This document discusses risk factors and risk assessment models for breast cancer, as well as risk reduction interventions. It notes that family history and genetic mutations significantly increase risk. Various models can estimate risk levels. Screening, chemoprevention drugs, lifestyle changes, and risk-reducing surgeries can lower risk, with options like bilateral mastectomy reducing risk by 50-90%. High-risk patients should understand their options to lower their lifetime risk of developing breast cancer.
3. lifetime risk of breast cancer in mutation
carriers
47%–66% -BRCA1
40%–57% BRCA2
Family history 1.5 to 3 fold
Personal history 0.5% to 1 % per year of
follow up
4. Familial/genetic factors
Demographic factors
Reproductive history
Lifestyle factor
Irradiadition <30 yrs of age( 55 fold)
breast density
Factors number of breast biopsies
1. FEA
2. AH,LCIS
5.
6. BRCAPRO & BOADICEA
GAIL MODEL
CLAUSS MODEL
TYRER-CUZICK MODEL
7. screening with mammogram
screening breast magnetic resonance
imaging
clinical breast exams
8. NON INVASIVE
1. LIFE STYLE
MODIFICATIONS
2. SURVEIILANCE
3. CHEMO
PREVENTION
INVASIVE
1. RRM
2. RRSO
9. WHOM ? HOW?
who do not want to
pursue RRS
want to delay RRS,
annual MRI in addition
to, and not instead
of, an annual
mammogram,
30 YRS
11. TAMOXIFEN (20 mg/d)
pre- and postmenopausal patients ≥35 years
of age
LE ≥10 years
≥1.7% 5-year risk for breast cancer as
determined by the modified Gail model
LCIS (category 1)
RALOXIFENE- 60 mg/Day
12. STAR TRIAL ( NCCN)-tamoxifen -for most
postmenopausal patients desiring non-
surgical risk-reduction therapy - decrease
invasive cancer risk
raloxifene 38% and tamoxifen 50%
ASCO RECOMMENDATIONS
1. tamoxifen (in premenopausal women)
2. tamoxifen, raloxifene, or exemestane (in
postmenopausal women)
13. SERM
Tamoxifen 20
mg/day
Raloxifene 60
mg/day
AI’S
25 mg/d of
exemestane
1 mg/d of
anastrozole.
[Not FDA
approved]
14.
15. 50% Reduction incidence of cancer among
patients using METFORMIN for more than 4
years
MECHANISM- directly and indirectly regulate
(through the insulin) the proliferation rate of
tumor progenitor cells in premalignant
lesions, preventing or delaying tumor
formation
16. Endometrial cancer
Cataract & Retinopathy
BMD-Osteoporosis
Thromboembolic Disease and Strokes
17. EXERSISE & BMI
ALCOHOL CONSUMPTION {<1 drink per day }
1 ounce of liquor,
6 ounces of wine
8 ounces of beer.
18. Have a strong family history of breast cancer
Have a personal history of breast cancer or
at present have breast cancer in one breast
Have tested positive for BRCA1 or BRCA2
gene mutations
Have been diagnosed with lobular carcinoma
in situ (LCIS)
Have had radiation therapy to the chest
before age 30
Have widely spread breast
microcalcifications or have dense breasts
19.
20. contralateral mastectomy synchronous with
the treatment of the primary tumor
as a bilateral procedure in women at high
risk of developing this disease.
23. Rice and Strickler in 1951
a rim of normal breast tissue was left
underneath the nipple-areolar complex (NAC)
OBSOLETE – increased risk of recurrences
24. Toth and Lambert -1991
initial major concern was –residual breast
tissue remaining on the longer skin flaps,infra
mammary fold,axillary tail
Barton et al disproved it – well planned incision-
to allow immeadiate reconstruction
native skin allows for better appearance,
position, and shape of both prosthetic implants
&autologous reconstruction
25. Strutures removed
1. Entire breast gland
2. NAC
3. Biopsy scar
4. Skin overlying the tumour
Structures Preserved
1. Remaining skin
2. Infra mammary fold
26. Type 1-only NAC removed
Type 2-NAC +SKIN overlying the
tumour+BIOPSY site if any
Type 3- similar to type 2 but resected
seperately leaving intact tissue in between
Type 4 –NAC is removed along with certain
amount of skin
27.
28. Reduced post mastectomy deformity and
improved breast shape
Scars are better and reduced
Need for extensive tissue expansion and for
myo cutaneous flap is minimal
Immaediate reconstruction has a beneficial
impact on patient’s psychology
29. Freeman in 1962
structures removed-Entire breast tissue
including the ductal tissue located in the
NAC
Structures preserved -the entire skin( dermis
&epidermis) of the breast
34. Several risk-reducing strategies exist
identify high-risk patients
High-risk surveillance with MRI as an adjunct
to mammography
Chemoprevention
Surgical prophylaxis remains the most
effective means to prevent breast cancer.