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Breast Cancer:
What every medical student should know.
Breast Cancer Awareness
Month
October 2009
For more information:
www.amsa.org
Women agonize... over cancer; we take as a
personal threat the lump in every friend's breast.
Martha Weinman Lear, Heartsounds
Impact:  With 1 million new cases in the world each
year, breast cancer is the most common
malignancy in women and comprises 18% of
all women’s cancers.
 Breast cancer incidence in women in the
United States is 1 in 8 (about 13%). Women
have a 3% chance of breast cancer causing
their death.
 For women in the U.S., breast cancer death
rates are higher than those for any other
cancer besides lung cancer.
 The American Cancer Society estimates that
each year, about 2000 new cases of invasive
breast cancer are diagnosed in men.
 It is estimated that about $8.1 billion is spent
each year on breast cancer treatment in the
Epidemiology:
 Over 75% of women who are diagnosed with breast cancer are age 50 or
older.
 The five-year relative survival rate is now 98 percent for women with breast
cancer caught before it spreads beyond the breast (compared to 72 percent
in 1982).
 Breast cancer incidence is greater in
women of higher socio-economic background.
The relationship of breast cancer risk with
socio-economic factors is most likely related to
life style differences like number of pregnancies
and age at first childbirth.
 Death rates have been decreasing since 1990.
These decreases are thought to be the result
of treatment advances, earlier detection through
screening, and increased awareness.
Incidence and Mortality of Female Breast
Cancer Based on Race and Ethnicity in the
U.S.
Rate
Per
100,000
About 90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging
process and life in general, not to inherited mutations.
Current
Age
Probability of breast cancer
in next 10 years
20 0.05% or 1 in 1,837
30 0.43% or 1 in 234
40 1.43% or 1 in 70
50 2.51% or 1 in 40
60 3.51% or 1 in 28
70 3.88% or 1 in 26
Lifetime risk: 12.28%; 1 in 8 women
Probabilities of Developing Invasive Breast Cancer Based on Age
Hereditary Breast Cancer:
 While about 20-30% of women diagnosed with breast cancer
have a family history of breast cancer, only about 5-10% of
breast cancer cases are caused by inherited gene mutations.
BRCA1 and BRCA2 mutations are the most common.
Lifetime breast
cancer risk
Median age of breast
cancer (years)
General population 12% 61
BRCA1 65% 43
BRCA2 45% 41
Breast Cancer Kills Men,Too.
 Less than 1% of all new breast cancer
cases occur in men.
 Men with a BRCA1 mutation have a
1% risk of developing breast cancer
by age 70; BRCA2 mutations confer
a 6% risk.
 Breast cancer prognosis, even in
stage I cases, is worse in men than in
women.
 Treatment for male breast cancer has
usually been a mastectomy, which
may be followed by radiation,
hormone therapy (such as with
tamoxifen), or chemotherapy.
Risk factors for male
breast cancer
Testicular abnormalities: cryptorchidia,
congential inguinal hernia, orchiectomy, orchitis,
testicular trauma
Hormonal alterations:
Infertility, Klinefelter’s syndrome, obesity,
cirrhosis (and heavy alcohol intake)
Family history of breast cancer, mutations in
BRCA1/2, CHEK2, PTEN
Benign breast lesions:
Nipple discharge, breast cysts, breast trauma
Exposure to radiation or high temperatures
Old age
Jewish descent
Types of Breast Cancer
DCIS: Ductal Carcinoma In Situ
LCIS: Lobular Carcinoma In Situ
IDC: Invasive Ductal Carcinoma
ILC: Invasive Lobular Carcinoma
Inflammatory Breast Cancer
Male Breast Cancer
Recurrent and Metastatic Cancer
Ductal carcinoma in situ
(DCIS) is the most
common type of non-
invasive breast cancer.
Invasive ductal carcinoma (IDC) is the
most common type of breast cancer,
comprising about 80% of all breast
cancers.
Signs to watch out for:
 a lump felt in the breast
 an inverted nipple
 nipple discharge (clear or bloody)
 nipple pain
 sores on the nipple and areola
 enlarged lymph nodes under the arm
Signs and Symptoms
Rapid change in the appearance of
one breast (days or weeks), with
visible enlargement of one breast,
discoloration with red, purple, pink or
bruised appearance and warmth of
the affected breast suggests
Inflammatory Breast Cancer.
