Lifestyle modification and prevention of breast cancer

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I made this e-grandroud presentation at the European School of Oncology on Thursday 11 July 2013. The recorded session is available on their web site.
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  • Good Afternoon, Good Evening and Good Morning to all Participants in today’s e-grandround.I would like to thank European School of Oncology for allowing me to make this presentation.I would also like to thank Dr. Fatima Cardoso who is my Discussant for this session.And my greetings to FracescaMarangoni of the ESO. I will now start my presentation on Lifestyle Modification and prevention of Breast Cancer. (Slide 4 please)
  • In order to discuss Lifestyle modification and prevention of breast cancer and to identify the factors which may influence the development of Breast Cancer we will remind ourselves of the steps that are likely to lead to breast cancer.The cells in the breast ducts and Lobules undergo Cell Proliferation under the influence of oestrogen Hormone.When breast cells are maturing particularly rapidly between Menarche and First Live Birth, they are most likely to be affected by cancer causing agents. (Slide 5 Please).
  • After the first Live birth Breast cells have matured and are less sensitive to such stimuli.Breast feeding further reduces the breast cell sensitivity to mutations. (Slide 6 please)
  • Normal ductal cells are in single layerWhen these cells proliferate too much they can become abnormal. (Slide 7 please)
  • Proliferating breast cells can change shape and orientation and thus become Dysplastic. (Slide 8 please)
  • Ovarian Oestrogen and Prgesterone affects breast stimulating the oestrogen ReceptorsDietary oestrogen and body fat affects breast via peripheral conversion requiring the enzyme Aromatase. (Slide 9 please)
  • All these factors have made the breast cancer as the commonest cancer in women. (Slide 10 please)
  • …. Slide 11 please
  • Although breast cancer is the commonest cancer diagnosed in women it has good treatments available and Breast Cancer is not the commonest cause of death in females. (Slide 12 please)
  • The incidence of breast cancer has been rising for many years but its mortality is falling primarily because of The increasing use of chemotherapy in pre menopausal women, RT after breast conserving surgery, the use of Tamoxifen and more recently Herceptin.The results of these improvements are an Increased number of SURVIVORS. (Slide 13 please)
  • When we look at the age of patients who have had operative treatment for a potentially curable breast cancer we notice that there are very few patients under the age of 30 who are diagnosed with breast cancer. Does it mean that something at the age 0f 30 makes them develop breast cancer? It is more likely that the agents responsible for breast cancer have been working since the birth and have taken a number of years to produce breast cancer. Lifestyle modification therefore need to start right from the birth of a female child. (Slide 14 please)
  • When we look at this slide we will notice that there can been be many different types of breast cancer. (Slide 15 please)
  • Their radiological appearance s are different. (Slide 16 please)
  • Their clinical presentations are different (Slide 17 Please)
  • The life events that are associated with breast cancer are well recognized (Slide 18 Please)
  • It is more likely that in patients who develops breast cancer many of these are working in combination at different time in their life. (Slide 19 please)
  • Histologically we know that there are two main types of breast cancer, Ductal and Lobular (Slide 20 Please)
  • Slide 21 please
  • A 50 years old lady who is pre menopausal has a higher risk of breast cancer than a fifty years old who has achieved menopause.Reduction in body weight around menopause decreases the risk of breast cancer. (Slide 23 Please)
  • The three main lifestyle changes that can reduce the risk of breast cancer are Diet, Having children below the age of 30, Multiparity and reduction in the amount of alcohol consumtion. (Slide 25 please)
  • Footballers wife has a child at 23 where as a lady who has three degrees has her first child at 35. This is a modifiable lifestyle factor. (Slide 30 Please)
  • Practical approaches to dietary modification that include increasing fruit and vegetable consumption, eating a low fat diet, reducing meat consumption, and avoiding alcohol are likely to be of potential overall benefit in lowering the risk of breast cancer.Three types of my patients ask about Lifestyle modification for the prevention of breast cancer 1. those who have had treatment for breast cancer2. Patients who have had breast cancer and have survivors ask about their daughters. Third who have some form of breast cancer in the family.
  • Lifestyle modification and prevention of breast cancer

