Breast Shape Changes Research Articles

Association between patient position-induced breast shape changes on prone and supine MRI and mammographic breast density or thickness.

The breast shape differs between the prone position in breast magnetic resonance imaging (MRI) and the supine position on an operating table. We sought to determine the relationship between patient position-induced changes on prone and supine MRI in breast shape and mammographic breast density or thickness. We evaluated data from 68 women with 69 breast cancers in this retrospective observational study. The difference in the minimal distance from the nipple to the pectoralis major (DNPp-s) or the internal thoracic artery between the prone and supine MRI (DNIs-p) was defined as the breast shape changes. Mammographic breast density was assessed by conventional 4-level classification and automated and manual quantification using a dedicated mammography viewer. The compressed breast thickness was recorded during mammography (MMG). We determined the association between patient position-induced breast shape changes on MRI and mammographic breast density or compressed breast thickness on MMG. On the conventional 4-level qualification, one breast appeared fatty, 39 appeared with scattered density, 23 appeared heterogeneously dense, and 6 breasts appeared extremely dense. Both automated and manual quantification of mammographic breast density differed between the 4 levels (p < 0.01 for both) and correlated with the 4 levels (p < 0.001 for both, r = 0.654 and 0.693, respectively). The manual quantification inversely correlated with DNPp-s and DNIs-p (p < 0.01 and < 0.05, r = - 0.330 and - 0.273, respectively). The compressed breast thickness significantly correlated with DNPp-s and DNIs-p (p < 0.01 for both, r = 0.648 and 0.467, respectively). Compressed breast thickness during MMG can predict the degree of patient position-induced changes in breast shape on MRI. The manual quantification of the mammographic breast density, which may reflect the biomechanical properties of the breast tissues, also correlates to the breast shape changes.

Surgical treatment after augmentation mammoplasty with polyacrylamide hydrogel.

Polyacrylamide hydrogel mammoplasty is a simple and relatively affordable surgery. However, this procedure is associated with a significant frequency of late complications, prompting its suspension in 2006. Despite this, patients continue facing long-term consequences. These include hydrogel migration, changes in breast shape and volume, granulomas, fistulas, and abscess formation. The clinical case described here presents the surgical treatment after augmentation mammoplasty with polyacrylamide hydrogel performed 35 years ago.

A comparison of textured vs smooth surfaced implants in sub fascial breast augmentation.

Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. This study examined the differences in outcomes between textured and smooth implants. A total of 385 patients underwent subfascial breast augmentation in two cohorts. The initial series (n=209) employed textured implants and the second (n=176) employed smooth implants. In all other respects, patient management was identical. Adverse outcomes, changes in breast morphometry, and patient satisfaction were compared between the two groups. The follow-up period ranged from to 74-272 weeks for smooth implants (mean 164 weeks, STD 50.6) and 78-279 weeks for textured implants (mean= 186 weeks, STD=54). The incidence of capsular contracture was the same for smooth and textured implants (4.7% and 6.2%, P=.64). Changes in breast shape at the lower pole, patient satisfaction, and the incidence of other adverse outcomes were the same in both groups. Subfascial placement of smooth and textured breast implants yielded similar outcomes.

Assessment of breast cancer awareness among female pharmacy students at a university in Turkey

BackgroundFemale breast cancer is the most frequently diagnosed cancer, and knowledge of breast cancer risk factors, and symptoms is crucial for early diagnosis and prevention. This study aims to evaluate breast cancer awareness among female students at a pharmacy faculty in Turkey.MethodsA cross-sectional online survey study was conducted among female students at the Suleyman Demirel University Faculty of Pharmacy between 2 November and 17 November 2023, in Isparta, Turkey.ResultsThis survey was answered by 237 (74.5%) female students. The median breast cancer risk factors score was 8 (IQR, 5–11), and the median breast cancer symptoms score was 5 (IQR, 2–8). Additionally, the breast cancer risk factors score was 46.16% (mean/max = 8.31/18, SD = 4.33) and the breast cancer symptom score was 58.5% (mean/max = 4.68/8, SD = 2.8). Few of the respondents (26.2%, and 20.3%, respectively) knew breast cancer risk factors such as late menopause, and no childbirth experience. Most respondents correctly answered symptoms of breast cancer, such as a painless and palpable breast lump, indrawing of the nipple, and sudden changes in breast shape (76.8%,44.3%, and 67.1% respectively). The students’ sources of information were medical websites (29.5%), social media (27%), physicians (22.8%), friends & family (14.8%), and pharmacists (5.9%).ConclusionsThis study showed that students’ knowledge of breast cancer risk factors was poor, but their knowledge of breast cancer symptoms was acceptable. Breast cancer awareness courses should be included in faculties. Additionally, more attention should be given to different educational interventions such as social media, television, and brochure distribution.

