cancer of a mammary gland, has been shown, that observance of the ordered diet has led to decrease in quantity of consumed fats (in percentage of the general power value of food) on 2,5 % (from 1,1 up to 3,9 %) in 4 tests by duration from 3 up to 6 months In tests on preventive maintenance of a cancer of a mammary gland the quantity of consumed fats decreased in a greater degree.
The conclusion
Observance of a recommended diet as method of primary preventive maintenance moderately reduces quantity consumed with food of sodium and fats, systolic and diastolic arterial pressure, the general level of cholesterol in blood.
Comments
Characteristics of participants of test can appear especially important at the decision of a question what of the received results can be applied to other populations. Many researches in which influence of salt consumed with food on a level the pressure or quantities of consumed fats on a level lipids in blood was studied, were spent in carefully controllable conditions (for example, in specialized chambers according to a metabolism or at a feed of voluntary participants by specially delivered products). That it is better to estimate influence of the lowered consumption of salt and fats on risk factors of cardiovascular diseases in a population, E. Brunner et al. has analysed the results of the clinical tests spent in out-patient conditions. Generalization of results of 17 tests has shown, that observance of recommendations on decrease in consumption of salt (confirmed by decrease daily excrection sodium with urine) and fats (estimated by means of special questionnaires) leads to the moderate decrease of the pressure and the general level of cholesterol in blood.
These results, possibly, are wider applied, the than results of the researches executed in conditions endocrinological branches; however and they can overestimate the influence of studied interventions on a state of health of the population as a whole. Voluntary participants of clinical tests differ from the general population (so more precisely, they usually observe all instructions of the report).
Consultations concerning a diet can be effective enough, however they also should be practical; the report of some researches provided during supervision from 10 up to 32 contacts of each participant to the doctor. Besides the effect from observance of a diet started to weaken after the termination of consultations. And, at last, though such influences on risk factors as decrease pressure and the general level of cholesterol in blood, lead to decrease in death rate from cardiovascular diseases, exact values of similar decrease are unknown. The results of research E. Brunner et al. specify that brief advice of doctors of primary medical aid to healthy adult people can have the certain sense. However from the economic point of view more justified approach to decrease in consumption of salt and fats and, hence, death rates from cardiovascular diseases can appear a combination of purposeful consultations to the newest populational interventions.
Perhaps, at one tumoral disease at women questions estrogen-gestagen therapy does not cause such disputes and inconsistent judgements, as at cancer of mammary gland. Spears break, the authorities are subverted, one epoch-making opening are replaced by others, and problem estrogen-gestagen therapy and cancer of mammary gland remains her same not clear, frightening and not causing any desire to be engaged. Components of this problem look as follows: cancer of mammary gland is the most frequent oncological disease of the women, having the menacing tendency to expansion; the role of estrogen in an induction and reinduction of cancer of mammary gland is indisputable, doubtless and does not demand proofs; estrogen-gestagen therapy essentially facilitates such heavy complications the period, as a bony rarefication, cardiovascular diseases, dyspareunia, urine incontinence, psychological problems and even illness of Alzheimer.
Unfortunately, the absence of the given reason discussion, inaccessibility to the majority of gynecologists and oncologists of the full information on problem cancer of mammary gland and estrogen-gestagen therapy as it is published basically in English and German languages, have generated set of myths – numbed and canonized. Our problem is much more modest – to acquaint doctors with modern sights at the given problem. For today it is lead more than 50 epidemiological researches studied frequency cancer of mammary gland up to or after estrogen-gestagen therapy(Link, 2003).
As we see, the relative risk to be ill with cancer of mammary gland is higher for women, ever used estrogen-gestagen therapy, in comparison with the women never accepted estrogen-gestagen therapy. A little above relative risk at the patients received estrogen-gestagen therapy at the moment of statement of diagnosis cancer of mammory gland (current use).
For increase in relative risk duration the estrogen-gestagen therapy more than 5 years is significant. However the medicine would not be medicine if in it the opposite points of view did not collide. Many perspective researches (Canadian National Breast Screening Study I, 1992; Netherlands Cohort Study, 1995) have not established statistically significant increase of risk Cancer of mammary gland at reception the estrogen-gestagen therapy. Similar data have been received by V. Beral. (1997), the generalized data 51 epidemiological researches with participation of 52 702 women with cancer of mammary gland and 108 411 healthy women. In considered the fullest the metaanalysis T.L. Bush, Covering 45 researches with 1975 for 2000, also it is not found proofs of that estrogen or combinations an estrogen raise risk of disease cancer of mammary gland.