In inflammatory breast cancer, cancer cells invade local lymphatic ducts,
impairing drainage and causing edematous swelling of the breast.
Peau d’orange: The skin of the breast is tethered by the suspensory ligament of
Cooper, which, with the accumulation of fluid, can cause the breast to take on a
dimpled appearance similar to an orange.
Inflammatory Breast Cancer
 Inflammatory breast cancer (IBC) accounts for between 1 percent and 6
percent of all breast cancer cases in the United States.
 The 5-year survival rate for patients with IBC is between 25-50 percent,
significantly lower than the survival rate for patients with non-IBC breast
cancer.
 IBC has a high risk of recurrence and is the most aggressive kind of
breast cancer. IBC is more likely to have metastasized at the time of
diagnosis than other breast cancer types.
 IBC affects women at an average age of 59 — about three to seven
years younger than the average age at which other types of breast
cancer are diagnosed.
 Men can develop the disease, but at an older age. Black women are
slightly more likely than are white women to have IBC.
Risk Factors
 The most significant risk factors for
breast cancer include gender (being
female) and age (growing older).
 Factors with minimal or no risk
include fertility treatment
abortion, deodorant and folic acid.
 Short-term use of hormones for
treatment of menopausal symptoms
appears to confer little or no breast
cancer risk.
Factors that Increase the Relative Risk (RR)
for Breast Cancer in Women
RR>4.0
• Female
• Age (65+)
• Inherited genetic mutations associated with breast cancer such as BRCA1/BRCA2
• Two or more first-degree relatives with breast cancer diagnosed at an early age
• Personal history of breast cancer
• High density breast tissue
• Biopsy-confirmed atypical hyperplasia
2.1<RR<4.0
• One first-degree relative with breast cancer
• High-dose radiation to chest
• High bone density (post-menopausal)
1.1<RR<2.0
Factors affecting circulating hormones:
• Late age at first full-term pregnancy (>30 yrs)
• Early menarche(<12 yrs)
• Late menopause
• No full-term pregnancies
• No breastfeeding
• Recent oral contraceptive use
• Recent and long-term hormone replacement therapy
• Obesity
Other factors:
• Personal history of endometrium, ovary or colon cancer
• Alcohol consumption
• Height (tall)
• High socioeconomic status
• Jewish heritage
 Surveillance
Mammography
Sonogram
MRI
Clinical and self breast exam
 Risk Avoidance
Diet and Exercise
 Chemoprevention
Tamoxifen
Raloxifene
 Prophylactic Surgery
Bilateral Prophylactic Mastectomy
Oophorectomy
Breast Cancer Screening and Prevention
Mammograms:
for low-income women and the uninsured.
 Mammograms are usually covered by health insurance for women
in the recommended age bracket. While some insurance plans
have no out-of-pocket expenses required, others charge a $10-$35
co-pay.
 Uninsured patients pay the full-price cost of a mammogram, which
ranges from $80 to $120.
 Some state and local health programs and employers provide
mammograms free or at low cost. Health departments, hospitals,
women’s centers, or other community groups may also have
information on how to access low-cost or free mammograms.
 The Centers for Disease Control and Prevention (CDC) coordinates
the National Breast and Cervical Cancer Early Detection Program
to provide screening services, including clinical breast exams and
mammograms, to low-income, uninsured women throughout the
United States. Visit the CDC website to find contact information for
local programs
 Information about low-cost or free mammography screening
programs is also available through NCI’s Cancer Information
Service (CIS) at 1–800–4–CANCER (1–800–422–6237).
Conventional Treatments
 Surgery
 Chemotherapy
 Hormonal therapy
 Radiation
 Just over the horizon: breast
cancer vaccine trials are under
way with vaccines like NeuVax,
which stimulates anti-Her2
immune response, and
Stimuvax, moving into phase III
trials.
Triple Negative Breast Cancer:
 Triple negative breast cancer (TNBC) is clinically characterized by the lack of
expression of estrogen, progesterone and HER2 hormone receptors.
 Comprises about 10-20% of breast cancers: more than one out of every 10.
 Does not respond to current hormonal therapy (such as tamoxifen or
aromatase inhibitors) or therapies that target HER2 receptors, such as
Herceptin (trastuzumab). Women diagonosed with TNBC generally face a
poorer prognosis.
