1 / 32

Breast Cancer

Breast Cancer. Michael J Kerin | Professor of Surgery, NUI Galway & University Hospital, Galway. Facts about Breast Cancer. Breast Cancer is the most common female cancer in Ireland It makes up 30% of all invasive cancers in females 2463 cases were diagnosed in 2007

sandra_john
Download Presentation

Breast Cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Breast Cancer Michael J Kerin| Professor of Surgery, NUI Galway & University Hospital, Galway

  2. Facts about Breast Cancer • Breast Cancer is the most common female cancer in Ireland • It makes up 30% of all invasive cancers in females • 2463 cases were diagnosed in 2007 • Breast Cancer is the most common cause of death in females in Ireland • 696 women died from breast cancer in 2005 • The number of non-invasive cancers detected has increased due to BreastCheck screening programs NCRI Report Cancer in Ireland Report Summary 2009

  3. NCRI Predictions 2005-2035Breast Cancer Incidence 2010-2030: 53% increase in incidence 4833 1771 3484  623 2781  137 2196

  4. Breast Cancer Services in Ireland Specialist Cancer Centres • Population of 250,000-300,000 per centre • 100 -150 new cancers p.a. per centre • High volume of cancer cases leads to experienced personnel …key to centre of excellence …reduces misdiagnosis GPs should be referring all potential breast cancer patients to specialist centres National Quality Assurance Standards for Symptomatic Breast Disease Services (Ireland 2000)

  5. National Cancer Control Programme 13 hospitals have stopped doing breast cancer surgery All non-specialist cancer centres have been directed not to conduct low volume, complex, elective cancer surgery Current Breast Cancer Specialist Centres: West:UHG (Letterkenny link) Limerick MWRH South: Cork University & Waterford Hospitals East: St Vincent’s & St James’ Mater & Beaumont

  6. No. of referrals to the Outpatient Breast Clinic2003-2008 University Hospital Galway

  7. BreastCheck: Western Area Screening Target Pop 50-64yrs 57,588 Target Pop per year 28,794 70% uptake 20,156 Cancers expected per year (1st screen): 150-180 Subsequent Screening: 71 No. of cancers detected in Breast Check Westto year end 2008106

  8. Total No. of Breast Cancer Cases 2003-2009 University Hospital Galway 2009: 32% were diagnosed at BreastCheck

  9. Breast Cancer in Ireland Article published Sept 2009 How we manage breast cancer has changed over the past decade • Minimally invasive diagnostic techniques • Breast Conserving Surgery • Sentinel Lymph Node Biopsy • Oncoplastics & Reconstruction • Day case surgery • Matching drug treatments to cancer types • Molecular biological techniques to identify cancer subtypes

  10. Cancer Diagnosis • BreastCheck Screening All women 50-64yrs are invited for free breast mammogram (x-ray) If diagnosis of cancer is made then patient is transferred to University Hospital Galway symptomatic service for further assessment and treatment • GP referral direct to breast clinic • Cancer Management • Symptomatic breast clinic • Same building as BreastCheck in Galway Ms Carmel Malone – Consultant Breast Surgeon, UHG

  11. Cancer Diagnosis-MWRH Limerick • Symptomatic Breast Unit • Access by GP referral • Clare, Limerick, Tipperary • Regional Population 360,000 Midwest Region

  12. Symptomatic Breast Unit MWRHActivity 2001-2009 Activity 2009: 5585 outpatient attendances 171 new cancers* (*single surgeon)

  13. Symptomatic Breast Unit MWRHNew Developments 2009-2010 • New breast surgeon • New breast radiologist • Breast Reconstruction clinic • Triple Assessment Clinics twice weekly • New Breast Unit building development

  14. Cancer Diagnosis: Triple Assessment Clinic Same day clinical assessment/ radiological evaluation and biopsy Standardised Management

  15. The Clinic Visit All urgent referral seen within 2 weeks Triple assessment process involves Clinical Assessment Radiological Assessment Biopsy (Pathological Assessment) Same day service

  16. Radiological Assessment • Mammography- all women over 35 years with a focal palpable abnormality • Ultrasound- focal palpable area on clinical assessment/focal area of pain • MRI- cancers

