Breast cancer prevention

1. Breast cancer prevention By Julian Kunz

2. What is Breast cancer? • Also known as mammacarcinoma • A malign tumor spreading from the lobar epithelium (lobar carcinoma) or the lactiferous ducts (ductal carcinoma)

3. Etiology • Most common malign tumor in the female population (~ 25%) • In women between 30 and 60 it is the most common cause of death in the western world • In germany 17000 women die of it every year • Even though it is very rare men can be affeceted too

4. Cause of death „mammacarcinoma“

5. Risks and Causes • Genetic factors: play a big rule in the type of breast cancer affecting young women • Breast cancer virus: Since the 1930s researchers have been looking for a virus analogous to the mamma-tumor-virus causing benign cancer in mice • Birth control pills: The adverse effect of these drugs hasn‘t been completely discovered; however there is a moderate risk increase if the medication has been taken for longer than 5 years

6. Risks and Causes • Hormone therapy: to reduce symptoms menopause • Pregnancy: an early first pregnancy reduces the risk of breast cancer • Osteoporosis prevention: calcium and vitamin D therapy also decrease the risk of breast cancer markedly

7. Prevention and Screening • 80 – 90% of all changes are discovered by women themselves even though only 20% examine themselves • The examination should be done on a monthly basis 5-7 days after menorrhoea • In case of a palpated anomaly women should consult their physician for a more detailed examination

8. „Discovering Hands“ • Blind people have a highly developed sense of touch • This special ability might be put to use in North Rhine-Westfalia (NRW) • In case of success it would create a new profession for blind women • Training programs will begin in 2008

9. Mammography • Is an x-ray examination with a special apparatus • The breast is comprimed between two plates of plexiglass to keep the breast in position (might result in bruises) • The applied x-rays are rather soft (26-30 keV) to increase the contrast  small neoplasmatic tissue formations can be seen

10. Sonography • Ultrasound-based technique done after palpation of an anomaly to rule out possible cysts and to estimate the size of the tumor • Only in addition to mammography as neither microcalcium nor tumors smaller than 5mm can be detected

11. MRI • An important imaging technique to find out if the breast has been affected by more than one tumor • Multifocality: more than one tumor in the same quadrant • Multicentrality: other tumors in other quadrants

12. Computer Assisted Detection (CAD) • CAD systems help searching digital images for typical structures and also to point out possibly diseased regions • It is a relatively young interdisciplinary technology combining elements of artificial intelligence and digital image processing • It serves mostly as a second opinion to the report of the responsible physician

13. Mammography-Screening-Centers • Currently a network of quality assured screening centers is being build up in Germany • Woman between the age 50 and 70 are invited once a year to get a mammography • In case of a report of an anomaly in the scan they are send for a biopsy of the suspicious tissue formation

14. Punching Biopsy • A needle is shot at high velocity into the neoplasmatic tissue • Done in locally sedated state • (At least 3 samples are taken to avoid mistakes

15. Needle Biopsy • With a syringe and a special needle tissues are drawn from a palpable tissue formation • As painful as venipuncture • In case of a malign tumor the result is sure wheras it is only 90% sure for a benign tumor

16. Advanced Breast Biopsy Instrumentation (ABBI) • Biopsy with relatively large probe (6-20 mm) • Done with x-ray to ensure localisation of target • Mostly used for analysis of microcalcification • Has only been in use for a few years  many unexperienced physicians