PLWC Slide Deck Series:

Understanding Breast Cancer

Presents2006

What is Cancer?

A group of 100 different diseases

The uncontrolled, abnormal growth of cells

Cancer may spread to other parts of the body

What is Breast Cancer?The most common type of cancer in women in the United States (excluding cancers of the skin) and the second most frequent cause of death from cancer in women

A disease in which normal cells in the breast begin to change, grow without control, and no longer die

Cancer that has not spread is called in situ, meaning in place

Cancer that has spread is called invasive or infiltrating

What is the Structure of the Breast?The breast is composed mainly of fatty tissue, which contains a network of lobes made up of tiny, tube-like structures called lobules that contain milk glands

Tiny ducts connect the glands, lobules, and lobes, and carry the milk from the lobes to the nipple

Blood and lymph vessels run throughout the breast

About 90% of all breast cancers originate in the ducts or lobes of the breast

What Are the Risk Factors for Breast Cancer?AgeRaceIndividual or family history of breast cancerA history of ovarian cancerA genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers)Estrogen exposureAtypical hyperplasia of the breastLobular carcinoma in situ (LCIS)Lifestyle factors (obesity, lack of exercise, alcohol use)Radiation

Hereditary Breast CancerAbout 15% of breast cancers are inheritedApproximately 80% of hereditary breast cancer is caused by mutations in the BRCA1 or BRCA2 genesWomen who inherit a BRCA mutation have a 50% to 85% chance of developing breast cancer in their lifetimeWomen with especially strong family history may consider preventive surgery to remove breast tissue and/or chemopreventionSeveral other genetic syndromes can increase breast cancer riskGenetic counseling and testing is available for most syndromesFor more information, www.plwc.org/genetics

Breast Cancer and Early DetectionEarly diagnosis means a better chance of successful treatmentMammography is the best tool doctors have to screen for breast cancerMany organizations recommend that women obtain a mammogram each year, starting at the age of 40Regular clinical breast examinations and breast self-examinations are also recommendedWomen are encouraged to discuss the frequency of screening with their doctors

What Are the Symptoms of Breast Cancer?New lumps or a thickening in the breast or under the arm

Nipple tenderness, discharge, or physical changes

Skin irritation or changes, such as puckers, dimples, scaliness, or new creases

Warm, red, swollen breasts with a rash resembling the skin of an orange

Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor)

No visible or obvious symptoms (asymptomatic)

How is Breast Cancer Evaluated?Screening and/or diagnostic mammography

Ultrasound

Magnetic Resonance imaging (MRI) scan

Biopsy is necessary to confirm a diagnosis

Blood tests are often used to determine if the cancer has spread outside the breast

Additional tests may be used to determine stage

Breast Cancer StagingStaging is a way of describing a cancer, such as the depth of the tumor and where it has spreadStaging is the most important tool doctors have to determine a patients prognosis Staging is described by the TNM system: the size of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to organs such as the liver or lungs)The type of treatment a person receives depends on the stage of the cancer

Stage 0 Breast CancerKnown as cancer in situ, meaning the cancer has not spread past the ducts or lobules of the breast (the natural boundaries)

Also called noninvasive cancer

Ductal carcinoma in situ (DCIS) is the most common in situ breast cancer

Stage I Breast CancerThe tumor is small and has not spread to the lymph nodes

Stage IIa Breast CancerStage IIa breast cancer describes a smaller tumor that has spread to the axillary lymph nodes (lymph nodes under the arm), or a medium-sized tumor that has not spread to the axillary lymph nodesStage IIa may also describe cancer in the axillary lymph nodes with no evidence of a tumor in the breast

Stage IIb Breast CancerStage IIb breast cancer describes a medium-sized tumor that has spread to the axillary lymph nodesStage IIb may also describe a larger tumor that has not spread to the axillary lymph nodes

Stage IIIa Breast CancerStage IIIa breast cancer describes any size tumor that has spread to the lymph nodes

Stage IIIb Breast CancerStage IIIb breast cancer has spread to the chest wall, or caused swelling or ulceration of the breast, or is diagnosed as inflammatory breast cancer

Stage IIIc Breast CancerStage IIIc breast cancer has spread to distant lymph nodes but has not spread to distant parts of the body

Stage IV Breast CancerStage IV breast cancer can be any size and has spread to distant sites in the body, usually the bones, lungs or liver, or chest wall

