2. KEY COMPONENTS OF THE BREAST
EXAMINATION
Patient sitting up, facing the examiner,
arms to the side
Inspection for symmetry, contour, scars,
skin lesions, erythema, nipple inversion
Palpation of the cervical and
supraclavicular basins
Palpation of the mass in the upright
position
3. KEY COMPONENTS OF THE BREAST
EXAMINATION
Patient sitting up, arms above head,
touching
Inspection for dimpling (hollow), retraction,
protruding mass
Patient sitting up, arms on hips, pressing
inward
Inspection for dimpling, retraction,
protruding mass, dimpling, or retraction
4. KEY COMPONENTS OF THE BREAST
EXAMINATION
Examination of the nipple including
gentle attempt to express discharge
Palpation of the mass in the supine
position.
Note size, consistency, borders, fixation,
and location (including clock position
and distance from areola)
8. KEY COMPONENTS OF THE BREAST
EXAMINATION
Palpation of the entire breast parenchyma
including inframammary fold, axillary tail
Note locations of any additional masses
including size and location
Examine the opposite breast in same way,
noting symmetry between any areas of
concern
14. PALPATION OF THE BREAST
In the case of tumors:
- by the Velpeau maneuver - it starts with the healthy
breast and then the diseased breast
- tumor site - the 5 quadrants
- tumor size
- shape - surface - contour of the tumor
- tumor consistency
- tumor mobility in relation to the skin, with deep
planes - pectoral muscle - Tillaux maneuver
15.
16.
17. - Adenopathy - Axillary lymphnodes- their
detection malignancies
- In inflammatory lesions:
- pain on palpation
- present fluctuation
PALPATION OF THE REGIONAL
LYMPHNODES
23. Mastitis
Mastitis is an infection of the breast that occurs
most commonly among women who are breast
feeding.
Three percent to 10% of lactating women may
develop signs or symptoms of mastitis.
Mastitis may be more common in lactating
women who have had a previous episode of
mastitis, women with cracks or sores on their
nipple, older women, and professional women.
When mastitis occurs in lactating women, it is
referred to as puerperal mastitis.
24. Mastitis
Nonpuerperal mastitis may also occur as a result of
trauma, possibly fibrocystic disease or sometimes an
unrecognized etiology.
Patients typically present with a hard, warm, red, tender,
swollen area of one breast. They may have associated
fever, shakes, chills, myalgia, and malaise.
Staphylococcus aureus is the most common causative
organism but streptococci, coagulase-negative
staphylococci, and
Escherichia coli may also be cultured from infected
patients.
25. MANAGEMENT
History and physical examination should focus on
identifying a likely etiology for the mastitis, as well
as the risk of breast cancer.
The possibility of inflammatory breast cancer,
though unlikely, must be kept in mind, particularly
in women with nonpuerperal mastitis with no clear
etiology.
26. MANAGEMENT
Some lactating women present with plugged ducts
or galactoceles. These may be hard masses in the
breast, with or without erythema or associated pain
or fever.
Imaging findings are relatively nonspecific.
However, ultrasound of the breast is useful in
identifying an underlying abscess and possibly
guiding intervention (see later)
27. MANAGEMENT
If no abscess is detected on either physical examination
or ultrasound, then management is conservative.
Antibiotics (dicloxacillin or cloxacillin, 250 mg orally
four times a day for 10 to 14 days) should be initiated.
Culturing the milk or any purulent nipple discharge for
antibiotic sensitivities may help guide a change if the
patient does not respond.
28. MANAGEMENT
The patient should be advised to rest, continue
nursing, and use warm compresses and shortacting
nonsteroidal antiinflammatory agents for pain control.
If no response is seen within 24 to 48 hours, coverage
should be switched to cephalexin or amoxicillin with
clavulanate, or should be based on the sensitivities of
culture.
29. Breast Abscess
Peripheral breast abscesses develop in about 5%
to 10% of women with mastitis, possibly because
of a delay in diagnosis or inadequate therapy.
The presentation is similar to that of mastitis
(pain, erythema, tenderness) but with a palpable
fluctuant mass.
30. Breast Abscess
There is usually a precedent history of lactation
or trauma, although this is not always the case.