 Treatments that target other processes may be helpful in treating triple
negative breast cancer when combined with chemotherapy:
 Avastin: interferes with VEGF (vascular endothelial growth factor),
inhibiting the growth of new blood vessels at the tumor site.
 Erbitux: interferes with EGFR (epidermal growth factor receptor), which is
often overexpressed in triple negative cancer.
 PARP inhibitors: inhibit poly (ADP-ribose) polymerase, an enzyme used
by cancer cells to repair DNA damage. One PARP inhibitor, dubbed BSI-
201, has been shown to improve survival in triple negative breast cancer
patients by 60% when added to standard chemotherapy drugs.
The Breast Cancer
Experience
Physical changes to the breasts
and side effects such as hair loss,
fatigue and lymphedema
Changes in sexuality and
desire, premature
menopause, infertility
Mental and emotional
changes such as
“chemobrain,” depression and
fear of recurrence
Positive lifestyle changes
such as increased exercise,
healthier eating, stress
reduction
Changes in relationships
with
family and friends
Financial hardships,
occupational changes
Complementary medicine can improve
quality of life for breast cancer patients:
 Acupuncture
 Meditation
 Aromatherapy
 Guided Imagery
 Hypnosis
 Journaling
 Chiropractic Therapy
 Massage
 Spirituality & Prayer
 Reiki
 Support Groups
 Tai Chi
 Shiatsu
 Yoga
 Music Therapy
 Progressive Muscle
Relaxation
 In the year 2008, there were about 2.5
million women in the U.S. who considered
themselves breast cancer survivors.
Advocacy

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Breast-Cancer-final.ppt

  • 1. Breast Cancer: What every medical student should know. Breast Cancer Awareness Month October 2009 For more information: www.amsa.org
  • 2. Women agonize... over cancer; we take as a personal threat the lump in every friend's breast. Martha Weinman Lear, Heartsounds
  • 3. Impact:  With 1 million new cases in the world each year, breast cancer is the most common malignancy in women and comprises 18% of all women’s cancers.  Breast cancer incidence in women in the United States is 1 in 8 (about 13%). Women have a 3% chance of breast cancer causing their death.  For women in the U.S., breast cancer death rates are higher than those for any other cancer besides lung cancer.  The American Cancer Society estimates that each year, about 2000 new cases of invasive breast cancer are diagnosed in men.  It is estimated that about $8.1 billion is spent each year on breast cancer treatment in the
  • 4. Epidemiology:  Over 75% of women who are diagnosed with breast cancer are age 50 or older.  The five-year relative survival rate is now 98 percent for women with breast cancer caught before it spreads beyond the breast (compared to 72 percent in 1982).  Breast cancer incidence is greater in women of higher socio-economic background. The relationship of breast cancer risk with socio-economic factors is most likely related to life style differences like number of pregnancies and age at first childbirth.  Death rates have been decreasing since 1990. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness.
  • 5. Incidence and Mortality of Female Breast Cancer Based on Race and Ethnicity in the U.S. Rate Per 100,000
  • 6. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and life in general, not to inherited mutations. Current Age Probability of breast cancer in next 10 years 20 0.05% or 1 in 1,837 30 0.43% or 1 in 234 40 1.43% or 1 in 70 50 2.51% or 1 in 40 60 3.51% or 1 in 28 70 3.88% or 1 in 26 Lifetime risk: 12.28%; 1 in 8 women Probabilities of Developing Invasive Breast Cancer Based on Age
  • 7. Hereditary Breast Cancer:  While about 20-30% of women diagnosed with breast cancer have a family history of breast cancer, only about 5-10% of breast cancer cases are caused by inherited gene mutations. BRCA1 and BRCA2 mutations are the most common. Lifetime breast cancer risk Median age of breast cancer (years) General population 12% 61 BRCA1 65% 43 BRCA2 45% 41
  • 8. Breast Cancer Kills Men,Too.  Less than 1% of all new breast cancer cases occur in men.  Men with a BRCA1 mutation have a 1% risk of developing breast cancer by age 70; BRCA2 mutations confer a 6% risk.  Breast cancer prognosis, even in stage I cases, is worse in men than in women.  Treatment for male breast cancer has usually been a mastectomy, which may be followed by radiation, hormone therapy (such as with tamoxifen), or chemotherapy. Risk factors for male breast cancer Testicular abnormalities: cryptorchidia, congential inguinal hernia, orchiectomy, orchitis, testicular trauma Hormonal alterations: Infertility, Klinefelter’s syndrome, obesity, cirrhosis (and heavy alcohol intake) Family history of breast cancer, mutations in BRCA1/2, CHEK2, PTEN Benign breast lesions: Nipple discharge, breast cysts, breast trauma Exposure to radiation or high temperatures Old age Jewish descent
  • 9. Types of Breast Cancer DCIS: Ductal Carcinoma In Situ LCIS: Lobular Carcinoma In Situ IDC: Invasive Ductal Carcinoma ILC: Invasive Lobular Carcinoma Inflammatory Breast Cancer Male Breast Cancer Recurrent and Metastatic Cancer Ductal carcinoma in situ (DCIS) is the most common type of non- invasive breast cancer. Invasive ductal carcinoma (IDC) is the most common type of breast cancer, comprising about 80% of all breast cancers.
