Breast cancer

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• Breast cancer
• Not a single disease.
• Type and stage.
• Grade/Lympho-vascular invasion
• Molecular biology.
• ER\PR
• Her-2-neu
• Other.
• Gene expression profiling. (Tumor and Patient)

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• What causes cancer?
• DNA damage. WHY? Always!
• Radiation, random, metabolic, toxins.
• Free radicals, adducts, breaks.
• Incomplete DNA repair.
• Error transmission.
• Failure to recognize damage.
• Failure to initiate programmed cell death.
• Lack of immune response.
• Suppression of normal genes
• Promotion of cellular proliferation

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Genetic Issues

• BRCA 1 and 2.
• Other p53, AT. PTEN
• Cancer susceptibility genes.
• Polymorphisms.
• Polygenic risk (the individuals genetic
  fingerprint)

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Breast Cancer Types

• Basal-like
• Luminal A ER good outcome
• Luminal B ER bad outcome
• Normal breast-like
• HER2/ER-

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The Future

• Microarrays
• Proteomics
• Positron Emission Mammography
• ?Percutaneous Lesion Destruction
• Personalized Therapy

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Microarrays

• Amsterdam 70
• Oncotype Dx20
• Estrogen-regulated gene set 1E 2E

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The Butterfly Effect

• Small initial changes can result in major
  variations in final conditions.