As an Obstetrics & Gynaecology, member of National Breast Cancer Foundation and a woman I find it very important to raise awareness about the importance of early detection of Breast Cancer. Make a difference! Spread the word about mammograms and encourage communities, organisations, your friends and family memebrs to get involved! Your help matters...
Criteria I – Introduction (4 points)1. Describe the common comCruzIbarra161
Criteria I – Introduction (4 points)
1. Describe the common complaint/problem selected- breast cancer
2. Discuss the pathophysiology of the common complaint/problem.
3. Detail the necessary review of systems and what would be seen on physical examination for this complaint/problem.
4. Provide rationale from the literature to support your work.
In the United State, breast cancer is the leading cause of cancer death among female. Breast cancer ranks second (after lung cancer) as a cause of cancer death in women. In 2016, around 245, 229 new cases of female breast cases reported, and 41,487 women died of this disease (CDC, 2019). In 2018, approximately 63,960 cases of in situ disease and 266,120 cases of invasive disease were diagnosed.1 About 40,920 breast cancer-related deaths occurred in 2018, which represents 6.7% of all cancer-related deaths.2 Female breast cancer is most common in middle-aged and older women; median age at diagnosis is 62 years.2 In 2016, more than 3.5 mil- lion women were breast cancer survivors.3 The lifetime risk of developing breast cancer in the United States is 12.4% (1 in 8 women ). (ACS, 2019)
Breast cancer mortality was 41% higher among black women (29.2 deaths per 100,000 population) than white women (20.6 deaths per 100,000 population). Breast cancer death rates decreased during 2010–2014 among both blacks and whites, although differences in trends by race and age were found. Overall, breast cancer death rates decreased faster among white women (-1.9% per year) compared with black women (-1.5% per year). Among women aged <50 years, breast cancer death rates decreased at the same pace among black and white women, whereas white women aged ≥50 years had significantly larger decreases. The largest difference by race was observed among women aged 60–69 years: breast cancer death rates decreased 2.0% per year among white women compared with 1.0% among black women. Death rates from breast cancer have been declining since about 1990, in part due to better screening and early detection, increased awareness, and continually improving treatment options, decline in prescriptive hormone replacement therapy after menopause. (ACS, 2019).
Breast cancer is a disease in which cells in the breast grow out of control. The majority of breast cancers (95%) are sporadic; only a small proportion, particularly those diagnosed in young women, are due to a highly penetrant autosomal-dominant trait. Over the past 5 years there has been consider- able progress in the identification and localization of the genes responsible for hereditary breast cancer. Two in particular have grabbed the headlines; these are BRCA1 and BRCA2. Subtypes of breast cancer include those driven by specific hormones, such as estrogen, progestogen or the protein HER2. Sixty percent of breast cancers are estrogen positive. Twenty percent of breast cancers are HER2-positive. Another 20 percent are triple-negative breast cancers, a type of breast cancer that tes ...
Criteria I – Introduction (4 points)1. Describe the common comCruzIbarra161
Criteria I – Introduction (4 points)
1. Describe the common complaint/problem selected- breast cancer
2. Discuss the pathophysiology of the common complaint/problem.
3. Detail the necessary review of systems and what would be seen on physical examination for this complaint/problem.
4. Provide rationale from the literature to support your work.
In the United State, breast cancer is the leading cause of cancer death among female. Breast cancer ranks second (after lung cancer) as a cause of cancer death in women. In 2016, around 245, 229 new cases of female breast cases reported, and 41,487 women died of this disease (CDC, 2019). In 2018, approximately 63,960 cases of in situ disease and 266,120 cases of invasive disease were diagnosed.1 About 40,920 breast cancer-related deaths occurred in 2018, which represents 6.7% of all cancer-related deaths.2 Female breast cancer is most common in middle-aged and older women; median age at diagnosis is 62 years.2 In 2016, more than 3.5 mil- lion women were breast cancer survivors.3 The lifetime risk of developing breast cancer in the United States is 12.4% (1 in 8 women ). (ACS, 2019)
Breast cancer mortality was 41% higher among black women (29.2 deaths per 100,000 population) than white women (20.6 deaths per 100,000 population). Breast cancer death rates decreased during 2010–2014 among both blacks and whites, although differences in trends by race and age were found. Overall, breast cancer death rates decreased faster among white women (-1.9% per year) compared with black women (-1.5% per year). Among women aged <50 years, breast cancer death rates decreased at the same pace among black and white women, whereas white women aged ≥50 years had significantly larger decreases. The largest difference by race was observed among women aged 60–69 years: breast cancer death rates decreased 2.0% per year among white women compared with 1.0% among black women. Death rates from breast cancer have been declining since about 1990, in part due to better screening and early detection, increased awareness, and continually improving treatment options, decline in prescriptive hormone replacement therapy after menopause. (ACS, 2019).
