BREAST CANCER AWARENESS MAKE HEALTHY CHOICES Sheraton Kuwait , Crystal Ballroom

1. European Breast Health DayHayatt - Ruqayah Abdulwahab Alqatami Breast Cancer Foundation in collaboration with the Polish Presidency in the Council of the European Union BREAST CANCER AWARENESS MAKE HEALTHY CHOICES Sheraton Kuwait , Crystal Ballroom 15 October 2011

2. BREAST CANCER AWARENESS Dr Salah Fayaz October 2011

3. What is a Breast? • The breast is composed mainly of fatty tissue, which contains a network of lobes made up of tiny, tube-like structures called lobules that contain milk glands • Tiny ducts connect the glands, lobules, and lobes, and carry the milk from the lobes to the nipple • Blood and lymph vessels run throughout the breast • About 90% of all breast cancers start in the ducts or lobes of the breast

4. Breast Cancer • Breast cancer is one of the commonest cancers in the world today. There are nearly 600 000 new cases of breast cancer each year.  The disease is commoner in the west than in Asia and Africa.  The incidence is low in Japan.   • The uncontrolled, abnormal growth of cells • It is not a single disease.  Rather, it is a mixture of cancerous diseases.  As two patients may have different diseases, and the ideal treatment for one, may not be the same for another.

5. Statistics cont. • For women in the U.S.and the U.K. breast cancer death rates are higher than those for any other cancer, besides lung cancer. • Besides skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women. More than 1 in 4 cancers in women (about 28%) are breast cancer. • In 2010, there were more than 2.5 million breast cancer survivors in the U.S.

6. Statistics • About 1 in 8 women in the United States (between 12 and 13%) will develop invasive breast cancer over the course of her lifetime. • In 2010, over 200,000 new cases of invasive breast cancer were diagnosed in women in the U.S., along with over 50,000 new cases of non-invasive (in situ) breast cancer. • About 1,900 new cases of invasive breast cancer were diagnosed in men. Less than 1% of all new breast cancer cases occur in men.

7. Statistics cont. • 50,000 new cases of breast cancer are diagnosed each year in the UK. That's one every 10 minutes. • About 300 men are diagnosed each year also. • There are an estimated 550,000 people living in the UK today who have had a diagnosis of breast cancer. • Just over 12,000 people die from breast cancer in the UK each year.

8. Statistics (Kuwait) • Breast cancer is ranked the most frequent type of malignancy diagnosed in Kuwait, with 1 in 5 cases of malignancies diagnosed in women being breast cancer. • In 2008, 313 new cases of breast cancer presented to the KCCC accounting for 22% of the 1,438 new malignancy cases. • The mean age of the patients was around 50 years which is much lower than the average age range of 60 - 65 years in western countries. • Only 20 - 25% were diagnosed with early breast cancer. • About 10% of the cases were diagnosed with disease already spread to distant sites on first diagnoses.

10. Statistics cont.

11. Statistics cont. • Death rates from breast cancer have been decreasing since 1991. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness, and decreased use of HRT.

12. Risk Factors Risk factors you can control • Weight • Diet • Exercise • Alcohol consumption • Smoking • Exposure to estrogen • Stress and anxiety

13. Risk Factors cont. Risk factors you can’t control • Gender • Age • Family history of breast cancer • Personal history of breast cancer • Race • Radiation therapy to the chest • Breast cellular changes • Exposure to estrogen • Pregnancy and breastfeeding • A personal history of ovarian cancer • A genetic predisposition (such as mutations to the BRCA1 or BRCA2 genes)

14. Breast Cancer Prevention • Chemo-prevention: Tamoxifen • Strong and different screening for high risk women • Considering prophylactic mastectomy in women with related genetic mutations.

15. Fallacies • Finding a lump in your breast means you have breast cancer. • Men do not get breast cancer. • A mammogram can cause breast cancer. • Breast cancer is contagious. • Antiperspirants and deodorants cause breast cancer. • Biopsies cause spread of the cancer. • Breast cancer is always hereditary.

16. Breast Cancer and Early Detection • Early diagnosis means a better chance of successful treatment • Self examination is an essential part of early detection • Mammography is the best tool doctors have to screen for breast cancer and can detect cancers too small to be felt • Recommendations differ; many state that women obtain a mammogram each year, starting at the age of 40 • Magnetic resonance imaging (MRI) may be used for very high risk women

17. Survival • 5-YEAR SURVIVAL RATE BY STAGE Stage 0 100% Stage I 98% Stage II 88% Stage IIIA 56% Stage IIIB 49% Stage IV 16%

18. Stage I Breast Cancer • The tumor is small and has not spread to the lymph nodes

19. Stage II Breast Cancer • Stage IIa breast cancer describes a smaller tumor that has spread to the axillary lymph nodes (lymph nodes under the arm), or a medium-sized tumor that has not spread to the axillary lymph nodes • Stage IIa may also describe cancer in the axillary lymph nodes with no evidence of a tumor in the breast • Stage IIb breast cancer describes a medium-sized tumor that has spread to the axillary lymph nodes • Stage IIb may also describe a larger tumor that has not spread to the axillary lymph nodes

20. Stage III Breast Cancer Stage IIIb breast cancer has spread to the chest wall, or caused swelling or ulceration of the breast, or is diagnosed as inflammatory breast cancer Stage IIIc breast cancer has spread to distant lymph nodes but has not spread to distant parts of the body • Stage IIIa breast cancer describes any size tumor that has spread to the lymph nodes

21. Stage IV Breast Cancer • Stage IV (metastatic) breast cancer can be any size and has spread to distant sites in the body, usually the bones, lungs or liver, or chest wall

23. Self-Breast Examination • If breast cancer is found early, most women can be treated with success. That is why routine breast self-exams, mammography, and checkups by your doctor are vital. • By doing a monthly breast self-exam, you learn how your breasts feel. This helps you detect any changes or signs of a problem. All women should do the exam once a month. This includes women who • have gone through menopause • are pregnant • are breast-feeding • have breast implants

24. How to Do a Breast Self-Exam The best time to do the breast self-exam is a few days after your period ends each month. Your breasts are less tender or swollen at this time. If you are not having periods, try to do the exam on the same day each month. Some women choose the first day of each month to help them remember. There are two parts to a breast self-exam—looking and feeling.

25. Signs of a Problem If you notice any of these symptoms during your breast self-exam, call your doctor: • A lump • Swelling • Skin irritation • Dimpling • Pain • Nipple retraction (nipple turns in) • Redness of nipple or breast skin • Scaly nipple or breast skin • Nipple discharge Any lump should be checked right away. Tests may be needed. In some cases, a biopsy may be done to look at the tissue.

26. Breast Imaging

27. Breast Imaging Proposed indications for using MRI for screening include: 1. Strong family history of breast cancer 2. Patients with BRCA-1 or BRCA-2 oncogene mutations 3. Evaluation of women with breast implants 4. History of previous lumpectomy or breast biopsy surgeries 5. Axillary metastasis with an unknown primary tumour 6. Very dense or scarred breast tissue

28. Biopsy

29. How is Breast Cancer Treated? • Treatment depends on stage of cancer • More than one treatment may be used • Surgery • Radiation therapy • Chemotherapy • Hormone therapy • Targeted therapy

30. Surgery

31. Radiotherapy

32. Thank you