Breast Cancer Detection Techniques

A DISSERTATION REPORT SUBMITTED IN THE PARTIAL

FULFILLMENT FOR THE AWARD OF
MASTER OF TECHNOLOGY
IN
DIGITAL COMMUNICATION
Submitted to
JIWAJI UNIVERSITY
GWALIOR (M.P.)

By
SHUJA BEHNA
ROLL NO.

Under the Guidance of

Prof. Neetu Sikarwar

Institute of Engineering, Jiwaji University

Gwalior MADHYA PRADESH, INDIA
2015 – 2017
 Declaration

I hereby declare that the work presented in the pre-dissertation

entitled “Breast Cancer Detection Techniques ” being submitted for
the degree of Master of Technology in Digital Communication is
genuine and has been carried out by me during the session 2015-17
in the Department of the ELECTRONICS Engineering from IEJU,
Gwalior (M.P) affiliated from Jiwaji Vishwavidyalaya, Gwalior
(M.P).
I further declare that this pre-dissertation to the best of my
knowledge and am not substantially the same as which has
been submitted for a degree of any other academic
qualification at any university or examining body in India or
abroad.

Shuja Behna
M.Tech
(Digital comm.)
Roll No-
 Abstract

Breast cancer accounts for more than 20% Indian women in

India. Early diagnosis tools and best the rapyes are available
for the breast cancer. As for as Indian women concerns, most
of them are not aware about the myths and facts of hidden
anatomy of breast, cause, diagnosis followed by the treatment
required to cure the evil disease i.e. breast cancer. Types of
breast cancers i.e. Ductal carcinoma in situ (DCIS), Invasive
ductal carcinoma, Lobular carcinoma in situ (LCIC), Invasive
lobular carcinoma, Inflammatory breast disease, various
diagnostic tools used to characterize the type of diseases,
various methods to detect the stages of cancers, advanced
imaging techniques (Ultrasound, MRI,CT Scan, PET Scan
etc.) and other biopsy tests required to assess the breast cancer
followed by the better treatment to improve the morbidity.
The extensive literature review done on this topic and this
literature review would be helpful to the community updating
about the breast cancer, how one can diagnose the evil disease
on time and get the best therapy available to live life happily.
 Contents
Page no.
Declaration
Abstract
Acknowledgement
1. Introduction 6-17
1.1 Zigbee Technology
1.2 Sensor Network Structure
1.3 Sensor Architecture Design
1.4 Ad hoc wireless sensor networks

1.5 Differences between sensor networks and

Ad-hoc networks
2. Literature Review 18-20
3. Proposed Work 21-23
3.1 Security and privacy
 3.2 Power requirement of wireless Sensor Networks

3.3 Challenges in real time

4. References 24-25

Acknowledgement

After the completion of this pre-dissertation, I experienced

feeling of achievement and satisfaction. So I would like to
take this opportunity to express my deep gratitude to all those
who helped me in various ways. It gives me immense pleasure
to express my gratitude and heartily thanks to my guide Prof.
Neetu Sikarwar for their invaluable guidance and constant
encouragement. They have spent their valuable time with me
and made me feel the real zest of research work. I would like
to express my sincere thanks to Prof. Neetu Sikarwar (Head
of the Department of Electronics Engineering, IEJU, Gwalior)
for providing all the facilities needed during my project work.

Shuja Behna
 M.Tech
(Digital comm.)
Roll No-

1. Introduction

Cancer is a class of diseases characterized by out-of-control

cell growth. Cancer harms the body when damaged cells
divide uncontrollably to form lumps or masses of tissue called
tumors (except in the case of leukemia where cancer prohibits
normal blood function by abnormal cell division in the blood
stream).

Tumors can grow and interfere with the digestive, nervous,

and circulatory systems and they can release hormones that
alter body function. There are over 100 different types of
cancer, and each is classified by the type of cell that is
initially affected. Breast cancer begins in breast tissue, which
is made up of glands for milk production, called lobules, and
the ducts that connect the lobules to the nipple as depicted.
The remainder of the breast is made up of fatty, connective,
and lymphatic tissue. Most masses are benign; that is, they are
not cancerous, do not grow uncontrollably or spread, and are
not life-threatening. Over 100,000 new breast cancer patients
are estimated to be diagnosed annually in India.

Figure : Pictorial presentation of breast with nodes, vessels,

lobules, ducts

Breast cancer is a tumor that starts from cells of the breast

tissue, either in cells that line the ducts that carry milk to the
nipples (ductal cancer) and/or in cells that line the lobules,
which are glands involved in milk production. Breast tumors
can be benign or malignant, the former are not life-
threatening, can usually be removed, do not invade adjacent
tissues or spread to other parts of the body and can include
fibrocystic tissue, fibroadenomas and benign breast disease.
Malignant breast tumors are cancerous and can invade
surrounding tissues or metastasize to other parts of the body
via the lymphatic system (lymphatic vessels and lymph
nodes), such as the liver and bone. If cancer cells have spread
to the surrounding lymph nodes, there is a much higher
probability that the tumor has entered the bloodstream and
metastasized to other parts of the body.

The histological classification of breast cancer includes

adenocarcinomas, cancers that originate in the glandular
tissue, which include the ducts and lobules and sarcomas,
cancers that originate in the connective tissue of muscle, fat or
blood vessels. Carcinoma in situ (CIS) is an early stage form
of cancer where the tumor is confined to the layer of the cells
where the cancer began and it has not invaded deeper breast
tissue or spread to other areas of the body. Breast cancer
includes the following types of disease.