    1. 1. the live session will start at 18:15 hours C.E.T. Welcome! you are part of a growing community of people interested in our educational programmes online. As of the 11th of July 2013 this is the 285th e-session that is offered to 5,xxx registered users who have viewed 24,xxx e-sessions since January 2008 Please note that this activity is CME accredited. At the end of the presentation, by closing the webcast window, you will be directed to the CME evaluation and multiple-choice test.
    2. 2. Expert: Dr. Abdul Basit, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom Discussant: Dr. Fatima Cardoso, Champalimaud Cancer Center, Lisbon, Portugal e-grandround Lifestyle modification and prevention of breast cancer
    3. 3. Lifestyle modification and prevention of breast cancer Abdul Basit University Hospital of North Staffordshire Stoke-on-Trent United Kingdom 3
    4. 4. How Does Breast Cancer Develop ? A multistep process taking many years in most cases Cell Proliferation Oestrogen Hormone breast cell division Cancer causing agents bind more strongly to maturing cells of girls and young women. From the Cornell University Program on Breast Cancer and Environmental Risk Factors in New York State 1997 4
    5. 5. How Does Breast Cancer Develop ? Puberty – First pregnancy After first full term pregnancy, breast cells are mature and are less sensitive to DNA damage. Breast feeding further reduces the breast cells’ sensitivity to mutations 5
    6. 6. 6
    7. 7. Dysplasia: Cells proliferate too much and look abnormal in shape and orientation. 7
    8. 8. How does the breast cancer develop ? Prof. Michael Baum University College , London ER Aromatase 8
    9. 9. 0 10,000 20,000 30,000 40,000 50,000 Other Mesothelioma Cervix Liver Multiple myeloma Brain with CNS Oral Ovary Leukaemias Uterus Pancreas Stomach Oesophagus Kidney Bladder Malignant melanoma N-H-L Prostate Colorectal Lung Breast Number of new cases Male Female Figure 1.1: The 20 most commonly diagnosed cancers (excluding non-melanoma skin cancer), UK, 2007 The largest group of survivors are those of breast cancer 9
    10. 10. Your views are important! Remember that you can ask questions and send comments at any time. 10
    11. 11. Breast cancer is not the number one killer Cause of Death in Females 2009 0 5000 10000 15000 20000 25000 30000 35000 IH D C VA D enentia Influenza Lung C ancer C hronic low erR espiratry B reastC ancer Number 11
    12. 12. 15% decrease (42- 27/100,000) Life time risk of 1:8 47,700 new cancers per annum (2008) < 50yrs 20% 50-70yrs 50% only 33% are Screen >70yrs 30% Rising Incidence over 25 years Falling mortality 50% increase (75-124/100,000) over 550,000 ‘survivors’ 8 out of 10 12
    13. 13. 3 26 99 186 203 123 52 0 50 100 150 200 250 <30 30-39 40-49 50-59 60-69 70-79 ≥80 Age Range 692 Operated Breast Cancer patients University Hospital of North Staffordshire 2008-09 13
    14. 14. 12 Things you must know before you can plan treatment for breast cancer Age at Diagnosis Tumour Size (1) Tumour Grade (2) Tumour Type Lymph Node Status (3) Lympho-vascular Invasion (Nottingham Prognostic Index) Margins of clearance Immunohistochemistry -3 (IHC-3) ER PgR Her2 Menopausal status Health performance status Presentation source Screening / Symptomatic 1,2,3 = Nottingham Prognostic Index (NPI) 14
    15. 15. 15
    16. 16. 16
    17. 17. Life events associated with breast cancer Age Sex – Female Race Age at Menarche Age at first live birth Multiparity – Nulliparity Breast Feeding 17
    18. 18. Life events associated with breast cancer (Cont) Contraceptive Pill Diet – Exposure to Oestrogens Alcohol Lack of exercise Age at Menopause Hormone Replacement Therapy 18
    19. 19. Ductal Cancer (Ductal Carcinoma of no special Type) Lobular Cancer 80 % 10 % 19
    20. 20. Breast cancer risk factors that are difficult to modify Age Race Age at menarche Age at menopause 20
    21. 21. 21
    22. 22. 22
    23. 23. Your views are important! Remember that you can ask questions and send comments at any time. 23
    24. 24. Recommended lifestyle modifications Diet Having first child under 30 Alcohol 24
    25. 25. 25
    26. 26. 26
    27. 27. 27
    28. 28. Before After Reduce intake of Animal sourced fat 28
    29. 29. 29
    30. 30. Thousands of women die from breast cancer caused by drinking: research The risk of developing breast cancer from drinking even small amounts of alcohol is being ignored by women with thousands now needlessly dying every year. Thousands of women die from breast cancer caused by drinking: research Telegraph.co.uk The risk of developing breast cancer from drinking even small amounts of alcohol is being ignored by women with thousands now needlessly dying every year. 30
    31. 31. 31
    32. 32. Phytoestrogens Wheat germ, rice , Oats, Barley, Beans, Lentils, Mung beans, Apples, Carrots, Pomegranates soybeans and soy products, linseed (flax), sesame seeds, coffee, mint. 32
    33. 33. 33
    34. 34. 34
    35. 35. Factors that might influence breast density - nutrition, physical activity, BMI, alcohol, and tobacco 35
    36. 36. Your views are important! Remember that you can ask questions and send comments at any time. 36
    37. 37. Reproductive History How many Children? Age at first live birth ? First Child before age 30 Breast feeding 12 months of total breast feeding in life time 37
    38. 38. Hormonal History Oral Contraceptive pill HRT (Combined) Intrauterine Contraceptive Coil Hormonal treatment for conception 38
    39. 39. Life Style Weight gain after menopause Lack of exercise High intake of animal fat Lack of vegetables and grain in diet Alcohol Smoking ? 39
    40. 40. Educating health promoting behaviours Weight reduction Physical activity and exercise 30 minutes most days. Having first child before the age of 30 Breast feeding for 12 months during reproductive life Diet – Less saturated and animal fat - more Fruit & Veg • Less processed and red meat - more fish • Less refined flour and sugar - more fibre Avoiding hormones in the ‘pill’ , HRT and IVF Alcohol - Less than 1 drink a day Stockphoto.comexercise and diet 40
    41. 41. Thank You for your attention 41
    42. 42. e-grandround Question & Answer Session
    43. 43. The next e-ESO session will take place next Thursday, July 18th, at the same time News from St Gallen Early Breast Cancer Conference 2013 Dr. Fatima Cardoso, Champalimaud Cancer Center, Lisbon, Portugal
    44. 44. For additional information, please visit www.e-eso.net This activity is CME accredited. Please close the webcast window to access the CME forms Thank you! for participating to this e-grandround

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