  • 10. Signs to watch out for:  a lump felt in the breast  an inverted nipple  nipple discharge (clear or bloody)  nipple pain  sores on the nipple and areola  enlarged lymph nodes under the arm
  • 11. Signs and Symptoms Rapid change in the appearance of one breast (days or weeks), with visible enlargement of one breast, discoloration with red, purple, pink or bruised appearance and warmth of the affected breast suggests Inflammatory Breast Cancer. In inflammatory breast cancer, cancer cells invade local lymphatic ducts, impairing drainage and causing edematous swelling of the breast. Peau d’orange: The skin of the breast is tethered by the suspensory ligament of Cooper, which, with the accumulation of fluid, can cause the breast to take on a dimpled appearance similar to an orange.
  • 12. Inflammatory Breast Cancer  Inflammatory breast cancer (IBC) accounts for between 1 percent and 6 percent of all breast cancer cases in the United States.  The 5-year survival rate for patients with IBC is between 25-50 percent, significantly lower than the survival rate for patients with non-IBC breast cancer.  IBC has a high risk of recurrence and is the most aggressive kind of breast cancer. IBC is more likely to have metastasized at the time of diagnosis than other breast cancer types.  IBC affects women at an average age of 59 — about three to seven years younger than the average age at which other types of breast cancer are diagnosed.  Men can develop the disease, but at an older age. Black women are slightly more likely than are white women to have IBC.
  • 13. Risk Factors  The most significant risk factors for breast cancer include gender (being female) and age (growing older).  Factors with minimal or no risk include fertility treatment abortion, deodorant and folic acid.  Short-term use of hormones for treatment of menopausal symptoms appears to confer little or no breast cancer risk.
  • 14. Factors that Increase the Relative Risk (RR) for Breast Cancer in Women RR>4.0 • Female • Age (65+) • Inherited genetic mutations associated with breast cancer such as BRCA1/BRCA2 • Two or more first-degree relatives with breast cancer diagnosed at an early age • Personal history of breast cancer • High density breast tissue • Biopsy-confirmed atypical hyperplasia 2.1<RR<4.0 • One first-degree relative with breast cancer • High-dose radiation to chest • High bone density (post-menopausal) 1.1<RR<2.0 Factors affecting circulating hormones: • Late age at first full-term pregnancy (>30 yrs) • Early menarche(<12 yrs) • Late menopause • No full-term pregnancies • No breastfeeding • Recent oral contraceptive use • Recent and long-term hormone replacement therapy • Obesity Other factors: • Personal history of endometrium, ovary or colon cancer • Alcohol consumption • Height (tall) • High socioeconomic status • Jewish heritage
  • 15.  Surveillance Mammography Sonogram MRI Clinical and self breast exam  Risk Avoidance Diet and Exercise  Chemoprevention Tamoxifen Raloxifene  Prophylactic Surgery Bilateral Prophylactic Mastectomy Oophorectomy Breast Cancer Screening and Prevention
  • 16. Mammograms: for low-income women and the uninsured.  Mammograms are usually covered by health insurance for women in the recommended age bracket. While some insurance plans have no out-of-pocket expenses required, others charge a $10-$35 co-pay.  Uninsured patients pay the full-price cost of a mammogram, which ranges from $80 to $120.  Some state and local health programs and employers provide mammograms free or at low cost. Health departments, hospitals, women’s centers, or other community groups may also have information on how to access low-cost or free mammograms.  The Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program to provide screening services, including clinical breast exams and mammograms, to low-income, uninsured women throughout the United States. Visit the CDC website to find contact information for local programs  Information about low-cost or free mammography screening programs is also available through NCI’s Cancer Information Service (CIS) at 1–800–4–CANCER (1–800–422–6237).