In some cases, the mass may not have been
palpable but was detected by ultrasound in a
mastitis patient.
31. Breast Abscess
Management consists of antibiotics and
drainage. However, many of these can be
successfully treated by needle aspiration rather
than incision and drainage.
Ultrasound guidance for the aspiration is
preferred to ensure complete aspiration of the
abscess.
32. Breast Abscess
When needle aspiration is not possible, or not
effective, incision and drainage may be
necessary.
The operation should be performed in the
operating room with sedation because local
anesthesia for an abscess is difficult to achieve.
The incision is placed directly over the abscess,
where the skin is thinnest.
33. Breast Abscess
Cultures should be obtained.
All loculations should be disrupted and the
wound irrigated with saline.
A small sample of the abscess wall should be sent
for pathology study to rule out cancer, even
though this is extremely unlikely, especially
among lactating women.
34. Breast Abscess
When needle aspiration is not possible, or not
effective, incision and drainage may be necessary.
The operation should be performed in the
operating room with sedation because local
anesthesia for an abscess is difficult to achieve.
The incision is placed directly over the abscess,
where the skin is thinnest.
35. Breast Abscess
Women who are lactating will have
questions regarding continued breast-
feeding.
Most antibiotics are safe during breast-
feeding, but this should be confirmed.
Nursing should continue on the opposite
side.
36. Breast Abscess
If the incision does not interfere with the ability of the
infant to latch on, breast-feeding may also continue on
the affected side.
If it does interfere, then a breast pump should be used
for several days until enough healing has occurred to
allow nursing.
The patient may notice milk draining from the abscess
cavity, but the antiinfectious properties of breast milk
may actually accelerate healing.
37. Pain and lump in
the breast
A 24 year old woman has
been breast feeding for 2
months.
She now presents with a
painful, red mass in the
lower outer quadrant of
her left breast.
1. What is the likely
diagnosis?
38. Lactational breast abscess
What advice would you give her about breast feeding?
Continue feeding to encourage drainage of the breast. An abscess develops when
there is a relative obstruction to flow from a lobule of the breast related to
inspissated material in the ducts.
Organisms most likely ascend the duct after gaining entry through the nipple
which may be cracked or damaged from feeding. The baby will not be harmed by
feeding from this breast and should be fed from the affected side first.
If feeding is too painful then the breast should be manually expressed.
39. 3. Outline you management plan for this woman
After a thorough history and examination the next
investigation should be an ultrasound to confirm the
presence and size of an abscess.
Differentiation from mastitis without abscess may be
difficult clinically. Heat packs and massage, particularly
in a warm shower, may also help.
Analgesia and antibiotics are usually required.
If the overlying skin is thin and necrotic it is usually
necessary to incise and drain a breast abscess.
40. Another method is to aspirate it with a large bore
needle often with US guidance.
This procedure may need to be repeated on a daily
basis until the abscess resolves but creates less risk of a
milk fistula and cosmetic deformity.
The possibility of an inflammatory cancer always needs
to be considered although this is unlikely in a lactating
woman.
As a result she should be followed up with clinical
examination and imaging after resolution of the
abscess.
42. Impact:
With 1 million new cases in the world each year, breast
cancer is the most common malignancy in women and
comprises 18% of all women’s cancers.
Breast cancer incidence in women in the United States
is 1 in 8 (about 13%).
Women have a 3% chance of breast cancer causing
their death.
For women in the U.S., breast cancer death rates are
higher than those for any other cancer besides lung
cancer.
The American Cancer Society estimates that each year,
about 2000 new cases of invasive breast cancer are
diagnosed in men.
It is estimated that about $8.1 billion is spent each year
on breast cancer treatment in the U.S.
43. Epidemiology:
Over 75% of women who are diagnosed with breast cancer are
age 50 or older.
The five-year relative survival rate is now 98 percent for women
with breast cancer caught before it spreads beyond the breast
(compared to 72 percent in 1982).
Breast cancer incidence is greater in women of higher socio-
economic background.
The relationship of breast cancer risk with
socioeconomic factors is most likely related to life style
differences like number of pregnancies and age at first
childbirth.
Death rates have been decreasing since 1990.
These decreases are thought to be the result of treatment
advances, earlier detection through screening, and increased
awareness.
