For information of chronic disease . very common these days and required early detection and cure. for education purpose .this is simplify version of very important but complex topic . This is only prevented by early detection and cure . By identifying red flags of disease first we can detect high group .by targeting high risk group we will be able to detect and treat disease with less resources.

1. BREAST CANCER
KOMAL QAMAR
ROLL NO 61

2. INTRODUCTION
•Cancer regarded as a group of diseases characterized by
•Abnormal growth of cells.
•Ability to invade adjacent tissues and even distant organs.
•The eventual death of patient if the tumor has progressed
beyond the stage in which it can successfully removed
•It can occur at any site or in any tissue
•It can be localized or can spread to other organs

3. BREAST CANCER
• Breast consists of fat, lobules, lobes and duct that transport milk
to nipple near areola ( pigmented area)
• Different lymphatics present to drain fluid
• It involves axillary , supra clavicular , infra clavicular and internal
mammary lymph nodes
• Its development is under control of different hormones ,
• After menearche , develoment occur under control of estrogren
and progesterone

4. •Before mentruation breast tenderness occur
•During pregnancy , haperplasia of lobulle by estrogen
progesteron
•After menupause atrophy of breast
•There are total 4 quadrant of breast
•Cancer is most common in upper lateral quadrant of
breast
•It is localized during early stages and block lymphatics
•But later on metastasis occure to bone brain liver etc.

6. •Stages of breast cancer

7. • There are different types of breast cancer
• Ductal
• Ductal carcinoma in situ
• Ductal invasive carcinoma
• Lobular
• Lobular carcinoma in situ
• Invasive lobular carcinoma
• Other
• fibro adenoma , inflamatory , mucinous
• Phyllodes tumors , paget, tubular

9. GLOBAL INDICATORS
•Incidence
•Incidence of breast cancer is higher in developed countries
•Global breast cancer incidence increased from 641,000 (95%
uncertainty intervals 610,000-750,000) cases in 1980 to 1,643,000
(1,421,000-1,782,000) cases in 2010, an annual rate of increase of
3·1%
• .( Forouzanfar, M. H., Foreman, K. J., Delossantos, A. M., Lozano, R., Lopez, A. D., Murray, C. J., & Naghavi, M. (2011). Breast
and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet (London, England), 378(9801),
1461–1484. https://doi.org/10.1016/S0140-6736(11)61351-2)

10. • Incidence rate varies from 27 per lac woman to eastern Africa to 98
per lac in western Europe
• It was estimated about1, 6 71, 149 new case reported in 2012 world
wide( GLOBOCAN 2012, Fact sheet 2012, breast cancer incidence and mortality worldwide 2012
summary)
• Incidence of breast cancer is about 11.9%and age standardized rate
is 43.3. World wide.(GLOBCAN 2013, world fact sheet,2013, report, Section of cancer
information , international agency for research on cancer, Lyon, France)

11. •Prevalence
• 5 year prevalence of breast cancer World wide is 36.4% in women
And 240.8/100, 000 population
• It is 25% of all new cancer cases
• About 1 in 8 U.S. women (about 12%) will develop invasive
breast cancer over the course of her life(American Cancer Society
• Increase in cases by 33% from (2015-2017) due to Increase population
growth(Global burden of disease cancer collaboration 2017)

12. • Motality and survival rate
• Motality rate is 6-20/lac
• Lower in developed counteries
• Higher in developing countriesGLOBCAN 2013, world fact
sheet,2013, report, Section of cancer information , international agency
for research on cancer, Lyon, France)
• Mean breast mortlity rate was 13.77/100000 population
in1990 than thre was decreas in mortility rate From 1995-
2015
• Overall slope was 0.7/100000 population worldwide from
• (1990-2015) Azamjah, N., Soltan-Zadeh, Y., Zayeri, F. Global Trend of Breast Cancer Mortality Rate: A 25-Year
Study. Asian Pacific Journal of Cancer Prevention, 2019; 20(7): 2015-2020. doi: 10.31557/APJCP.2019.20.7.2015

13. •Incidence of breast cancer in pakistan
•Age specific incidence rate is highest in Pakistan amoung the
asian coutries krachi cancer registry shows incidence rate
51.7/100000 in 1995-1997
•In Lahore 47.6/10000 population 2010-2012
•In past women aged 60-64 had highest incidence rate but
from 2016 onward large increase in breast cancer incidence
among 50-64 are expected
•Approximately 90000 cases reported every year

14. •Prevalence of breast cancer in Pakistan
•In Pakistan 1 woman out of 9 is suffering from breast
cancer
•In an investigation, 28730 cases reported in Anmol and
6718 was suffering from breast cancer (2000-2009)
•Ratio among male and female was 100:2
•About 46% cases reported from Lahore(2012)
•33% was of breast cancer admitted in nuclear medicine
oncology institute Islamabad (NORI report 2010 -2012)

