The exact cause of asthma is unknown, but it is believed to be the result of a genetic component, as well as environmental factors. Based on this understanding, the following are several key risk factors that are believed to increase the likelihood of an individual developing asthma- Being obese or overweight. Having an allergy, including hay fever or atopic dermatitis. A history of the disease in your family. Being a smoker. Exposure to secondhand smoke. Exposure to pollution or exhaust fumes. Exposure to chemicals in the workplace (a risk faced by factory workers, hairdressers etc.) Miscellaneous urban environmental factors. Frequent use of antibiotics during formative years.

Based on the severity of symptoms , the National Asthma Education and Prevention Program (NAEPP) has grouped asthma into 4 categories – mild intermittent, mild persistent, moderate persistent, and severe persistent. This classification system is used to help guide treatment. Mild Intermittent Asthma: Does not impact normal daily life Symptoms occur less than 2 days per week. Broken sleep due to shortness of breath less than twice a month. Need to use rescue inhaler less than twice a month. FEV1 (forced expiratory volume 1) is normal. Mild Persistent Asthma:  Has minimal impact on normal daily life Symptoms occur more than 2 days per week, but not every day. Broken sleep due to shortness of breath more than twice a month. Need to use rescue inhaler more than twice a month. FEV1 >80% predicted. Moderate Persistent Asthma: Has some impact on normal daily life Symptoms occur daily. Broken sleep due to shortness of breath more than once a week. Need to use rescue inhaler daily. FEV1 60-80% predicted. Severe Persistent Asthma: Daily life impacted by symptoms Symptoms occur multiple times a day. Broken sleep due to shortness of breath on most nights. Need to use rescue inhaler several times a day. FEV1 <60% predicted.

The breast cancer staging system is based on three main factors: invasiveness spread to lymph nodes and spread to other parts of the body. The staging system uses number 0-4 to better identify feature and prognosis of particular cancer. Stages of Breast Cancer: Stage 0: This classification is used to describe non-invasive breast cancers, like DCIS. Stage 1a: This classification describes invasive breast cancer where the tumor is at least 2 centimeters long and remains contained in the breast, with no evidence of spread to the lymph nodes or other tissues Stage 1b: This classification describes invasive breast cancer where there are small 0.2-2 millimeter groups of cancer cells found within the lymph nodes. This stage can present with or without a tumor in the breast. Stage 2a: This classification describes invasive breast cancer where there are medium (>2 millimeters) sized tumors found within axillary lymph nodes. This stage can be present with or without a tumor in the breast. However, if there is a tumor in the breast that is larger than 2 centimeters, but smaller than 5 centimeters and no spread to the axillary lymph nodes, this that tumor could also be described as stage 2a. Stage 2b:

Breast Cancer Treatments The treatment of breast cancer will be individualized and based on genetic factors, grade, and stage identified in the diagnosis. There are five main categories of treatment; surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapies. Any combination of these can be chosen by the patient and the doctor for the best potential outcome. Surgery Surgery to remove the mass is the most common form of treatment for breast cancer. This procedure involves removing the mass as well as the nearby healthy tissue called the margins. The margin is removed in hopes of eradicating the entire tumor and preventing further spread of the cancer. The pathology report will identify if the surgery resulted in “clear margins”, which means that the tumor has not begun to spread outside of the main mass. Occasionally, in more advanced stages of cancer, chemotherapy will be used before surgery to shrink the tumor before its removal. There are three potential surgical options available and range from removing portions of the tumor to removing the entire breast. A lumpectomy, otherwise known as a partial mastectomy, is the least aggressive surgery option available. It only removes the main lump along with the healthy marginal tissue surrounding the tumor.

As with all treatments for disease, the side effects of breast cancer therapy depends on the plan of care. Most breast cancer therapies have similar main side effects. These include pain, nausea, fatigue, hair loss, and osteoporosis (weakening of the bones). However each of the treatment options comes with their own specific set of particular side effects as well. Chemotherapy treatments: can increase the risk of infection, cause anemia, dry skin, brittle nails and an increase in mouth ulcers. More seriously, chemotherapy can affect fertility in both men and women. It can also result in menopausal-like symptoms due to the interference of normal hormonal cycles. The length of time these side effects are experienced by patients depends on the specific drugs used and the total length of treatment. Radiation therapy: side effects are generally divided into two categories: short-term and long-term effects. Short-term effects are caused by the radiation treatment itself and results in severe skin irritations and reddening, breast swelling, breast pain, and change in breast size, shape, or color. Long-term side effects begin weeks to months after the radiation therapy ends and cause hardened breast tissue, breast tenderness, and inflamed lungs resulting in a reoccurring dry cough. Hormonal therapy: as it blocks the normal uptake of specific, crucial hormones for a woman’s monthly cycle, many menopausal-like symptoms including hot flashes, night sweats, vaginal dryness, and mood changes can occur.