Ductal carcinoma in situ (DCIS) is the most common type

of non-invasive cancer in women, where cancer cells have not
spread beyond the duct walls into surrounding breast tissue.
The prevalence of DCIS is strongly correlated with
mammographic screening and in countries such as the US, can
be as high as 18% of all newly diagnosed but in countries
such as India, represents a very low proportion of total disease
since most cases present in late stage.

Invasive or infiltrating ductal carcinoma originates in the

breast duct, has broken through the wall of the duct into
surrounding fatty tissue of the breast and is capable of
metastasizing to other organs of the body through the
lymphatic system and bloodstream. This represents about 80%
of breast cancers.

Lobular carcinoma in situ (LCIS) is not cancer but is

sometimes classified as a non-invasive breast cancer and
women who have this condition are more likely to develop
invasive breast cancer in the future.

Invasive or infiltrating lobular carcinoma originates in the

milk-producing glands or lobules of the breast and can spread
to other parts of the body. This is less common and represents
about 1 in 10 breast cancer diagnoses.
Other (less common) types of breast cancer: inflammatory
breast cancer (1-3% of all breast cancers), triple negative
breast cancers, mixed tumors, medullary carcinoma (3-5% of
all breast cancers), metaplastic carcinoma, mucinous
carcinoma, paget disease of the nipple, tubular carcinoma,
papillary carcinoma, adenoid cystic carcinoma (adenocystic
carcinoma), phyllodes tumor and angiosarcoma. Estrogen
receptor (ER) and Progesterone receptor (PR) status
Confirmed carcinomas of the breast are subjected to a test to
determine the estrogen receptor (ER) and progesterone
receptor (PR) status. Breast cancers that contain estrogen
receptors on the outside surface of their cells are ER-positive
cancers while those with progesterone receptors are called
PR-positive cancers. Women who are positive for either or
both receptors generally have a better prognosis because they
are more responsive to hormone therapy than without any of
these receptors.

Prevalence in India

Cancer is a leading cause of death group worldwide and

accounted for 7.4 million deaths (around 13% of all deaths) in
2004. The main types of cancer are:

• Lung (1.3 million deaths/year)

• Stomach (803,000 deaths)

• Colorectal (639,000 deaths)

• Liver (610,000 deaths)

• Breast (519,000 deaths)

More than 70% of all cancer deaths occurred in low- and

middle-income countries. Deaths from cancer worldwide are
projected to continue rising, with an estimated 11.5 million
deaths in 2030.

The incidence of Breast Cancer is increasing, particularly in

previously low incidence areas such as Asia. In fact in India,
it is considered the leading Cancer among women in certain
metros such as Mumbai, Bangalore & Thiruvananthapuram.
As per the Indian Council of Medical Research-population
Based Cancer Registry (ICMR-PBCR) data, breast cancer is
the commonest cancer among women in urban registries of
Delhi, Mumbai, Ahmedabad, Calcutta, and Trivandrum here it
constitutes > 30% of all cancers in females . In the rural
PBCR of Barshi, breast cancer is the second commonest
cancer in women after cancer of the uterine cervix. The age
standardized incidence rates (AARs) range from 6.2 to 39.5
per 100,000 Indian women. The AARs vary from region,
ethnicity, religion, with the highest incidence reported at 48.3
per 100,000 women in the Parsi community of Mumbai. The
incidence of this disease has been consistently increasing, and
it is estimated it has risen by 50% between 1965 and 1985.
The rise in incidence of 0.5–2% per annum has been seen
across all regions of India and in all age groups but more so in
the younger age groups (< 45 years). In general, breast cancer
has been reported to occur a decade earlier in Indian patients
compared to their western counterparts. While the majority of
breast cancer patients in western countries are
postmenopausal and in their 60ies and 70ies, the picture is
quite different in India with premenopausal patients
constituting about 50% of all patients (SGPGIMS Lucknow
data).
More than 80% of Indian patients are younger than 60 years
of age. The average age of patients in 6 hospital-based cancer
registries ranged from 44.2 years in Dibrugarh, 46.8 years in
Delhi, 47 years in Jaipur, to 49.6 years in Bangalore and
Chennai. The average age of breast cancer patients has been
reported to be 50–53 years in various population-based studies
done in different parts of the country . A significant
proportion of Indian breast cancer patients are younger than
35 years of age. This proportion varies between 11% (Tata
Memorial Hospital (TMH) Mumbai) to 26% (SGPGIMS
Lucknow). Young age has been associated with larger tumor
size, higher number of metastatic lymph nodes, poorer tumor
grade, low rates of hormone receptor-positive status, earlier
and more frequent locoregional recurrences, and poorer
overall survival .

Cause/Risk factor of breast cancer

Studies have found the following risk factors for breast

cancer:

Age: The chance of getting breast cancer increases as you get

older. Most women are over 60 years old when they are
diagnosed.
Personal health history: Having breast cancer in one breast
increases your risk of getting cancer in your other breast.
Also, having certain types of abnormal breast cells (atypical
hyperplasia, lobular carcinoma in situ [LCIS], or ductal
carcinoma in situ [DCIS]) increases the risk of invasive breast
cancer. These conditions are found with a breast biopsy.

Family health history: Your risk of breast cancer is higher if

your mother, father, sister, or daughter had breast cancer. The
risk is even higher if your family member had breast cancer
before age 50. Having other relatives (in either your mother’s
or father’s family) with breast cancer or ovarian cancer may
also increase your risk.

