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Hamartoma: a benign breast tumour consisting of cells and tissue usually found within the breast. In the absence of atypia, there is no associated cancer risk.

Herceptin: a new drug based on monoclonal antibody technology (an example of "magic bullet" therapy) that targets a receptor on the cancer cell that is not expressed on normal cells. Herceptin has recently been approved by the National Institute of Clinical Excellence for use in patients with early breast cancer who overexpress the HER-2 receptor.   HER-2 stands for Human Epithermal Growth Factor Receptor 2. It is expressed in about 20% of breast cancers only.  It is a family of 4 growth factor receptors.  A monoclonal antibody drug that specifically targets this site was developed and is known as trastuzumab (trade name Herceptin).  The HER-2 pathway is now well established and treatment with trastuzumab has shown significant improvement with survival in patients with metastatic or advance breast cancer.  Several trials evaluated this in early breast caner and most notably NSABPB 31 / NCCTGN 9831 and the HERA trial reported their data showing significant improvements in disease free survival and overall survival when this agent is used in conjunction with adjuvant chemotherapy.  These trials used Herceptin for a total of between 2-3 years. Against this one has to consider some significant side-effects.  With an anthracycline based chemotherapy regimen, a 1-4 % risk of congestive heart failure was reported> Avoiding use of simultaneous use of an anthracycline based chemotherapy agent lowers the rate of cardiac events.  Cardiac function and monitoring is essential whilst on trastuzumab. Patients who have HER-2 over expression have generally more aggressive tumours than those who have HER-2 negative cancers.  Trastuzumab has provided these patients with targeted therapy to improve their overall outcome. Further trial on trastuzumab are ongoing as well as the use of other HER-2 targeting kinase inhibitors such as Lapatinib.

Histology: assessment by a pathologist of normal or diseased tissue, after processing and staining, who makes a diagnosis after evaluating the microscopic features of the material.

Histopathology: the histological study of diseased tissue.

Hormone replacement therapy (HRT): replacement of the female sex hormones to relieve symptoms of the menopause. HRT also offers protection against softening of the bones, the cardiovascular urogenital and other systems from oestrogen deprivation. HRT can be taken as tablets, patches, creams or implants. HRT can affect the breasts. There is a small association with breast cancer risk, estimated to be about an excess risk of 1% after ten years use. The risk is apparently higher in combined oestrogen-progestagen use compared with oestrogen alone. A progestagen is prescribed as part of HRT in women who have a uterus (eg not previously removed at hysterectomy). HRT breast cancer risk is often not applicable to those who have an early natural or surgical menopause until the average age of menopause (between 51 and 52 years of age) is reached. Against this has to weighed the beneficial effects of HRT. HRT may aggravate benign breast conditions such as fibrocystic change, simple cyst formation and mastalgia. Benign breast symptoms as a result of HRT are usually self-limiting or can be controlled/avoided by appropriate HRT use. HRT use should be carefully counselled in those with a breast cancer history or breast cancer risk. See also What’s new.

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