Introduction Risk factors Symptoms and presentation History

1. Haneen Hassan Shaker.
Baghdad university/Alkindy college
of Medicine.
hassanhaneen13@gmail.com

2. • Introduction
• Risk factors
• Symptoms and presentation
• History

3. Introduction
• Globally, breast cancer is the most frequent cancer among women;
comprising about 23 % of all female cancers.
• It is also the leading cause of cancer-related deaths.
• Breast cancer survival rates vary greatly worldwide, ranging from over
80% in North America, Sweden and Japan to around 60% in middle-
income countries and below 40% in low income regions of the world .
• The low survival rates in less developed countries are mainly attributed
to the lack of awareness programs, resulting in a high proportion of
women presenting in late-stages.

4. Breast Cancer among Iraqi Individuals
∞ Breast cancer is the most common type of malignancy among the Iraqi population in
general.
∞ responsible for about one third of the registered female cancers and almost one
quarter of female deaths from the disease
∞ Within the last two decades, there has been an obvious increase in the incidence
rates of breast cancer, which became one of the major threats to Iraqi female health.
∞ It has a tendency to affect middle aged women
∞ In 2010, it has been reported that out of 721 women, who presented with palpable
breast masses in a screening center for early detection of breast cancer in Iraq, 143
were diagnosed with breast cancer
∞ Although 90.6% of those patients detected the lumps initially by themselves, only 32%
sought medical advice within the first month while 16. % visited the doctor one year
later.

6. Risk Factors
Modifiable
factors
Non modifiable
factors

8. ☻Gender: more prevalent in women.
One (MALE) in every 150 cases (female).
☻Age: The chance of getting breast cancer goes up as
a woman gets older.
Over 80% of all female breast cancers occur among
women aged 50+ years

10. ☻Genetic risk factor:
• Women who carry the BRCA1 and BRCA2 genes have a
considerably higher risk of developing breast cancer.
• Those have cancer early in life usually before the
age of 40 .

13.  Race/Ethnic background:
Overall, white women are slightly more likely to get breast
cancer than African-American women.
 African-American women, though, are more likely to die
of breast cancer.
Asian and Native-American women have a lower risk of
getting and dying from breast cancer.

15. HISTORY
• Age
Carcinoma of the breast is extremely
rare in teenagers and unusual in the
twenties.
From the thirties onwards, there is a
progressively increasing incidence,
which peaks in the late fifties. The
condition remains common into old
age.
• Ask about all the modifiable
and non modifiable risk factors.

16. Symptoms & presentation
1-Classically, the patient notices a painless lump
• the size of which does not correlate with the length of the history.
• Occasionally, a prickling sensation in the breast draws attention to
the swelling.
• The first symptom may be an axillary lump, with the primary lesion in
the breast being less obvious or even impalpable.

19. 2-The patient may notice skin dimpling caused by tethering, skin
ulceration, change in the breast size and shape, eczema (paget’s
dis)
3-The nipple may become retracted & destroyed ; Ask about.
Unilateral or bilateral
New or old retraction
Spontaneous or manually returned back
Associated with underlying lump
If there is any discharge
Symptoms & presentation

20. 4- nipple discharge: Ask about:

21. Characteristics of nipple discharge

22. 5- breast pain ; ask about:

23. 6-Backache due to bony metastases is a common
symptom of advanced disseminated disease, but an uncommon
mode of presentation.
7- Occasionally, a pathological fracture may be the first
sign of the disease, as may symptoms from cerebral, lung or
abdominal deposits.
8-systemic symptoms commonly associated with cancer,
such as malaise and weight loss in the late stages.
Symptoms & presentation

24. Past medical history ;
• Hx of benign breast disease
• Hx of previous cancer (breast , ovaries, lungs , colon)
• Hx of previous radiation exposure.
Past surgical history :
• Breast biopsy
• Lumpectomy
• Mastectomy
• Oophorectomy
• Hysterectomy

25. Family history:
 Breast cancer risk is higher among women whose close blood
relatives have this disease.
 Risk increased 5times in women with two or more first
degree relatives, Especially if the disease occurred in early age
bellow the age of 50.
 Family history of ovarian ,lung and colonic ca.
Drug history :
Hx of estrogen therapy for along periods.
Using hormone therapy(HRT) after menopause.

26. Social history ;
 Alcohol consumption.
 Being overweight or obese.
 Tobacco smoke: Smoking may increase the risk of
breast cancer.
Gynecological history :
• Nulliparous or multiparous
• Age of getting her first child.
• Number of children
• Lactating or not.
• Exclusive breast feeding and for how long , or using bottle
feeding

27. Menstrual history :
• Age of the menarche
• age of the menopause
• Regularity , duration and the amount of blood loss.
Women with early menarche (before age 12) or
late menopause after the age of 55 have a slightly increased
risk of breast cancer.