Post on 09-Jan-2016
description
Breast Breast CancerCancer
DR/FATMA AL-THOUBAITYASSOCIATE PROFESSORSURGICAL CONSULTANT
Introduction.Introduction. Epidemiology.Epidemiology. Risk factor.Risk factor. Clinical features.Clinical features. Screening.Screening. BSE.BSE.
18.8%.18.8%. 30.6% less than 40 years.30.6% less than 40 years. 73.5 % locally advanced disease.73.5 % locally advanced disease.
Breast cancer :a lot to be done’’. Breast cancer :a lot to be done’’. JKAU:Med Sci,vol 7,(1999).JKAU:Med Sci,vol 7,(1999).
The most common form of cancer The most common form of cancer among women.among women.
The second most common cause of The second most common cause of cancer related mortality.cancer related mortality.
1 of 8 women (12.2%)1 of 8 women (12.2%) One third of women with breast One third of women with breast
cancer die from breast cancer.cancer die from breast cancer.
What is breast cancer?What is breast cancer? Breast cancer is where cancerous Breast cancer is where cancerous
(malignant) cells are found in the (malignant) cells are found in the breast tissue.breast tissue.
There are several types of breast There are several types of breast cancer.cancer.
Ductal cancer (effects the ducts Ductal cancer (effects the ducts and also is the most common and also is the most common type)type)
Lobular .Lobular . Inflammatory cancer.Inflammatory cancer.
Types of breast cancerTypes of breast cancer
In situIn situ Intraductal (DCIS)Intraductal (DCIS) Intralobular (LCIS)Intralobular (LCIS)
InvasiveInvasive Infiltrating ductal carcinomaInfiltrating ductal carcinoma Tubular carcinomaTubular carcinoma Medullary carcinomaMedullary carcinoma Mucinous carcinomaMucinous carcinoma
Breast Cancer-Breast Cancer-EpidemiologyEpidemiology
#1 noncutaneous cancer in U.S. women#1 noncutaneous cancer in U.S. women >200,000 cases of invasive disease in 2002>200,000 cases of invasive disease in 2002
#2 cancer death (North American women)#2 cancer death (North American women) (#1=lung cancer) (#1=lung cancer) 40,000 deaths in 200240,000 deaths in 2002
1 in 8 lifetime incidence1 in 8 lifetime incidence 1 in 30 women will die of breast cancer1 in 30 women will die of breast cancer Incidence increases with ageIncidence increases with age
Risk Factors for Risk Factors for BreastBreast Cancer Cancer
Female (1% male)Female (1% male) AgingAging Relative (mother Relative (mother
or sister)or sister) Menstrual historyMenstrual history
early on setearly on set late menopauselate menopause
Child birthChild birth After the age of 30After the age of 30
Exogenous EstrogenExogenous Estrogen Hormonal replacement Hormonal replacement
therapy(HRT)therapy(HRT) 30% increased risk 30% increased risk
with long term use with long term use Oral Contraceptives(OC)Oral Contraceptives(OC)
risk slightrisk slight risk returns to normal risk returns to normal
once the use of OC’s once the use of OC’s has been discontinuedhas been discontinued
Risk Factors for Risk Factors for BreastBreast CancerCancer
Radiation exposureRadiation exposure Breast diseaseBreast disease
Atpyical HyperplasiaAtpyical Hyperplasia Intraductal carcinoma in situIntraductal carcinoma in situ Intralobular carcinoma in situIntralobular carcinoma in situ
ObesityObesity DietDiet
FatFat AlcohoAlcoholl
GeneticsGenetics BRCA-1BRCA-1 BRCA-2BRCA-2 P53, Rb-1P53, Rb-1 Her-2/neu, c-Her-2/neu, c-
erB2, c-mycerB2, c-myc
Incidence of Breast CA Incidence of Breast CA Increases with AgeIncreases with Age
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10
Probability of
Developing Invasive Breast CA
(% )
Age 30 Age 40 Age 50 Age60
Current Patient Age
next 10 yrnext 20 yrnext 30 yr
Abnormal signs and Abnormal signs and symptomssymptoms
PuckeringPuckering DimplingDimpling RetractionRetraction Nipple dischargeNipple discharge Thickening of skin or lump or Thickening of skin or lump or
“knot”“knot” Retracted nippleRetracted nipple
Abnormal signs and Abnormal signs and symptomssymptoms
Change in breast sizeChange in breast size Pain or tendernessPain or tenderness RednessRedness Change in nipple positionChange in nipple position Scaling around nipplesScaling around nipples Sore on breast that does not Sore on breast that does not
healheal
Methods of Methods of DetectionDetection
Clinical exam by MD or Clinical exam by MD or nursenurse
MammographyMammographyMonthly breast self-exam Monthly breast self-exam
(BSE)(BSE)
Mammography-Mammography-SensitivitySensitivity
Sensitivity is 77-95% overall Sensitivity is 77-95% overall 54-58% in women < 40 54-58% in women < 40 81-94% in women > 6581-94% in women > 65
Depends on lesion size, conspicuity, tissue Depends on lesion size, conspicuity, tissue density, patient age, hormone status, image density, patient age, hormone status, image quality, and interpretive skill of the radiologistquality, and interpretive skill of the radiologist
There is inter- and intra-observer variability in There is inter- and intra-observer variability in the interpretation by the radiologistthe interpretation by the radiologist
MammogramsMammograms Getting a mammogram is an Getting a mammogram is an
effective way to detect breast effective way to detect breast cancer in its early stages.cancer in its early stages.