44. Incidence and Mortality of Female Breast
Cancer Based on Race and Ethnicity in the U.S.
Rate
Per
100,000
45. About 90% of breast cancers are due to genetic abnormalities that
happen as a result of the aging process and life in general, not to
inherited mutations.
Current Age Probability of breast cancer in next 10 years
20 0.05% or 1 in 1,837
30 0.43% or 1 in 234
40 1.43% or 1 in 70
50 2.51% or 1 in 40
60 3.51% or 1 in 28
70 3.88% or 1 in 26
Lifetime risk: 12.28%; 1 in 8 women
Probabilities of Developing Invasive Breast Cancer
Based on Age
46. Hereditary Breast Cancer:
While about 20-30% of women diagnosed with breast cancer
have a family history of breast cancer, only about 5-10% of
breast cancer cases are caused by inherited gene mutations.
BRCA1 and BRCA2 mutations are the most common.
Lifetime breast
cancer risk
Median age of breast
cancer (years)
General
population
12% 61
BRCA1 65% 43
BRCA2 45% 41
47. Breast Cancer Kills Men,Too.
Less than 1% of all new breast cancer
cases occur in men.
Men with a BRCA1 mutation have a 1%
risk of developing breast cancer by age
70; BRCA2 mutations confer a 6% risk.
Breast cancer prognosis, even in stage I
cases, is worse in men than in women.
Treatment for male breast cancer has
usually been a mastectomy, which may
be followed by radiation, hormone
therapy (such as with tamoxifen), or
chemotherapy.
Risk factors for male breast cancer
Testicular abnormalities: cryptorchidia, congential
inguinal hernia, orchiectomy, orchitis, testicular
trauma
Hormonal alterations:
Infertility, Klinefelter’s syndrome, obesity, cirrhosis
(and heavy alcohol intake)
Family history of breast cancer, mutations in
CHEK2, PTEN
Benign breast lesions:
Nipple discharge, breast cysts, breast trauma
Exposure to radiation or high temperatures
Old age
Jewish descent
48. Types of Breast Cancer
DCIS: Ductal Carcinoma In Situ
LCIS: Lobular Carcinoma In Situ
IDC: Invasive Ductal Carcinoma
ILC: Invasive Lobular Carcinoma
Inflammatory Breast Cancer
Male Breast Cancer
Recurrent and Metastatic Cancer
Ductal carcinoma in situ (DCIS) is
the most common type of non-
invasive breast cancer.
Invasive ductal carcinoma (IDC) is the most
common type of breast cancer, comprising
about 80% of all breast cancers.
49. Signs to watch out for:
a lump felt in the breast
an inverted nipple
nipple discharge (clear or bloody)
nipple pain
sores on the nipple and areola
enlarged lymph nodes under the arm
50. Signs and Symptoms
Rapid change in the appearance of one
(days or weeks), with visible
breast, discoloration with red, purple,
bruised appearance and warmth of the
breast suggests Inflammatory Breast
In inflammatory breast cancer, cancer cells invade local lymphatic ducts, impairing
drainage and causing edematous swelling of the breast.
Peau d’orange: The skin of the breast is tethered by the suspensory ligament of
Cooper, which, with the accumulation of fluid, can cause the breast to take on a
dimpled appearance similar to an orange.
51. Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) accounts for between 1 percent and 6 percent of
all breast cancer cases in the United States.
The 5-year survival rate for patients with IBC is between 25-50 percent, significantly
lower than the survival rate for patients with non-IBC breast cancer.
IBC has a high risk of recurrence and is the most aggressive kind of breast cancer.
IBC is more likely to have metastasized at the time of diagnosis than other breast
cancer types.
IBC affects women at an average age of 59 — about three to seven years younger
than the average age at which other types of breast cancer are diagnosed.
Men can develop the disease, but at an older age. Black women are slightly more
likely than are white women to have IBC.
52. Risk Factors
The most significant risk factors for breast
cancer include gender (being female) and
age (growing older).
Factors with minimal or no risk include
fertility treatment abortion, deodorant and
folic acid.
Short-term use of hormones for treatment
of menopausal symptoms appears to confer
little or no breast cancer risk.