Certain genome changes: Changes in certain genes, such as

BRCA1 or BRCA2, substantially increase the risk of breast
cancer. Tests can sometimes show the presence of these rare,
specific gene changes in families with many women who ave
had breast cancer, and health care providers may suggest ways
to try to reduce the risk of breast cancer or to improve the
detection of this disease in women who have these genetic
changes. Also, researchers have found specific regions on
certain chromosomes that are linked to the risk of breast
cancer. If a woman has a genetic change in one or more of
these regions, the risk of breast cancer may be slightly
increased. The risk increases with the number of genetic
changes that are found. Although these genetic changes are
more common among women than BRCA1 or BRCA2, the
risk of breast cancer is far lower.
Radiation therapy to the chest: Women who had radiation
therapy to the chest (including the breasts) before age 30 are
at an increased risk of breast cancer. This includes women
treated with radiation for Hodgkin lymphoma. Studies show
that the younger a woman was when she received radiation
treatment, the higher her risk of breast cancer later in life.

Reproductive and menstrual history:

—The older a woman is when she has her first child, the
greater her chance of breast cancer.

—Women who never had children are at an increased risk of

breast cancer.

—Women who had their first menstrual period before age 12

are at an increased risk of breast cancer.

—Women who went through menopause after age 55 are at an

increased risk of breast cancer.

—Women who take menopausal hormone therapy for many

years have an increased risk of breast cancer.

Race: In the United States, breast cancer is diagnosed more

often in white women than inAfrican American/black,
Hispanic/Latina, Asian/Pacific Islander, or American
Indian/Alaska Native women.
Breast density: Breasts appear on a mammogram (breast x-
ray) as having areas of dense and fatty (not dense) tissue.
Women whose mammograms show a larger area of dense
tissue than the mammograms of women of the same age are at
increased risk of breast cancer.
History of taking DES: DES was given to some pregnant
women in the United States between about 1940 and 1971. (It
is no longer given to pregnant women.) Women who took
DES during pregnancy may have a slightly increased risk of
breast cancer. The possible effects on their daughters are
under study.
Being overweight or obese after menopause: The chance of
getting breast cancer after menopause is higher in women who
are overweight or obese.
Lack of physical activity: Women who are physically
inactive throughout life may have an increased risk of breast
cancer.
Drinking alcohol: Studies suggest that the more alcohol a
woman drinks, the greater her risk of breast cancer. Having a
risk factor does not mean that a woman will get breast cancer.
Most women who have risk factors never develop breast
cancer. Many other possible risk factors have been studied.
For example, researchers are studying whether women who
have a diet high in fat or who are exposed to certain
substances in the environment have an increased risk of breast
cancer. Researchers continue to study these and other possible
risk factors.

Manifestation

Early breast cancer usually doesn’t cause symptoms. But as

the tumor grows, it can change how the breast looks or feels.
The common changes include and depicts.

1. A lump or thickening in or near the breast or in the

underarm area

2. A change in the size or shape of the breast

3. Dimpling or puckering in the skin of the breast

4. A nipple turned inward into the breast

5. Discharge (fluid) from the nipple, especially if it’s bloody

6. Scaly, red, or swollen skin on the breast, nipple, or areola

(the dark area of skin at the center of the breast). The skin
may have ridges or pitting so that it looks like the skin of an
orange.

Detection and Diagnosis.

The detection and diagnosis of breast cancer depends upon

personal and family medical history also. The physical
examination like one or more imaging tests, such as a
mammogram reveals the unwanted growth of cells in breast.
Women who have regular clinical breast exams and
mammograms to find breast cancer early; the treatment is
more likely to work well because breast cancer is detected
early. The followings are the breast cancer detection
techniques.

Clinical Breast Exam

During a clinical breast examination both arms raised over

head, let them hang by sides, or press hands against your hips.
The difference in size or shape between breasts indicates
suspicion on cancer. The skin of breasts is checked for a rash,
dimpling, or other abnormal signs. Nipples may be squeezed
to check for fluid. Using the pads of the fingers to feel for
lumps, checking of entire breast, underarm, and collar-bone
area. A lump is generally the size of a pea before anyone can
feel it. The exam is done on one side and then the other. The
lymph nodes near the breast to see if they are enlarged. A
lump will feel its size, shape, and texture then it will also be
checked to see if the lump moves easily. Benign lumps often
feel different from cancerous ones. Lumps that are soft,
smooth, round, and movable are likely to be benign. A hard,
oddly shaped lump that feels firmly attached within the breast
is more likely to be cancer, but further tests are needed to
diagnose accurately.

Mammogram

A mammogram is an x-ray picture of tissues inside the breast.

Mammograms can often show a breast lump show a cluster of
tiny specks of calcium. These specks are called
icrocalcifications. Lumps or specks can be from cancer,
precancerous cells, or other conditions. Further tests are
needed to find out if abnormal cells are present. Before they
have symptoms, women should get regular screening
mammograms to detect breast cancer early:

➢ Women in their 40s and older should have mammograms

every 1 or 2 years.
➢ Women who are younger than 40 and have risk factors for
breast cancer should ask their health care provider whether to
have mammograms and how often to have them.

If the mammogram shows an abnormal area of the breast,

clearer, more detailed images of that area can be obtained by
diagnostic mammograms to know more about unusual breast
changes, such as a lump, pain, thickening, nipple discharge, or
change in breast size or shape. Diagnostic mammograms may
focus on a specific area of the breast. They may involve
special techniques and more views than screening
mammograms.

