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The occurrence of breast cancer in men compared to women differs, developing 8-10 years later in men (Fentiman et al., 2006; 2009). The association of MBC with older age may mean that reported mortality due to breast cancer, as distinct from other age-related comorbidities, may be underestimated. Furthermore, Spiers and Shaaban (2010) note that, although in western countries breast cancer rates appear to be declining, the statistics quoted refer only to female breast cancer. These authors compared the incidence of 350 current MBC diagnoses annually in the UK, with figures reported in the late 1970’s and the start of the decade. They found an increasing rate of MBC incidence in the UK comparable to that observed in the United States by Stang and Thomssen (2008). The above discussion raises the question of why male breast cancer incidence appears to be increasing in the UK?
For non BRCA 1 or 2 carriers, age is a significant risk factor for the development of MBC (Cutuli et al., 2010; Fentiman 2009). Therefore, as the proportion of people in the UK classed as old or very old continues to rise (Office of National Statistics (ONS), 2015) it could be argued that a comparable rise in the incidence of MBC can be expected. Brinton et al. (2015) investigated additional risk factors and concluded that, out of 101 MBC sufferers and 217 controls, MBC risk was increased by levels of endogenous oestradiol, although no association was found with circulating androgens. Interestingly, the risk of MBC conferred by high circulating endogenous oestradiol was consistent with that associated with postmenopausal female breast cancer, reported by Kaaks et al. (2014), Dallal et al. (2014), Falk et al. (2013) and others. Brinton et al. (2015) controlled for variables that may confer risk of MBC such as cigarette smoking but did not control for known risk factors that include BRCA 1/ 2 status, previous history of gynecomastia and diagnosis of Klinefelter syndrome.
These are significant omissions that undermine the reliability of Brinton et al.’s (2015) findings. Sufferers of Klinefelter syndrome, for example, have a high ratio of circulating oestrogens compared to androgens (Weiss et al., 2005). Given that, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2016), the incidence of this condition affects 1 in 500 males, (which is higher than the incidence of MBC) it is reasonable to argue that the risk factor that contributed to MBC in Brinton at al.’s (2015) study could be attributed to this condition, and not high circulating oestradiol levels with no influence from androgens, as suggested.
Fentiman (2009) summarises research that has associated working with hydrocarbons or in hot environments with MBC. Other studies have examined if the trend towards increased Body Mass Index (BMI) observed in populations of western countries such as the US and UK may be linked to the incidence of MBC. Brinton et al., (2008), for example, found that a BMI of more than 30 conferred a risk of MBC, but this study was based upon a small sample size and thus provided limited statistical power to substantiate the authors’ findings. A case-controlled study of 156 men diagnosed with MBC conducted by Ewertz et al., 2001 found no significant associations with parity and age at first childbirth, which is unsurprising given the gender of their sample population. These authors associated the risk of MBC with obesity and diabetes which is not supported by consensual research demonstrating that this link is unsubstantiated (Giovannucci, et al., 2010). Furthermore, Ewertz et al. found no consistent pattern in the association between cigarette smoking and MBC, which is challenged by later studies of female breast cancer. These include Dossus et al. (2013), Xue et al. (2011), Luo et al. (2011) and McCarty et al. (2009).