Impact of autologous breast reconstruction on bra fit.

To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction. We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t-test or Wilcoxon signed-rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction. Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit. Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.

Alpelisib Efficacy in Advanced Breast Cancer

Breast cancer is one of the popular problems related to the medical field. Breast cancer become more aggressive, and the incidence rate keeps increasing yearly. The incidence indicates the slow progression of the disease. Yearly, there are more than one million new cases that get worse. Probably the incidence rate will increase significantly in the next years. Breast cancer develops silently without medical attention, and most cases are discovered during a routine clinic visit. While other cases may accidentally discover breast lumps, changes in breast shape or size, and nipple discharge. Breast cancer highly affects women worldwide. Mortality rates of breast cancer are improving, but still, the survival rate in the advanced stage is decreasing. Nowadays, Chemotherapy is considered the gold-standard approach for most cancer types and a modest improvement in both survival rates and toxicity reduction. Therefore, this article aims to focus on the use of one of the modest drugs that treat advanced breast cancer, which is Alpelisib, and highlight the mechanism of action, indication, contraindication, pharmacodynamic, pharmacokinetic, dose, and its side effects. Alpelisib is being developed by Novartis company. The first clinical trials started in Oct 2010. It was approved in the USA on May 24th, 2019. Alpelisib works by inhibiting the phosphatidylinositol 3-kinase (PI3K) which leads to inhibiting the activation of some signaling pathways. Alpelisib is used in combination with fulvestrant to treat advanced breast cancer in postmenopausal women with some genetic mutations.

PCOS Detection and Breast Cancer Detection

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder that affects people with ovaries, typically during their reproductive years. Detecting PCOS is crucial for timely intervention and management. PCOS detection involves a multifaceted approach, encompassing both clinical and laboratory methods. Clinical assessment of PCOS often begins with a comprehensive medical history, physical examination, and evaluation of symptoms, such as irregular menstruation, excess hair growth, and acne. Transvaginal ultrasound is commonly employed to visualize the ovaries and identify the characteristic cysts. Blood tests, measuring hormone levels like testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), aid in the diagnosis. Additionally, insulin resistance and glucose tolerance tests may be conducted, as PCOS is frequently associated with metabolic disturbances. Breast Cancer Detection: Breast cancer is a significant global health concern, and early detection is essential for improved prognosis and survival rates. Various techniques are employed for breast cancer detection, combining clinical assessment, imaging, and biopsy procedures. Clinical breast examination involves a physical assessment by a healthcare professional to identify any palpable lumps, changes in breast shape, or skin abnormalities. Mammography, a low-dose X-ray, is a primary imaging modality for breast cancer screening. Other imaging techniques, such as ultrasound and magnetic resonance imaging (MRI), are used for supplemental evaluation. In cases where abnormalities are detected, a biopsy is performed to confirm the presence of cancer cells. Biopsies may include fine-needle aspiration, core needle biopsy, or surgical biopsy, providing definitive evidence of malignancy. Advances in technology, such as digital mammography and the development of artificial intelligence algorithms for image analysis, continue to enhance the precision and efficiency of breast cancer detection, thereby contributing to early diagnosis and effective treatment.

Combined treatment with basalt stone and placenta extract to improve the chronic pain and scar after breast cancer surgery: a case report

BackgroundThe changes in body image caused by breast deformities and postoperative pain have a detrimental influence on the physical and mental health of patients with breast cancer. The postoperative quality of life (QOL) of these patients reduces significantly owing to the changes in the breast, an organ unique to women, that occur following breast cancer surgery.Case presentationThis case report presents the case of a Asian woman in her early 40 s with postoperative hypertrophic scarring and contraction of the scar following mastectomy; the patient presented with decreased range of motion of the upper arm, hyperpigmentation from radiation burns, changes in breast shape, and chronic pain. The patient received a combination therapy comprising Basalt Stone Treatment and the application of horse placenta extract. As a result of a total of eight sessions conducted once every two weeks, the patient's pain and scar improved. No adverse events were observed after the therapy.ConclusionCombination therapy with Basalt Stone Treatment and horse placenta extract improved the chronic pain and scar after breast cancer surgery.