  17. Pathological Evaluation Any abnormality seen on imaging OR palpable abnormality Ultrasound guided core biopsy

  18. Cancer Service Management:Multidisciplinary Meetings & Teleconferencing • Multi Disciplinary Team (MDT) meetings are an integrated team approach to health care • Reduce the chance of oversight that may occur when only one medical discipline is involved • MDTs held over teleconference link are becoming regular in hospital setting MDT videoconferencing

  19. Summary Triple Assessment Clinic

  20. Treatment: Surgery • Mastectomy (whole breast removal), • Lumpectomy/Wide Local Excision (partial breast surgery) • Sentinel Node Biopsy (to see if cancer has spread to lymph nodes) • Breast reconstruction (can be immediate or at later date) Who is involved? • Breast Surgery team • Histopathologists (analyse tissue to see if it is benign or cancer and how it might respond to particular drug treatments) • Plastic/Reconstructive Surgery team

  21. Treatment: Chemotherapy • Drugs that kill or control cancer cells. • Normal cells can also be affected but they can recover easier • These drugs can be used on their own or with each other. Sometimes chemotherapy is given before surgery. • Often given in cycles e.g. every 3 weeks with a rest period between treatments. • Chemotherapy may be injected into a vein, through an intravenous infusion or in tablet form. • Hormone/Receptor Targeting Therapy • Tamoxifen, Herceptin, Anastrozole • Treatment may be for several years to prevent cancer recurrence Who is involved? - Oncology team

  22. Treatment: Radiotherapy • Radiation is the use of high energy x-rays, applied specifically to the cancer area (breast, armpit, chest wall etc) • Cancer cells are killed. Normal cells can also be affected but they recover easier • Can be given before, during or after chemotherapy • It will usually be given daily, Monday to Friday, for 3-6 weeks. • Radiotherapy may require patient to stay near the hospital for the treatment duration. • Inis Aoibhinn (Cancer Care West) provides accommodation to patients undergoing Radiotherapy treatment at UHG Who is involved? • Radiotherapy team

  23. Cancer Management • Each cancer is assessed individually and each patient managed differently What surgery is best, when to give chemo, how long to give radiotherapy etc. • Patients are reviewed regularly in the first year after surgery and while other treatments are taking place • Clinic appointments become less frequent as the years progress • Multidisciplinary teams manage your cancer care • Vital communication between surgeons, histopathologists, oncologists, radiotherapists, breast care nurses

  24. Breast Cancer Research

  25. Breast Cancer Research:Where we are now? • Breast cancer is not one disease • Collection of disease types likely to have different cellular origins • Types (Estrogen sensitive, Herceptin sensitive) • Subtypes (Luminal A, B etc.) • Genotypes (predisposed risk, individual patient response to therapy) • Research required at a depth and scale not previously estimated or possible Advances in Breast Cancer: Pathways to Personalized MedicineClinical Cancer Research Focus - Dec 2008

  26. Question:Why Research? MultidisciplinaryCentres of Excellence AnswerImprove patient care & therapies

  27. Molecular Profiling:CancerGenes Research Questions? What genes are involved in causing breast cancer? Are genes affected by chemotherapy, radiotherapy etc? Can we develop a cancer gene profile that will improve diagnosis and treatment of breast cancer?

  28. Population GeneticsBackground Only a very small number of breast cancers have a family link Our study: Breast Cancer Associated Genes in an Indigenous Population Collaborative study with University of Oxford1000 patients & controls from West of Ireland Effect of low/moderate penetrance gene mutations - Combination confers increased risk What we have reported…. • In the first analysis of moderate-penetrance breast cancer susceptibility variants in a cohort of Irish breast cancer patients, we have identified that CHEK2 is associated with increased breast cancer susceptibility

  29. Gene & Cell Therapy:Adult Stem Cells • Potential to develop into many different cell types in the body • Do they develop into cancer cells? • Can they be used to target cancer cells? • Can cells “home” to bone, lungs etc?

  30. Where to get more information on breast cancer management & research National Breast Cancer Research Institute www.nbcri.ie Midwest Cancer Centre www.midwesterncancercentre.ie BreastCheck www.breastcheck.ie Breast Cancer Research, NUI Galway www.nuigalway.ie/surgery National Cancer Control Programme www.hse.ie(search for NCCP under Find a Health Service) National Cancer Registry www.ncri.ie Action Breast Cancer www.cancer.ie/action Local/national information days

  31. Lab personnel & postgrads ___________________ Research Lab including some equipment purchased by NBCRI

More Related