53. Factors that Increase the Relative Risk (RR) for BC in Women
RR>4.0
• Female
• Age (65+)
• Inherited genetic mutations associated with breast cancer such as BRCA1/BRCA2
• Two or more first-degree relatives with breast cancer diagnosed at an early age
• Personal history of breast cancer
• High density breast tissue
• Biopsy-confirmed atypical hyperplasia
2.1<RR<4.0
• One first-degree relative with breast cancer
• High-dose radiation to chest
• High bone density (post-menopausal)
1.1<RR<2.0
Factors affecting circulating hormones:
• Late age at first full-term pregnancy (>30 yrs)
• Early menarche(<12 yrs)
• Late menopause
• No full-term pregnancies
• No breastfeeding
• Recent oral contraceptive use
• Recent and long-term hormone replacement therapy
• Obesity
Other factors:
• Personal history of endometrium, ovary or colon cancer
• Alcohol consumption
• Height (tall)
• High socioeconomic status
• Jewish heritage
54. Surveillance
Mammography
Sonogram
MRI
Clinical and self breast exam
Risk Avoidance
Diet and Exercise
Chemoprevention
Tamoxifen
Raloxifene
Prophylactic Surgery
Bilateral Prophylactic Mastectomy
Oophorectomy
Breast Cancer Screening and Prevention
56. Triple Negative Breast Cancer:
Triple negative breast cancer (TNBC) is clinically characterized by the lack of
expression of estrogen, progesterone and HER2 hormone receptors.
Comprises about 10-20% of breast cancers: more than one out of every 10.
Does not respond to current hormonal therapy (such as tamoxifen or
aromatase inhibitors) or therapies that target HER2 receptors, such as
Herceptin (trastuzumab). Women diagonosed with TNBC generally face a
poorer prognosis.
Treatments that target other processes may be helpful in treating triple
negative breast cancer when combined with chemotherapy:
Avastin: interferes with VEGF (vascular endothelial growth factor),
inhibiting the growth of new blood vessels at the tumor site.
Erbitux: interferes with EGFR (epidermal growth factor receptor), which is
often overexpressed in triple negative cancer.
PARP inhibitors: inhibit poly (ADP-ribose) polymerase, an enzyme used
by cancer cells to repair DNA damage. One PARP inhibitor, dubbed BSI-
201, has been shown to improve survival in triple negative breast cancer
patients by 60% when added to standard chemotherapy drugs.
57. The Breast Cancer
Experience
Physical changes to the
breasts and side effects such as
hair loss, fatigue and
lymphedema
Changes in sexuality
and desire, premature
menopause, infertility
Mental and emotional
changes such as
“chemobrain,” depression
and fear of recurrence
Positive lifestyle changes
such as increased
exercise, healthier eating,
stress reduction
Changes in
relationships with
family and friends
Financial hardships,
occupational changes
58. A 60 year old woman presents
with a lesion on her right breast.
She thinks it started as an insect
bite but has been getting
progressively worse over the last
6 months.
59. 1. What is the diagnosis?
This appears to be a locally advanced carcinoma of
the right breast. It is stage T4b at least.
2. What investigations would you arrange?
The diagnosis should be confirmed with
mammography and core biopsy of the lesion. Then
appropriate history and examination to detect
regional and systemic metastases she should undergo
thorough staging. Imaging with bone scan and CT
chest and abdomen would be appropriate with other
investigations as directed by the clinical findings.
60. 3. What are the principles of management?
After staging there should be discussion in a
multidisciplinary setting to plan therapy which
takes into account the patient's overall condition
and wishes.
Locally advanced tumours are typically treated
with neoadjuvant chemotherapy and hormonal
therapy followed by mastectomy and axillary
clearnce to obtain locoregional disease control.
Editor's Notes
Additional notes are based on website sources that are cited. These notes are meant to help structure your discussion. Feel free to edit slides and customize the presentation. This is a template to get you started!