Other Imaging Tests

If an abnormal area is found during a clinical breast exam or

with a mammogram, the doctor may order other imaging tests:

Ultrasound: A woman with a lump or other breast change

may have an ultrasound test. An ultrasound device sends out
sound waves that people can’t hear. The sound waves bounce
off breast tissues. A computer uses the echoes to create a
picture. The picture may show whether a lump is solid, filled
with fluid (a cyst), or a mixture of both. Cysts usually are not
cancer. But a solid lump may be cancer.
MRI: Magnetic Resonance Imaging (MRI) uses a powerful
magnet linked to a computer. It makes detailed pictures of
breast tissue. These pictures can show the difference between
normal and diseased tissue.
Bone scan: In bone scan a small amount of a radioactive
substance injected into a blood vessel. It travels through the
bloodstream and collects in the bones. A machine called a
scanner detects and measures the radiation. The scanner
makes pictures of the bones. The pictures may show cancer
that has spread to the bones.

CT scan: Computed Tomography (CT) scans used to look for

breast cancer that has spread to the liver or lungs. An x-ray
machine linked to a computer takes a series of detailed
pictures of chest or abdomen. Patient receives contrast
material by injection into a blood vessel in arm or hand. The
contrast material makes abnormal areas easier to see.

PET Scan : PET stands for positron emission tomography

and it uses radiation, or nuclear medicine imaging, to produce
3-dimensional, color images of the functional processes
within the human body. The machine detects pairs of gamma
rays which are emitted indirectly by a tracer (positron-
emitting radionuclide) which is placed in the body on a
biologically active molecule. The images are reconstructed by
computer analysis. Modern machines often use a CT X-ray
scan which is performed on the patient at the same time in the
same machine. PET scans can be used to diagnose a health
condition, as well as for finding out how an existing condition
is developing. PET scans are often used to see how effective
an ongoing treatment is.

Biopsy

A biopsy is the removal of tissue to look for cancer cells. A

biopsy is the only way to tell for sure if cancer is present. One
may need to have a biopsy if an abnormal area is found. An
abnormal area may be felt during a clinical breast exam but
not seen on a mammogram. Or an abnormal area could be
seen on a mammogram but not be felt during a clinical breast
exam. In this case, use of imaging procedures (such as a
mammogram, an ultrasound, or MRI) are helpful locate the
area and remove tissue. A surgeon or breast disease specialist
required for a biopsy. There are number of ways to remove
fluid or tissue from breast:
Fine-needle aspiration biopsy (FNAC): A thin needle used
to remove cells or fluid from a breast lump for investigations.

Core biopsy: A wide needle used to remove a sample of

breast tissue.

Skin biopsy: If there are skin changes on breast, a small

sample of skin should be taken for analysis.

Surgical biopsy: It includes the removal of tissue.

—An incisional biopsy takes a part of the lump or abnormal
area.

—An excisional biopsy takes the entire lump or abnormal

area.

A pathologist will check the tissue or fluid removed from

breast for cancer cells. If cancer cells are found, the
pathologist can tell what kind of cancer it is. The most
common type of breast cancer is ductal carcinoma. It begins
in the cells that line the breast ducts. Lobular carcinoma is
another type. It begins in the lobules of the breast.

If the biopsy confirms the breast cancer, its needs to examine

the extent (stage) of the disease to help you choose the best
treatment. The stage is based on the size of the cancer,
whether the cancer has invaded nearby tissues, and whether
the cancer has spread to other parts of the body. Staging may
involve blood tests and other tests:

Lymph node biopsy: The stage often is not known until after

surgery to remove the tumor in breast and one or more lymph
nodes under arm. A sentinel lymph node biopsy used to
remove the lymph node most likely to have breast cancer
cells. The surgeon injects a blue dye, a radioactive substance,
or both near the breast tumor. Or a radioactive substance
injected under the nipple. A scanner used to find the sentinel
lymph node containing the radioactive substance or looks for
the lymph node stained with dye. The sentinel node is
removed and checked for cancer cells. Cancer cells may
appear first in the sentinel node before spreading to other
lymph nodes and other places in the body.
These tests can show whether the cancer has spread and to
what parts of body. When breast cancer spreads, cancer cells
are often found in lymph nodes under the arm (axillary lymph
nodes). Also, breast cancer can spread to almost any other part
of the body, such as the bones, liver, lungs, and brain. When
breast cancer spreads from its original place to another part of
the body, the new tumor has the same kind of abnormal cells
and the same name as the primary (original) tumor. For
example, if breast cancer spreads to the bones, the cancer cells
in the bones are actually breast cancer cells. The disease is
metastatic breast cancer, not bone cancer. For that reason, it is
treated as breast cancer, not bone cancer. The new tumor
called as ?distant? or metastatic disease.

Lab Tests with Breast Tissue and Treatment Options:

There are some special lab tests on the breast tissue (that was
removed) which should be performed. On basis of these tests
revelations, the cancer therapy would be suggested:

Hormone receptor tests: Some breast tumors need hormones

to grow. These tumors have receptors for the hormones
estrogen, progesterone, or both. If the hormone receptor tests
show that the breast tumor has these receptors, then hormone
therapy is most often recommended as a treatment option.

HER2/neu test: HER2 (Human Epidermal Growth Factor

Receptor 2)/neu protein is found on some types of cancer
cells. This test shows whether the tissue either has too much
HER2/neu protein or too many copies of its gene. If the breast
tumor has too much HER2/neu, then targeted therapy may be
a treatment option. It may take several weeks to get the results
of these tests.

