Dilek Aygin Breast Cancer and Epidemiology Dilek Aygin.
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Breast Cancer and Epidemiology
Dilek AyginDilek Aygin
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Breast CancerBreast Cancer► The most common form The most common form
of cancer among womenof cancer among women► The second most The second most
common cause of common cause of cancer related mortalitycancer related mortality
► 1 of 8 women (12.2%)1 of 8 women (12.2%)► One third of women with One third of women with
breast cancer die from breast cancer die from breast cancerbreast cancer
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►Breast cancer, accounting for 23% of Breast cancer, accounting for 23% of all female cancers around the globe.all female cancers around the globe.
►There is marked geographical There is marked geographical variation in incidence rates, being variation in incidence rates, being highest in the developed world and highest in the developed world and lowest in the developing countries in lowest in the developing countries in Asia and Africa. Asia and Africa.
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The breast cancer situation is no The breast cancer situation is no different in Turkeydifferent in Turkey
► According to data provided by the Turkish Association According to data provided by the Turkish Association for Cancer Research and Control (TKASK), 150,000 for Cancer Research and Control (TKASK), 150,000 people are diagnosed with cancer each year in Turkey. people are diagnosed with cancer each year in Turkey.
► Even though breast cancer can be treated successfully Even though breast cancer can be treated successfully when diagnosed early, thousands of women still die when diagnosed early, thousands of women still die from the disease each year, and experts say breast from the disease each year, and experts say breast cancer awareness in Turkey is at an inadequate level. cancer awareness in Turkey is at an inadequate level.
► breast cancer is the most common cancer among breast cancer is the most common cancer among Turkish women, which represents 26.5% of all female Turkish women, which represents 26.5% of all female cancers.cancers.
Ministry of Health: The most frequent ten cancers in females in Turkey. http:/ / www.saglik.gov.tr
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To the estimations of the Health Ministry resources To the estimations of the Health Ministry resources (Tuncer, 2006, www.saglık.gov.tr), the number of breast (Tuncer, 2006, www.saglık.gov.tr), the number of breast
cancer patients in the period of 2007-2012 has beencancer patients in the period of 2007-2012 has been
seen in Table seen in Table 11..
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Global Differences in Breast Cancer Global Differences in Breast Cancer Diagnosis and Outcomes: SurvivalDiagnosis and Outcomes: Survival
► Estimated mortality-to-incidence ratios are Estimated mortality-to-incidence ratios are generally lower in developed regionsgenerally lower in developed regions11
USA (83–88%)2*
Europe (60–83%)2*
Developing countries (45–72%)3**
Women diagnosed: *1990–1994; **1982–1992 AS
R 5
-year
surv
ival
1Shibuya, et al. BMC Cancer 2002;2:37; 2Coleman, et al. Ann Oncol 2003;14(Suppl 5):V128–V149; 3Sankaranarayanan, et al. IARC Sci Publ 1998;145:135–73
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0.250.25
0.320.32 0.370.37
0.330.33
0.450.45
0.270.27
0.390.39
0.270.27
0.380.38
0.350.35
0.450.450.420.42
0.480.48
0.390.39
0.370.37
00..3232
GLOBAL STATISTICS:GLOBAL STATISTICS:Breast cancer mortality in different Breast cancer mortality in different
countriescountries
SLIDE CREDIT:Gilberto SchwartsmannSLIDE CREDIT:Gilberto Schwartsmann
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GLOBAL STATISTICS:GLOBAL STATISTICS:Mortality vs. Degree of economic Mortality vs. Degree of economic
developmentdevelopment
More developed countries0.33 (189 deaths / 579 cases )
Less developed countries0.39 (184 deaths / 471 cases)
SLIDE CREDIT:Gilberto SchwartsmannSLIDE CREDIT:Gilberto Schwartsmann
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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 (which begins in the lobes Lobular (which begins in the lobes of the breast and often is found in of the breast and often is found in both breasts)both breasts)
► Inflammatory cancer (its where Inflammatory cancer (its where the breast appears swollen and the breast appears swollen and hot) its also very uncommonhot) its also very uncommon..