Breast cancer is a disease in which cells in the breast grow out of control. The majority of breast cancers (95%) are sporadic; only a small proportion, particularly those diagnosed in young women, are due to a highly penetrant autosomal-dominant trait. Over the past 5 years there has been consider- able progress in the identification and localization of the genes responsible for hereditary breast cancer. Two in particular have grabbed the headlines; these are BRCA1 and BRCA2. Subtypes of breast cancer include those driven by specific hormones, such as estrogen, progestogen or the protein HER2. Sixty percent of breast cancers are estrogen positive. Twenty percent of breast cancers are HER2-positive. Another 20 percent are triple-negative breast cancers, a type of breast cancer that tes ...
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
Myths And Facts About Breast Cancer.
Breast cancer is the most common cancer in the world, with around 2.26 million new cases diagnosed each year. With around 0.7 million fatalities per year worldwide, it is one of the major causes of death among female cancer patients. It is quite common in those aged 25 to 70, with peak prevalence in women aged 50 to 69.
Breast cancer occurs when a pre-cancerous tumour progresses to a malignant tumour in a multi-stage process that is triggered by abnormal and uncontrolled growth of normal cells. These abnormalities are brought on by physical carcinogens (ultraviolet and ionising radiation), chemical carcinogens (alcohol, aflatoxin, tobacco smoke), and biological carcinogens (viral infections, bacteria, or parasites). Breast cancer risk is also increased by genetic factors. 5 to 10% of breast cancer instances are caused by genetic abnormalities passed down through a family’s generations.
Well, knowing one’s risk towards a breast cancer helps to screen for it and detect it early in case it does occur. Breast cancer risk factors can be of the following types:
Inherent or unchangeable
Environmental
Behavioural
In this document, there is a detailed information about the breast cancer and its pathogenicity, how to diagnose, and its types.
Also there is a full information about the ovaries and their main desorders.
Hope you enjoy it.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Racial Differences in Accepting Pegfilgrastim Onpro Kit (On-Body Injector) Us...EditorSara
Neulasta Onpro kit eliminates need for additional clinic visit after chemotherapy. Given the racially diverse population in our institution, we investigated acceptance of Onpro kit among patients on chemotherapy.Single-institution, retrospective review conducted in patients with GI tumors who received Onpro kit within 1 hour of completion of systemic chemotherapy from Jan 2014 through Jan 2018...
APL:Retinoic Acid and Retinoid Pharmacology, a Breakthrough TodayEditorSara
Acute promyelocytic leukemia(APL),a specific characteristic of t(15;17) chromosomal translocation,molecular gene analyses are conclusive in vivo evidence that oncogenic pml/RARa fusion plays a crucial role in APL leukemogenesis [1-3]. Since the introduction of initial 13-cis retinoic acid(13-cis RA)[4],and currently all-trans RA(ATRA) [5] and tamibarotene [6],RA plus chemotherapy or RA plus As2O3 regimen is currently the standard of care [7]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
STAT-6 In Hodgkin Lymphoma Pathobiology and Treatment-Review of the LiteratureEditorSara
Classical Hodgkin Lymphoma (cHL), consists of rare neoplastic Hodgkin and Reed-Sternberg cells (HRS) residing in a prominent inflammatory background. HRS show deregulated activation of multiple signaling pathways and transcription factors. The activation of these pathways and factors is partly mediated through interactions of HRS with various other types of cells in the microenvironment, but also through genetic lesions...
Lipocalin 2 as a Potential Diagnostic and/or Prognostic Biomarker in Prostate...EditorSara
Lipocalin 2 (LCN2) is a 25 kDa secreted protein, initially purified from neutrophil granules, and mainly expressed in immune cells, hepatocytes, renal cells, prostate, cells of the respiratory tract and cardiomyocytes. LCN2 belongs to the family of lipocalins known for their ability to traffic small hydrophobic molecules such as lipids and retinoids...
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
Myths And Facts About Breast Cancer.
Breast cancer is the most common cancer in the world, with around 2.26 million new cases diagnosed each year. With around 0.7 million fatalities per year worldwide, it is one of the major causes of death among female cancer patients. It is quite common in those aged 25 to 70, with peak prevalence in women aged 50 to 69.
Breast cancer occurs when a pre-cancerous tumour progresses to a malignant tumour in a multi-stage process that is triggered by abnormal and uncontrolled growth of normal cells. These abnormalities are brought on by physical carcinogens (ultraviolet and ionising radiation), chemical carcinogens (alcohol, aflatoxin, tobacco smoke), and biological carcinogens (viral infections, bacteria, or parasites). Breast cancer risk is also increased by genetic factors. 5 to 10% of breast cancer instances are caused by genetic abnormalities passed down through a family’s generations.
Well, knowing one’s risk towards a breast cancer helps to screen for it and detect it early in case it does occur. Breast cancer risk factors can be of the following types:
Inherent or unchangeable
Environmental
Behavioural
In this document, there is a detailed information about the breast cancer and its pathogenicity, how to diagnose, and its types.
Also there is a full information about the ovaries and their main desorders.
Hope you enjoy it.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Racial Differences in Accepting Pegfilgrastim Onpro Kit (On-Body Injector) Us...EditorSara
Neulasta Onpro kit eliminates need for additional clinic visit after chemotherapy. Given the racially diverse population in our institution, we investigated acceptance of Onpro kit among patients on chemotherapy.Single-institution, retrospective review conducted in patients with GI tumors who received Onpro kit within 1 hour of completion of systemic chemotherapy from Jan 2014 through Jan 2018...