To stress how prevalent this disease is, you could ask that attendees raise their hand if they know someone who has had breast cancer. Many students will likely have been touched in some way by the breast cancer experience.
http://www.breastcancer.org/symptoms/understand_bc/
“In the U.S., an average lifetime is about 80 years. So, it’s more accurate to say that 1 in 8 women in the U.S. who reach the age of 80 can expect to develop breast cancer. In each decade of life, the risk of getting breast cancer is actually lower than 13% for most women.”
http://www.cancer.gov/aboutnci/servingpeople/breast-snapshot.pdf
See the Susan G. Komen Foundation website for more info.: http://ww5.komen.org/
U.S. women have the highest incidence rates of breast cancer in the world
See the Breast Cancer Symptoms Guide:
Http://images.google.com/imgres?imgurl=http://breast-cancer-symptoms-guide.com/wp-content/uploads/2009/04/breast-cancer-incidence-ethnic-2007.jpg&imgrefurl=http://breast-cancer-symptoms-guide.com/breast-cancer-risk/&usg=__bFCOnzo1cPSex5CvVlRq8tx0uSM=&h=510&w=423&sz=91&hl=en&start=1&um=1&tbnid=vVccxWIAUAOSkM:&tbnh=131&tbnw=109&prev=/images%3Fq%3Dbreast%2Bcancer%2Bethnic%26hl%3Den%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7GGLL_en%26sa%3DN%26um%3D1
(chart includes data from 2000-2004)
“Compared to African American women, white women are slightly more likely to develop breast cancer, but less likely to die of it. One possible reason is that African American women tend to have more aggressive tumors, although why this is the case is not known. Women of other ethnic backgrounds — Asian, Hispanic, and Native American — have a lower risk of developing and dying from breast cancer than white women and African American women.”
http://breast-cancer-symptoms-guide.com/wp-content/uploads/2009/04/age-prob-breast-cancer-300x298.jpg
American Cancer Society, Surveillance Research 2007
The names BRCA1 and BRCA2 stand for breast cancer susceptibility gene 1 and breast cancer susceptibility gene 2, respectively.
See: http://www.cancer.gov/cancertopics/factsheet/risk/brca
Most breast and ovarian cancers occur in women over the age of 50. Women with harmful BRCA1 or BRCA2 mutations often develop breast or ovarian cancer before age 50.
A woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation.
Regardless, women who have a relative with a harmful BRCA1 or BRCA2 mutation and women who appear to be at increased risk of breast and/or ovarian cancer because of their family history should consider genetic counseling to learn more about their potential risks and about BRCA1 and BRCA2 genetic tests.
Harmful BRCA1 mutations may also increase a woman’s risk of developing cervical, uterine, pancreatic, and colon cancer (1, 2). Harmful BRCA2 mutations may additionally increase the risk of pancreatic cancer, stomach cancer, gallbladder and bile duct cancer, and melanoma (3).
Male breast cancer, pancreatic cancer, and prostate cancer appear to be more strongly associated with BRCA2 gene mutations (2–4).
Mutations in several other genes, including TP53, PTEN, STK11/LKB1, CDH1, CHEK2, ATM, MLH1, and MSH2, have been associated with hereditary breast and/or ovarian tumors
Ovary removal can reduce in 51% the risk of breast cancer in women which have mutations in BRCA1 or BRCA2 genes
See American Cancer Society Guide to Male Breast Cancer: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_male_breast_cancer_28.asp
http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_male_breast_cancer_28.asp
http://www.johnwnickfoundation.org/index.html
http://www.breastcancer.org/symptoms/types/dcis/
According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.
There are two main reasons this number is so large and has been increasing over time:
People are living much longer lives. As we grow older, our risk of breast cancer increases.
More people are getting mammograms, and the quality of the mammograms has improved. With better screening, more cancers are being spotted early.
Discuss inflammatory breast cancer to highlight the unique presentation of a particularly aggressive form of breast disease.
http://www.mayoclinic.com/health/inflammatory-breast-cancer/DS00632/DSECTION=symptoms
Other conditions have symptoms resembling those of inflammatory breast cancer. A breast infection (mastitis) also causes redness, swelling and pain, but breast infections usually develop during breast-feeding. With an infection, you're likely to have a fever, which is unusual (but not unheard of) in inflammatory breast cancer.
