الفهرس 
Breast Parenchyma And Support StructuresOnly 14 pages are availabe for public view
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Abstract
Physicians have been documenting breast cancer on papyrus since the 17th century B.C. Discovered in Egypt in 1862, the Edwin Smith papyrus is believed to have been written by the god Imhotep and details eight cases of breast tumors, referred to as ”bulging tumors of the breast.” The author of the papyrus concluded that there was no treatment for breast cancer .Although breast cancer has been around for thousands of years, treatment did not come about until recently and in ancient Egypt was practically nonexistent. The only ”treatment” available subjected women to a barbaric type of surgery ending with cauterization (to stem blood flow) -- using boiling oil -- or a tool called a fire drill without the benefit of anesthesia or antisepsis. The Egyptians had a tendency to blame foreign gods for diseases and prayed to the god Bes and goddess Sekhmet to protect them because of the absence of a humane treatment for breast cancer ( Rene Jackson and Alberto Righ ,2006 ).
Breast cancer is the most common cause of cancer death among women worldwide .Incidence rates are higher in more developed countries. In Egypt, breast cancer is the most common cancer among women, representing 18.9% of total cancer cases (35.1% in women and 2.2% in men) among the Egypt National Cancer Institute (NCI) series of 10 556 patients during the year 2001with an age-adjusted rate of 49.6 per 100 000 population ( Elatar I, 2002.Ibrahim AS ,2002 ).
The established risk factors for breast cancer include female gender, age, previous breast cancer, benign breast disease, hereditary factors, early age at menarche , late age at menopause, late age at first full-term pregnancy, obesity, use of post menopausal hormone replacement therapy, use of oral contraceptives, exposure to low-dose ionizing radiation in midlife and exposure to high-dose ionizing radiation early in life. Correlated risk factors for breast cancer include never having been pregnant, having only one pregnancy rather than many, not breast feeding after pregnancy, diethylstilbestrol (DES), certain dietary practices (high intake of fat and low intakes of fiber, fruits, and vegetables), tobacco smoking, abortion, breast trauma, breast augmentation, large breast size, synthetic estrogens, electromagnetic fields, and alcohol consumption( Sylvie Wittmann et al and Christopher I. Li et al ,2003).
Screening for breast carcinoma depends greatly upon the age interval and risk factor .Women at Average Risk Begin mammography at age 40. For women in their 20s and 30s, it is recommended that clinical breast examination be part of a periodic health examination, preferably at least every three years. Women at increased risk of breast cancer might benefit from additional screening strategies beyond those offered to women of average risk, such as earlier initiation of screening, shorter screening intervals, or the addition of screening modalities other than mammography and physical examination, such as ultrasound or magnetic resonance imaging. However, the evidence currently available is insufficient to justify recommendations for any of these screening approaches( Robert A. Smith et al,2003 ).
Breast conservation therapy (BCT) with lumpectomy and radiation has allowed many women to preserve their breasts and avoid disfiguring surgery. Lumpectomy and breast irradiation is a standard therapy for early breast cancer patients who desire breast conservation. However, the overall rate of mastectomy exceeds that of BCT in the United States. There have been significant advances in patient awareness of the options available for local management of early breast cancer and changes in the attitudes of physicians, including surgeons, allowing a gradual rise in the rate of BCT in the last two decades( Janice K.Ryu,2002 ).
Whereas surgical resection has traditionally been the standard of care for the treatment of focal malignancies, recent improvements in imaging technologies have enabled the development of minimally invasive high-temperature thermal tumor ablation, a technique that uses imaging guidance for the accurate percutaneous placement of needle-like applicators . The primary mechanism of tumor destruction for these methods is based upon subjecting the entire tumor volume to cytotoxic temperatures ( 50°C) for short durations (4 –12 min) to induce tumor coagulation and necrosis from energy sources such as RF ( Dodd G.D. et al, 2000 ).
Radiofrequency ablation (RFA) destroys tumor cells through the generation of frictional heat by intracellular ions moving in response to a high frequency alternating current. An electrode is inserted into the tumor under ultrasound guidance, and a larger electrode pad is placed against the patient’s skin, usually on the anterior thigh. The electrode placed in the tumor contains secondary electrodes that are deployed in the tumor into a star-like array. This multiprong electrode can generate an ablation zone of 3-6 cm in diameter. At the University of Texas M. D. Anderson Cancer Center are in the final stages of a multicenter clinical trial exploring the use of RFA for the treatment of invasive breast tumors < 2 cm in size ( Mirza AN et al ,2001 ).