Lifestyle and diet factors 26

Eating the right kinds of foods before, during, and after

treatment of cancer can is helpful to keep stronger. The proper
nutrition should be taken and drink enough of the foods that
contain key nutrients (vitamins, minerals, protein,
carbohydrates, fat, and water). The side effects of cancer and
cancer treatments, however, may make it difficult to eat well.
Symptoms that interfere with eating include anorexia, nausea,
vomiting, diarrhea, constipation, mouth sores, trouble with
swallowing, and pain. The cancer treatment may also affect
appetite, taste, smell, and the ability to eat enough food or
absorb the nutrients from food. As a result, patient may
become malnourished from the lack of key nutrients.
Malnutrition can make you feel weak, tired, and unable to
resist infections or withstand cancer therapies. On the other
hand, many people have mild or no side effects.

• When cancer patient can eat, try to have meals and

snacks with sufficient calories and Protein – which will
help to stay stronger, prevent body tissues from breaking
down, and rebuild tissues that may harm by cancer treatment.
• Try a liquid meal replacement for extra calories and
protein. The products that contain high levels of isolated soy
isoflavone always keep the patients stronger.

• Keep foods stocked and handy that requires little or no

preparation, such as peanut butter, pudding, applesauce, tuna
fish, cheese, and eggs.

• Try to drink plenty of fluids, especially on days when you

don’t feel like eating. Water is essential to your body’s proper
functioning. For adults, six to eight cups of fluids per day is a
good target.

• If your symptoms persist or worsen, consult your

physician immediately. He or she will also be able to suggest
prescription remedies that work well to control side effects.

• Cancer and its treatments destroy the body’s ability to

make white blood cells. This can weaken cancer patient’s
immune system and put him/her at risk for infections that you
would not normally be susceptible to, including food borne
illnesses.
Therapies

Breast cancer treatment:- There are several treatment

options for women diagnosed with breast cancer that include
surgery, chemotherapy, radiation therapy, hormonal therapy
and targeted therapies. The most appropriate treatment
depends on the woman’s risk profile and stage of disease,
which can range from I-IV and is based on the tumor size,
location, and involvement of lymph nodes and whether or not
tumor has spread to surrounding tissue or distant organs.
Treatment for breast cancer depends on:

• Stage of your cancer (whether it is just in the breast or has

spread to other places in the body),

• Type of breast cancer,

• Characteristics of the cancer cells,

• Menopausal status, and

• General state of your health.

What is "staging?"

Once breast cancer has been diagnosed, more tests will be

done to find out if the cancer has spread from the breast to
other parts of the body. This is called staging. Your doctor
needs to know the stage of your disease to plan treatment. The
following stages are used for breast cancer:

Breast cancer in situ (Stage 0)

About 30 percent of breast cancers are identified very early.

They are sometimes called carcinoma in situ. There are two
types of breast cancer in situ. One type is ductal carcinoma in
situ (also known as intraductal carcinoma). The other type is
lobular carcinoma in situ. Lobular carcinoma in situ is not
cancer but is a marker for patients at higher risk for future
development of breast cancer. For the purpose of classifying
the disease, it is also called breast cancer in situ, carcinoma in
situ or stage 0 breast cancer.

Stage I

The cancer is no bigger than 2 centimeters (about 1 inch) and

has not spread outside the breast, or the cancer is no bigger
than 2 centimeters and there is lymph node involvement with
cells measuring less than 2 millimeters (micrometastasis).

Stage II

Stage II is divided into stages IIA and IIB.

Stage IIA

• The cancer is no bigger than 2 centimeters and has spread to

the lymph nodes under the arm (the axillary lymph nodes).

• The cancer is between 2 and 5 centimeters (from 1 to 2

inches) and has not spread to the lymph nodes under the arm.

• There is cancer detected in the lymph nodes under the arm

with no detectable cancer in the breast (unknown primary).

Stage IIB

Stage III is divided into stages IIIA, IIIB and IIIC. Stage IIIA
is defined by either of the following:

Stages IIIA

• The cancer is 5 centimeters or less in size and has spread to

lymph nodes under the arm that have grown into each other or
into other structures, or to lymph nodes near the breastbone.

• The cancer is larger than 5 centimeters in size and has spread

to the lymph nodes under the arm.

Stage IIIB

• The cancer has grown into the chest wall and/or the skin of
the breast with or without evidence of spread to the lymph
nodes.
• The cancer may have spread to lymph nodes under the arm
that have grown into each other or into other structures, or to
lymph nodes near the breastbone.

Stage IIIC is defined by any tumor size with one of the

following:

• The cancer has spread to the lymph nodes above or below

the collarbone.

• There are more than 10 lymph nodes under the arm involved
with cancer.

• There is involvement of the lymph nodes near the

breastbone.

Stage IV

The cancer has spread to other organs of the body. The sites
where breast cancer is most likely to spread are the bones,
lungs, liver or brain.

Inflammatory Breast Cancer

Inflammatory breast cancer is a special class of breast cancer

that is rare. The breast looks as if it is inflamed because of its
swollen and red appearance. Sometimes it may feel warm.
The skin may show signs of ridges and wheals (raised areas)
or it may look pitted like the skin of an orange. This type of
cancer tends to be more aggressive. Inflammatory breast
cancer may be stage IIIB, IIIC or stage IV.

Recurrence

Recurrent disease means that the cancer has come back

(recurred) after it has been previously treated. It may come
back in the breast, the lymph nodes, the soft tissues of the
chest (the chest wall), or in another part of the body.

How is breast cancer treated?

There are different treatments for each patient with breast

cancer depending on the stage and type.

o Surgery (an operation to remove the cancer)

o Radiation therapy (using high-dose x-rays to kill cancer

cells)

o Chemotherapy (using drugs to kill cancer cells)

o Hormone therapy (using hormones to stop the cells from

growing)

• Targeted therapy (using drugs targeting a unique marker on

the breast cancer cells)

• New types of treatment are being tested in clinical trials.