Breast surgery or radiation therapy may block the lymphatic vessels in breast skin, temporarily making the breast swell and become discolored. When caused by surgery or radiation treatments, however, these changes gradually subside.
http://breastcancer.about.com/od/types/p/ibc.htm
Inflammatory breast cancer, unlike ductal or lobular breast cancers, is usually not detected until after it has reached a more advanced stage of development. It is treated first with chemotherapy, and then with surgery, which is exactly the reverse order in which ductal and lobular cancers are typically treated.
http://www.breastcancer.org/symptoms/understand_bc/risk/factors.jsp
“Although men can get breast cancer, too, women’s breast cells are constantly changing and growing, mainly due to the activity of the female hormones estrogen and progesterone. This activity puts them at much greater risk for breast cancer.”
http://www.breastcancer.org/symptoms/understand_bc/risk/factors.jsp
Weight. Being overweight is associated with increased risk of breast cancer, especially for women after menopause. Fat tissue is the body’s main source of estrogen after menopause, when the ovaries stop producing the hormone. Having more fat tissue means having higher estrogen levels, which can increase breast cancer risk.
Diet. Diet is a suspected risk factor for many types of cancer, including breast cancer, but studies have yet to show for sure which types of foods increase risk. It’s a good idea to restrict sources of red meat and other animal fats (including dairy fat in cheese, milk, and ice cream), because they may contain hormones, other growth factors, antibiotics, and pesticides. Some researchers believe that eating too much cholesterol and other fats are risk factors for cancer, and studies show that eating a lot of red and/or processed meats is associated with a higher risk of breast cancer. A low-fat diet rich in fruits and vegetables is generally recommended.
Exercise. Evidence is growing that exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.
Alcohol consumption. Studies have shown that breast cancer risk increases with the amount of alcohol a woman drinks. Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk.
Smoking. Smoking is associated with a small increase in breast cancer risk.
Exposure to estrogen. Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any breaks, can increase the risk of breast cancer. Some of these risk factors are under your control, such as:
taking combined hormone replacement therapy (estrogen and progesterone; HRT) for several years or more, or taking estrogen alone for more than 10 years
being overweight
regularly drinking alcohol
Recent oral contraceptive use. Using oral contraceptives (birth control pills) appears to slightly increase a woman’s risk for breast cancer, but only for a limited period of time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk.
Stress and anxiety. There is no clear proof that stress and anxiety can increase breast cancer risk. However, anything you can do to reduce your stress and to enhance your comfort, joy, and satisfaction can have a major effect on your quality of life. So-called “mindful measures” (such as meditation, yoga, visualization exercises, and prayer) may be valuable additions to your daily or weekly routine. Some research suggests that these practices can strengthen the immune system.
Radiation therapy to the chest. Having radiation therapy to the chest area as a child or young adult as treatment for another cancer significantly increases breast cancer risk. The increase in risk seems to be highest if the radiation was given while the breasts were still developing (during the teen years).
http://www.cancer.gov/cancertopics/factsheet/risk/brca#16
American Cancer Society Screening Recommendations:
Annual mammograms, starting at age 40
Clinical breast exams
every year starting at age 40
every 3 years for women age 20-39
Self-breast exams monthly, starting at age 20
Surveillance:
Mammography:
Mammography can detect cancers several years before it can felt through a clinical exam.
Mammography along with physical breast examination is the modality of choice for screening for catching early breast cancer.
It has been recommended that women age 40 and older should have mammograms every 1 to 2 years.
Digital mammograms represent a new technology that may be helpful in identifying breast cancers in younger women with dense breasts. Computer Aided Detection is being used more frequently in an attempt to improve the accuracy of mammograms.
MRI or magnetic resonance imagery is a sensitive tool but is extremely expensive and has a high number of false positives. MRIs in conjunction with mammograms are recommended only for women at the highest risk, meaning with a genetic mutation or a strong family history of breast or ovarian cancer.
Clinical and self breast exams:
A clinical breast examination, in which a doctor or nurse examines the breast for lumps or irregularities, is recommended once every three years starting at age 20, then once a year at age 40 and up.
Studies have shown that self-exams do not reduce breast cancer death rates, but at least 40% of breast cancers are identified by women doing self-exams.
Risk Avoidance:
Studies suggest that obesity after 50 plays a role in breast cancer and may increase the risk of developing post- menopausal breast cancer.