It is recommended by the It is recommended by the AMERICAN CANCER SOCIETY AMERICAN CANCER SOCIETY that all women over 40 get a that all women over 40 get a yearly mammogram. yearly mammogram.
Its also recommended that Its also recommended that women over 20 should get a women over 20 should get a mammogram every 2-5 years mammogram every 2-5 years depending on your risk.depending on your risk.
(picture courtesy of breast cancer.org)(picture courtesy of breast cancer.org)
.
Mammography Mammography
Why don’t women get Why don’t women get MXR’s?MXR’s?
Factors that may discourage annual mammography among low-Factors that may discourage annual mammography among low-income women with access to free mammograms: a study using income women with access to free mammograms: a study using multi-ethnic, multiracial focus groups. Bobo JK, multi-ethnic, multiracial focus groups. Bobo JK, Psychol. RepPsychol. Rep. . Oct. 1999, 85(2).Oct. 1999, 85(2).
Fear of radiation, anxiety that may not find Fear of radiation, anxiety that may not find CA, worry that CA might actually be detected, CA, worry that CA might actually be detected, embarrassment, discomfort, painembarrassment, discomfort, pain
Factors assoc. w/ higher rates: Factors assoc. w/ higher rates: higher income, ages 65-74, non-white raceshigher income, ages 65-74, non-white races Also higher in women who obtain regular Also higher in women who obtain regular
check ups or who are vitamin userscheck ups or who are vitamin users
Clinical examinationClinical examination Performed by doctor or Performed by doctor or
trained nurse practitionertrained nurse practitioner Annually for women over Annually for women over
4040 At least every 3 years for At least every 3 years for
women between 20 and 40women between 20 and 40 More frequent examination More frequent examination
for high risk patientsfor high risk patients
Clinical Breast Exam Clinical Breast Exam (CBE)(CBE)
Sensitivity is 40-69%Sensitivity is 40-69%
Specificity is 86-99%Specificity is 86-99%
PPV is 4-50%PPV is 4-50% In one study, only 4% of women with an In one study, only 4% of women with an
abnormal CBE had cancerabnormal CBE had cancer
Staging of Breast CancerStaging of Breast Cancer
The American Joint Committee The American Joint Committee on Cancer (AJCC) has designated on Cancer (AJCC) has designated staging by TNMstaging by TNM
T= tumor sizeT= tumor size N = lymph node involvementN = lymph node involvement M = metastasisM = metastasis
Monthly Self ExamsMonthly Self Exams Its important to remember Its important to remember
that monthly self exams are that monthly self exams are also a good tool for early also a good tool for early detection.detection.
Hereis a web site that has the Hereis a web site that has the complete monthly self-exam complete monthly self-exam program @program @
.cyberus.ca/bse2.htm#bse2 http://www.infobreastcancer
Picture courtesy of Yahoo healthPicture courtesy of Yahoo health
Breast Self Exam (BSE)Breast Self Exam (BSE)
Accuracy of BSE is unknownAccuracy of BSE is unknown
Estimate of sensitivity: 26-41%Estimate of sensitivity: 26-41%
Specificity is unknownSpecificity is unknown
Breast Self Breast Self ExaminationExamination
Opportunity for woman Opportunity for woman to become familiar to become familiar with her breastswith her breasts
Monthly exam of the Monthly exam of the breasts and underarm breasts and underarm areaarea
May discover any May discover any changes earlychanges early
Begin at age 20, Begin at age 20, continue monthlycontinue monthly
When to do BSEWhen to do BSE Menstruating women- 5 to 7 Menstruating women- 5 to 7
days after the beginning of days after the beginning of their periodtheir period Menopausal women - Menopausal women - same date each monthsame date each month Pregnant women – Pregnant women – same date each monthsame date each month Takes about 20 minutesTakes about 20 minutes Perform BSE at least Perform BSE at least once a monthonce a month Examine all breast tissueExamine all breast tissue
Why don’t more Why don’t more women practice BSE?women practice BSE?
FearFear EmbarrassmentEmbarrassment YouthYouth Lack of Lack of
knowledgeknowledge Too busy, Too busy,
forgetfulnessforgetfulness
Reference Reference
httpbcra.nci.nih.gov/brc/ Clinical surgery edited by Michael Clinical surgery edited by Michael
M.Henry Jeremy M.Henry Jeremy N.Thompson.second edition.N.Thompson.second edition.