Anatomical Breast Implant Assessment Using Ultrasound: A Case Series from the International Breast Implant Check Clinic.

Breast augmentation with anatomic implants can achieve a natural look, but over time, implant-related complications can occur. This includes a risk of potential rotation, which can cause a change in breast shape. Reported rates of rotation vary widely (0%-42%). Implant rotation is often detected by physical examination only or as a perioperative finding. Change in breast shape after augmentation requires clinical evaluation. In-office ultrasound allows for detailed assessment of implants for rotation and other complications. Women with anatomical breast implants seeking follow-up at the International Breast Implant Check Clinic in Stockholm, Sweden, from April 2020 to July 2022 were included in the study. Using a standardized protocol, subjective symptoms were recorded, and a physical examination followed by an ultrasound assessment was performed by a single board-certified plastic surgeon (M.J.) trained in implant assessment via ultrasound. Rotation was defined as an implant rotated past 30 degrees off the breast midline at 6 o'clock. The study included 308 women (mean age 40.1, range 20-78) with bilateral anatomical implants. Overall, 40 women (13.0%) reported a change in breast shape; 35 had one or more implant-related complications, including five with rotation on ultrasound. Of the 308 women, 11 (3.6%) had rotations upon physical examination, and an additional 10 cases were identified using ultrasound. Rotation is a potential complication of anatomical breast implants. However, in this study, change in breast shape was more commonly caused by other implant-related complications. Ultrasound is a valuable tool in evaluating causes of change in breast shape.

A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction.

Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods. This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared. A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04). Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement. Therapeutic, III.

A study on assess the knowledge towards warning signs of breast cancer and prevention among the 4th year b.sc nursing student from SBCN

The most life-threatening illness that is the primary cause of female morality is Breast cancer. Breast cancer research has led to extraordinary breakthroughs in our understanding of the illness over the last two decades, leading in more effective medicines. Now days, In most Of all malignant diseases, one of the most deadly occurring cancer are those cancers occurring in the breast, accounting for 23 percent of all cancer fatalities. It is now a global issue, yet it is still detected in its advanced stages due to women’s neglect in self-inspection. The greater parts of people learn from their disease is thorough practice of screening procedures. Others may come with a breast lump that was discovered by accident, a change in breast shape or size, or nipple discharge, although mastalgia is not unusual. To diagnose breast cancer, a physical examination, imaging, particularly mammography, and tissue biopsy are required. Early detection increases the chances of survival.

Combination of Convolutional Neural Network and AdaBoost for Breast Cancer Diagnosis

Breast cancer is a cancer that develops from breast tissue. Early symptoms of breast cancer include the existence of a lump in the breast, a change in breast shape, or dimpling on the skin. This research explores the potential of ensemble learning, with a focus on the AdaBoost algorithm, to enhance the performance of Convolutional Neural Networks (CNN) in image classification tasks, particularly with breast cancer image datasets. The architectures in focus were VGG-16, ResNet50, and Inception V4, three prevalent CNN models with proven efficiency in image recognition tasks. Coupling these CNN models with AdaBoost led to notable performance improvements in individual tests. The study further pushed the envelope by constructing an ensemble model that combined all three CNN models. This ensemble, with AdaBoost, demonstrated impressive performance across various datasets. With precision and recall scores exceeding 0.94, an F1-Score of 0.96, and an overall accuracy of 0.95 to 0.99. The significant performance boost can be attributed to the richer feature space generated by the ensemble of multiple CNN models and the iterative refinement of predictions provided by the AdaBoost algorithm. Despite the ensemble model's complexity and increased computational demand, the results provide a compelling justification for its use. Further research could delve into optimizing such ensemble models, exploring other ensemble strategies, or testing the models on diverse datasets and tasks beyond image classification.

