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Understanding Risk Factors and Screening Recommendations for Early Detection of Breast Cancer

Understanding Risk Factors and Screening Recommendations for Early Detection of Breast Cancer . Breast Cancer: Facts and Stats. Breast Cancer rate increased approximately 1% each year from the 1940’s to early 1980’s. Sharp increase from 1980’s to 1990’s- Likely due to increase in screening.

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Understanding Risk Factors and Screening Recommendations for Early Detection of Breast Cancer

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  1. Understanding Risk Factors and Screening Recommendations for Early Detection of Breast Cancer

  2. Breast Cancer: Facts and Stats Breast Cancer rate increased approximately 1% each year from the 1940’s to early 1980’s. Sharp increase from 1980’s to 1990’s- Likely due to increase in screening. Decrease found from 2002-2003 despite drop in mammography use. Likely due to decrease in Estrogen Replacement. One in Eight American Women will have breast cancer.

  3. Breast Cancer: Facts and Stats For 2009: 192,370 new cases of invasive breast cancer estimated In 1975: 107 cases per 100,000 white women 94 cases per 100,000 black women In 2005: 126 cases per 100,000 white women 114 cases per 100,000 black women Since 1975, the death rate in white women has decreased while remaining unchanged in Black Women.

  4. Breast Cancer: Facts and Stats In Men: 1,910 cases estimated for 2009 1.2 cases per 100,000 in 2005 No real change in rate since 1975 Death rate is 0.3 per 100,000

  5. Breast Anatomy

  6. Breast Cancer: Facts and Stats Types: In Situ and Invasive In Situ: 10-25% of all Breast Cancers Occur in the milk Lobules or Ducts of the breast and remain within that tissue. Cancer cells have not invaded nearby breast tissue. Favorable Prognosis

  7. Breast Cancer: Facts and Stats Invasive: 75-90% of all Breast Cancers Originate in Lobules or Ducts but have spread to surrounding tissue, increasing risk for spread to lymph nodes, distant sites. Prognosis: Depends upon extent of invasion Limited to Breast: 5 year survival is 98% Spread to Lymph Nodes: 84% Spread to Distant Site: 27%

  8. Breast Cancer: Facts and Stats Inflammatory Breast Cancer: 1-5% of all Breast cancers Fastest growing Commonly mistaken for Skin infection Rare Breast Cancers- medullary, mucinous, tubular, metaplastic, and papillary breast cancers Favorable Prognosis

  9. Breast Cancer: Risk Factors • Age: risk increases annually after age 50 • Race: whites more then minorities, though black women have higher death rate. • Prior history of Breast Cancer: 1-2% of recurrence per year. • Atypical Hyperplasia of the Breast: found on biopsy.

  10. Breast Cancer: Risk Factors Family History: first degree relatives second degree relatives especially before menopause Paternal side equal to Maternal and is additive.

  11. Breast Cancer: Risk Factors Genetics: 5-10% of Breast Cancers are due to inheritance. BRCA-1: 60-90% risk in lifetime BRCA-2: 30-85% risk in lifetime 30-85/100 women with BRCA-1/BRCA-2 will develop Breast Cancer in their lifetime. Average Risk in America is 12/100

  12. Breast Cancer: Risk Factors History of Ovarian Cancer: BRCA-1 and BRCA-2 are associated with higher risk of both ovarian and breast cancer. History of Lobular Carcinoma in situ. Exposure to Radiation: X-rays, radiation therapy, accidents. DES- DiethylStilbestrol used to prevent miscarriage in the 1960’s.

  13. Breast Cancer: Risk Factors Prolonged Estrogen/Progesterone Exposure: -Menstruation before age 11, menopause after 55. -First pregnancy after 35. Pregnancy and breast feeding is protective. -recent and long term use of Estrogen Replacement Therapy Surgical removal of Ovaries is protective.

  14. Breast Cancer: Risk Factors Lifestyle: -Obesity -more than 1-2 alcoholic beverages/day increases risk by 25% -red meats and dairy- food containing animal fats Regular Exercise is Protective

  15. Breast Cancer: Risk Factors Smoking- slight increased risk Birth Control Pills- controversial, some studies show increased risk, others do not. Decreases risk of ovarian and endometrial (uterine) cancer. Increased risk of liver cancer. Phytoestrogens: may be protective if consumed before puberty. Controversial, and not recommended for high risk patients

  16. Breast Cancer: Screening Mammogram: Annually starting at age 40, 10 years prior to first degree relative’s diagnosis age. Age 40-49: lowers risk of death by 15% risk of false positives Age 50-69: decreased risk of death by 23% Age 70+: recommended

  17. Breast Cancer: Screening Clinical Breast Exams: Every 3 years 20-39 Annually age 40+ Recommended by American Cancer Society No opinion from US Preventative Services Task force. Self Breast Exams: not enough evidence

  18. Breast Cancer: Screening Follow Up Mammogram Results: Bi-Rads Categories 0 - Needs further imaging: Further radiographic images, Ultrasound, MRI 1 - Normal: Annual mammogram 2 - Benign Findings- benign cystic changes: Annual mammogram 3 - Abnormal, likely benign: short term 3-6 months. 4 - Abnormal: highly suspicious: Biopsy

  19. Breast Cancer: Screening Follow Up Diagnostic Mammogram: Follow up of a category 0, 3, or 4 mammogram. To investigate an area of concern identified by self breast exam and/or clinical breast exam.

  20. Breast Cancer: Screening Follow Up Other Imaging Modalities: Ultrasound: uses sound waves to image solid versus cystic (fluid filled) masses. Tumor versus cyst. Cons: Not good screening test because does not produce an accurate image of entire breast, high rate of false positives, and operator dependent.

  21. Breast Cancer: Screening Follow Up MRI: Magnetic Resonance Imaging Especially useful for BRCA positive women. Sensitive in identifying cancer in the opposite breast when diagnosed in one breast. May improve sensitivity of mammogram for high risk women. Cons: Requires use of contrast, High false positive rate, cost.

  22. Breast Cancer: Screening Follow Up Under Investigation: PET: Positron Emission Tomography- creates an image based on cell consumption of glucose. Cancer cells are more active. Widely used to identify spread (metastasis) to distant sites, but image of breast tissue is poor.

  23. Breast Cancer: Screening Follow Up Under Investigation: Molecular Breast Imaging: Experimental use of a radioactive agent that is injected and absorbed into breast tissue. Thermography: Use of infrared technology to detect temperature differences in tissue.

  24. Breast Cancer: Early Detection Understand your own risk profile: What you have control over: Lifestyle Screening Breast Cancer Risk Calculator: http://www.halls.md/breast/risk.htm What you don’t: Age, gender, genetics, Menstrual history.

  25. Questions/Comments

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