There was a curious conclusion about senselessness of the further supervision and researches which, in their opinion, will not change the conclusions and conclusions of all previous researches. At the same time they do not exclude slight increase of risk of cancer of mammary gland at duration estrogen-gestagen therapy of 5 years and more. At the critical analysis of various publications it is possible to draw a conclusion, that less than 5-years esrtrogen-gestagen therapy does not lead to statistically significant increase of risk to be ill with cancer of mammary gland.
In 2012 the results of one of the most scale researches Women’s International Study of long duration estrogen after menopause (WISDOM), called to estimate the reason and the actual sizes of increase of risk of cancer of mammary glad are expected at estrogen-gestagen therapy. In numerous researches interesting supervision that after termination estrogen-gestagen therapy the relative risk of development of cancer of mammary gland in the first year decreases up to 1,0 are resulted.
Similar data are received both T.L. Bush (2001). In this connection it is possible to approve with confidence, that estrogen-gestagen therapy does not increase lethality from cancer of mammary gland. It explains the stimulation the estrogen-receptors already developed, but still to clinically not shown tumour leads to its higher differentiation, than at so-called neoinduction estrogen. Difference highly-differentiated tumours from low-differentiated, we believe, it is known to each doctor. One more clinically significant problem is the difficulty pf mammary diagnostics of cancer of mammary gland (especially small sizes) owing to increase in density of a body gland at estrogen-gestagen therapy. In the majority of researches, various on technics and a technique of estimation, the increase in density of a body gland on the average on 20-30 % is ascertained (Link, 2003).
Traditionally believe, that estrogen worsen all forecasts for such patients. At the same time numerous supervision of cases of cancer of mammary gland during pregnancy and its interruptions at diagnosed cancer of mammary gland consistently specify absence “estrogen influences”. On the basis of rather limited quantity of cases in these researches it is impossible to bear final judgement about safety estrogen-gestagen therapy after special treatment cancer of mammary gland. For clearing this question the further are required prospective researches. At the same time encouraging enough achievements allow to approach to an individualization of indications for estrogen-gestagen therapy. Certainly, “treated” cancer of mammary gland is not absolute contra-indication for estrogen-gestagen therapy.
Conclusion
Bringing preliminary results, we can draw following conclusions.
- tstrogen substitutional hormonal therapy spent within less than 5 years, does not raise the risk of disease with cancer of mammary gland for the woman.
- More than 5-years duration of estrogen-gestagen therapy increases approaches cancer of mammary gland on the average in 1,2-1,4 times. Seeming obvious increase of risk at increase in duration estrogen-gestagen therapy does not prove to be true, however data of greater metaanalyses do not represent it convincing proofs.
- There are no convincing proofs of that increase of disease cancer of mammary gland means simultaneous increase lethality.
- Convincing enough and extremely probable it is represented, that lethality for those who received estrogen-gestagen therapy and have ill cancer of mammary gland , below, than at the women who are not accepted estrogen-gestagen therapy.
- cancer of mammary gland, diagnosed during reception estrogen-gestagen therapy, has more favorable forecast, than cancer of mammary gland without estrogen-gestagen therapy.
- In the first years after termination estrogen-gestagen therapy the relative risk of disease cancer of mammary gland decreases even below 1,0.
- Mammographical diagnostics at estrogen-gestagen therapy is complicated in view of increase of density of a body gland. However it does not lead to increase of death rate at patients with cancer of mammary gland, concerning to this group.
- There are no sufficient proofs of that estrogen-gestagen therapy worsens the parameters of cancer of mammary gland. If to compare a present situation that occured in gynecology, endocrinology and oncology several years ago, we can believe with confidence: now doctors have much more variants of the decision and opportunities for their choice when it is a question about estrogen-gestagen therapy. Discussion and a choice of variants estrogen-gestagen therapy should consider an individual approach to a situation. All pro and contra, all benefits and risks should be opposed each other, carefully and are seriously weighed. We hope, that cited by us in this clause data will help competent and thoughtful doctors in a new fashion, more objectively to look at problem estrogen-gestagen therapy and cancer of mammary gland and to make the correct decision.
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