  • 17. Conventional Treatments  Surgery  Chemotherapy  Hormonal therapy  Radiation  Just over the horizon: breast cancer vaccine trials are under way with vaccines like NeuVax, which stimulates anti-Her2 immune response, and Stimuvax, moving into phase III trials.
  • 18. Triple Negative Breast Cancer:  Triple negative breast cancer (TNBC) is clinically characterized by the lack of expression of estrogen, progesterone and HER2 hormone receptors.  Comprises about 10-20% of breast cancers: more than one out of every 10.  Does not respond to current hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin (trastuzumab). Women diagonosed with TNBC generally face a poorer prognosis.  Treatments that target other processes may be helpful in treating triple negative breast cancer when combined with chemotherapy:  Avastin: interferes with VEGF (vascular endothelial growth factor), inhibiting the growth of new blood vessels at the tumor site.  Erbitux: interferes with EGFR (epidermal growth factor receptor), which is often overexpressed in triple negative cancer.  PARP inhibitors: inhibit poly (ADP-ribose) polymerase, an enzyme used by cancer cells to repair DNA damage. One PARP inhibitor, dubbed BSI- 201, has been shown to improve survival in triple negative breast cancer patients by 60% when added to standard chemotherapy drugs.
  • 19. The Breast Cancer Experience Physical changes to the breasts and side effects such as hair loss, fatigue and lymphedema Changes in sexuality and desire, premature menopause, infertility Mental and emotional changes such as “chemobrain,” depression and fear of recurrence Positive lifestyle changes such as increased exercise, healthier eating, stress reduction Changes in relationships with family and friends Financial hardships, occupational changes
  • 20. Complementary medicine can improve quality of life for breast cancer patients:  Acupuncture  Meditation  Aromatherapy  Guided Imagery  Hypnosis  Journaling  Chiropractic Therapy  Massage  Spirituality & Prayer  Reiki  Support Groups  Tai Chi  Shiatsu  Yoga  Music Therapy  Progressive Muscle Relaxation
  • 21.  In the year 2008, there were about 2.5 million women in the U.S. who considered themselves breast cancer survivors.

Editor's Notes

  1. Additional notes are based on website sources that are cited. These notes are meant to help structure your discussion. Feel free to edit slides and customize the presentation. This is a template to get you started!
  2. To stress how prevalent this disease is, you could ask that attendees raise their hand if they know someone who has had breast cancer. Many students will likely have been touched in some way by the breast cancer experience. http://www.breastcancer.org/symptoms/understand_bc/ “In the U.S., an average lifetime is about 80 years. So, it’s more accurate to say that 1 in 8 women in the U.S. who reach the age of 80 can expect to develop breast cancer. In each decade of life, the risk of getting breast cancer is actually lower than 13% for most women.” http://www.cancer.gov/aboutnci/servingpeople/breast-snapshot.pdf
  3. See the Susan G. Komen Foundation website for more info.: http://ww5.komen.org/
  4. U.S. women have the highest incidence rates of breast cancer in the world See the Breast Cancer Symptoms Guide: Http://images.google.com/imgres?imgurl=http://breast-cancer-symptoms-guide.com/wp-content/uploads/2009/04/breast-cancer-incidence-ethnic-2007.jpg&imgrefurl=http://breast-cancer-symptoms-guide.com/breast-cancer-risk/&usg=__bFCOnzo1cPSex5CvVlRq8tx0uSM=&h=510&w=423&sz=91&hl=en&start=1&um=1&tbnid=vVccxWIAUAOSkM:&tbnh=131&tbnw=109&prev=/images%3Fq%3Dbreast%2Bcancer%2Bethnic%26hl%3Den%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7GGLL_en%26sa%3DN%26um%3D1 (chart includes data from 2000-2004) “Compared to African American women, white women are slightly more likely to develop breast cancer, but less likely to die of it. One possible reason is that African American women tend to have more aggressive tumors, although why this is the case is not known. Women of other ethnic backgrounds — Asian, Hispanic, and Native American — have a lower risk of developing and dying from breast cancer than white women and African American women.”