APL:Retinoic Acid and Retinoid Pharmacology, a Breakthrough TodayEditorSara
Acute promyelocytic leukemia(APL),a specific characteristic of t(15;17) chromosomal translocation,molecular gene analyses are conclusive in vivo evidence that oncogenic pml/RARa fusion plays a crucial role in APL leukemogenesis [1-3]. Since the introduction of initial 13-cis retinoic acid(13-cis RA)[4],and currently all-trans RA(ATRA) [5] and tamibarotene [6],RA plus chemotherapy or RA plus As2O3 regimen is currently the standard of care [7]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
STAT-6 In Hodgkin Lymphoma Pathobiology and Treatment-Review of the LiteratureEditorSara
Classical Hodgkin Lymphoma (cHL), consists of rare neoplastic Hodgkin and Reed-Sternberg cells (HRS) residing in a prominent inflammatory background. HRS show deregulated activation of multiple signaling pathways and transcription factors. The activation of these pathways and factors is partly mediated through interactions of HRS with various other types of cells in the microenvironment, but also through genetic lesions...
Lipocalin 2 as a Potential Diagnostic and/or Prognostic Biomarker in Prostate...EditorSara
Lipocalin 2 (LCN2) is a 25 kDa secreted protein, initially purified from neutrophil granules, and mainly expressed in immune cells, hepatocytes, renal cells, prostate, cells of the respiratory tract and cardiomyocytes. LCN2 belongs to the family of lipocalins known for their ability to traffic small hydrophobic molecules such as lipids and retinoids...
Peripheral T-Cell Lymphomas: Progress in TreatmentEditorSara
Peripheral T-Cell Lymphomas (PTCL) arises from mature T-cells and they represent an extremely heterogeneous group. They are sub-classified into three major groups based on clinical presentation and localization, namely the nodal, extra nodal and leukemic PTCL. This review focuses on nodal PTCL which are the most frequently encountered entities...
Circulatingtumordna (Ctdna) in Prostate Cancer: Current Insights and New Pers...EditorSara
Prostate Cancer (PC) is the common tumor in men, which represents one of leading cause of cancer death throughout the world. Most patients were diagnosed too late for curative treatment. So, it is necessary to develop a minimal invasive method to identify novel biomarkers. Currently, plasma DNA has attracted increasing attention as a potential tumor marker..
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...EditorSara
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types..
Deadenylase Expression in Small Cell Lung Cancer Related To Clinical Characte...EditorSara
Lung cancer is the second common malignancy and the most aggressive cancer worldwide with late diagnosis and poor prognosis. The search for biomarkers that promote early diagnosis and improve therapeutic strategies focuses to the understanding of the mechanisms underlying cancer development and progression. The deregulation of gene expression is one of the cancer hallmarks reflected to the stability..
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...EditorSara
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Higher Rates of Helicobacter Pylori Infection and Gastric Intestinal Metaplas...EditorSara
The rate of Helicobacter pylori (H. pylori) infection is higher in minority patients in the United States [1]. Gastric intestinal metaplasia (IM) is associated with H. pylori infection and carries an increased risk for gastric cancer over time, in particular for patients from regions of high gastric cancer incidence [2]. We aimed to compare the rates of Helicobacter pylori infection and gastric intestinal metaplasia...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...EditorSara
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Myelomastocytic leukemia is a very rare variant of myeloid leukemia, behaves clinically very aggressive and belongs to the group of so-called metachromatic leukemias. Metachromatic leu- kemias comprise leukemias with at least 10 to 20% tumor cells exhibiting metachromatic gran- ules: mast cell leukemia...
Analysis of Treatment Option for Synchronous Liver Metastases and Colon Recta...EditorSara
Colorectal or bowel cancer is one of the major cause of cancer worldwide. Research has shown that 15 to 20 % colorectal cancer patients are also diagnosed with synchronous liver metastases (LM) at presentation and about one third eventually develop liver lesions (Leporrier, Maurel, Chiche, Bara, Segol, and Launoy, 2006; Manfredi, Lepage, Hatem, Coatmeur, Faivre, and Bou-vier, 2006)...
An Adrenal Mass in a Patient with Lynch SyndromeEditorSara
Adrenocortical cancer (ACC) is a rare malignancy (estimated annual incidence 0.7 to 2.0 cases per million individuals worldwide) with a poor prognosis. In contrast, Lynch Syndrome (LS) is a much more commonly encountered hereditary syndrome that predisposes individuals to colon cancer and multiple other malignancies.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
On February 21, 2020, at Codogno Hospital (in the Lodi?s Province, Lombardy, Italy), Italy?s Coronavirus ?patient one? was discovered. In the following week the cases within the Province of Lodi increased exponentially and it was interpreted as a disease cluster originating from the hospital.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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1. Breast Cancer Awareness
Afa Bayramova*
Department of Gynaecology & Obstetrics, Yaroslavl State Medical University, Russia
Volume 1 Issue 3- 2018
Received Date: 15 June 2018
Accepted Date: 18 July 2018
Published Date: 25 July 2018
1. Abstract
As an Obstetrics&Gynaecology, member of National Breast Cancer Foundation and a woman
I find it very important to raise awareness about the importance of early detection of Breast
Cancer. Make a difference! Spread the word about mammograms and encourage communities,
organisations, your friends and family memebrs to get involved! Your help matters.