• Therapy is considered adjuvant when it is given after
surgery, when no cancer cells can be seen, to prevent cancer
from recurring.

• Therapy is considered neoadjuvant when it is given before

surgery to shrink the tumor and make it easier to remove, or to
assess the response of the tumor to a specific type of treatment
options include.

Surgery includes lumpectomy (removal of a lump and the

surrounding tissue), which is also called breast-conserving
survey, mastectomy (removal of all the breast tissue although
muscles underneath breast are no longer removed), lymph
node removal (or axillary lymph node dissection) which takes
place during time of lumpectomy or mastectomy if biopsy
shows that breast cancer has spread. Other options include
preventive surgeries such as prophylactic mastectomy for
women at high-risk and prophylactic ovary removal to lower
estrogen production in the body. Emerging evidence from
trials suggest that the removal of axillary lymph nodes is not a
determinant of breast cancer recurrence and survival in early-
stage patients, which is contrary to prevailing practices.56-58
In one trial of 856 early-stage patients, dissection of lymph
nodes with evidence of spread did not influence breast cancer
5-year recurrence or mortality rates.
In another trial (the National Surgical Adjuvant Breast and
Bowel Project B-32 study) of 3,986 node-negative patients,
women were randomized to axillary lymph node dissection or
no further surgery; the investigators found that the
intervention was not associated with disease control or
survival but was associated with significantly greater
morbidity, including shoulder abduction deficit, arm volume,
arm numbness and tingling.

In another study of 5,539 women undergoing breast-

conserving surgery, immune system assays which are more
sensitive in detecting micro-metastases in node-negative
women, were not associated with improved survival.

Radiation therapy includes external beam and internal

(implantation of radioactive seeds) radiation, and is usually
given after surgery to destroy any remaining cancerous cells
left behind. While the former is a well-tested, long-standing
treatment option, the latter has recently being developed and
is still being studied for its efficacy and adverse effect profile,
although evidence from at least 4 trials demonstrate a
consistent lower recurrence rate when radiation therapy
supplements surgery.

The advantages of internal radiation include a much shorter

treatment interval, a localized and focused approach of
radiation to the affected area (and hence lower dose exposure)
rather than the whole breast and therefore fewer adverse
effects related to radiation. Disadvantages are that benefits
and side effects of this newer technology are not well-
understood and that it requires extra training/expertise to be
correctly carried out. Two European trials have shown that
10-16 Gy boosts can reduce recurrence by 4.6% to 3.6% at 3
years (p=0.044) and from 7.3% to 4.3% at 5 years (p<.001).
A randomized clinical trial is underway (National Surgical
Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG
0413) to compare the effects of internal (partial breast) and
external (whole-breast) irradiation in women with Stage 0, I
and II breast cancer.

Chemotherapy is a systemic therapy that can be administered

either before surgery (to shrink the tumor) or afterwards (to
reduce the risk of recurrence). For early-stage disease, it is
usually administered to help remove cancer cells from the
body and to reduce the risk of recurrence. For advanced-stage
disease, it is given to destroy as many cancer cells as possible.
A meta-analysis of 60 trials and 28,764 women of
combination chemotherapy versus no chemotherapy showed a
37% reduction in relapse and 30% reduction in death for
women under the age of 50 years, and a 19% reduction in
relapse and 12% reduction in death for women aged 50-69
years; the benefit on recurrence was present in all age groups
and in the presence and absence of tamoxifen.

Hormonal therapy is a treatment option for hormone

receptor-positive cancers. It can be given for early-stage
disease to either reduce the amount of estrogen or block its
action to reduce the risk of recurrence. It can also be given for
advanced-stage or metastatic disease to shrink or slow the
growth of existing tumors. Hormone therapy includes
aromatase inhibitors, selective estrogen receptor modulators
and estrogen receptor down regulators as well as surgical
treatments such as removal of ovaries and fallopian tubes.
Tamoxifen use of at least 5 years is associated with a 12%
reduction in recurrence and a 9% reduction in mortality over a
15-year follow-up period, in ER-positive and ER-unknown
breast tumors.
The benefits of tamoxifen appear to be optimized at 5 years
with current recommendations to discontinue adjuvant
tamoxifen after 5 years. Recent trials (Arimidex-Nolvadex
study in postmenopausal women (ARNO-95) and the
Intergroup Exemestane Study (IES)) have shown benefits of
aromatase inhibitors over tamoxifen for disease-free survival
and complications.

Targeted therapies target cancer cell properties specifically

as opposed to chemotherapy which also destroys normal,
healthy cells and includes treatments such as herceptin and
tykerb, which both block cancer cell growth in HER2-positive
breast cancers, and avastin, which blocks growth of new
blood vessels depending for cancer cell growth.

