الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
With an anticipated increase of over 2 million cases in 2020, breast cancer (BC) will surpass all other cancers in terms of frequency of diagnosis. It also accounts for about 680,000 female cancer deaths annually, making it the top cancer killer in this demographic.
Although the precise reason for carcinogenesis is still a mystery, there are a number of known risk factors that increase the likelihood of breast cancer developing. Among the most crucial are a country’s gender, age distribution, and level of economic growth. Procreative factors, such as the total number of births, the average age of the first child, and breastfeeding rates, as well as hormonal factors, mostly associated with the duration of estrogen exposure, are also crucial.There are a number of risk factors for breast cancer, including heredity, hormone replacement therapy, poor nutrition, and obesity. Hormonal contraceptives, alcohol use, and early radiation exposure are all listed as major contributors to the onset of breast cancer.
Stratification of risks ought to inform breast cancer screening protocols.categories, such as those indicating an increased risk (e.g., BRCA1/2 mutations) and those indicating an average risk. When it comes to screening for breast cancer, mammography is still the gold standard. Women with thick breasts had a higher rate of cancer detection when ultrasound screening was added to mammography. However, there is no better method than a breast biopsy to detect breast cancer.
Several indicators can be used to predict or assess prognosis, including as TNM staging, histological subtype, hormonal receptor, HER2 receptor status, and proliferation index Ki67.
Treatment options for breast cancer vary by stage, taking into account factors such as lesion size, axillary lymph node status, local and distant disease spread, immunohistochemistry, patient age, and performance status. These factors inform decisions about surgery, chemotherapy, radiotherapy, hormonal treatment, and targeted therapy.
Breast cancer survivors and patients undergoing mastectomy (who have risk factors) should get radiation therapy after surgery.
The use of regional node irradiation (RNI) after a mastectomy is mandatory in cases where the margins are positive, the tumor grade is high, the genomic risk score is high, the tumor type is triple negative, or the patient is very young. RNI improves local control, disease-free survival, and breast cancer mortality in patients treated with relatively modern systemic therapy, but it has no discernible effect on overall survival.
Radiotherapy often comes with a host of adverse effects, including physical, mental, and social ones. Among the most often reported adverse effects of radiation for breast cancer patients, exhaustion, skin responses, and discomfort rank high.
Chronic radiation can cause a number of serious side effects, including damage to the lungs, lymphoedema, brachial plexopathy, shoulder mobility issues, and even secondary cancers.
One of the most problematic side effects of breast cancer treatment is the development of problems in the arm and shoulder. Ninety percent or more of breast cancer patients will experience some kind of arm symptom. Arm lymphoedema, brachial plexus neuropathy, and reduced shoulder movement are the most important consequences. These illnesses frequently manifest simultaneously and share some common pathologic components that cause mobility restrictions.
We found that there were several factors related to shoulder affection in breast cancer patients who underwent regional nodal irradiation (RNI) at Minia University Hospital. These factors included the patients’ ages, weights, the average dose of radiation that reached the shoulder region during RNI, and the number of lymph nodes that were removed. Shoulder affection was measured using the qDASH questionnaire and assessed radiologically using magnetic resonance imaging (MRI) on the shoulder region.
Conclusion
Our findings indicate that there are multiple factors contributing to shoulder morbidity following breast cancer treatment.There was a correlation between the mean radiation dosage, the volume of the shoulder that received doses of 10 gy, 20 gy, or 30 gy, as well as shoulder affection following radiation, apart from patient age, weight, and surgical removal of axillary lymph nodes.