  5. http://breast-cancer-symptoms-guide.com/wp-content/uploads/2009/04/age-prob-breast-cancer-300x298.jpg American Cancer Society, Surveillance Research 2007
  6. The names BRCA1 and BRCA2 stand for breast cancer susceptibility gene 1 and breast cancer susceptibility gene 2, respectively. See: http://www.cancer.gov/cancertopics/factsheet/risk/brca Most breast and ovarian cancers occur in women over the age of 50. Women with harmful BRCA1 or BRCA2 mutations often develop breast or ovarian cancer before age 50. A woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation. Regardless, women who have a relative with a harmful BRCA1 or BRCA2 mutation and women who appear to be at increased risk of breast and/or ovarian cancer because of their family history should consider genetic counseling to learn more about their potential risks and about BRCA1 and BRCA2 genetic tests. Harmful BRCA1 mutations may also increase a woman’s risk of developing cervical, uterine, pancreatic, and colon cancer (1, 2). Harmful BRCA2 mutations may additionally increase the risk of pancreatic cancer, stomach cancer, gallbladder and bile duct cancer, and melanoma (3). Male breast cancer, pancreatic cancer, and prostate cancer appear to be more strongly associated with BRCA2 gene mutations (2–4). Mutations in several other genes, including TP53, PTEN, STK11/LKB1, CDH1, CHEK2, ATM, MLH1, and MSH2, have been associated with hereditary breast and/or ovarian tumors Ovary removal can reduce in 51% the risk of breast cancer in women which have mutations in BRCA1 or BRCA2 genes
  7. See American Cancer Society Guide to Male Breast Cancer: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_male_breast_cancer_28.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_male_breast_cancer_28.asp http://www.johnwnickfoundation.org/index.html
  8. http://www.breastcancer.org/symptoms/types/dcis/ According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases. There are two main reasons this number is so large and has been increasing over time: People are living much longer lives. As we grow older, our risk of breast cancer increases. More people are getting mammograms, and the quality of the mammograms has improved. With better screening, more cancers are being spotted early.
  9. Discuss inflammatory breast cancer to highlight the unique presentation of a particularly aggressive form of breast disease. http://www.mayoclinic.com/health/inflammatory-breast-cancer/DS00632/DSECTION=symptoms Other conditions have symptoms resembling those of inflammatory breast cancer. A breast infection (mastitis) also causes redness, swelling and pain, but breast infections usually develop during breast-feeding. With an infection, you're likely to have a fever, which is unusual (but not unheard of) in inflammatory breast cancer. Breast surgery or radiation therapy may block the lymphatic vessels in breast skin, temporarily making the breast swell and become discolored. When caused by surgery or radiation treatments, however, these changes gradually subside.
  10. http://breastcancer.about.com/od/types/p/ibc.htm Inflammatory breast cancer, unlike ductal or lobular breast cancers, is usually not detected until after it has reached a more advanced stage of development. It is treated first with chemotherapy, and then with surgery, which is exactly the reverse order in which ductal and lobular cancers are typically treated.
  11. http://www.breastcancer.org/symptoms/understand_bc/risk/factors.jsp “Although men can get breast cancer, too, women’s breast cells are constantly changing and growing, mainly due to the activity of the female hormones estrogen and progesterone. This activity puts them at much greater risk for breast cancer.”
  12. http://www.breastcancer.org/symptoms/understand_bc/risk/factors.jsp Weight. Being overweight is associated with increased risk of breast cancer, especially for women after menopause. Fat tissue is the body’s main source of estrogen after menopause, when the ovaries stop producing the hormone. Having more fat tissue means having higher estrogen levels, which can increase breast cancer risk. Diet. Diet is a suspected risk factor for many types of cancer, including breast cancer, but studies have yet to show for sure which types of foods increase risk. It’s a good idea to restrict sources of red meat and other animal fats (including dairy fat in cheese, milk, and ice cream), because they may contain hormones, other growth factors, antibiotics, and pesticides. Some researchers believe that eating too much cholesterol and other fats are risk factors for cancer, and studies show that eating a lot of red and/or processed meats is associated with a higher risk of breast cancer. A low-fat diet rich in fruits and vegetables is generally recommended. Exercise. Evidence is growing that exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week. Alcohol consumption. Studies have shown that breast cancer risk increases with the amount of alcohol a woman drinks. Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk. Smoking. Smoking is associated with a small increase in breast cancer risk. Exposure to estrogen. Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any breaks, can increase the risk of breast cancer. Some of these risk factors are under your control, such as: taking combined hormone replacement therapy (estrogen and progesterone; HRT) for several years or more, or taking estrogen alone for more than 10 years being overweight regularly drinking alcohol Recent oral contraceptive use. Using oral contraceptives (birth control pills) appears to slightly increase a woman’s risk for breast cancer, but only for a limited period of time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk. Stress and anxiety. There is no clear proof that stress and anxiety can increase breast cancer risk. However, anything you can do to reduce your stress and to enhance your comfort, joy, and satisfaction can have a major effect on your quality of life. So-called “mindful measures” (such as meditation, yoga, visualization exercises, and prayer) may be valuable additions to your daily or weekly routine. Some research suggests that these practices can strengthen the immune system. Radiation therapy to the chest. Having radiation therapy to the chest area as a child or young adult as treatment for another cancer significantly increases breast cancer risk. The increase in risk seems to be highest if the radiation was given while the breasts were still developing (during the teen years).
