Introduction...• Most frequently diagnosed life –threatening cancer in women• Leading cause of cancer death inwomen• A major public health issue globally - 1 million new cases annually - 400,000 annual death - 4.4 million living with the dx
Epidemiology...• Prevalence is worldwide• Incidence is higher in the developedworld• highest in North America,NewZealand /Australia• lowest in Asia & Sub- Sahara Africa
Epidemiology...• Mortality decreasing in the developedWorld• Life time risk is 1 in 6 overall & 1 in 8for invasive disease
Risk factors... Precise etiology is unknown• Age : rises sharply with age,rare in <25yrs• Sex : 100x commoner in female• Race/ethnicity : commoner in whites• Family history : most widely recognizedbreast cancer risk factors 5-10% of all breastcancers are hereditary
Risk factors... Family history :• One or more first degree relative withbreast or ovarian cancer• Breast cancer occurring in an affectedrelative < 50yrs• Male relative with breast cancer• BRCA1 and BRCA2 mutations• Ataxia- telangiectasia heterozygotes• Ashkenazi Jewish descent
-20 -30% women with BCA have atleast onerelative witness BCA-Only 5- 10% of BCA patient have an identifiablepredisposed factor-BRCA 1 & 2 account for 3- 8% of BCA & 15 &20% of familiar cases.
Risk factors·BRCA 1-TSG located on xsome 17-Life time risk of developing BCA & Ovarian CA85% & 40%-Mastectomy reduces the risk of BCA by 95%
Risk Factors· BRCA 2 -Located on xsome 13 -Increase risk of male BCA -Spectrum of associated BCA similar to noncarriers
Imaging ...• Ultrasonography - further xterize amammographically detectedabnormality - to identify a cystic mass - alternative to mammography indense breast - USS guided biopsy - measure & clip a lesion prior to neoadjuvant chemotherapy - improved specificity when usedappropriately
• MRI - Xterization of an indeterminatelesion - Detection of occult breastcancer in px with carcinoma in anaxillary LN - Evaluation of suspectedmultifocal or bilateral tumor
Biopsy...• A clinically suspicious mass should bebiopsized,irrespective of imaging findings• FNAC• Tissue Biopsy• Open Biopsy
Other investigations...• CXR• FBC• SERUM ALP• LFT• ABDOMINOPELVIC USS• BONE SCAN• HORMONE RECEPTOR STATUS• HER2 OVEREXPRESSION
Treatment ..• Multimodality & Multidisciplinary• Surgery is the primary treatmentmodality- early stage,cured with surgery alone• Aim of surgery is complete resectionof the primary tumor with negative margins& pathologic staging of the tumor & Axilla
Indications for Mastectomy·Tumor size > 5cm·Multicentric cancers·Local recurrence ffg BCS·Centrally located tumours·No facillity for radiotherapy
INDICATIONS FOR MASTECTOMY*prior radiation therapy to the breast or chest wall*Radiotherapy contraindicated In pregnancy*Inflammatory breast cancer*Persistent positive pathologic Margin*Active connective tissue dx
Radiotherapy ...• Routine in BCS,May be indicated postmastectomy• Aim is eradication of local residualsubclinical dx & minimize local recurrencerates• 2 approaches : EBRT or PBI
Post Mastectomy RT- Indications• Positive post mastectomy margins• Primary tumors larger than 5cm• Involvement of 4 or More LN• Skin or Chest wall involvement
Side effects of RT...• Fatigue• Skin desquamation• Breast pain• Breast swelling• Rib #• Pulmonary fibrosis• Cardiac dx• Secondary malignancies
Adjuvant systemic therapy...• Aim is to prevent recurrence & improveoverall survival• Choice of therapy depend on : - hormone status - menopausal status - HER2 status - risk of recurrence & potentialbenefit• Combination therapy
Neo adjuvant therapy..• Aim is to improve surgical outcome &surgical options - operable BC,Increase the chancesof BCS -Inoperable, LABC: Achievingoperability
LABC• Locoregional Rx is based on tumorresponse to neodjuvant• Consist of surgery-either mastectomyor BCS & post operative RT• surgery should be done ONLY if amacroscopically complete resection ispossible
recurrence dx...• Post BCS : Total mastectomy +adjuvant chemotherapy or endocrinetherapy• Post MRM : local resection ofrecurrence where feasible + radiotherapy ifno RT b4.
Metastatic disease..• Aim is to palliate symptoms,prolongsurvival,maintain QOL• Visceral metastasis- poor prognosis• Chemotherapy is indicated for hrmeinsensitive MBCA• Hormone therapy preferred when everapplicable
Conclusion...• Breast cancer survival rates haveincreased significantly, particularly inyounger women.• The need for increased publicawareness & early detection cannot beoveremphasized.