Breast Cancer

1. Breast Cancer The Penncrest High School Medical Scholars Club

2. Things You probably don’t Know About Breast Cancer -The older a woman, the more likely she is to get breast cancer -Young women can get breast cancer, even in their 20s -White women are more likely to get breast cancer than women of any other racial or ethnic group - African American women are more likely to die from breast cancer than white women -Out of every one hundred cases of breastcancer, one will occur in a man. 

3. Risk Factors • being a woman • getting older • having an inherited mutation in the BRCA1 or BRCA2 breast cancer gene • lobular carcinoma in situ (LCIS) • a personal history of breast or ovarian cancer • a family history of breast, ovarian or prostate cancer • having high breast density on a mammogram • having a previous biopsy showing atypical hyperplasia • starting menopause after age 55 • never having children • having your first child after age 35 • radiation exposure, frequent X-rays in youth • high bone density • being overweight after menopause or gaining weight as an adult • postmenopausal hormone use (current or recent use) of estrogen or estrogen plus progestin    

4. Symptoms • Breast/ armpit lump • Bloody/clear nipple discharge • Breast size/shape change • Inverted or retracted nipple • Scaling/flaking of the nipple/ breast skin • Breast appears to be red • Armpit swelling • Nipple pain • Unusual breast pain

5. Diagnostics

6. Detection & Diagnosis Breast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between. Breast cancer is often first suspected when a lump or change in the breast is found or when an abnormal area is seen on a mammogram. Most of the time, these findings do not turn out to be cancer. However, the only way to know for sure is through follow-up tests. Over the past 20 years, great progress has been made in the early detection and treatment of breast cancer. As a result, the number of breast cancer survivors continues to rise. There are over 2.9 million survivors in the United States today (more than any other group of cancer survivors).

7. Self Exam • This routine exam is quick and easy and can be done to look for anomalies in front of the mirror and while in the shower. • The exam can be done as follows: apply light pressure to the surface of the breast and then apply firmer pressure in order to assess deeper tissues. This is done to find lumps or abnormally thick areas of the breast. • Any discrepancies would require attention from a physician to determine if the lumps are benign or malignant.

8. Clinical Exam • The clinical exam is essential in detecting and diagnosing breast cancer. • After reaching 20 years old, it is recommended that a clinical exam be done every three years to be aware of any changes that may occur that can lead to cancer. • The physician will ask questions and then begin the exam. The exam will require the patient to be topless as to allow the physician to look and feel for anomalies. The breasts as well as the crucial underarm area will be examined for rashes, lumps, indentations, or discharge. By the end, the physician will determine hether extra steps or further examination is necessary.

9. Mammogram • This special x-ray is designed to check the breasts from multiple angles for areas of possible tissue/cyst build up. • In the image, breast tissue appears white and opaque while fatty tissues are darker and translucent. • Mammograms are especially helpful in targeting specific lumps and following the progress of suspicious growths.

10. Ultrasound • Can determine whether something is a cyst or a mass that may be cancer • Possible cysts have fluid excreted from them using a needle & a syringe. If clear fluid is removed, no further evaluation is necessary. • Can be used to find the exact location of a possible or known tumor

11. MRI • Not a test to determine whether cells/tissues are benign or malignant (like a biopsy) • May detect tumors in dense breast tissues

12. Biopsy • The removal of cells or tissues due to suspicion • These cells and/or tissues are examined microscopically • Only way to determine if a suspicious spot is benign or malignant

13. Ductal Lavage • A type of screening tool that is used to detect breast cancer in women of high risk • Cells are collected from the milk ducts of the breast for analysis • If caught early, cancer will confine itself to a single duct before moving onto another

14. Types of breast cancer Penncrest High School

15. Ductal Carcinoma in SITU Non-invasive cancer where abnormal cells are found in the lining of the breast milk duct It is a very early cancer that is highly treatable Cancer does not spread unless left undetected or untreated

16. Invasive Ductal Carcinoma (IDC) - Abnormal cancer cells begin to form in the milk ducts and will eventually spread to other tissue within the breast. Facts: -IDC is the most common cancer making up 70-80% of all breast cancer diagnosis. -IDC is the breast cancer that affects men.