Breast cancer is the most common type of tumors among the female population of the United
States. One in eight women will be diagnosed with breast cancer in their lifetime.
Clinics of Oncology
Citation: Afa Bayramova, Breast Cancer Awareness. Clinics of Oncology. 2018; 1(3): 1-8.
United Prime Publications: http://unitedprimepub.com
3. Introduction
Annually, more than one million cases of this disease are reg-
istered in the world, and with an average life expectancy of 80
years the risk of developing breast cancer is 12.5%. Over the past
20 years, there has been a steady trend towards an increase in the
incidence of this type of cancer, especially in cities and megaci-
ties. Since 1985, he is the first among women with oncological
diseases, accounting for 31.2%. It is well known that an annual
preventive examination contributes to the early detection of
tumors. However, often patients refer to a doctor already with
obvious signs of a tumor, and this complicates the subsequent
treatment. One of the reasons is the lack of understanding of the
importance of early diagnosis of the disease. Now scientists have
deeply penetrated into the mechanisms of the origin of the can-
cer cell, although much is still unclear. Like other cancers, breast
cancer remains insidious and aggressive. Therefore, it is very im-
portant for any person to have an idea of the development of this
disease: it is forewarned, therefore, armed [1].
4. Why Do Women Get Breast Cancer?
There is hardly an unequivocal answer to this quite legitimate
question. Breast cancer has been known since time immemorial:
its cases are described, for example, in the ancient Egyptian pa-
pyri of the doctor Imhotep (3000 BC), in the Babylonian medi-
cal code of Hammurabi (2,250 years BC); Hippocrates (400
BC) repeatedly refers to it, and Galen (130-200 BC) calls breast
tumors cancer because of their external similarity to crab (in
Greek the word “crab” and “cancer” sound the same: karkinos).
Unlike many diseases, the causes of which are elucidated, the
basis for the development of malignant tumors is more complex
*Corresponding Author (s): Bayramova A, Department of Gynaecology & Obstetrics,
Yaroslavl State Medical University, Russia, E-mail: yourdoctor.md@gmail.com
Review Article
mechanisms and a variety of causes, including genetic features,
environmental factors and many others.
Tumors of the breast can be either benign, or malignant, or can-
cerous. The latter are much less common. Malignant tumors
arise accidentally or are associated with heredity. In 10% of
cases, the disease is transmitted from generation to generation
and is due to congenital mutations in the BRCA1 or BRCA2
predisposition genes (from English Breast Cancer).
The most common benign disease of the mammary glands is
various mastopathy, which refers to a large group of dyshormo-
nal hyperplasias (proliferation of breast tissue caused by hor-
monal disorders) and is associated with impaired functions of
the ovaries, adrenals, pituitary gland, thyroid gland or with
hormone exchange disorders due to liver diseases , obesity, etc.
These proliferations of the mammary gland tissue can be in the
form of dense nodules, cysts or diffuse formations. Some of
these changes can be attributed to precancerous [2].
And that’s surprising, breast cancer is found not only in women,
but also in men, but much less often: about 1% of all cases are
associated with the male population. Among the causes of mam-
mary tumors in men - a rare mutation in the gene predisposi-
tion BRCA2, obesity, hormonal disorders. In contrast to benign
growth of breast tissue, malignant degeneration necessarily re-
quires prompt treatment.
It is known that unlike normal cells, tumor cells do not pass
after division into a rest phase, but continue to grow uncontrol-
lably. Tumor formation is a multistage process. The growth and
progression of the tumor, that is, its transition from the initial to
2. Keywords
Breast cancer; Breast cancer
awareness; Gynaecology
3. tissue. Although malignant degeneration with mastopathy oc-
curs quite rarely, nevertheless the appearance of the first signs of
mastopathy, detected by palpation, that is, careful probing of the
gland, is an occasion to appeal to a mammologist.
Mammography (X-ray examination) and ultrasound are the main
methods of early detection of breast and mastopathy tumors. The
results of these studies are often confirmed by puncture of the
mammary gland, when the syringe sample of the alleged neo-
plasm is examined under a microscope. Very often, the changes
in the mammary gland are detected by the patients themselves
when examining the glands in the first 6-10 days after the onset
of menstruation.
What are the signs that should be alerted to during an independ-
ent examination?
5.1. Early Signs of Breast Cancer
Every woman needs regular self-examination. To do this, it is
enough to go to the mirror and carefully examine your chest.
In most cases, the following symptoms can be seen:
• deformation
• swelling
• an increase or decrease in the breast that has occurred without
cause
• сhanges in the nipple or areola zone: erosion, retracted nip-
ple, and discharge from the nipple, which are not associated with
pregnancy and feeding
• changes on the skin like “lemon crust”
• a painless tight formation or a thickened patch in the mammary
gland that can be touched by hands.
If you notice one of the above signs, you should immediately call
your doctor and be examined.
