2. MOST COMMON CANCER in women all over India and
accounts for 26% of all cancers in women in Indian cities.1
AGE SHIFT, and the average age of developing breast cancer has
shifted from 50 - 70 years to 30 - 50 years; and cancers in the
young tend to be more aggressive.
An estimated 70218 women died in India (1st) due to
breast cancer, more than any other country in the world.
(second: China - 47984 deaths and third: US - 43909 deaths ).2
Breast Cancer Facts
(India)
1. (Source: PBCR 2009 - 2011 )
2. According to GLOBOCAN (WHO), for the year 2012,
3. Anatomy of Breast
• The breast is a glandular
organ.
• It is made up of a
network of mammary
ducts.
• Each breast has about
15-20 mammary ducts
that lead to lobes that
are made up of lobules.
• The lobules contain cells
that secrete milk that are
stimulated by estrogen
and progesterone which
are ovarian hormones.
5. GENDER - All
women are
at risk
Age
Family/Personal
History
Reproductive
History
Menstrual
History
Race
Genetic
Factors
Breast Cancer Risk Factors
unalterable factors
Radiation
Treatment with
DES
6. All
women are
at risk
Obesity
Breastfeeding
Not having
children
Birth Control
Pills
Alcohol
Hormone
Replacement
Therapy
Exercise
All
women are
at risk
Obesity
No Breastfeeding
Not having
children
Birth Control
Pills
Alcohol
Hormone
Replacement
Therapy
Breast Cancer Risk Factors
that can be controlled
Lack of
Exercise
7. Genetic mutations
Responsible for up to
10% of all breast cancers
Genes
Contribution to
Hereditary Breast
Cancer
BRCA1 20% - 40%
BRCA2 10% - 30%
TP53 < 1%
PTEN < 1%
Undiscovered genes 30% - 70%
8. Signs and Symptoms
8
Most common:
lump or
thickening in
breast. Often
painless
Change in color
or appearance
of areola
Redness or pitting
of skin over the
breast, like the
skin of an orange
Discharge
or
bleeding
Change in size
or contours of
breast
10. Carcinoma Breast – Types
Ductal ….
Infiltrating
Invasive
80% of all
cancer
Ductal cancer
cells breaking
through the wall
Non-infiltrating
Non-invasive
4-5% of cancer.
Ductal
cancer
cells
11. Cancer distribution based
on molecular type
~70%
Hormone receptor (Estrogen
receptors (ER) and progesterone
receptors (PR; also called PgR))
HER2 (Human epidermal growth factor
receptor 2 (HER2/neu))
Triple negative, not positive to
receptors for estrogen, progesterone,
or HER2
Triple positive, positive for estrogen
receptors, progesterone receptors and
HER2
If breast cancer cells have estrogen receptors, the cancer is called ER-
positive breast cancer. If breast cancer cells have progesterone receptors,
the cancer is called PR-positive breast cancer. If the cells do not have either
of these two receptors, the cancer is called ER/PR-negative. About two-
thirds of breast cancers are ER and/or PR positive.
12.
13. Treatment
Plan
OB Ca
I
II
LABC III
MBC IV
Only Locoregional Rx (+ Syst Rx)
LR Rx + Systemic Rx
Systemic Rx + LR Rx + Systemic Rx
(Neoadjuvant) (Adjuvant)
Systemic Rx + LR Rx
Stages
of
Breast
Ca
14. Neoadjuvant & adjuvant CT are
same.
Preferred regimen : AC T
For HER-2 + add Transtuzumab.
18-25%*
*Indian Journal of Cancer, Vol. 47, No. 1, January-March, 2010, pp. 1-2
LABC
17. Comparison & Benefits
• EVE + EXE combination is showing superiority in PFS in terms of HR –
combination is superior to FUL 500mg having risk reduction of 50%.
• EVE offers better safety profile.
Treatment
Hazard ratio (95% Confidence Interval)
FUL 250mg FUL 500mg
Overall (local assessment)
EVE + EXE 53% 41%
EVE + TAM 35% 19%
Overall (BOLERO-2 central assessment)
EVE + EXE 60% 50%
The hazard ratio (HR) is an estimate of the treatment hazard rate divided by the comparator
hazard rate; HR of > 1 indicates that the hazard rate is higher in the treatment group and the
comparator group is more effective; HR of < 1 indicates that the hazard rate is higher in the
comparator group and the treatment group is more effective.
Bachelot et al. Breast Cancer Res Treat (2014) 143:125–133