Effectiveness of Video-assisted Teaching Programme on Knowledge regarding Breast Self-examination among BSc Nursing 2ndYear Students of MMINSR, SKIMS, Soura

Background: The goal of breast self-examinationfor women is to notice changes in the breast thatshould be broughttothe attentionof physiciansforfurtherevaluation. Theseincludebreast lumps, changes in breast shape, size, or contour, and colour of breast and nipple. Objectives: To assess the pre-test and post-test knowledge level regarding breast self-examination among BSc Nursing 2ndyear students of MMINSR, SKIMS, Soura, to compare pre-test and post-test knowledge scores regardingbreast self-examination among BSc Nursing 2ndyear students of MMINSR, SKIMS, Soura,and to determine the association of pre-test knowledge scores regarding breast self-examination among BSc Nursing 2ndyear students with selected demographical variables. Methodology: Pre-experimental one-group pre-test post-test design was used. The setting chosen for the present study was MMINSR, SKIMS, Soura, Srinagar, Kashmir. The current study included 50 BSc Nursing 2ndyear students selectedby purposive sampling technique. A self-structured questionnaire was used. Results: The pre-test showed that 62% of participants had moderate knowledge, 38% had inadequate knowledge, and none of the subjectshad adequate knowledge. The post-test revealed that 86% had adequate knowledge, 14% had moderate knowledge, and none of the study subjects had inadequate knowledge. Conclusion:Pre-test findings concluded that the studysubjectshadmoderateknowledgeregarding breast self-examination. So, there was a need to make them aware by educating them regarding breast self-examination.

Direct-to-Implant, Prepectoral Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Year Follow-Up.

Prepectoral breast reconstruction has recently experienced a resurgence in popularity. However, in direct-to-implant (DTI) reconstruction, there is no opportunity for capsular modifications before final implant insertion. Implant pocket and breast shape are thus maintained, initially, solely by the mastectomy skin flaps, and eventually, by attachments of the periprosthetic capsule. The present study aims to quantify changes in breast geometric measurements over time following DTI prepectoral breast reconstruction. A retrospective chart review was performed for patients who underwent bilateral prepectoral DTI reconstruction performed by a single surgeon from June of 2016 to January of 2018. Patients followed for more than 2 years were included. Yearly standardized frontal photographs were analyzed, and nipple-to-midline, sternal notch-to-nipple, and midclavicle-to-lower pole measurements were obtained. Patient demographics, operative details, and complications were documented. A total of 72 breasts (38 women) undergoing direct-to-implant, prepectoral breast reconstruction were included in the final analysis. Acellular dermal matrix was used in 56 breasts only (78.9%) for anterior coverage. The average change in nipple-to-midline distance after 2 years decreased by 0.41 cm (range, -2.00 to 2.97 cm), sternal notch-to-nipple distance decreased by 0.62 cm (range, -4.98 to 5.4 cm), and midclavicle-to-lower pole distance decreased 0.10 cm superiorly (range, -6.07 to 3.6 cm). In breasts that underwent postmastectomy radiation therapy, the average changes were -0.08, -0.43, and -0.56 cm, respectively. No patient in this cohort had severe malposition requiring further surgery. The present study provides insight into geometric breast measurements following prepectoral breast reconstruction at 2-year follow-up. The minimal breast shape changes observed demonstrate the feasibility of prepectoral DTI reconstruction with or without the use of acellular dermal matrix. Therapeutic, IV.

Tumor deformation correction for an image guidance system in breast conserving surgery.

Breast cancer is the most common cancer in women, and surgical resection is standard of care for the majority of breast cancer patients. Unfortunately, current reoperation rates are 10-29%. Uncertainty in lesion localization is one of the main factors contributing to these high reoperation rates. This work uses the linearized iterative boundary reconstruction approach to model patient breast deformation due to abduction of the ipsilateral arm. A preoperative supine magnetic resonance (MR) image was obtained with the patient's arms down near the torso. A mock intraoperative breast shape was measured from a supine MR image obtained with the patient's arm up near the head. Sparse data was subsampled from the full volumetric image to represent realistic intraoperative data collection: surface fiducial points, the intra-fiducial skin surface, and the chest wall as measured with 7 tracked ultrasound images. The deformed preoperative arm-down data was compared to the ground truth arm-up data. From rigid registration to model correction the tumor centroid distance improves from 7.3 mm to 3.3 mm, average surface fiducial error across 9 synthetic fiducials and the nipple improves from 7.4 ± 2.2 to 1.3 ± 0.7, and average subsurface error across 14 corresponding features improves from 6.2 ± 1.4 mm to 3.5 ± 1.1 mm. Using preoperative supine MR imaging and sparse data in the deformed position, this modeling framework can correct for breast shape changes between imaging and surgery to more accurately predict intraoperative position of the tumor as well as 10 surface fiducials and 14 subsurface features.

