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- 1. Evidence Analysis Case Study Lauren Gizzi Is there a correlation between serum vitamin D levels and the development and/or progression of breast cancer?
- 2. OVERVIEW • Background of Breast Cancer • Background of Serum Vitamin D • Introduction of Patient • EAL Question • PICO • Inclusion & Exclusion criteria • Included Articles • Excluded Articles • Conclusion & Grade
- 3. Breast Cancer • Breast cancer is an uncontrolled growth of breast cells. • It usually begins in the cells of the lobules or the ducts • Less commonly it can begin in the stromal tissues • Overtime it can invade healthy breast tissue and into the lymph nodes. • Once in the lymph nodes- it has access to spread to other body parts via pathways. • Breast Cancer’s stage refers to how far the cancer cells have spread beyond the original tumor.
- 4. Types of Breast Cancer • DCIS- Ductal Carcinoma In Situ- (non-invasive) • IDC – Invasive Ductal Carcinoma • Tubular Carcinoma • Medullary Carcinoma • Mucinous Carcinoma • Papillary Carcinoma • Cribriform Carcinoma • ILC- Invasive Lobular Carcinoma In Situ (non- invasive) • LCIS- Lobular Carcinoma • Male Breast Cancer • Paget’s Disease of the Nipple • Phllodes Tumor of the Breast • Recurrent and Metastatic Breast Cancer
- 5. Breast Cancer Subtypes • Four major molecular subtypes: • Luminal A • Luminal B • Triple negative/basal-like • HER2 type
- 6. TNM Staging System • TNM (Tumor, Node, Metastasis) TX – the tumor can’t be measured or found T0 – no evidence of the primary tumor Tis – cancer is “in situ” T1,2,3,or 4 – numbers based on the size of the tumor and extent to which it has grown into the neighboring tissue. The higher the # the larger the tumor and/or the more it has grown into the breast tissue NX – the nearby lymph nodes cant be measured N0 – nearby lymph nodes do not contain cancer N1,2, or 3 – Based on the # of lymph nodes involved and how much cancer is found in them. The higher the # the greater the extent of the lymph node involvement MX – metastasis cant be measured or found M0 – there is no distant metastasis M1 – distant metastasis is present
- 7. Stages of Breast Cancer • Stage 0 • Stage I • Stage II • Stage III • Stage IV
- 8. Breast Cancer Classifications • HR+ or HR- • ER+ or ER– • PR+ or PR– • HER2+ or HER2– • Triple+ or Triple–
- 9. Vitamin D • Fat-soluble vitamin that is important for good overall health and strong and healthy bones. Also an important factor in making sure muscles, heart, lungs, and brain work well and your body can fight infection. • Serum 25(OH)D is the best indicator of vitamin D status Serum 25 hydroxy-vitamin D abbreviated as 25OHD
- 10. How do we get vitamin D • Sunlight* • Naturally in the diet: • Fatty Fish (salmon & tuna) • Fish liver oil (cod liver oil) • Liver • Egg yolks • Fortified Foods • Milk • Juice • Breads • Cereals • Dietary Supplements and/or MVI
- 11. Introduction to Patient-LL • LL is a 42 year old woman with R sided breast cancer. • Underwent R sided mastectomy w/ a L prophylactic Mastectomy • She will require radiation post op and will have a latissimus flap preformed on the R to protect the expander tissue • Cancer type: invasive ductal carcinoma Right – Stage 3 T3N3 ER+, PR+, HER2-
- 12. Is there a correlation between serum vitamin D levels and the development and/or progression of breast cancer?
- 13. PICO P-population I-intervention O-outcome Women with breast cancer Serum vitamin D concentrations Concentration levels affect breast cancer development and/or progression of the disease
- 14. Inclusion/Exclusion Criteria CRITERIA INCLUDED EXCLUDED Subjects Non-pregnant woman Pregnant women, non- human (animals) & men Age _ _ Health Status Breast Cancer Other Cancers Year 1999-present Prior to 1999 Outcome Affect on development and/or progression Affect on Survival Other Study Design Case-Control Prospective Meta-analysis Other Intervention Vitamin D Other vitamins/minerals
- 15. Search Plan & Results • Search Engines: • Science Direct • AACR Journals • Google Scholar • Mahoney Library • Open Access • Search Terms: • Breast Cancer • Serum Vitamin D • Development • Total Number of Articles: 15 • Included:6 • Excluded: 9
- 16. If you would like to know more about this topic and the results of the case study, please feel free to contact me. Thank You
Editor's Notes
- Breast cancer refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk producing glands, or in the ducts, the passage that drain milk from the lobules to the nipple. Less commonly it can begin in the stromal tissue, which include the fatty and fibrous connective tissues of the breast. Overtime it can invade healthy breast tissue and make its way into the lymph nodes, small organs that filter out foreign substances in the body. if cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. Breast Cancer’s stage refers to how far the cancer cells have spread beyond the original tumor.
