Breast cancer is the second most common cancer affecting females worldwide. Risk factors include age, family history, genetic factors, reproductive history, and lifestyle factors. The document discusses the incidence, risk factors, etiology, clinical features, diagnostic workup, management, and recent advances in breast cancer. Biomarkers, imaging modalities, surgical approaches, chemotherapy, and targeted therapies are evolving to improve diagnosis and treatment outcomes in breast cancer.

2. Dr Sriram
Dr Dinesh
Dr Pareekshith
Department of GENERAL SURGERY
MMCH AND RESEARCH
CENTER,CALICUT
MENTOR: Dr. C. M. Lakshminarayanan
Professor & HOD

3.  Incidence
 Risk factors
 Etiopathogenesis
 Clinical features
 Management
 Recent advancements

8.  Breast cancer is SECOND most common cancers
affecting females.
 It is the 2nd most common cause of death due to
cancer in women after Lung cancer.
 one in 100 Indian females is likely to develop breast
cancer during her lifetime.

10. Age
Gender
Race
Country of birth
Family History
Genetic Risks
Personal History
Certain types of
benign breast
disesase
Menstrual History
Reproductive History
Oral Contraceptives
Hormone Replacement
Alcohol
Diet
Obesity
Ionising radiation
Nonmodifiable Risks Modifiable Risks

11.  Age
Increases with age.
Mostly common in middle age group
Gender
average risk for women in life time-12.2%
More common in women than men (150:1)


12. Country of birth
More common in West
Sporadic breast cancer 65-75%
Familial breast cancer 20-30%
Hereditary breast cancer 5-10%

13. Family History
 1st degree relatives of patient-> risk increased by
2 or 3 fold
Risk is much higher if
-B/L carcinoma
-Early onset 50% risk
-Multiple members
Family history of ovarian cancer

14. BRCA 1 BRCA 2
Long arm of chromosome 17 Long arm of chromosome 13
40% of familial breast CA 20-30% familial breast CA
45% of lifetime risk for ovarian CA. 30% of ovarian CA
High grade Low grade
Hormone receptor negative Positive
Unfavourable prognosis. Favourable prognosis.
Genetic factors

15.  SYNDROMES ASSOCIATED WITH
BREAST CANCER:
SYNDROME GENE MUTATION
- Li-Fraumeni syndrome P53
- Cowden’s syndrome PTEN
- Muir syndrome MSH2 / MLH1
- Ataxia telengiectasia ATM
-Putz-jeghrs syndrome STK11/LKB1

16. Personal History of Previous Cancer
 3- to 4-fold increased risk
 Contralateral breast
 Ovary
 Endometrium
 Certain Types of Benign breast diseases
Type Relative risk
Non proliferative disease 1
Proliferative without atypia 1.3-1.9
Proliferative with atypia 3.7-4.2
Ductal involvement by cells of atypical ductal
hyperplasia
>7

17.  Menarche < age 12 increases risk
 Menopause > age 55 increases risk
 1st child after age 30 or nulliparous
 Prolonged combined estrogen & progesterone
replacement therapy
 OCP’S- ???
 BILATERAL OOPHORECTOMY BEFORE THE AGE OF 40
YEARS IS PROTECTIVE AGAINST BREAST CANCER.

19.  Diet
 Alcohol
 High fat diet
 Irradiation
 Risk factors for young women
 Hodgkin lymphoma and fluoroscopic tests
 Obesity
 Androstenodione Estrone
 Radial scar
Adipose tissue

20.  BREAST FEEDING IS PROTECTIVE
 SMOKING AND OCP ARE NOT PROVED TO BE
RISK FACTOR FOR CARCINOMA BREAST

21. GAIL MODEL
Computer model available that can calculate an
individual woman’s 5-yr risk of breast cancer
Developed by the National Cancer Institute
Utilizes a series of questions to calculate risk based on
nonmodifiable & modifiable factors
Administered by a health care professional

24.  Histopathology
Cancer cells are
divided
Invading
through
basement
membrane
Invasive
carcinoma
No
Carcinoma in
situ

25. Classification of
breast cancer
In situ
(15-30%)
Ductal
carcinima
insitu (80%)
Lobular
carcinoma
insitu
(20%)
Invasive
(70-85%)
Invasive ductal
carcinoma
with
productive
fibrosis (80%)
Invasive
lobular
carcinoma
(10%)
Mucinous
(colloid)
(2.4%)
Tubular
(1.5%) Medullary
(1.2%)
Papillary
(1%)

27. Subtype ER Her- 2 -Neu Ki67
Luminal A +ve -ve Low
Luminal B +ve +ve High
Her-2-Neu over
expression group
-ve +ve High
Basal cell like ER and PR -ve -ve High
Claudin-Low -ve -ve High

