What you need to know: Breast Cancer

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What you need to knowBreast Cancer
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BREAST CANCER

• Pamela Esquivel, NP-C
• Breast Health Center
• Loma Linda University Medical Center

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What is cancer?

• A group of diseases characterized by uncontrolled
  growth and spread of abnormal cells.
• Everyone is at risk of developing cancer.
• 2nd leading cause of death, behind heart
  diseases.

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What is Breast Cancer?

• A malignant tumor from cells in the breast
• Main Types ductal carcinomas and lobular
  carcinomas.
• Mostly found in women but men can get it too!

Normal breast tissue
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How Common is Breast Cancer?

• Estimated 184,450 new cases in the United States
  in 2008 (1990 men)
• In California 21,160 new cases (130 men)
• Estimated 40, 930 deaths in the United States in
  2008 (450 men)
• In California 4,235 deaths (30 men)
  

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Probability of Developing Invasive Breast Cancer

• Birth to 39 1 in 210
• 40-59 1 in 26
• 60-69 1 in 28
• 70 1 in 15
• Birth to death 1 in 8

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How Common is Breast Cancer?

• The most common form of cancer in women
  (after skin cancers)
• The second leading cause of cancer death for
  women, after lung cancer.

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Warning Signs

• Breast lump or thickening
• Nipple changes or drainage
• Skin irritation or dimpling
• Skin scaliness or redness
• Enlarged lymph node
• Early cancer in most cases has no symptoms or
  warning signs. Early detection guidelines should
  be followed.

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Non-modifiable Risk Factors

• Being female
• Being over 50
• Having a family history
• Age at menarche
• Age at natural menopause
• Exposure to Radiation
• Previous breast cancer

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Modifiable Risk Factors

• Pregnancy/Breastfeeding
• Obesity
• Hormone Replacement Therapy
• Oral contraceptive use
• Alcohol
• Physical Activity

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Mammography, Women 40 and Older US, 2003

• Mammogram within the past year
• Immigration
• Born in US 55.4
• Born in US Territory 58.7
• In US less than 10 years 40.6
• In US 10 years 53.0

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DetectionMammograms can save your life!

• A mammogram is an X-ray of the breast
• Medicare, MediCal and most insurances will pay
• Help exists for low income women with no
  insurance
• Get a mammogram yearly once you turn 40

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Tips for Good Mammograms

• Use an FDA certified mammography service
• Use the same facility for easy yearly comparisons
• If you change facilities, bring copies of old
  mammograms
• Avoid the week right before your period when
  breasts are sore

• Dont wear deodorant, powder or cream under your
  arms
• Bring a list of any previous breast treatments
  you may have had
• Follow up to get your results dont assume
  things are normal

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If Your Mammogram is not normal.

• An abnormal mammogram doesnt mean you have
  cancer 10 of women need repeat mammograms
• Of these, 8 10 have needle biopsies performed
  to get more information

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Mammogram
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Breast Cancer
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Breast Cancer
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If You Find You Have CancerTreatment Options

• The 5-year survival rate for cancer found
  localized is 95
• Early Stage mastectomy or local removal with
  radiation therapy.
• Systemic Therapy Hormones and/or combination
  chemotherapy.
• Later Stage combination chemotherapy or
  hormones and radiation therapy for selected
  clinical problems

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Surgical Treatment of Breast Cancer

• Which surgical option is best? Consider
• Size of tumor in relation to breast
• Cosmesis
• Multicentricity, multiple tumors
• Extensive DCIS at resected margins
• Previous breast irradiation, or any
  contraindication to radiation therapy (collagen
  vascular dz, severe pulmonary dz)
• Patient preferences

• Lumpectomy /- SLN bx/ALND PLUS XRT
• Total Mastectomy /- SLN bx/ALND
• Modified radical mastectomy (MRM) total
  mastectomy ALND
• Radical mastectomy includes removal of pectoralis
  muscles, rarely done

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Radiation Therapy

• 5 days per week for 5-6 weeks
• Begins approximately 3 to 6 weeks after surgery
  to ensure complete healing has taken place
• Done after adjuvant chemotherapy
• Done after lumpectomy, sometimes after mastectomy
  (tumor at chest wall, tumor gt/ 5cm, 4 or more
  LN, inflammatory breast cancer, locally advanced
  breast cancer)

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Reconstruction

• Can be delayed or immediate
• Implants/tissue expanders
• Myocutaneous flaps common donor sites are lower
  abdomen (TRAM), back (Latissimus flap), lateral
  hip
• DIEP (deep inferior epigastric perforator)
  flap-no muscle is removed

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Medical Treatment of Breast Cancer

• Chemotherapy
• Most common Doxorubicin (Adriamycin),
  Cyclophosphamide (Cytoxan), Taxanes (Taxotere,
  Taxol) 5-Flourouracil (5FU), Methotrexate
  Trastuzumab (Herceptin)-for tumors
  overexpressing HER2
• Used in combination A/C, CMF, TAC
• Can be neoadjuvant (pre-op), and/or adjuvant
  (post-op)

• Hormonal therapy
• Tamoxifen
• Aromatase inhibitor (prevents estrogen conversion
  peripherally)
• Letrozole/Anastrozole
• Chemoprevention
• Tamoxifen
• NSABP P2 trial (STAR)
• Compares Tamoxifen versus Raloxifene
• Others? (aspirin, statins)

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Can Breast Cancer Risk Be Reduced?

• Remember the other modifiable risk factors such
  as
• your diet
• alcohol consumption
• exercising 30 minutes a day!

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Risk ReductionEat Your Fruits and Vegetables

• Eat at least 5 servings of fruits and vegetables
  a day
• Limit your consumption of high-fat meats and
  dairy
• Drink lots of water

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PreventionWatch your weight

• Maintain a healthful weight throughout life,
  balance caloric intake with physical activity
• Adopt a physically active lifestyle
• 30 minutes or more 5 days a week
• 45 minutes or more of moderate to vigorous 5 days
  a week, may further reduce risk to Breast Cancer

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ACS Breast Cancer Screening Recommendations

• Yearly mammograms starting at age 40 and
  continuing for as long as you are healthy.
• CBE every 3 years for women in their 20s and
  30s, yearly for women 40 and over.
• Notify your doctor without delay if you notice
  any changes in your breasts. BSE is an option for
  women to find changes starting in their 20s.
• Women at increased risk should talk to their
  doctors about benefits and limitations of
  starting mammography testing earlier and having
  additional tests with new technologies.

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How to get more information

• The American Cancer Society can help
• 1-800-ACS-2345
• www.cancer.org

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Thank you