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Update in Breast Cancer

Ana Maria Lopez, MD, MPH, FACPAssociate Dean, Outreach and Multicultural Affairs

Professor of Medicine and Pathology

Medical Director, Arizona Telemedicine Program

Educational Objectives

1. Learn what is breast cancer

2. Discuss risks to breast cancer

3. Outline prevention measures for

breast cancer

What is breast cancer?

breastcancer.org

http://geneticpeople.com/?tag=breast-cancer

gatheringbasket.org

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What causes breast cancer?

• Causes and risk factors

Risk Factors

• Age: • 95% in women 40yo +• highest in 70-74 yo

• FH• Personal history• Genetic risk:

• BRCA 1/2, TP 53, ATM

• Nulliparous• 1st full term pregnancy

after 35 yo• No lactation• HRT• Alcohol• Overweight/obesity• Physical inactivity

70% of breast cancers are in patients without identifiable risk factors

Risk Calculators

• www.cancer.gov/bcrisktool

NCI/NSABP

Hereditary Breast Cancer Risks

5-10% of all breast cancers

• Ashkenazi Jewish descent

• 3 or more 1st or 2nd degree relatives

• 1st degree relative with bilateral breast cancer

• 2 or more 1st or 2nd degree relatives with ovarian cancer

• Male breast cancer

BRCA 1 and BRCA 2

• Code for DNA repair• Presence of gene, increases the risk of getting breast

cancer up to 80% in her lifetime• BRCA1 or BRCA2 mutations make up about half of all

cases of inherited breast cancer• associated with ovarian cancer and prostate cancer• can be inherited either from the mother or the father.

Other Inherited Genes

• TP53 gene• codes for the tumor suppressor protein p53• Mutations cause Li-Fraumeni syndrome: associated

with early onset breast cancer• Ataxia Telangiectasia (ATM) gene

Females with one defective copy of the ATM gene and one normal copy of the gene are at increased risk for breast cancer.

concurringopinions.com

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presstv.ir

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ladycarehealth.com

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Prevention

Prevention: saves us from the pain of being sick

--Unknown

health.usf.edu

Prevention Studies

• Tamoxifen• Raloxifen: STAR (Study of Tamoxifen and

Raloxifene)• Raloxifene is as effective as tamoxifen in

reducing invasive but not nonivasive (DCIS) BC risk

• Both drugs reduce invasive BC risk by about 50%• Raloxifene: 36% fewer uterine cancers, 29%

fewer blood clots • Both increase blood clots.

Aspirin

• In an epidemiologic study, aspirin appeared to lower breast cancer risk

• Need prospective trial

Vitamin D

• Helps with calcium absorption to maintain bone density

• In clinical trials

Fat

• WINS

• Low fat diet (< 30%)

• 5Y FU: new breast cancers--9.8% low-fat diet; 12.4% standard diet (24% reduction)

• largest risk reduction – 42%--in ER negative tumors

What about soy? Flax? Phytoestrogens?

• Eat what you like!

• Eat healthy!

• Do not change your diet drastically to include phytoestrogens.

• There may be safety concerns re: pharmaceutically concentrated soy products

Lifestyle

• Maintain a healthy weight• Decrease intake overall. Increase vegetables

in specific (2/3 of plate) • Increase activity: 3-4 hours of exercise per

week

• Decrease alcohol intake

Early Detection

kodak.com

Computer-aided detection and diagnosis (CAD)

canada.com

Tomosynthesis (3D mammography)

Treatment

ultimateboxingresults.com

riskofbreastcancer.net

indianapublicmedia.org

dailymail.co.uk