How is Breast Cancer Treated?Treatment depends on stage of cancer

More than one treatment may be used

Surgery

Radiation therapy

Chemotherapy

Hormone therapy

Targeted therapy

Factors Considered in Treatment DecisionsThe stage and grade of the tumor

The tumors hormone receptor status (ER, PR)

Factors that may signify an aggressive tumor, such as HER-2/neu amplifications

The presence of known mutations to breast cancer genes

The patients menopausal status

The patients age and general health

Cancer Treatment: SurgeryGenerally, surgery to remove the tumor with or without radiation therapy is initial treatment

For invasive cancer, lymph nodes are removed and evaluated

More invasive surgery (such as mastectomy) is not always better; discuss with your doctor

Breast reconstruction is an option after mastectomy

Cancer Treatment: Adjuvant TherapyTreatment given in addition to surgery to reduce the risk of recurrence

May include radiation therapy, chemotherapy, biologic therapy, and hormone therapy

Cancer Treatment: Radiation TherapyThe use of high-energy x-rays or other particles to destroy cancer cells

Usually used to treat breast cancer after surgery

Different methods of delivery

External-beam: outside the body

Internal: uses implants inside the body

Side effects may include fatigue, swelling, and skin changes

Cancer Treatment: ChemotherapyDrugs used to kill cancer cells

May be given before surgery to shrink a large tumor (neoadjuvant chemotherapy) or after surgery to reduce the risk of recurrence (adjuvant chemotherapy)

A combination of medications is often used

Cancer Treatment: Hormone TherapyUsed to manage tumors that test positive for either estrogen or progesterone receptors

May be used alone or together with chemotherapy

Tamoxifen (Nolvadex) is a common hormone therapy and is effective in many premenopausal and postmenopausal women

Aromatase inhibitors are also used alone or following tamoxifen use as treatment for postmenopausal women, including anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin)

New Therapies: Targeted TherapyTreatment designed to target cancer cells while minimizing damage to healthy cells

Used to stop the action of abnormal proteins that cause cells to grow and divide out of control

Trastuzumab (Herceptin) for women with a HER-2/neu-positive breast cancer either with or after adjuvant chemotherapy

Bevacizumab (Avastin) blocks angiogenesis (the formation of new blood vessels) and is under evaluation in clinical trials

The Role of Clinical Trials for the Treatment of Breast CancerClinical trials are research studies involving peopleThey test new treatment and prevention methods to determine whether they are safe, effective, and better than the best known treatmentThe purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled processClinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

Clinical Trials: Patient SafetyInformed consent: Participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks

Informed consent is an ongoing process; participants are constantly updated as new information becomes available

Participation is always voluntary, and patients can leave the trial at any time

Clinical Trials: PhasesPhase I trials determine safety and dose of a new treatment in a small group of peoplePhase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a given form of cancerPhase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the current, standard treatment for that disease; phase III trials involve a large number of patients

Clinical Trials ResourcesCoalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org)

CenterWatch (www.centerwatch.com)

National Cancer Institute (www.cancer.gov/clinical_trials)

Coping With the Side Effects of Cancerand its TreatmentSide effects are treatable; talk with the doctor or nurse

Fatigue is a common, treatable side effect

Pain is treatable; non-narcotic pain relievers are available

Antiemetic drugs can reduce or prevent nausea and vomiting

Lymphedema following breast cancer surgery can often be managed with help from your doctor

For more information, visit www.plwc.org/sideeffects

Follow-Up CareImportant to detect possible recurrence at the earliest stage

Monthly breast self-examinations

Physical examinations

Mammograms

Pelvic examinations

More information can be found in the ASCO Patient Guide: Follow-Up Care for Breast Cancer

Where to Find More Information: PLWC Guide to Breast Cancer (www.plwc.org/breast)OverviewMedical IllustrationsRisk Factors PreventionSymptomsDiagnosisStaging With IllustrationsTreatmentSide Effects of Cancer and Cancer TreatmentQuestions to Ask the DoctorCurrent ResearchPatient Information ResourcesClinical Trials Resources

People Living With Cancer (www.plwc.org)PLWC is the cornerstone of ASCOs patient resources programVisitors to PLWC will find:PLWC Guides to more than 90 types of cancerCoping resourcesAsk the ASCO Expert Series, including chats, Q&A forums, and event transcriptsCancer information in SpanishThe latest cancer newsFor patient information resources, please call 888-651-3038