17. Triple Negative Breast Cancer Triple Negative Breast Cancer means the three most common types of receptors known to fuel most breast cancer growth(estrogen, progesterone, and the HER-2/neu gene)are not present in the cancer tumor Common treatment such as hormone therapy or drugs that target estrogen, progesterone, and HER-2/neu are not effective. Chemotherapy is viewed as an effective treatment

18. Breast Cancer During Pregnancy Pregnancy does not cause breast cancer but you can start to show your symptoms while pregnant. The most common solution to breast cancer during pregnancy is a lumpectomy or a mastectomy.

19. Metastatic Breast Cancer Metastatic breast cancer is also classified as Stage 4 cancer. This means that the cancer has spread to other parts of the body. Including the bones, brain, liver, and the lungs

20. Growth of Breast Cancer Cells can also break away from the primary, or main tumor and spread to other parts of the body. The cells spread by traveling through the blood stream and/or lymphatic system. This process is called metastasis.       

21. Growth of Breast Cancer To grow, malignant breast tumors need to be fed. They get nourishment by developing new blood vessels in a process called angiogenesis. The new blood vessels supply the tumor with nutrients that promote growth. As the malignant breast tumor grows, it can expand into nearby tissue. This process is called invasion.       

22. Stages of Breast Cancer Cancer Spreads -Surrounding tissues -Lymph Nodes -Blood Testing -Lymph Node Biopsies -Chest X-Rays -CT Scans  -Stages -I -II -III -IV

23. Stages ctd… grows into surrounding tissues, travels through lymph vessels, or travel through blood by veins and capillaries. Various tests, such as lymph node biopsies, chest x-rays, and CT scans, can reveal how advanced the disease state has become. If the tumor is less than two centimeters is or smaller, the disease is classified as stage I. Stage II tumors are two and five centimeters in size and has spread to one to three lymph nodes, OR there are no affected lymph nodes but the tumor is greater than five centimeters. Stage three breast cancer is diagnosed when the cancer is larger than five centimeters has spread to up to nine lymph nodes. Stage four, most advanced stage of breast cancer, is defined as when the disease state has advanced to involving parts of the body other than the breast

24. Various Treatment Types Mastectomy versus lumpectomy (breast conserving surgery) plus radiation and overall survival in early breast cancer Different adjuvant chemotherapy combinations and overall survival in early breast cancer Radiation therapy following mastectomy and overall survival in stage II & III breast cancer Tamoxifen and overall survival in estrogen receptor-positive breast cancer Neoadjuvant (preoperative) hormone therapy for women with estrogen receptor-positive breast cancer Adjuvant chemotherapy and overall survival Lumpectomy plus radiation therapy in the treatment of ductal carcinoma in situ (DCIS) High-dose chemotherapy with stem cell transplant for women with metastatic breast cancer and for women with non-metastatic breast cancer at high risk for recurrence Aromatase inhibitors and disease-free survival in early breast cancer

25. Chemotherapy • Uses medicine to target and destroy cancerous cells • Affects the whole body because it passes through the bloodstream • Can be used for both early and advanced-stage cancers

26. Tamoxifen • Generic name is Nolvadex • its a SERM They act on estrogen receptors like agonists and antagonists do • Agonist • attach to a receptor of a cell and promotes action • Antagonist • attaches to the receptor of a cell and blocks the agonists SERM effect on receptors varies from tissue so they can inhibit or stimulate estrogen like action in tissues

27. Tamoxifen…ctd. Is given to breast cancer patients after surgery or chemotherapy and radiation to reduce the risk of it coming back (40% to 50% in postmenopausal women and by 30% to 50% in premenopausal women) Only effective on hormone receptor positive/early stage breast cancer a pill given once a day ( recommended that it should be taken at the same time everyday) and taken for 3-5 years can shrink the hormone receptor positive breast cancer even before surgery has other benefits like lowers cholesterol