  13. http://www.cancer.gov/cancertopics/factsheet/risk/brca#16 American Cancer Society Screening Recommendations: Annual mammograms, starting at age 40 Clinical breast exams every year starting at age 40 every 3 years for women age 20-39 Self-breast exams monthly, starting at age 20 Surveillance: Mammography: Mammography can detect cancers several years before it can felt through a clinical exam. Mammography along with physical breast examination is the modality of choice for screening for catching early breast cancer. It has been recommended that women age 40 and older should have mammograms every 1 to 2 years. Digital mammograms represent a new technology that may be helpful in identifying breast cancers in younger women with dense breasts.  Computer Aided Detection is being used more frequently in an attempt to improve the accuracy of mammograms. MRI or magnetic resonance imagery is a sensitive tool but is extremely expensive and has a high number of false positives.  MRIs in conjunction with mammograms are recommended only for women at the highest risk, meaning with a genetic mutation or a strong family history of breast or ovarian cancer. Clinical and self breast exams: A clinical breast examination, in which a doctor or nurse examines the breast for lumps or irregularities, is recommended once every three years starting at age 20, then once a year at age 40 and up. Studies have shown that self-exams do not reduce breast cancer death rates, but at least 40% of breast cancers are identified by women doing self-exams. Risk Avoidance: Studies suggest that obesity after 50 plays a role in  breast cancer and may increase the risk of developing post- menopausal breast cancer. Dietary fats may increase your risk of developing breast cancer.  Diets high in fruits, vegetables, and grains may help to reduce the risk. Some vitamins and minerals are thought to protect against breast cancer, specifically vitamins A, C, D, and E, and calcium, selenium, and iodine. Some doctors recommend that breast cancer patients take antioxidant supplements. Monitor your alcohol intake.  Small amounts of alcohol have been shown to be protective against heart disease, but  excess alcohol may play a  role in breast cancer. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. Exercise Studies have shown that four hours per week of exercise reduced the risk of breast cancer by 50%. The risk was even lower if exercise had been part of your regimen since the teens and 20s Chemoprevention: Tamoxifen is a type of drug called a selective estrogen receptor modulator (SERM). SERMs act by blocking any estrogen present in the body from attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors and killing tumor cells. Tamoxifen can be used in both pre- and postmenopausal women. http://www.mayoclinic.com/health/breast-cancer/DS00328/DSECTION=treatments-and-drugs http://www.cancer.gov/STAR The Study of Tamoxifen and Raloxifene, or STAR, is a clinical trial designed see how the drug raloxifene compares with the drug tamoxifen in reducing the incidence of breast cancer in postmenopausal women who are at increased risk of the disease. Initial results of STAR show that the drug raloxifene is as effective as tamoxifen in reducing the breast cancer risk of the women on the trial. In STAR, both drugs reduced the risk of developing invasive breast cancer by about 50 percent. In addition, within the study, women who were assigned to take raloxifene daily and who were followed for an average of about four years, had 36 percent fewer uterine cancers and 29 percent fewer blood clots than the women who were assigned to take tamoxifen. Uterine cancers, especially endometrial cancers, are a rare but serious side effect of tamoxifen. Both tamoxifen and raloxifene are known to increase a woman's risk of blood clots. Participants in STAR who were assigned to take raloxifene had fewer serious side effects from that drug than participants assigned to take tamoxifen, including fewer uterine cancers, blood clots, and cataracts
  14. http://www.cancer.gov/cancertopics/factsheet/Detection/mammograms http://www.costhelper.com/cost/health/mammogram.html