But even if it seems visually that there are no problems, every
woman after 40 years of age should regularly, at least once a
year, undergo a mammogram[5].
It is also important for women under 40 to be examined by a
doctor: annually consult a gynecologist and perform ultrasound
of the mammary glands. As studies show, about 80% of all ill
women were able to independently notice the first symptoms of
breast cancer. Basically, among all the detected tumoral forma-
tions, most of it turns out to be benign. But the help of a specialist
- a doctor-mammologist is needed in any case.
It is important to remember that the disease, detected at an early
stage, is completely curable in almost 90% of cases, and the third
stage can be treated only by 40%.
5.2. Without delay and panic
Often, the assumption or conclusion of a doctor-mammologist
about the presence of pathological changes in the mammary
gland generates the most unpleasant fears in patients, and at
times panic. However, to date, there are already many methods
to clarify the diagnosis of breast cancer and prescribe appropri-
ate treatment if the diagnosis is confirmed. This is, first of all,
the markers (risk factors) of tumor growth found in the blood
of patients. Their main purpose is early detection of malignant
neoplasms and relapses, as well as evaluation of the effective-
ness of treatment of the disease. When referring to a dispensary
or a specialized clinic, the patient will be offered to donate blood
for the analysis of such markers. With regard to breast cancer,
there is not yet a strictly specific marker, so a set of tests for sev-
eral markers is applied. Concentrations of these markers in the
serum of patients depend on the degree of malignancy and stage
of the disease and are therefore important for the diagnosis and
prognosis of the disease. There are other parameters that allow
a specialist to suspect a disease progression or a metastatic de-
feat of other organs. Analysis of these indicators, to some extent
associated with breast tumors, makes it possible to plan further
actions: to prescribe chemo- or hormone therapy, surgical treat-
ment or therapeutic and prophylactic drugs in case of mastopathy
or benign tumors, for example, fibroadenoma of the breast. The
list of diagnostic tests varies depending on the material capabili-
ties of the clinic and patients, as well as on the specific case of
the disease [6].
The main thing is to make timely and professional analyzes,
guided by the recommendations of specialists. In life, unfortu-
nately, cases of treatment of patients to various healers and to
so-called folk medicine are not uncommon. Without belittling
the importance of phytotherapy and homeopathy, oncologists are
strongly advised to contact specialized institutions: specialized
dispensaries and clinics, where qualified doctors will help the
patient. Delay in choosing the right method of therapy is very
dangerous.
6. Complex Treatment
The basis for the treatment of breast cancer is a combined com-
plex approach combined with surgical treatment. The tumor
is affected by drugs, radiation, hormones. Removal of the en-
tire breast, or mastectomy, is often replaced by compromise
organ-preserving treatment: removal of the glandular segments
with axillary lymph nodes. Preserve and restore the shape of
the breast can allow reconstructive surgery, the importance of
which is obvious, especially for young patients. Operable (sub-
ject to surgery) is usually the first-second stage of cancer. With
advanced tumors or inoperable cancer, additional treatment is
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4. required, which slows the growth of the tumor and allows sur-
gical intervention. However, in most cases, one surgical treat-
ment is not enough. If the risk of recurrence is low, that is, the
tumor is small (less than 1 cm), there are no metastases to nearby
and distant lymph nodes, the degree of malignancy is low, and
tumor cells carry the receptors of tumor cells to estrogens and
progesterone (the main sex hormones of women), then surgical
treatment is often gives a steady positive effect. But sometimes
postoperative complications develop in the form of bleeding and
wound suppuration. Due to the removal of lymph nodes, lymph
drainage from the tissues is broken and lymphostasis develops,
usually a few weeks after the operation. Often, lymphostasis is
provoked by infections, hot and sunny baths, physical exertion.
That is why patients who have undergone a mastectomy are not
recommended to inject into the hand on the operated side, there
are contra-indicated solariums and saunas, they need to avoid
infection of the skin through cracks or scratches. Useful spe-
cial hand massage and gymnastics, improving the circulation of
lymph and restoring the work of joints.
6.1. Success depends on the forecast
The most effective treatment of breast tumors is possible only
taking into account the prognosis of the course of the disease
and the patient’s response to a particular drug, that is, there are
a number of factors indicative of a favorable or unfavorable out-
come of the disease, as well as the sensitivity of the tumor to
the treatment. These factors include tumor size, the presence of
lymph node metastases, the tumor histology (its structure de-
termining malignancy), the level of estrogen and progesterone
receptors in tumor cells, and others[7].
7. Morphological and Molecular Biological Factors of
Breast Cancer Prognosis and Treatment Effectiveness
• Tumor size
• The number of metastatic lymph nodes
• Histology of the tumor
• Germination of the tumor with blood and lymphatic
vessels
• Indicators of DNA synthesis activity
• Ploidy of tumor cells
• The intensity of the division of tumor cells (the level of
the nuclear protein of mitosin, the level of the nuclear antigen
Ki-67, etc.)
• Presence of estrogen and progesterone receptors
• The level of activators and inhibitors (blockers) of
plasminogen (a protein that participates in many cellular inter-
actions, in invasion and metastasis, etc.).
