How are inheritance and a family history involved in breast cancer risk?

Most women do not develop breast cancer. When it does develop it results from mutations in multiple cancer-associated genes. The first of these mutations can be either inherited from ones parents (familial cancer) or they can occur after conception (sporadic cancers). A few of the inherited mutations - called high penetrance mutations are associated with a prominent family history of breast cancer and high breast cancer risk. However, most of the inherited mutations are associated with a smaller increase in the risk of breast cancer and a less prominent family history of breast cancer (these mutations are called low penetrance mutations). Most breast cancer cases (about two thirds) are known as sporadic, meaning that rare mutations have occurred. In these cases the initial rare cancer gene mutations occurred after conception; these cases have no connection to family history.

FIBROCYSTIC DISEASE:
Fibrocystic breasts are characterized by lumpiness and usually discomfort in one or both breasts. The lumpiness is due to small breast masses or breast cysts. The condition is very common and benign, meaning that fibrocystic breasts are not malignant (cancerous). Fibrocystic breast disease (FBD), now referred to as fibrocystic changes or fibrocystic breast condition, is the most common cause of "lumpy breasts" in women and affects more than 60% of women. The condition primarily affects women between the ages of 30 and 50, and tends to become less of a problem after menopause. CAUSES: The most significant contributing factor to fibrocystic breast condition is a woman's normal hormonal variation during her monthly cycle. Many hormonal changes occur as a woman's body prepares each month for a possible pregnancy. The most important of these hormones are estrogen and progesterone. These two hormones directly affect the breast tissues by causing cells to grow and multiply. Many hormones aside from estrogen and progesterone also play an important role in causing fibrocystic breasts. Prolactin, growth factor, insulin, and thyroid hormone are some of the other major hormones that are produced outside of the breast tissue, yet act in important ways on the breast. In addition, the breast itself produces hormonal products from its glandular and fat cells. Signals that are released from these hormonal products are sent to neighboring breast cells. The signals from these hormone-like factors may, in fact, be the key contributors to the symptoms of fibrocystic breast condition. These substances may also enhance the effects of estrogen and progesterone and vice versa. The same cyclical hormones that prepare the glandular tissue in the breast for the possibility of milk production (lactation) are also responsible for a woman's menstrual period. However, there is a major difference between what happens in the breast and uterus. In the uterus (the womb), these hormones promote the growth and multiplication of the cells lining the uterus. If pregnancy does not occur, this uterine lining is sloughed off and discharged from a woman's body duringmenstruation. In the breast, these same hormones stimulate the growth of breast glandular tissue and increase the activity of blood vessels, cell metabolism, and supporting tissue. All this activity may contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period. When the monthly cycle is over, however, these stimulated breast cells cannot simply slough away and pass out of the body like the lining of the uterus. Instead, many of these breast cells undergo a process of programmed cell death, called apoptosis. During apoptosis, enzymes are activated that start digesting cells from within. These cells break down and the resulting cellular fragments are then further broken down by scavenger cells (inflammatory cells) and nearby glandular cells.

During this process, the fragments of broken cells and the inflammation may lead to scarring (fibrosis) that damages the ducts and the clusters (lobules) of glandular tissue within the breast. The inflammatory cells and some of the breakdown fragments may release hormone-like substances that in turn act on the nearby glandular, ductal, and structural support cells. The amount of cellular breakdown products, the degree of inflammation, and the efficiency of the cellular cleanup process in the breast vary from woman to woman. These factors may also fluctuate from month to month in an individual woman. They may even vary in different areas of the same breast in a woman. SIGNS AND SYMPTOMS:

Breast lumps or areas of thickening that tend to blend into the surrounding breast tissue Generalized breast pain or tenderness Fluctuating size of breast lumps Green or dark brown nonbloody nipple discharge that tends to leak without pressure or squeezing Changes that occur in both breasts, rather than just one Monthly increase in breast pain or lumpiness from midcycle (ovulation) to just before your period

PATHOPHYSIOLOGY:

REFERENCES:

http://www.ncbi.nlm.nih.gov/pubmed/3511705 http://www.medicinenet.com/fibrocystic_breast_condition/page2.htm http://www.mayoclinic.com/health/fibrocysticbreasts/DS01070/DSECTION=symptoms