Knowledge and awareness on breast cancer among midwives and auxiliary midwives from three townships in Lower Myanmar

Background: In Myanmar, more than seventy percent of the population reside in rural areas and as the midwives (MW) and auxiliary midwives (AMW) are the basic health care workers who provide crucial health information to the rural women, their knowledge and awareness on breast cancer needs to be explored.Methods: A cross-sectional descriptive study was carried out to assess the perceived knowledge and awareness of MWs and AMWs regarding the early signs and symptoms, risk factors, and screening of breast cancer.Results: A total of 203 respondents (including 154 MWs and 49 AMWs) participated in the study. The mean age of the participants was 20.27±3.6 years and the majority (96%) was single. The majority of respondents (94%) had heard of breast cancer and breast cancer screening. AMWs had a significantly lower knowledge on risk factors such as: family history (68% versus 19%); nulliparity (62% versus 43%); change in shape of breast (47% versus 25%); dimpling (44.3% versus 18.45%); lumps in axilla (42% versus 21%); use of oral contraceptive pills (34% versus 8%) than the MWs.Conclusions: More knowledge on breast cancer and breast cancer screening need be imparted to the MWs and AMWs to be able to convey knowledge and information of breast cancer to the women residing in rural areas.

Abnormally large malignant breast tumor with breast abscess: a rare clinical image.

Breast cancer develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of skin. A 36-year-old female without any significant history came with the complaint of the sudden growth of breast tissues without pain in the last one month followed by pus discharge for one week along with red patches around the nipple. On physical examination, the tumor measured about 18cmx14cm. After investigations and biopsy, the patient was diagnosed with a malignant breast tumor.

Clinical Oncology Research and Reports (E-ISSN: 2693-4787) Dear Dr. Wilma D. Heemsbergen, Greetings! I am writing this email to introduce our Journal “Clinical Oncology Research and Reports” due for release our upcoming issue in the End of May. We have just gone through your published manuscript which was quite interesting “Breast-shape changes during radiation therapy after breast-conserving surgery” so we

Extracranial metastases from glioblastoma multiforme (GBM) are rare, especially cutaneous metastasis. However, the metastatic mechanism of GBM remains unknown with no current consensus regarding the best therapeutic regimen. We report the clinical, imaging and pathological features of a case of a 47 years old man with primary glioblastoma; who 12 months after receiving a macroscopically total resection and adjacent radiotherapy, developed scalp metastasis and subsequent multiple skin metastasis. We also discuss the details of this case in comparison with the previously reported cases in literature in terms of clinical presentation, lesions’ site, management and survival.

A Study to Assess the Knowledge and Expressed Practices regarding Breast Self-Examination among Women in a Selected Area of Haryana

Breast self-examination is a very simple screening tool for breast cancer. It requires minimal training to be imparted to women. They are instructed to detect any asymmetry with the other breast in terms of a lump, change in breast shape or of the overlying skin (puckering), any abnormal discharge from the nipples &amp;/or any breast lesion that does not heal easily. Teaching women about this importance of breast self-examination is a core subject of community nursing. It was therefore thought important to assess the background knowledge regarding the same amongst women of a selected area in Haryana. The aim of the study was to assess the knowledge and expressed practices regarding breast self-examination among women in a selected area of Haryana. A sample of 50 women was chosen. Data collection was done by using Google form questionnaire after assessing their willingness and ability to participate in this survey by filling up this online form. After assessing the knowledge level, it was found that 80% (n=40) were having adequate knowledge regarding breast self-examination and 20% (n=10) were having inadequate knowledge regarding breast self-examination. 52% of the women (n=26) were practicing breast self-examination and rest were not. Awareness regarding breast self-examination was adequate in the sample studied. However, the practice of performing the same was present in only about 50% of the women in the above-mentioned sample. The findings of the study highlights the need for educational programs to create awareness among women regarding regular breast screening behavior.

A Comparative Study of Meta Heuristic Model to Assess the Type of Breast Cancer Disease

Breast cancer is the expansion of cancer from the breast tissue and a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple or a red scaly patch of skin. This disease is becoming a leading cause of death among women in the whole world; meanwhile, if it is recognized in the early stage and accurate diagnosis of this disease can ensure a long survival of women. Here, the knowledge base has been created using the concept of data mining to recognize the disease based on the early data. In this paper, data mining has been used to create the association rules and statistical, soft computing and evolution algorithms have been used to select optimal classifier based on earlier data. In this context, three types (training on the whole dataset and new tested data have been created, tenfold and 98% training and 2%tested data) of techniques have been used to estimate the disease type (named consequent item) based on the nine attributes (named antecedent item) of the breast cancer data set.