Many monographs are devoted to the study of these and other
factors, we note only those that are of fundamental importance
for the development of breast cancer in women. First, it is the
receptors of steroid hormones - specific proteins that selectively
bind the molecules of the corresponding steroids penetrating into
the cells. The presence of receptors in tumor cells for estrogens
and progesterone suggests that the tumor is sensitive to hormo-
nal therapy and that there is little possibility of metastasis. The
presence of epidermal growth factors in the tumor tissue (sub-
stances that promote the growth of certain types of cells) also in-
dicates the sensitivity of the tumor to treatment with hormones.
When there are no receptors for steroid hormones in tumor cells,
then treating tumors with hormonal therapy is meaningless[8].
The HER2 / neu receptor also participates in signaling to cell
division. Its blocking can slow or stop the division of tumor cells
and the growth of tumors that depend on these signals. For such
a blockade, the herceptin preparation was developed. When the
gene encoding this receptor is actively transcribed (rewritten), it
is advisable to use chemotherapy with the use of herceptin, and
hormone treatment in this case is ineffective.
Malignant tumors are capable of metastasizing and invading. In
these processes, the main role is played by the proteins uPA and
PAI-1. If their levels exceed certain minimum values, the risk
of breast cancer increases by a factor of 1.5-2, so the data are
important for the prognosis.
The growth of a malignant tumor is accompanied by the forma-
tion in it of a branched network of capillaries - comparatively
small blood vessels. The process is regulated by the growth fac-
tor of the vascular endothelium. A high level of this protein in
the tumor indicates an unfavorable prognosis for both early and
progressive malignant processes. Analysis of the activity of the
growth factor of the epithelium stimulated the creation of new
drugs that block the growth of malignant cells, for example, the
promising drug avastin.
Recently it was found out that in the breast tissue with the help
of the aromatase enzyme own estrogens are synthesized. There-
fore, suppression of the synthesis of this enzyme with drugs, for
example arimedex and aromazine, can reduce the risk of breast
cancer. Thus, thanks to the research of biochemists and molec-
ular biologists, biologically significant parameters were avail-
able to physicians to predict the course of the disease at various
stages and to select appropriate therapy for disseminated breast
cancer. First, these are the levels of receptors for estrogens and
progesterone in the tumor, which make it possible to evaluate
the appropriateness of hormone therapy and to foresee its result.
Secondly, the level of activity of the Her2 / neu gene, allowing to
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5. detect patients with an increased risk of recurrence of the breast
tumor and the risk of its metastasis in the early stages of the
disease. Thirdly, the level of the growth factor of the epithelium,
indicating a prognosis of tumor development in the beginning
and in the later stages of the disease [9].
8. Molecular-Biological Background of Breast Cancer
What molecular mechanisms are at the heart of cancer? It is
known that the development of the tumor is associated with a
disruption in the growth and differentiation of cells and their ma-
lignant degeneration. In many cases, these disorders are caused
by mutations or a sharp increase in the activity of cellular onco-
genes - normal genes that participate in the regulation of the cell
cycle, signaling and other cell life processes. Now we know a lit-
tle more than 100 different proto-oncogenes - normal cell genes,
the increased activity of which changes or a change in their
structure leads to the synthesis of oncoproteins, which play a
key role in cellular life. Such activation of proto-oncogenes and
their transformation into oncogenes are possible as a result of
mutations, chromosome rearrangements and other mechanisms
[10]. There are about 50,000 functioning genes in the human
cell, therefore the share of potential oncogenes responsible for
malignant cell growth is quite high. In the case of breast cancer,
probably no more than 10 oncogenes are involved.
In addition, cell cycle disorders and uncontrolled multiplication
of cells can be associated with mutations in suppressor genes,
or tumor suppressors. These include, for example, mutations in
the BRCA1 and BRCA2 genes already mentioned. These genes
encode high molecular weight nuclear proteins that correct DNA
damage and maintain the stability of the genome, and the prod-
uct of the BRCA1 gene participates in the correct distribution of
chromosomes in cell division, suppresses excessive hormone-
dependent multiplication of breast cells, which occurs, for ex-
ample, during puberty and lactation pregnant women. That is
why the mutations of this gene lead to a whole spectrum of dis-
orders, ranging from new gene mutations and chromosomal re-
arrangements to the unrestrained reproduction of cells of estro-
gen-dependent organs that determine the development of breast
and ovarian tumors. Thus, mutations in the BRCA1 / BRCA2
genes disrupt the control of DNA damage and maintain the in-
tegrity of the cellular genome, which causes the appearance of
malignant cell clones [11].
In addition to mutations, the activity of tumor suppressor genes
and other genes responsible for regulation may change as a re-
sult of disorders in the DNA molecule. This is also true of breast
cancer[12].
In some laboratories, with the help of special microchips, the
profiles of changes in the cells of breast tumors are examined.
For example, French researchers compared the profiles of such
changes in different samples of malignant cells before and after
treatment with doxorubicin, which allowed to outline and sub-
stantiate the strategy of chemotherapy. They isolated a group of
496 genes, the activity (expression) of which differs from the
expression of these genes in normal mammary tissue. Several
years ago, the results of an investigation of the expression of 200
genes, obtained on 122 samples of tumor tissue of the mammary
gland, were published. Several groups of breast cancer genes
have been isolated, beginning with the expression of genes close
to normal and ending with genes with the expression giving the
worst prognosis[13].