2. Literature Review
1.[1] An Artifical intelligence based software application for
microcalcification detection on mammogram images, İsmail
İşeri̇ , Signal Processing and Communication Application
Conference (SIU), 2016 24th, 23 June 2016
In this study, a software framework is proposed for detecting
of microcalcification clusters which are abnormalities in
mammogram images. Apart from the two well known
methods two different feature extraction methods integrating
to this software an artificial intelligence based detection
system has been developed. In the study Gray Level Co-
occrrance Matrix(GLCM), Equal Width
Discritization(EWD2), Wavelet Transform and Multiple
Window Based Analysis (MWBA) were used as for feature
extraction Artifical Neural Network (ANN) was used as
classifier. The highest AUC value was obtained by the
MWBA method(AUC=0,91)
2.[2] Microwave imaging system for early detection of breast
cancer, Faihaa Mohammed Eltigani, Maged Ali Ali Yahya,
Mazin Elfadil Osman,  Communication, Control, Computing
and Electronics Engineering (ICCCCEE), 2017 International
Conference on, 16-18 Jan. 2017
Breast cancer is the most common cancer among females, and
one of the leading causes of death worldwide. Nowadays, the
most common method for breast cancer detection is X-ray
mammogram screening. Since mammography employs
ionizing radiations, the repetition of exposure is not
recommended. Aiming to overcome this limitation of the X-
ray mammogram screening, a new, low-cost and safe
microwave imaging technique was developed in this study.
The proposed technique depends on the significant contrast in
the dielectric properties of the normal and the tumor tissues.
The Computer Simulation Technology Microwave Studio was
used to create a model of breast with tumor of 5mm radius.
And a circular patch antenna was used in this study. The
breast model was placed in front of the antenna, which used as
a transmitter as well as a receiver of the microwave. The
reflected waves were processed in order to form an image of
the tumor. The reconstruction of the reflected waves permits a
clear identification of the tumor.

3.[3] Performance analysis of filtering techniques for speckle

reduction on breast ultrasound images Hanung Adi Nugroho
Yuli Triyani Made Rahmawaty Igi Ardiyanto Lina Choridah
Electronics Symposium (IES), 2016 International 29-30
Sept. 2016
Breast cancer is one of the most frequent types of cancer
occurs in women and also the leading cause of women's death
in the world. Ultrasonography (USG) is the common modality
which is used as the diagnosis tool due to its low cost and
portability. It is used to early detect breast cancer. In the USG,
the degradation of image edge character is indistinct or
speckle noise frequently occurred at the time of the
acquisition. It is important to carry out an effective process to
reduce speckle noise. Some filters are proposed for reducing
the speckle. However, the results cannot preserve the edges
and the details of the USG images. This paper aims to study
the performance of some filtering techniques in reducing
speckle noise that can preserve the edges and the details of
breast USG images. Multiple parameter measurements to
determine image quality among others mean square error
(MSE), signal to noise ratio (SNR), speckle index (C),
average difference (AD) and contrast to speckle ratio (CSR)
are used to compare and evaluate of Wiener filter, anisotropic
diffusion filter (ADF), Perona-Malik filter, detail preserved
anisotropic diffusion (DPAD) filter, speckle reduction
anisotropic diffusion (SRAD), anisotropic diffusion filter with
memory based on speckle statistics (ADMSS) and maximum
homogeneity over a pixel neighborhood (m-homog). Based on
the measurement parameter can specify filter that are
providing a robust filter for de-speckling, preserving edges
and details, while improving contrast of breast ultrasound
images.

4.[4] An enhancement in automatic seed selection in breast

cancer ultrasound images using texture features Lipismita
Panigrahi Keshri Verma Bikesh Kumar Singh  Advances in
Computing, Communications and Informatics (ICACCI),
2016 International Conference on 21-24 Sept. 2016
Automatic seed selection is an important and crucial step
toward the boundary detection in ultrasound B-scan images.
This paper focuses on a methodological framework that can
automatically detect a seed point of an ultrasound image by
using texture features. Based on the selected seeds of cluster
the ultrasound images are segmented using active contour, K-
means and Otsu methods. The comparative analysis of these
segmentation techniques is also reported. The proposed
method is applied on 116 ultrasound images in which 45 are
benign cases and 71 malignant cases. The quantitative
experimental results show that the proposed method can
successfully find an accurate seed point based on texture
features and it has the ability to segment the image with high
accuracy of 89.65 %. The proposed method is faster and
performs more accurate segmentation than existing algorithms

5.[5] Ultrasound computed tomography for quantitative

breast imaging M. Pérez-Liva J. L. Herraiz N. González-
Salido L. Medina-Valdés J. Camacho C. Fritch J.M. Udías
Medical Engineering Physics Exchanges/Pan American
Health Care Exchanges (GMEPE/PAHCE), 2016 Global  4-9
April 2016
Ultrasound computer tomography is an emerging medical
imaging modality with promising capabilities for breast
cancer screening. It allows studying several acoustical
properties of the tissues. The transmission modality of USCT
provides maps of the speed of sound and the acoustic
attenuation of the tissues. The mentioned properties offer high
resolution and excellent contrast tissue representation. The
levels of contrast in a speed of sound map are comparable to
the ones obtained in a mammogram as this property is well
correlated with the density in the tissues. On the other hand,
the acoustic attenuation is expected to provide enhanced
levels of contrast compared to mammography, due to a higher
tissue type dependence, improving the detection of
malignancies. This work presents preliminary results for
acoustic attenuation and speed of sound reconstruction using a
ray-tracing algorithm. We investigated experimental data
from the acquisition of a tissue-mimicking phantom. The
results were compared with an estimation of the X-ray
attenuation coefficient (25 keV) of the phantom (information
provided by mammography) to demonstrate the improvements
in terms of contrast when acoustic attenuation maps are
employed. Further tests are required, but these results show
the potential of the USCT maps to identify malignant tissues
in the breast.
6[6] Quantitative study of image features of clustered
microcalcifications in for-presentation mammograms Juan
Wang Yongyi Yang Robert M. Nishikawa  Image Processing
(ICIP), 2016 IEEE International Conference on 25-28 Sept.
2016
Mammogram images are now increasingly acquired with full-
field digital mammography (FFDM) systems in the clinics.
Traditionally, the “for-processing” format of FFDM images is
used in computer-aided diagnosis (CAD) of breast cancer. In
this study, we investigate the feasibility of using “for-
presentation” format of FFDM (which are more readily
available) in development of CAD algorithms for
microcalcification (MC) lesions. We conduct a quantitative
evaluation of both the image features and the detectability of
individual MCs on a set of 188 mammograms acquired in
both formats. The results demonstrate that there is a high
degree of agreement in the image features between the two
image formats, and that a slight increase in false-positives in
MC detection is observed in for-presentation images.
7.[7] Directional SUSAN image boundary detection of breast
thermogram Elham Mahmoudzadeh Maryam Zekri
Mohammad Ali Montazeri Saeid Sadri Sima Taghizadeh
Dabbagh IET Image Processing ( Volume: 10, Issue: 7, 7
2016 )  20 June 2016
Thermography of the breast has been shown to be well suited
to detect early signs of breast cancer. This study proposes a
novel method for boundary detection of breast thermography
images using directional SUSAN method. Among breast
thermography image processing steps, breast isolation from
background and from each other is an essential stage for
proper detection of breast cancer. For this purpose, in this
study, breast boundary is grouped into three regions
depending on the region property. The algorithm of boundary
detection is different for each region. Specially, for bottom
breast boundary, directional SUSAN edge detector is
presented that uses two rectangle masks to create a directional
SUSAN gradient image with emphasis on oblique useful
edges and omitting undesirable ones. Then cubic parabolic
interpolation is implemented to determine a set of edge points
on the boundaries. At last, an effective search algorithm is
executed to correct some false points in order to extract breast
boundaries accurately. The performance of the proposed
approach illustrated by applying on the images of three
databases. Experimental results show that this method acts
effectively and confirm the accurate boundary detection.
Moreover, statistical measures are calculated to indicate the
remarkable capabilities of the proposed approach.