28. Tamoxifen SIDE EFFECTS • increased tumor orbone pain • hot flashes • nausea • fatigue • mood swings • depression • headache • hair thinning • constipation • dry skin • loss of libido

29. Radiation • The patient is examined through linear accelerator containing a cat scan, to determine where to target high levels of radiation on the breast cancer cells, using seed or pellets. • There are two types of radiation • External Radiation: Delivers high doses of radiation to breast cancer cells from a machine outside the body. • Internal Radiation: Delivers high doses of radiation from implants placed directly into or near a breast tumor.

30. Radiation Side Effects • Radiation causes irritation, redness, and or dryness to the treated area. • Another side effect is fatigue, especially after couple weeks after the the treatment

31. Hormonal Therapy • Hormonal therapy is using medicine to block of hormones to prevent cancer cells from spreading. • Two most common hormone therapies • SERMs (Selective Estrogen Receptor Modulators) • Targets estrogen hormones at the breast cancer cells to prevent the growth of the cells • Tamoxifen is a commonly-used hormone therapy used to prevent breast cancer recurrence. • Hormone therapy is also used for post-menopausal women at high risk for developing breast cancer. • Aromatase Inhibitors • These drugs stop the reproduction of estrogen hormones by binding to the enzyme which produces of estrogen • Then cancer cells starve from the lack of estrogen • NOT effective on hormone receptive breast cancers

32. Hormonal Therapies Side Effects • This type of therapy can causes hot flashes; vaginal discharge, dryness and irritation; irregular periods; decreased sex drive; and mood changes. • Aromatase inhibitors may also cause joint and muscle pain, as well as an increased risk of bone thinning.

33. Surgery • There are four types of surgery that a patient can under go • Lumpectomy • Removal of only tumor and possible surrounding tissue • Also known as breast-conserving surgery • Partial or segmental mastectomy or quadrantectomy • Removes more breast tissue than Lumpectomy • Radiation is given off after surgery • Total Mastectomy • Removal of the entire breast but no lymph nodes are removed • This process is usually used for treat in-situ, microinavasive, or stage IA breast cancers. • Radical mastectomy • All breast tissue is removed, and lymph nodes are also sampled • Many people need breast reconstruction immediately or delayed after the surgery

34. Targeted Therapies • Treatment that targets specific characteristics of cancer cells • Less likely to harm normal cells than chemotherapy • Should not be used by pregnant women • 5 known target therapies used by doctors • Herceptin, Tykerb, Avastin, Perjeta, and Afinitor

35. Powerful Diagnostic Tool--Decoding Genomes • Recently developed • Sequence of patients' genome of the cancer cells • Increased accuracy of treatment • Beneficial to the patients and their families

36. Study #1 • 39-year-old female • Acute myeloid leukemia (AML) • Standard diagnos test • Stem cell transplant • Diagnostic dilemma • Genoma sequence test • Chemotherapy with ATRA • 6 weeks, $40,000

37. Study #2 • Female • Breast cancer-age 37 • Ovarian cancer-age 39 • Ovarian tumor returned-age 42 • Genome sequencing allowed precautions take for family

38. Progress for the Future • "These cases of personalized genomic medicine are just some of the first examples of what will likely be commonplace in the near future." - Boris Pasche, MD, PhD, of the University of Alabama in Birmingham • As technology is enhanced, cost and time will decrease • More than 300 cancer patients and their tumors

39. Prevention & risk factors There are steps you can take that may reduce your risk. These include: maintaining a healthy weight exercise limiting alcohol intake avoid postmenopausal hormones, For women at risk of estrogen-receptor positive breast cancer. taking tamoxifen or raloxifene may reduce the risk

40. Gene Therapy

41. October 2012 marks the 28th anniversary of Breast Cancer Awareness Month, a time to not only reflect on those who have lost their battle to the disease, but also to encourage its prevention. Thank You! We Support All Breast Cancer Awareness