In many laboratories, experiments are underway to create a “mo-
lecular portrait” of breast tumors. Japanese researchers, for ex-
ample, obtained a molecular profile of genes in the treatment of
patients with docetaxel. It turned out that sensitive and resistant
to this drug tumors clearly differ in the activity of 76 genes.
Of course, these approaches are still very laborious and expen-
sive to apply in practice, but they are important for the devel-
opment of more specific and simple methods of analyzing the
effectiveness of treatment. Such data will help in the future to
predict the course of the disease and the sensitivity of the tumor
to therapy.
The appearance of cancer can be associated not only with the
disruption of the work of oncogenes and other genes, but also
with viral infections.
In the last 10 years there has been strong evidence that a retrovi-
rus related to the mammary gland tumor virus, or MMTV (from
the English Mouse Mammary Tumor Virus) circulates in the
human body. Their activation is a complex chain of biochemi-
cal processes, similar to the activation of some retroviruses that
cause leukemia in humans and animals[14].
First, in the sera of many patients with breast cancer, antibod-
ies to proteins related to the structural proteins of the MMTV
membrane were detected. Then, in DNA of peripheral blood
lymphocytes and in tumor tissue, in approximately 40% of pa-
tients with sporadic breast cancer, sequences similar in struc-
ture to the genes of this retrovirus were detected using highly
sensitive methods. From the genome of tumor cells entering the
pleural cavity of patients with breast cancer, DNA sequences,
95-97% corresponding to the full-length provirus, were isolated
and cloned.
MMTV-related human provirus, or hMTV (from the English
human Mammary Tumor Virus), was detected in the genome
of lymphocytes and tumor cells, but not in normal human tis-
sues. This indicates an external source of retroviral infection.
The incidence of MMTV-homologous sequences varies from
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6. 0-1% (UK) to 75-80% (Tunisia). There are several assumptions
about the ways of getting the virus into the human body, includ-
ing infection through the lymphoid tissue of the gastrointestinal
tract from contaminated with mouse feces products. The distri-
bution of MMTV-homologous sequences in human populations
corresponds to the spread of this species of mice. It is possible to
transfer MMTV to the person from the mouse both directly and
through intermediate “hosts” (cats, primates).
Recently, a team of researchers from the United States, led by
Dr. S. Ross, showed that the primary target for retroviral infec-
tion may be tree cells-certain lymphoid cells that absorb foreign
proteins and virus particles by pinocytosis-the process of absorb-
ing liquids and foreign bodies. It turned out that these cells can
then produce an infectious virus and transmit it to other cells,
in particular B- and T-lymphocytes. In the absence of dendritic
cells, the effectiveness of MMTV infection decreases dramati-
cally; undoubtedly, it depends on other reasons. For circulation in
the body of both mice and humans, MMTV uses peripheral blood
lymphocytes. At this stage, the number of copies of provirus in
the genome is relatively small. During the active division of the
epithelial cells of the mammary gland, growing under the action
of hormones, the provirus built into the cellular genome is able to
rapidly multiply copies thousands of times. Apparently, the provi-
rus can be built into the cells of the mammary gland, which pos-
sess the properties of stem cells, which subsequently give rise to
multiple foci of tumor growth. There is evidence of the possible
direct or indirect involvement of hMTV in the development of
breast cancer. In experiments with cultures of human breast can-
cer cells containing (+) and not containing (-) proviral sequences,
a group of American researchers found that high activity of genes
associated with immune response to infection was observed in (+)
cells. In addition, in these (+) cells, eight genes that were com-
pletely inactive in (-) cells were activated. Comparison of gene
expression patterns with microarrays showed that the total activ-
ity of genes in infected hMTV cells corresponds to the activity of
genes in the inflammatory process involving interferons, that is,
a viral infection plays a very definite role in the development of
breast cancer [15].
9. What is the Difference between Infected and Non-
Infected Hmtv Tumors?
Answers to this question were tried byAustralian biologists. They
showed that in the early stages of breast cancer in patients of one
of the Sydney clinics infected with this retrovirus, the tumors
in their structure and growth are similar to mammary tumors in
mice. However, some similarities in the development of mam-
mary and human breast cancer were noted long before this work.
Both in humans and in mice, breast tumors are known, in which
very rapid growth begins immediately in several foci. There is
reason to believe that such tumors arise from stem-type cells
that have acquired the ability to malignant growth due to either
genomic disorders in cells or a viral infection. New in the study
of Australian scientists was the fact of accumulation in the nuclei
of infected hMTV human breast tumors of inactive protein - the
product of the p53 gene suppressing tumor growth, which we
mentioned above. Why this protein does not work, it remains to
be seen, but such tumors are characterized by faster growth, most
often they are localized in the area of
the ducts of the mammary
glands[15].