  15. A few key points: http://www.breastcancer.org/treatment/surgery/mast_vs_lump.jsp Surgery: Research shows that lumpectomy followed by radiation is likely to be equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor). Chemotherapy: Discuss recent developments in genomic assays like Oncotype DX, which personalize treatment plans by analyzing pt’s genetic profiles to predict likelihood of chemotherapeutic response and adverse effects. http://www.breastcancer.org/symptoms/testing/types/oncotype_dx.jsp If you have early-stage, ER+ breast cancer, Oncotype DX is a test that can help you and your doctor make a more informed decision about whether or not you need chemotherapy. When is radiation appropriate? http://www.breastcancer.org/symptoms/testing/types/oncotype_dx.jsp Brachytherapy, also known as internal radiation, is another way to deliver radiation therapy. Instead of aiming radiation beams from outside the body, radioactive seeds or pellets are placed directly into the breast tissue next to the cancer. It is often used as a way to add an extra boost of radiation to the tumor site (along with external radiation to the whole breast), although it may also be used by itself (see below). Tumor size, location, and other factors may limit who can get brachytherapy. http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_5.asp Brachytherapy, compared to whole body irradiation, is associated with many advantages such as reduction of the treatment duration from 6.5 weeks to 5 days, minimal scar tissue formation, and intact and unaffected implant. Since, it also helps to effectively control the tumor growth with lesser side effects, the partial radiation therapy may serve as an alternative treatment modality to women with early stage breast cancer following augmentation mammoplasty. Vaccines: http://www.reuters.com/article/pressRelease/idUS133892+23-Feb-2009+PRN20090223 http://www.washingtonpost.com/wp-dyn/content/article/2008/04/13/AR2008041301616.html http://www.apthera.com/products.php?id=3
  16. Discuss triple negative breast cancer to highlight a particularly hard to treat form of breast disease. http://www.biparsciences.com/000010.html
  17. http://bcresourcedirectory.org/directory/11-survivorship_index.htm “From the very instant you receive your diagnosis of breast cancer until you take the very last breath of life, you are a survivor. While survivorship is the goal of treatment, reaching and living it does not mean life becomes less complicated.” Once a woman is diagnosed with breast cancer, the initial news and subsequent treatment regimens, which are often difficult physically and emotionally, will transform her life and the lives of loved ones and friends around her.
  18. http://www.breastcancer.org/treatment/comp_med/types/ Along with conventional treatments such as chemotherapy, radiation and surgery, complementary medicine can play an important adjunct role in improving the well-being of breast cancer patients. Complementary medicine includes techniques such as acupuncture, herbal medicine, massage, support groups, and yoga. Sometimes called holistic medicine, complementary medicine typically addresses how disease affects the whole person: physically, emotionally, spiritually, and socially. Examples: Much research is being done on how acupuncture can help relieve some of the symptoms of cancer and side effects of cancer treatment. Acupuncture has been shown to help relieve fatigue, hot flashes, nausea, vomiting, and pain. One study, completed at Duke University and published in 2002, compared the use of acupuncture to the use of Zofran (chemical name: ondansetron), an anti-nausea medication, before breast cancer surgery to reduce the nausea that can occur after surgery. The acupuncture treatment was found to work better than Zofran at controlling nausea. 2. Although there are no scientific studies showing that Reiki is effective in treating any disease, a Reiki treatment may be able to bring about feelings of: deep relaxation warmth or sleepiness increased well-being Support groups There have been a number of studies about the potential benefits of support groups for people with breast cancer. In 2005, a review article compared 5 studies (one not yet complete) involving support groups for patients with metastatic breast cancer. The article reported that while one study identified increased survival time resulting from participation in support groups, 9 other studies did not show survival benefits. All of the studies, however, reported that participation in support groups resulted in positive effects on psychological well-being.
  19. http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp http://www.clevelandleader.com/node/8843 Summary slide reviewing factors involved in improving breast cancer survival: increased awareness/screening, new treatments/technologies, advocacy efforts, etc.
  20. Discuss how advocacy has been pivotal to the survival of women and men through efforts that raise awareness, advocate for research, and consolidate funding for the breast cancer cause. Pass out “Ten Ways To Advocate for Breast Cancer Awareness” and Komen/Army of Women documents downloadable on AMSA’s website.