Breast cancer is caused by malignant cells in the lining of the milk glands or ducts of the breast (McCartney, 2001). The characteristics of the cancer depend on where in the glandular or ductal unit the cancer occurs, and this determines the subtype. Ductal carcinoma, for example, begins in the ducts; lobular carcinoma involves the lobules or glands. If the cancer has not yet spread, it is termed ôin situ.ö Once the cancer becomes invasive, it can spread to the regional lymph nodes or to other organ systems in the body and become systemic. The primary lymph nodes for the breast are in the axilla, and this is the first place to which it usually spreads. If the cancer gets into the bloodstream, it can be carried anywhere, and the most likely sites for systemic metastases are the lungs, liver, skin, soft tissue, and bones.
Every woman is at risk for breast cancer, and the risk increases with age, regardless of family history (McCartney, 2001; NCI, 2003). According to the National Cancer Institute, women over age 60 are at the greatest risk, and is uncommon before menopause. Other risk factors include a family history of breast cancer; early onset of menstruation, and late onset of menopause; women who have not had children or who have not breast-fed children; women taking hormone replacement therapy; women who have had radiation therapy to the chest; increased breast density; being obese after menopause; and some studies have indicated that physical inactivity and a high alcohol intake may increase the risk of a woman getting breast cancer (Donatelle, 2004, 154; NCI, 2003; McCartney, 2001) . Despite this, most women who develop breast cancer have none of the known risk factors, and family history only plays a role in between five and 10 percent of cases. Despite these factors, many women do not consider themselves at risk, and delay getting mammograms or delay evaluation of symptoms (Facione, 2002, 256). In a study of...