At the same time, a group of researchers led by Profsohmer
Selmont from Austria, using genetic engineering structures,
showed that the product of one of the MMTV genes contains an
amino acid sequence corresponding to amino acid sequences in
the immunoreceptors, or ITAM from Immunoreceptor Tyrosine-
based Activation Motifs, involved in the transmission of signals
that regulate the development of cells. The hyperactivation of
these signaling pathways due to the manifestation of provirus in
epithelial cells of the breast can lead to cell degeneration and the
development of breast cancer. The possibility of the appearance
of morphologically altered cells capable of three-dimensional
growth in a culture medium in vitro was tested by us in experi-
ments with human embryonic kidney epithelial cells that were
cultured with virus-producing mouse cells. It has been shown
that viral sequences are indeed embedded in the cellular genome
and RNA transcripts are formed on them. The introduction of
provirus into the genome of a cell can lead to a change in the
activity of genes in the area of
such a combination. In addition,
in the mouse retroviral genome, there are hormone-sensitive
regulatory elements that can also alter or completely disrupt
the functioning of cellular genes. Let us also recall the encoded
MMTV amino acid sequences in ITAM that can mediate signifi-
cant changes in virus-infected cells. However, in subsequent cell
division as a result of chromosome rearrangements, some of the
chromosomes are lost along with the copies of the provirus em-
bedded in the cellular gene. Thus, tumor degeneration is likely
only in a limited number of cells. In other words, in addition to
the horizontal transmission of hMTV, there seems to be a verti-
cal one: from mother to child. In this case, lymphoid tissue of
the human intestine can serve as a “gateway” of retroviral infec-
tion, and lymph nodes - a reservoir. It is important that when
multiplying the number of proviral copies in the cell genome,
a minimal immune response to infection is observed, although
signs of inflammation are found in infected cells. For example,
as already mentioned, genes encoding proteins that are involved
in regulatory processes with interferon are active. According to
some researchers, the inflammation in the mammary glands, as
well as their sharp involution, that is, mass reduction of tissues
(for example, after abortion or sudden cessation of lactation),
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7. may increase the risk of malignant cell degeneration.
The involvement of MMTV in the development of a malignant
tumor, and possibly also tumors of other localizations, allows
isolating carriers of hMTV to a risk group along with patients
from hereditarily burdened families carrying mutations in the
genes of predisposition[16].
***
So, thanks to the efforts of specialists in the field of clinical bio-
chemistry and genetics, molecular biology, virology and immu-
nology, it was possible to compile a fairly capacious “molecular
portrait” of breast cancer. While the efforts of scientists are fo-
cused on elucidating the causes and mechanisms of the onset of
tumors, doctors seek to recognize tumors at possibly early stages
that are well amenable to treatment and prognosis. That is why
the number of parameters for cancer diagnosis and evaluation of
its development continues to grow. About some of them we told
in the article offered to the reader. Which of these markers will
be most effective and will find application in the clinic, will show
the near future [17].
Although inexorable statistics indicate an increase in the inci-
dence of breast cancer, experts have reason for optimism. As Dr.
Selmon pointed out: “As far as cancer is concerned, the human
mind is so ingenious ...” Undoubtedly, early preclinical diagnos-
tics can now significantly improve the results of treatment and
achieve better survival of patients, return them to active life and
give hope for a full recovery.
10. Factors of Heredity
Breast cancer in 10% of cases is inherited. If one of the two cop-
ies or alleles of the BRCA1 gene in a woman carries a mutation,
the probability of developing breast cancer increases to 85%, and
the cancer of the ovaries - up to 40%. In carriers of such muta-
tions, the risk of colon cancer increases, and in men - prostate
cancer. In the BRCA1 gene, up to 700 different mutations are
detected, which are typical for women in certain geographical
regions. In the case of mutations in the BRCA2 gene, the risk of
developing malignant tumors of the breast and ovaries is rela-
tively lower. It is shown that the frequency of mutations in the
BRCA1 gene in patients with familial breast cancer is about an
order of magnitude higher than in the BRCA2 gene. Mutations in
the BRCA1 gene are found in 16% of families with two or more
close relatives suffering from malignant breast tumors in the ab-
sence of ovarian cancer. The combination of these two diseases
in the family is also due to mutations in the BRCA1 / BRCA2
genes. It turned out that mutations in the BRCA1 gene are found
in 61% of patients with family cases of breast and ovarian cancer.
Mutations in the BRCA1 / BRCA2 genes can cause other forms
of cancer.
Carriers of these mutations need a regular visit to the mammolo-
gist, since they have a risk of breast cancer reaching 80-90%,
and their nearest relatives are advised by a geneticist. In addition
to these, there are other genes, mutations or certain allelic vari-
ants of which can promote the development of breast tumors and
some other malignant tumors. However, this contribution is not
as significant as in the case of the BRCA1 / BRCA2 genes.
The hypothesis of a possible mutation arises in the geneticist if
two or more breast cancer patients are found among the immedi-
ate relatives of the patient, if the disease develops before the age
of 45, with tumors in two mammary glands or in cancer with
multiple foci of the tumor, and in the presence of cancer ovaries.
Sporadic breast cancer develops for no apparent reason, although
there are certain factors, not related to hereditary predisposition,
increasing the risk of its occurrence.
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