- So as I mentioned breast cancer can be in different areas of the breast – the ducts, the lobule, or in some cases, the tissue in between. The tissue removed during the biopsy (or during surgery) is first looked at under a microscope to see if cancer is present and whether it is a carcinoma or some other type of cancer (like a sarcoma). then if there is enough tissue, the pathologist may be able to determine if the cancer is in situ (not invasive) or invasive. The biopsy is also used to determine the cancer's type, such as ductal or lobule carcinomas _ Inflammatory breast cancer = a rare, rapidly developing cancer that makes the breast red, swollen, and tender. Paget's disease of the breast starts on the nipple and extends to the dark circle of skin around the nipple. Most Phyllodes tumors are benign, but 10 percent are malignant. These tumors are a form of sarcoma because they grow in the connective tissue of the breast, not in the ducts
- Most breast cancers are luminal tumors. Luminal tumor cells look the most like cells of breast cancers that start in the inner (luminal) cells lining the mammary ducts. luminal A tumors tend to have the best prognosis, with fairly high survival rates and fairly low recurrence rates Compared to luminal A tumors, luminal B tumors also tend to have factors that lead to a poorer prognosis including: Poorer tumor grade, Larger tumor size, Lymph node-positive Triple negative/basal-like tumors are often aggressive and have a poorer prognosis (at least within the first five years after diagnosis)
- The T (size) category describes the original (primary) tumor. The N (lymph node involvement) category describes whether or not the cancer has reached nearby lymph nodes The M (metastasis) category tells whether or not there is evidence that the cancer has traveled to other parts of the body. subscript Once your TNM characteristics are known, the pathologist assigns a stage to the cancer. For example, a T1 N0 M0 breast cancer would mean that the breast tumor is less than 2 centimeters across (t1), has not involved the lymph nodes (N0), and has not spread to the distant parts of the body (m0). This example would be grouped as a stage 1.
- Based on how closely the biopsy sample looks to normal breast tissue and how rapidly the cancer cells are dividing. The grade can help predict a woman’s prognosis. In general, a lower grade number indicates a slower growing cancer that is less likely to spread while a higher number indicates a faster growing cancer that is more likely to spread. Stage 0 would indicate there is no evidence of cancer cells breaking out of the part of the breast in which they started or getting through to or invading neighboring normal tissue Stage 1 – the tumor measures up to 2 centimeters and no lymph nodes are involved Stage 2 – invasive; tumor measures between 2-5 centimeters or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage 3 – locally advanced; the tumor in the breast is more than 1 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast Stage 4 – metastatic; cancer has spread beyond the breast, underarm, and internal mammary lymph nodes or to other parts of the body near to or distant from the breast The tumor grade helps in deciding whether or not further treatment is needed following surgery
- Classified based on hormone receptors and HER 2 status HR meaning “hormone receptor” ER meaning “estrogen receptor” PR meaning “progesterone receptor” If the breast cancer cells contain either estrogen or progesterone receptors, they can be called hormone receptor-positive (or just hormone-positive). If the breast cancer cells don’t have either estrogen or progesterone receptors, they are said to be hormone receptor-negative HER2 positive: are Cancers that have too much HER2 protein or extra copies of the HER2 gene HER2 negative: are Cancers that don’t have excess HER2 And lastly, If the breast cancer cells don’t have estrogen or progesterone receptors and don’t have too much HER2, they are called triple-negative whereas cancers that are ER-positive, PR-positive, and have too much HER2 are triple positive
- Serum 25 hydroxy-vitamin D as abbreviated into 25OHD
- *Sunlight is the main source of vitamin D. When our skin is exposed to it, certain biological processes convert sunlight into vitamin D in our bodies.
- Which for those of you who don’t know a Prophylactic mastectomy is surgery to remove one or both breasts to reduce the risk of developing breast cancer. Your latissimus dorsi muscle is located in your back, just below your shoulder and behind your armpit. It's the muscle that helps you do twisting movements. In a latissimus dorsi flap procedure, an oval flap of skin, fat, muscle, and blood vessels from your upper back is used to reconstruct the breast. This flap is moved under your skin around to your chest to rebuild your breast. The blood vessels of the flap are left attached to their original blood supply in your back. A breast tissue expander is an inflatable breast implant designed to stretch the skin and muscle to make room for a future, more permanent implant. a tissue expander is inserted beneath your skin and chest muscle. the nurse practitioner will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander will be removed in a second operation and either flap reconstruction or a permanent implant will be inserted. No M (metastasis) specified in her chart