► Picture from WebMD.comPicture from WebMD.com
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Risk Factors for Risk Factors for BreastBreast CancerCancer
► Female (1% male)Female (1% male)► AgingAging► Relative (mother or Relative (mother or
sister)sister)► Menstrual historyMenstrual history
early on setearly on set late menopauselate menopause
► Child birthChild birth After the age of 30After the age of 30
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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
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Risk Factors for Risk Factors for BreastBreast Cancer Cancer
► 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
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GeneticsGenetics
► BRCA-1BRCA-1► BRCA-2BRCA-2► P53, Rb-1P53, Rb-1► Her-2/neu, c-erB2, c-Her-2/neu, c-erB2, c-
mycmyc
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Staging of Breast CancerStaging of Breast Cancer
►The American Joint Committee on The American Joint Committee on Cancer (AJCC) has designated staging Cancer (AJCC) has designated staging by TNMby TNM
►T= tumor sizeT= tumor size►N = lymph node involvementN = lymph node involvement►M = metastasisM = metastasis
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Stage 1Stage 1
►Tumor Tumor << 2.0 cm 2.0 cm in greatest in greatest dimensiondimension
►No nodal No nodal involvement (N0)involvement (N0)
►No metastases No metastases (M0)(M0)
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Stage IIStage II
►Tumor > 2.0 Tumor > 2.0 << 5 5 cmcm
oror►Ipsilateral axillary Ipsilateral axillary
lymph node (N1)lymph node (N1)►No Metastasis (M0)No Metastasis (M0)
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Stage IIIStage III
►Tumor > 5 cm (T3)Tumor > 5 cm (T3)►or ipsilateral axillary lymph nodes or ipsilateral axillary lymph nodes
fixed to each other or other fixed to each other or other structures (N2)structures (N2)
►involvement of ipsilateral internal involvement of ipsilateral internal mammary nodes (N3)mammary nodes (N3)
►Inflammatory carcinoma (T4d)Inflammatory carcinoma (T4d)
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Stage IV (Metastatic breast Stage IV (Metastatic breast cancercancer))
►Any TAny T►Any NAny N►Metastasis (M1)Metastasis (M1)
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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
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Symptoms and Symptoms and ScreeningScreening
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Normal breast physiology and Normal breast physiology and anatomyanatomy
►Symmetry and balanceSymmetry and balance►SizeSize
weightweight menstrual cyclemenstrual cycle pregnancy and lactationpregnancy and lactation
►TextureTexture►ShapeShape
ageage
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Abnormal signs and symptomsAbnormal signs and symptoms
►PuckeringPuckering►DimplingDimpling►RetractionRetraction►Nipple dischargeNipple discharge►Thickening of skin or lump or “knot”Thickening of skin or lump or “knot”►Retracted nippleRetracted nipple
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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 healSore on breast that does not heal
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Methods of DetectionMethods of Detection
►Clinical exam by MD or nurseClinical exam by MD or nurse►MammographyMammography►Monthly breast self-exam Monthly breast self-exam
(BSE)(BSE)
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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
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MammographyMammography► X-ray of the breastX-ray of the breast► Has been shown to Has been shown to
save lives in patients save lives in patients 50-6950-69
► Data mixed on Data mixed on usefulness for usefulness for patients 40-49patients 40-49
► Normal mammogram Normal mammogram does not rule out does not rule out possibility of cancer possibility of cancer completelycompletely
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MammographyMammography
American Cancer Society recommends:American Cancer Society recommends:
Women (asymptomatic) 40 Women (asymptomatic) 40 years of age and older should years of age and older should have a mammogram every have a mammogram every yearyear..
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Mammography-more Mammography-more guidelinesguidelines
►Mammogram facility guidelinesMammogram facility guidelines►Avoid mammogram week before periodAvoid mammogram week before period►Don’t wear deodorant powder or creamDon’t wear deodorant powder or cream►Bring a list of the places and dates of Bring a list of the places and dates of
other mammograms,other mammograms, biopsies you’ve biopsies you’ve had beforehad before
► If you don’t hear from the MD within 10 If you don’t hear from the MD within 10 days, call the facilitydays, call the facility
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Breast Self ExaminationBreast Self Examination►Opportunity for woman to Opportunity for woman to
become familiar with her become familiar with her breastsbreasts
►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, continue Begin at age 20, continue monthlymonthly
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When to do BSEWhen to do BSE► Menstruating women- 5 to 7 days Menstruating women- 5 to 7 days
after the beginning of 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
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Why don’t more women Why don’t more women practice BSE?practice BSE?
►FearFear►EmbarrassmentEmbarrassment►YouthYouth►Lack of knowledgeLack of knowledge►Too busy, Too busy,
forgetfulnessforgetfulness
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ConclusionConclusion
HEALTH HEALTH PROFESSIONALS;PROFESSIONALS;
have a have a responsibility as responsibility as
patient advocates patient advocates for breast cancer for breast cancer
awarenessawareness
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THANK YOUTHANK YOU
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POYRAZLAR LAKE / SAKARYA / TURKEY
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SAKARYA / TURKEY
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SAKARYA UNIVERSITY CAMPUS
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SAKARYA UNIVERSITY CAMPUS
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SAKARYA UNIVERSITY CAMPUS