BreastCancerAwarenessDrRobertDohner by panniuniu

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									  Understanding Risk
 Factors and Screening
 Recommendations for
Early Detection of Breast
        Cancer
 Breast Cancer: Facts and Stats
Breast Cancer rate increased approximately
  1% each year from the 1940’s to early
  1980’s.
Sharp increase from 1980’s to 1990’s- Likely
  due to increase in screening.
Decrease found from 2002-2003 despite drop
  in mammography use. Likely due to
  decrease in Estrogen Replacement.
One in Eight American Women will have
  breast cancer.
 Breast Cancer: Facts and Stats
For 2009: 192,370 new cases of invasive
                 breast cancer estimated
In 1975: 107 cases per 100,000 white women
          94 cases per 100,000 black women
In 2005: 126 cases per 100,000 white women
          114 cases per 100,000 black women
Since 1975, the death rate in white women has
  decreased while remaining unchanged in
  Black Women.
 Breast Cancer: Facts and Stats
In Men: 1,910 cases estimated for 2009
        1.2 cases per 100,000 in 2005
        No real change in rate since 1975
        Death rate is 0.3 per 100,000
Breast Anatomy
 Breast Cancer: Facts and Stats
Types: In Situ and Invasive
In Situ: 10-25% of all Breast Cancers

  Occur in the milk Lobules or Ducts of the
     breast and remain within that tissue.
  Cancer cells have not invaded nearby
     breast tissue.
  Favorable Prognosis
 Breast Cancer: Facts and Stats

Invasive: 75-90% of all Breast Cancers
Originate in Lobules or Ducts but have spread
  to surrounding tissue, increasing risk for
  spread to lymph nodes, distant sites.
Prognosis: Depends upon extent of invasion
  Limited to Breast: 5 year survival is 98%
  Spread to Lymph Nodes: 84%
  Spread to Distant Site: 27%
 Breast Cancer: Facts and Stats
Inflammatory Breast Cancer:
     1-5% of all Breast cancers
     Fastest growing
     Commonly mistaken for Skin infection
Rare Breast Cancers-
medullary, mucinous, tubular, metaplastic,
  and papillary breast cancers
Favorable Prognosis
    Breast Cancer: Risk Factors

 Age: risk increases annually after age 50
 Race: whites more then minorities, though
     black women have higher death rate.
 Prior history of Breast Cancer: 1-2% of
     recurrence per year.
 Atypical Hyperplasia of the Breast: found
     on biopsy.
   Breast Cancer: Risk Factors

Family History: first degree relatives
     second degree relatives
     especially before menopause

     Paternal side equal to Maternal and is
          additive.
   Breast Cancer: Risk Factors
Genetics: 5-10% of Breast Cancers are due to
     inheritance.
BRCA-1: 60-90% risk in lifetime
BRCA-2: 30-85% risk in lifetime
30-85/100 women with BRCA-1/BRCA-2
  will develop Breast Cancer in their lifetime.
Average Risk in America is 12/100
  Breast Cancer: Risk Factors
History of Ovarian Cancer: BRCA-1 and
 BRCA-2 are associated with higher risk of
 both ovarian and breast cancer.
History of Lobular Carcinoma in situ.
Exposure to Radiation: X-rays, radiation
 therapy, accidents.
DES- DiethylStilbestrol used to prevent
 miscarriage in the 1960’s.
   Breast Cancer: Risk Factors
Prolonged Estrogen/Progesterone Exposure:
  -Menstruation before age 11, menopause
      after 55.
  -First pregnancy after 35. Pregnancy and
      breast feeding is protective.
  -recent and long term use of Estrogen
      Replacement Therapy
Surgical removal of Ovaries is protective.
   Breast Cancer: Risk Factors
Lifestyle:
  -Obesity
  -more than 1-2 alcoholic beverages/day
      increases risk by 25%
  -red meats and dairy- food containing
      animal fats
Regular Exercise is Protective
   Breast Cancer: Risk Factors
Smoking- slight increased risk
Birth Control Pills- controversial, some
  studies show increased risk, others do not.
  Decreases risk of ovarian and endometrial
  (uterine) cancer.
  Increased risk of liver cancer.

Phytoestrogens: may be protective if
  consumed before puberty. Controversial,
  and not recommended for high risk patients
    Breast Cancer: Screening

Mammogram: Annually starting at age 40, 10
 years prior to first degree relative’s
 diagnosis age.
 Age 40-49: lowers risk of death by 15%
    risk of false positives
 Age 50-69: decreased risk of death by 23%
 Age 70+: recommended
    Breast Cancer: Screening
Clinical Breast Exams:
  Every 3 years 20-39
  Annually age 40+
  Recommended by American Cancer Society
  No opinion from US Preventative Services
      Task force.
Self Breast Exams: not enough evidence
Breast Cancer: Screening Follow Up
Mammogram Results: Bi-Rads Categories
0 - Needs further imaging: Further
  radiographic images, Ultrasound, MRI
1 - Normal: Annual mammogram
2 - Benign Findings- benign cystic changes:
     Annual mammogram
3 - Abnormal, likely benign: short term 3-6
  months.
4 - Abnormal: highly suspicious: Biopsy
 Breast Cancer: Screening Follow
               Up
Diagnostic Mammogram:
 Follow up of a category 0, 3, or 4
     mammogram.
 To investigate an area of concern identified
     by self breast exam and/or clinical breast
     exam.
Breast Cancer: Screening Follow Up
Other Imaging Modalities:
Ultrasound: uses sound waves to image solid
      versus cystic (fluid filled) masses. Tumor
      versus cyst.

Cons: Not good screening test because does not
  produce an accurate image of entire breast, high
  rate of false positives, and operator dependent.
Breast Cancer: Screening Follow Up
MRI: Magnetic Resonance Imaging
Especially useful for BRCA positive women.
Sensitive in identifying cancer in the opposite
  breast when diagnosed in one breast.
May improve sensitivity of mammogram for
  high risk women.

Cons: Requires use of contrast, High false
 positive rate, cost.
Breast Cancer: Screening Follow Up

Under Investigation:
PET: Positron Emission Tomography-
 creates an image based on cell consumption
 of glucose. Cancer cells are more active.
 Widely used to identify spread (metastasis)
 to distant sites, but image of breast tissue is
 poor.
Breast Cancer: Screening Follow Up

Under Investigation:
Molecular Breast Imaging: Experimental use
 of a radioactive agent that is injected and
 absorbed into breast tissue.

Thermography: Use of infrared technology to
 detect temperature differences in tissue.
 Breast Cancer: Early Detection
Understand your own risk profile:
What you have control over:
 Lifestyle
 Screening
 Breast Cancer Risk Calculator:
     http://www.halls.md/breast/risk.htm
What you don’t:
 Age, gender, genetics, Menstrual history.
Questions/Comments

								
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