Dietary fats may increase your risk of developing breast cancer. Diets high in fruits, vegetables, and grains may help to reduce the risk. Some vitamins and minerals are thought to protect against breast cancer, specifically vitamins A, C, D, and E, and calcium, selenium, and iodine. Some doctors recommend that breast cancer patients take antioxidant supplements.
Monitor your alcohol intake. Small amounts of alcohol have been shown to be protective against heart disease, but excess alcohol may play a role in breast cancer.
Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol.
Exercise Studies have shown that four hours per week of exercise reduced the risk of breast cancer by 50%.
The risk was even lower if exercise had been part of your regimen since the teens and 20s
Chemoprevention:
Tamoxifen is a type of drug called a selective estrogen receptor modulator (SERM). SERMs act by blocking any estrogen present in the body from attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors and killing tumor cells. Tamoxifen can be used in both pre- and postmenopausal women.
http://www.mayoclinic.com/health/breast-cancer/DS00328/DSECTION=treatments-and-drugs
http://www.cancer.gov/STAR
The Study of Tamoxifen and Raloxifene, or STAR, is a clinical trial designed see how the drug raloxifene compares with the drug tamoxifen in reducing the incidence of breast cancer in postmenopausal women who are at increased risk of the disease.
Initial results of STAR show that the drug raloxifene is as effective as tamoxifen in reducing the breast cancer risk of the women on the trial. In STAR, both drugs reduced the risk of developing invasive breast cancer by about 50 percent. In addition, within the study, women who were assigned to take raloxifene daily and who were followed for an average of about four years, had 36 percent fewer uterine cancers and 29 percent fewer blood clots than the women who were assigned to take tamoxifen. Uterine cancers, especially endometrial cancers, are a rare but serious side effect of tamoxifen. Both tamoxifen and raloxifene are known to increase a woman's risk of blood clots.
Participants in STAR who were assigned to take raloxifene had fewer serious side effects from that drug than participants assigned to take tamoxifen, including fewer uterine cancers, blood clots, and cataracts
A few key points:
http://www.breastcancer.org/treatment/surgery/mast_vs_lump.jsp
Surgery: Research shows that lumpectomy followed by radiation is likely to be equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Chemotherapy: Discuss recent developments in genomic assays like Oncotype DX, which personalize treatment plans by analyzing pt’s genetic profiles to predict likelihood of chemotherapeutic response and adverse effects.
http://www.breastcancer.org/symptoms/testing/types/oncotype_dx.jsp
If you have early-stage, ER+ breast cancer, Oncotype DX is a test that can help you and your doctor make a more informed decision about whether or not you need chemotherapy.
When is radiation appropriate?
http://www.breastcancer.org/symptoms/testing/types/oncotype_dx.jsp
Brachytherapy, also known as internal radiation, is another way to deliver radiation therapy. Instead of aiming radiation beams from outside the body, radioactive seeds or pellets are placed directly into the breast tissue next to the cancer. It is often used as a way to add an extra boost of radiation to the tumor site (along with external radiation to the whole breast), although it may also be used by itself (see below). Tumor size, location, and other factors may limit who can get brachytherapy.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_5.asp
Brachytherapy, compared to whole body irradiation, is associated with many advantages such as reduction of the treatment duration from 6.5 weeks to 5 days, minimal scar tissue formation, and intact and unaffected implant. Since, it also helps to effectively control the tumor growth with lesser side effects, the partial radiation therapy may serve as an alternative treatment modality to women with early stage breast cancer following augmentation mammoplasty.
Vaccines:
http://www.reuters.com/article/pressRelease/idUS133892+23-Feb-2009+PRN20090223
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/13/AR2008041301616.html
http://www.apthera.com/products.php?id=3
Discuss triple negative breast cancer to highlight a particularly hard to treat form of breast disease.
http://www.biparsciences.com/000010.html
http://bcresourcedirectory.org/directory/11-survivorship_index.htm
“From the very instant you receive your diagnosis of breast cancer until you take the very last breath of life, you are a survivor.
While survivorship is the goal of treatment, reaching and living it does not mean life becomes less complicated.”
Once a woman is diagnosed with breast cancer, the initial news and subsequent treatment regimens, which are often difficult physically and emotionally, will transform her life and the lives of loved ones and friends around her.