8.[8] A neural network based breast cancer prognosis model

with PCA processed features Smita Jhajharia Harish Kumar
Varshney Seema Verma Rajesh Kumar  Advances in
Computing, Communications and Informatics (ICACCI),
2016 International Conference on  21-24 Sept. 2016
Accurate identification of the diagnosed cases is extremely
important for a reliable prognosis of breast cancer. Data
analytics and learning based methods can provide an effective
framework for prognostic studies by accurately classifying
data instances into relevant classes based on the tumor
severity. Accordingly, a multivariate statistical approach has
been coupled with an artificial intelligence based learning
technique to implement a prediction model. Principal
components analysis pre-processes the data and extracts
features in the most relevant form for training an artificial
neural network that learns the patterns in the data for
classification of new instances. The diagnostic data of the
original Wisconsin breast cancer database accessed from the
UCI machine learning repository has been used in the study.
The proposed hybrid model shows promising results when
compared with other classification algorithms used most
commonly in the literature and can provide a future scope for
creation of more sophisticated machine learning based cancer
prognostic models.

9.[9] Application of Artificial Metaplasticity fundamentals to

WBCD Breast Cancer Database classification method J.
Fombellida I. Martín-Rubio D. Andina World Automation
Congress (WAC), 2016
The Metaplasticity is an inherent property of the Biological
neuron connections that consists in the capacity of modifying
the learning mechanism using the information present in the
network itself during the training. This concept can be applied
to Artificial Learning Algorithms using a technique called
Artificial Metaplasticity. The idea is to improve the results in
Machine Learning taking as the base the hypothesis studied
by Metaplasticity in Biological Learning. This paper presents
and discuss the results of applying an Artificial Metaplasticity
implementation based on the information present at the output
 of the network in Multilayer Perceptrons at artificial neuron
learning level. The objective of this study is a state-of-the-art
research: the diagnosis of breast cancer data from the
Wisconsin Breast Cancer Database.

3. Proposed Work

Objectives

1. To determine the important common genetic variants that

underlie breast, ovarian and prostate cancer risk, and to
estimate their effects on risk, individually and in combination.
2. To assess interaction between genetic loci and known or
suspected environmental/lifestyle risk factors, i.e. to examine
whether environmental/lifestyle risk factors modify genetic
susceptibility to breast, ovarian and prostate cancer.
3. To assess whether the association between genetic
factors, environmental/lifestyle risk factors and cancer risk is
stronger for certain tumour subtypes, and affect clinical
outcome.
4. To develop different algorithm models including genetic
and environmental/lifestyle factors for these cancers, to allow
the prediction of breast, ovarian and prostate cancer among
individuals in the population at large.
5. To investigate the efficacy and cost-effectiveness of
using these risk models in prevention strategies, and the
associated organisational, ethical, legal and social
implications.

4. References

1. Breasted JH, editor. The Edwin Smith Surgical

papyrus. Chicago, Illinois: The University Chicago Press;
1930. special edition, 1984.

2. Lyons AS, Petrucelli RJ. Medicine - An illustrated

history. New York: Harry N. Abrams Publishers; 1978. pp.
294–317.

3. Homer. Iliad. [Translated by WHD Rouse] New York: A

Signet Classic. New American Library; 1966. p. 36.

4. Ariel IM. Breast cancer, a historic review: is the past

prologue? In: Ariel IM, Cleary JB, editors. Breast Cancer
Diagnosis and Treatment. New York: McGraw-Hill; 1987. pp.
3–26.

5. Lewison EF. The surgical treatment of breast cancer; an

historical and collective review. Surgery. 1953;34:904–
53. [PubMed]

6. Rozen WM, Rajkomar AKS, Anavekar NS, Ashton MW.

Post-mastectomy breast reconstruction: a history in
evolution. Clinical Breast Cancer. 2009;9:145–54. doi:
10.3816/CBC.2009.n.024. [PubMed][Cross Ref]