Breast Cancer An Overview

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Breast CancerAn Overview

• Dr. Christina Tzagarakis-Foster
• November 9, 2006

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Breast Cancer Statistics
-Breast cancer is the second leading cause of
cancer-related deaths in women today -Most
common cancer among women worldwide (excluding
nonmelanoma skin cancers) - Male breast cancers
account for approximately 1 of all breast cancer
cases. -The American Cancer Society estimates
that in 2006, approximately 212,920 women in the
United States will be diagnosed invasive breast
cancer.
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Life-time risks of developing BC

• Age Specific Probabilities of Developing Breast
  Cancer
• Probability of Developing Breast Cancer Within 10
  Years
• Age Within 10
  Years or 1 in
• 20   0.04 2500
• 30   0.43 233
• 40   1.55
  65
• 50   2.44 41
• 60   3.44 29

REF  American Cancer Society. Breast cancer
facts figures 2001-2002. Atlanta, GA ACS,
Inc., 2001.
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Ethnic Profile

• White, Hawaiian, and African-American women have
  the highest incidence of invasive breast cancer
  in the US
• Korean, American Indian, and Vietnamese women
  have the lowest incidence of invasive breast
  cancer in the United States.
• African-American have the highest death rate
  from breast cancer and are more likely to be
  diagnosed with a later stage of breast cancer
  than White women.

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Cases of BC Worldwide

• Top 3 countries - Iceland, Denmark, Netherlands
• The risk of getting breast cancer worldwide is
  lowest in western Africa and eastern Asia. But
  studies show women can take on the breast cancer
  risk of the country they move to within as little
  as one generation.

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What is Cancer?

• Abnormal cell division
• Due to mutations in DNA

dominant recessive
REF Alberts, Molecular Biology of the Cell
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Types of Breast Cancer

• Majority (over 80) begins in either the milk
  ducts or the lobular (milk-producing) tissue.
• Either type, if diagnosed early enough, may be
  called in situ (IDC).

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• Lobular carcinoma in situ (LCIS) It is a
  lesion found in the milk-glands that has not
  spread. Although not a true cancer, it may
  increase the risk of developing into cancer
  later.
• Ductal carcinoma in situ (DCIS) This is breast
  cancer at its earliest stage that has not spread.
  Nearly 100 of women with cancer at this stage
  can be cured.
• Invasive lobular carcinoma (ILC) This cancer
  starts in the milk glands (lobules), breaks
  through the wall of the gland and invades the
  fatty tissue of the breast.
• Invasive ductal carcinoma (IDC) This cancer
  starts in the milk ducts, breaks through the wall
  of the duct, and invades the fatty tissue of the
  breast. IDC is the most common type of breast
  cancer, as it accounts for nearly 80 of breast
  cancer.

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Stages of Breast Cancer

• Stage 0 (called carcinoma in situ)
• refers to abnormal cells lining a gland in the
  breast (Lobular carcinoma in situ or LCIS) or
  abnormal cells lining a duct (Ductal carcinoma in
  situ or DCIS).
• Stage I
• early stage breast cancer where the tumor is
  less than 2 cm across and hasn't spread beyond
  the breast.
• Stage II
• early stage breast cancer where the tumor is
  either less than 2 cm across and has spread to
  the lymph nodes under the arm or the tumor is
  between 2 and 5 cm or the tumor is greater than
  5 cm and hasn't spread outside the breast
• Stage III
• locally advanced breast cancer where the tumor
  is greater than 5 cm across and has spread to the
  lymph nodes under the arm or the cancer is
  extensive in the underarm lymph nodes or the
  cancer has spread to lymph nodes near the
  breastbone or to other tissues near the breast
• Stage IV
• metastatic breast cancer where the cancer has
  spread outside the breast to other organs in the
  body

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Detection of BC

• BSE/CSE
• Mammogram
• Ultrasound
• MRI

REFhttp//familydoctor.org/018.xml
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Inherited BC

• 5-10 of all breast cancers are inherited
• BRCA1 and BRCA2 most common genes related to
  hereditary BC
• autosomal dominant pattern
• It is estimated that 86 percent of the women
  with a mutation in the BRCA-1 gene will develop
  breast cancer by age 70.

REF http//ghr.nlm.nih.gov/conditionbreastcancer
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Other Genetic Factors

• Variations of the ATM, CHEK2, and RAD51 genes
  increase the risk of developing breast cancer.

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Spontaneous BC

• p53
• HER2/cerbB-2/neu
• ER?/ER?

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BC Treatments Therapies

• Surgery and radiation treatment
• Chemotherapy

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Estrogen Receptors Bind Estrogen
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BC Therapies (cont)

• SERMS (Tamoxifen)
• Aromatase Inhibitors

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BC therapies (cont)

• Herceptin (Trastuzumab) Genetech

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Risk Factors

• Age
• Gender
• Race
• Genetic
• Long menstrual history
• Environmental
• Reproductive

REF From the Environmental Epidemiology
Branch, Division of Cancer Etiology, National
Cancer Institute, Bethesda, Maryland
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Risk Factors (cont)

• HRT
• Ionizing Radiation
• Obesity
• Alcohol
• Physical Activity

REF http//www.cancer.org/docroot/CRI/content
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Social Impact of BC

• Alters the womans self image
• Impacts the womans sexuality
• Impacts her relationships
• Isolates her from her peers
• Imposes financial burdens
• Causes changes in lifestyle

Sammarco A. Psychosocial stages and quality of
life of women with breast cancer. Cancer Nurs.
2001 Aug24(4)272-7.   
Shapiro SL, Lopez AM, Schwartz GE, et al. Quality
of life and breast cancer relationship to
psychosocial variables. J Clin Psychol. 2001
Apr57(4)501-19.  
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Breast Cancer Rates in Marin County
Marin County Breast Cancer Rates Flawed
(dateline June 1, 2003) REF http//imaginis.com/b
reasthealth/news/news6.01.03.asp
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References

• http//www.cancer.org
• http//ghr.nlm.nih.gov/conditionbreastcancergene
  s
• http//www.hologic.com/lc/brhealthrf.htmrf
• www.komen.org
• www.nci.org