15. EPIDEMIOLOGICAL FACTORS
Host factors
• 1.Age
• Most common between 35-50 years of age
• incidence of breast cancer increases with age and than reach plateau phase
• Secondary rise occur after age of 65
• If woman developed her first breast cancer before 45 than there is three
times more chance of developing second cancer
• In Pakistan mostly woman affected in Their 4th decade of life
• western women affected in fifth decade of their lived

16. •2.Family history
• High risk present in those with positive family history mostly if
mother and sister developed breast cancer in premenopausal age
• Mostly occur due to mutation in BRCA 1
• And BRCA2 genes
•3.Parity
• Early age , full term pregnancy has protective nature
• Pregnancy in thirties increases the risk
• Nulliparous and unmarried woman also have high risk.

17. • 4.Breat feeding
•Longer the women breastfeed, the greater reduction in
risk
•So incidence is lower in developing countries due to
more frequent and longer nursing
•Breast feeding suppress ovulation and trigger terminal
differentiation of luminal cells

19. 5.obesity
• Obese women under forty have low incidence (anovulatory cycle)
• After forty there is increase incidence (high estrogen from. Fat cells)

20. 6.age at menarche and menopause
• Early menarche and late menopause double the risk
• Incidence is four times higher in forty years of menstruation as
compare to thirty
•9.socioeconomic status
• Higher in high socioeconomic group mostly due to;
• Late pregnancy
• No or shorter breast feeding

21. •Agent factor
1.radiation
• Radiation on chest,neuclear accident or due to atomic bomb exposure
• woman in early age who received high radiation dose has high
incidence than in old age
• 2.Hormonal factor
• Plays key role
• High level of estrogen and progesterone increase chance of
breast cancer

22. •Biopsy of breast
• Prior breast biopsy increases the incidence
•Oral contraceptive pills
•Use of oral contraceptive pills before first pregnancy or
before 20 years

23. •Environmental factors
environmental toxins
• Environmental toxins like organochloride pesticide have estrogenic effect
•Occupational exposure
• Ionizing radiation
• Metals :zinc, iron, copper, Nickle
• Pesticides
• Increase chance of cancer.
•Custom habits and life style
•Medications

24. SIGN AND SYMPTOMS
•Swelling or lump in breast
•Skin Dimpling look like orange peel
•Breast or nipple pain
•Nipple discharge
•Nipple retraction
•Swollen lymph nodes
•Redness , scaling irritation of nipple or skin

25. SCREENING
• Breast self examination by patient (BSE)
• Palpation by physician
• Thermography
• Mammography
• Ultasound
• MRI
• FNAC

26. LEVELS OF PREVENTION

27. PREVENTION
•Primordial prevention
•By discouraging harmful life styles, and preventing risk
factors of disease by individual or mass education
•Promote physical activity and exercise
•Eat health food like fruits vegetables
•Avoid fat rich food
•Obese person should encourage to reduce weight which
increase mean age of menarche

28. •Promote breast feeding
•Guide people about harmful effect of late
pregnancies
•Avoid unnecessary exposure of x-rays and
radiation
•Promote regular screening

29. •Primary prevention
•Health promotion
• 1.Adopt strenuous physical activity (reduce ovulation after menarche and
decrease weight)
• 2.avoid fat rich food to reduce obesity
• 3.use vegetables and friuts
• 4.avoid smoking and alcohol
• 5.Periodic medical examination
• 6.Environment modification for prevention of pesticides, radiation, metal
hazards
• 7.Breast feed

31. •Specific protection
•Discontinue prolonged hormonal therapy
•Avoid radiation exposure
•Avoid early biopsy with out any symptoms
•Limit exposure of different types of carcinogen.

32. •Secondary prevention
•Early diagnosis and prompt treatment
•Eearly detection by
•1.breast self examination by patient
•2Palpation by physician
•3.Thermography
•4.Mammography
•5.Ultrasound
•6.Doppler ultrasound

33. • 7.Fine needle aspiration cytology
• 8.MRI for grading and staging of tumor
•Prompt treatment
• Hormone replacement therapy
• Radiotherapy
• Chemothepy
• Mastectomy

34. •Tertiary prevention
•Disability limitation
• Mostly no disability is related with breast cancer
• Certain complications are related with treatment wound infection
• Shoulder immobility
• Skin desquamation
• Neutropenia
• Lymphedema
• Toxicity of chemotherapy
• Vaginal bleeding related to hormonal therapy
•palliativecare given to reduce the side effect of treatment

35. PALLIATIVE CARE

36. •Rehabilitation
•Pshycological rehablitation
• Restoration of personal confidence and dignity
• Social rehabilitation
•Restoration of family and social relation ship