Breast Cancer

1. Breast Cancer Dr. Anita Holman

2. Outline • Cancer Overview • Incidence • Normal Composition of the Breast • Types of Breast Cancer • Risk Factors • Screening

3. Cancer Overview • What is the definition of cancer? • Cancer occurs when cells in the body begin to grow out of control.

4. Incidence • According to the National Cancer Institute: • Approximately 230,480 women and 2,140 men will be diagnosed with breast cancer in 2011 • Approximately 39,520 women and 450 men will die from breast cancer in 2011

5. Breast Cancer • Breast cancer is the second most commonly diagnosed cancer among women (second to skin cancer) • Breast cancer is the second leading cause of cancer deaths for women (second to lung cancer) • Breast cancer accounts for 27% of all new cases of cancer diagnosed in women.

6. Incidence

7. Death Rate

8. Composition of the Breast

9. What is a Normal Breast? • No breast is typical. • Most women say their breasts feel lumpy or uneven. • The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. • Breasts also tend to change as you age.

10. Lumps in the Breast • Breast cancer can cause lumps in the breast however most breast lumps are caused by other medical conditions • Fibrocystic breasts causes noncancerous changes in the breast that can make them lumpy, tender, and sore. • Cysts are small fluid-filled sacs that can develop in the breast.

11. Common Types of Breast Cancer • Ductal carcinoma. The most common kind of breast cancer. It begins in the cells that line the milk ducts in the breast, also called the lining of the breast ducts. • Ductal carcinoma in situ (DCIS). The abnormal cancer cells are only in the lining of the milk ducts, and have not spread to other tissues in the breast. • Invasive ductal carcinoma. The abnormal cancer cells break through the ducts and spread into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body.

12. Common Types of Breast Cancer • Lobular carcinoma. In this kind of breast cancer, the cancer cells begin in the lobes, or lobules, of the breast. Lobules are the glands that make milk. • Lobular carcinoma in situ (LCIS). The cancer cells are found only in the breast lobules. Lobular carcinoma in situ, or LCIS, does not spread to other tissues. • Invasive lobular carcinoma. Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

13. Risk Factors • Female gender • Getting older. • Being younger when you first had your menstrual period. • Starting menopause at a later age. • Being older at the birth of your first child. • Never giving birth. • Personal history of breast cancer or some non-cancerous breast diseases.

14. Risk Factors

15. Risk factors • Family history of breast cancer especially first degree relatives (mother, sister, daughter). • Treatment with radiation therapy to the breast/chest. • Being overweight (increases risk for breast cancer after menopause). • Long-term use of hormone replacement therapy (estrogen and progesterone combined). • Having changes in the breast cancer-related genes BRCA1 or BRCA2

16. Screening Test • A screening test is a test that is used to detect disease in people that have no signs or symptoms of disease • Mammogram is the screening test recommended for breast cancer detection.

17. Screening Test • The American Congress of Obstetricians and Gynecologists Recommend: • Mammography every year starting at age 40 for women with no family history of breast cancer

18. Screening • In women with a family history of breast cancer screening is recommended 10 years earlier than the age of the person that had breast cancer or age 40 (whichever occurs first)

19. Screening Test • Ultrasonography is an established adjunct to mammography in the imaging evaluation. • It is not recommended as a screening modality for women at average risk of developing breast cancer. • Ultrasonography may be an option for additional screening in women at high risk who are candidates for magnetic resonance imaging (MRI) screening but cannot receive MRI because of gadolinium contrast allergy, claustrophobia, or other barriers.

20. Screening • The American Cancer Society recommends MRI of the breasts for women who have: • Have a known BRCA1 or BRCA2 gene mutation • Have a first-degree relative with a BRCA1 or BRCA2 gene mutation and have not had any testing themselves • A lifetime risk of breast cancer of 20% or greater, according to risk assessment tools that are based mainly on family history • A history of radiation therapy to the chest between the ages of 10 years and 30 years

21. Screening • There is no effective screening test for ovarian cancer • For women with known BRAC mutations the American Congress of Obstetrics and Gynecology recommends periodic screening with CA 125 and transvaginal ultrasonography beginning between the ages of 30 and 35 years or 5-10 years earlier than the earliest age of first diagnosis of ovarian cancer in the family

22. Screening • Self breast examination: • 50% of all breast cancer in women less than age 50 and 70% of all breast cancer in women older than age 50 were detected by women themselves

23. Percentage of Women Age 40 years and Older In the US Who Have had a Mammogram in the Last Two Years

24. Percentage of Women Age 40 years and Older In the US Who Have had a Mammogram in the Last Two Years by Age

25. Percentage of Women Age 40 years and Older In the US Who Have had a Mammogram in the Last Two Years by Education Level

26. Staging for Breast Cancer • Stage 0 (carcinoma in situ) – The cancer is confined to the lining of the ducts or the lobules of the breast • Stage I- the tumor is smaller than 2cm and there are no tumor in any lymph nodes

27. Staging for Breast Cancer • Stage IIA: 1) No evidence of tumor in the breast but axillary nodes are positive 2) The tumor is less than 2cm and has spread to the axillary nodes on the same side 3) The tumor is more than 2cm but less than 5cm and has not spread to the axillary lymph nodes • Stage IIB 1) The tumor is more than 2cm and less than 5cm and has spread to axillary nodes 2) The tumor is more than 5cm but has not spread to the lymph nodes

28. Staging for Breast Cancer • Stage IIIA: 1) No evidence of tumor in the breast but the lymph nodes are positive and not freely movable 2) tumor in the breast is and axillary nodes are positive and not freely movable • Stage IIIB- the tumor has spread to the chest wall • Stgae IIIC- Cancer extends to the skin and chest wall • Stage IV- spread to other parts of the body

29. Survival Rates • Stage 0 – 93-100% • Stage I - 88% • Stage IIA – 81% • Stage IIB – 74% • Stage IIIA – 67% • Stage IIIB – 49% • Stage IIIC – 41% • Stage IV – 15%

30. Conclusion • Breast cancer is a health issue that needs attention and awareness • The screening test recommended by the ACOG is mammogram unless the patient has certain risk factors • Screening should begin at age 40 • Survival rate increases the earlier the cancer in detected