31.  HISTORY AND PHYSICAL EXAMINATION
 RADIOLOGICAL ASSESSMENT
 PATHOLOGICAL ASSESSMENT

32.  MAMMOGRAPHY
 ULTRASONOGRAPHY
 MAGNETIC RESONANCE IMAGING

34.  To distinguish scar from recurrence in women
who have had previous breast conservation
therapy for cancer
 To assess multifocality and multicentricity in
lobular cancer and to assess the extent of
high-grade ductal carcinoma in situ (DCIS). It
is less useful in low-grade DCIS;
 It is the best imaging modality for the
breasts of women with implants;
 As A screening tool in high-risk women
(because of family history

35.  FINE NEEDLE ASPIRATION BIOPSY
 CORE NEEDLE BIOPSY
 EXCISIONAL BIOPSY

36.  LFT
 USG abdomen and pelvis.
 Biopsy of metastatic lesion – very important (
biomarkers may differ in primary and
secondary deposits)
 Pleural fluid analysis, Ascitic fluid analysis.
 CT CHEST & ABDOMEN.
 MRI/ PET CT
 Whole body scan.

40.  CHEST XRAY
 „ECG
 „Blood for hemoglobin, total leukocyte count
(TLC), differential leukocyte count (DLC)
and
 Erythrocyte sedimentation rate (ESR)
 „Blood for sugar, urea and creatinine.
 Blood grouping and typing

43.  1. BCS + SLN biopsy +RT
 2. MRM
WITH ADJUVANT
SYSTEMIC
THERAPY

44. • NEAOADJUVANT CHEMOTHERAPY
• BCS/MRM
• RADIOTHERAPY

45. Primary goal of therapy
 Improvement and maintenance of Quality of life
 Prolongation of survival

46.  Main stay of treatment is AGGRESSIVE
CHEMOTHERAPY
 More useful in hormone negative tumours.
 Hormone positive tumours not responding to
ET
 Patients with symptomatic visceral
metastasis.

47.  BONE METASTASIS
 Rx – Bisphosphonates IV (Zolendronic acid-
4mg,Pamidronate-90mg) RT
 Internal fixation, spinal decompression,
laminectomy.
 ORAL Calcium and Vitamin D3
supplements

48.  Brain mets
Localised Surgery
Steroid followed by RT
 Spine
Steroid with decompression and
stabilization
 Malignant Ascites
Symptomatic > diuretics,
Paracentesis
Peritoneo venous shunts

49.  Limited role
 Radiotherapy

52. BIOMARKERS
RECEPTORS
PATHOLOGY
IMAGING MODALITIES
CLASSIFICATIONS
SURGICAL APPROACH
CHEMOTHERAPY

53.  BC1, BC2, BC3
 BC3 posses highest individual diagnostic
power
 CA15-3, CA27-79, KK-LC-1,
 KK-LC-1[kita-Kyushu lung antigen-1]
expressed in triple negative breast
cancer

54.  IGF-1, E-Cadherin , PTEN
 Loss of E Cadherin is hallmark of invasive
lobular carcinoma

55.  LIQUID BIOPSY
 RADIOACTIVE SEED LOCALIZATION- I125
 STEREOTACTIC MAMMOGRAPHIC CORE
NEEDLE BIOPSY
 NEEDLE LOCALIZED BIOPSY UNDER
MAMMOGRAPHY
 VACUUM ASSISTED BIOPSY
 MRI GUIDED CORE NEEDLE BIOPSY

56.  Xero mammography- dense breasts
 PET/CT
 PET/MRI
 Breast ductal endoscopy
 Diffusion Weighted Imaging with ADC
 Thermography

57.  MRI is superior to mammography in
detecting cancer in patients receiving HRT
and young females
 One view breast tomosynthesis- least
radiation dose

58.  Based on genomic hybridization
 Cluster A- poor prognosis
 Cluster B- good prognosis

59.  ILC BASED ON RECEPTOR STATUS

61.  Skin sparing mastectomy/ key hole
mastectomy
 Nipple sparing mastectomy
 Oncoplasty

63.  NEWLY APPROVED DRUGS
 Ixabepilone - Anthracycline and taxane
resistant cases
 Lapatinib - Second line HER2new therapy
 Sunitinib - Refractory metastatic breast
cancers
 Bevacizumab – monoclonal antibody against
VEGF

64.  Nelipepimut-S :- Investigating as vaccine
to prevent clinical recurrence in high risk
patients
 Pembrolizumab- monoclonal IgG4
antibody
 Fulvestrant – ER degrader