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What you need to know: Breast Cancer

What you need to know: Breast Cancer . BREAST CANCER. Pamela Esquivel, NP-C Breast Health Center Loma Linda University Medical Center. What is cancer?. A group of diseases characterized by uncontrolled growth and spread of abnormal cells. Everyone is at risk of developing cancer.

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What you need to know: Breast Cancer

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  1. What you need to know:Breast Cancer

  2. BREAST CANCER • Pamela Esquivel, NP-C • Breast Health Center • Loma Linda University Medical Center

  3. What is cancer? • A group of diseases characterized by uncontrolled growth and spread of abnormal cells. • Everyone is at risk of developing cancer. • 2nd leading cause of death, behind heart diseases.

  4. What is Breast Cancer? • A malignant tumor from cells in the breast– • *Main Types: ductal carcinomas and lobular carcinomas. • Mostly found in women but men can get it too! Normal breast tissue

  5. How Common is Breast Cancer? • Estimated 184,450 new cases in the United States in 2008 (1990 men) • In California 21,160 new cases (130 men) • Estimated 40, 930 deaths in the United States in 2008 (450 men) • In California 4,235 deaths (30 men)

  6. Probability of Developing Invasive Breast Cancer • Birth to 39 1 in 210 • 40-59 1 in 26 • 60-69 1 in 28 • 70+ 1 in 15 • Birth to death 1 in 8

  7. How Common is Breast Cancer? • The most common form of cancer in women (after skin cancers) • The second leading cause of cancer death for women, after lung cancer.

  8. Warning Signs* • Breast lump or thickening • Nipple changes or drainage • Skin irritation or dimpling • Skin scaliness or redness • Enlarged lymph node • *Early cancer in most cases has no symptoms or warning signs. Early detection guidelines should be followed.

  9. Non-modifiable Risk Factors • Being female • Being over 50 • Having a family history • Age at menarche • Age at natural menopause • Exposure to Radiation • Previous breast cancer

  10. Modifiable Risk Factors • Pregnancy/Breastfeeding • Obesity • Hormone Replacement Therapy • Oral contraceptive use • Alcohol • Physical Activity

  11. Mammography, Women 40 and Older US, 2003 • %Mammogram within the past year • Immigration: • Born in US 55.4 • Born in US Territory 58.7 • In US less than 10 years 40.6 • In US 10+ years 53.0

  12. Detection:Mammograms can save your life! • A mammogram is an X-ray of the breast • Medicare, MediCal and most insurances will pay • Help exists for low income women with no insurance • Get a mammogram yearly once you turn 40

  13. Use an FDA certified mammography service Use the same facility for easy yearly comparisons If you change facilities, bring copies of old mammograms Avoid the week right before your period when breasts are sore Don’t wear deodorant, powder or cream under your arms Bring a list of any previous breast treatments you may have had Follow up to get your results – don’t assume things are normal Tips for Good Mammograms

  14. If Your Mammogram is not normal. • An abnormal mammogram doesn’t mean you have cancer –10% of women need repeat mammograms • Of these, 8 – 10% have needle biopsies performed to get more information

  15. Mammogram

  16. Breast Cancer

  17. Breast Cancer

  18. The 5-year survival rate for cancer found localized is 95% Early Stage: mastectomy or local removal with radiation therapy. Systemic Therapy: Hormones and/or combination chemotherapy. Later Stage: combination chemotherapy or hormones and radiation therapy for selected clinical problems If You Find You Have Cancer:Treatment Options

  19. Lumpectomy +/- SLN bx/ALND PLUS XRT Total Mastectomy +/- SLN bx/ALND Modified radical mastectomy (MRM)= total mastectomy & ALND Radical mastectomy includes removal of pectoralis muscles, rarely done Which surgical option is best? Consider: Size of tumor in relation to breast Cosmesis Multicentricity, multiple tumors Extensive DCIS at resected margins Previous breast irradiation, or any contraindication to radiation therapy (collagen vascular dz, severe pulmonary dz) Patient preferences Surgical Treatment of Breast Cancer

  20. Radiation Therapy • 5 days per week for 5-6 weeks • Begins approximately 3 to 6 weeks after surgery to ensure complete healing has taken place • Done after adjuvant chemotherapy • Done after lumpectomy, sometimes after mastectomy (tumor at chest wall, tumor >/ 5cm, 4 or more + LN, inflammatory breast cancer, locally advanced breast cancer)

  21. Reconstruction • Can be delayed or immediate • Implants/tissue expanders • Myocutaneous flaps: common donor sites are lower abdomen (TRAM), back (Latissimus flap), lateral hip • DIEP (deep inferior epigastric perforator) flap-no muscle is removed

  22. Chemotherapy Most common: Doxorubicin (Adriamycin), Cyclophosphamide (Cytoxan), Taxanes (Taxotere, Taxol) 5-Flourouracil (5FU), Methotrexate Trastuzumab (Herceptin)-for tumors overexpressing HER2 Used in combination: A/C, CMF, TAC Can be neoadjuvant (pre-op), and/or adjuvant (post-op) Hormonal therapy Tamoxifen Aromatase inhibitor (prevents estrogen conversion peripherally) Letrozole/Anastrozole Chemoprevention Tamoxifen NSABP P2 trial (STAR) Compares Tamoxifen versus Raloxifene Others? (aspirin, statins) Medical Treatment of Breast Cancer

  23. Can Breast Cancer Risk Be Reduced? • Remember the other modifiable risk factors such as: • your diet • alcohol consumption • exercising 30 minutes a day!

  24. Risk Reduction:Eat Your Fruits and Vegetables • Eat at least 5 servings of fruits and vegetables a day • Limit your consumption of high-fat meats and dairy • Drink lots of water

  25. Prevention:Watch your weight • Maintain a healthful weight throughout life, balance caloric intake with physical activity • Adopt a physically active lifestyle • 30 minutes or more 5 days a week • 45 minutes or more of moderate to vigorous 5 days a week, may further reducerisk to Breast Cancer

  26. ACS Breast Cancer Screening Recommendations • Yearly mammograms starting at age 40 and continuing for as long as you are healthy. • CBE every 3 years for women in their 20’s and 30’s, yearly for women 40 and over. • Notify your doctor without delay if you notice any changes in your breasts. BSE is an option for women to find changes starting in their 20’s. • Women at increased risk should talk to their doctors about benefits and limitations of starting mammography testing earlier and having additional tests with new technologies.

  27. How to get more information • The American Cancer Society can help: • 1-800-ACS-2345 • www.cancer.org

  28. Thank you

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