Presented by: Katarina Bojanić Mentor: A. Žmegač Horvat

FACTS & EPIDEMIOLOGY Most common malignancy in women (25-30%) 2nd leading cause of cancer deaths (after lung c.) > 570,000 new cases worldwide each year 2,300 new cases >800 deaths in Croatia (2005)

One out of eight women will be diagnosed Strikes a small percentage of men ≈1,500 new cases expected to be diagnosed in men next year

Every three minutes a woman in the US is diagnosed with BC Every 12 minutes a woman dies from BC All women are at risk (rare in women <40; 10% of palpable masses malignant)

Female Breast Anatomy Each breast = 15 to 20 sections (lobes) arranged like petals of daisy Inside lobe = smaller structures (lobules) End of each lobule = tiny sacs (bulbs), produce milk

Lobes, lobules, bulbs- linked by network of thin tubes (ducts) Carry milk: bulbs → dark area of skin (areola) Duct Areola Breast profile A ducts B lobules C dilated section of duct to hold milk D nipple E fat F pectoralis major muscle G chest wall/rib cage Enlargement A normal duct cells B basement membrane (duct wall) C lumen (center of duct)

Risk Factors Gender Age, Race Weight (obesity) Nonmodifiable risks Modifiable risks Gender Age, Race Family/Personal history of BC Genetic factors Menstrual history Certain types of breast disease Radiation Weight (obesity) Exercise Alcohol Reproductive history Hormone replacement therapy Oral contraceptive use Breastfeeding

Genetic risk factors →10 % of BC familial (hereditary) BRCA 1 & BRCA 2 → tumor suppressor genes (breast cancer gene) →role in cellular DNA repair →mutation increases risk P53, RAS, C-MYC, RB gene

Noninvasive Cancers (in situ) Types of Breast Cancer Invasive Cancers Noninvasive Cancers (in situ) spread from ducts or lobes into fatty tissue limited to ducts or lobes & does not spread into fatty tissue

Detection methods Self breast exam Clinical examination Mammography > 35 Ultrasound < 35 Biopsy if indicated

Mammography X-ray picture of the breast to detect breast cancer Detects a breast lump before it can be felt Age Frequency of Mammogram 40 1-2 year 50 Every year <49 with family hy of breast cancer Consult health care providers about risks Slide 21 A mammogram is an x-ray of the breast. The modern mammogram uses x-rays especially designed for the breast and uses very low levels of radiation. Mammograms are a very important part of breast cancer screening as they can detect small breast cancers before they can be felt and can reduce the risk of dying from the disease. References: NCI CancerNet: What you need to know about breast cancer CancerCare Inc. Patient Briefs: A mammogram can help save your life

BIOPSY RESULTS 80% of all breast biopsies turn out to be benign

Clinical Breast Exam Performed by doctor Every 3 y. for women 20 – 39 Yearly for women > 40 yrs of age Slide 20 Breast self-examination or BSE is an examination a woman does of her own breasts, which the American Cancer Society recommends monthly for women over 20 years of age. Changes that should be reported to a physician include a lump or thickening in the breast or under the arm, a change in breast size or shape, fluid coming from the nipple, or any change in the breast skin. A clinical breast examination is an exam of the breast conducted by a health care professional, recommended every three years in women between ages 20 and 39 and annually in women over age 40. Mammography is recommended by ACS annually from age 40 on. Reference: American Cancer Society Website: Breast Cancer Resource Center: Detection and Symptoms

Breast Self-Exam Monthly starting at the age of 20! Still menstruating 2-3 days after period ends No longer menstruating same day every month

Two parts of BSE 1) Visual 2) Palpatory: Examine each breast separately Use pads of middle three fingers; feel the texture Examine the armpits

Patterns

Visual: Discharge or bleeding. Most common: Lump or thickening in breast. Often painless Discharge or bleeding. Redness or pitting of skin over the breast; like the skin of an orange. Change in size or contours of breast. Change in color or appearance of areola.

Abnormal Breast Changes Lump in the breast Changes in breast size of shape Notify Your Doctor Nipple discharged or tenderness Changes in the skin of the breast

TREATMENT OPTIONS & PROGNOSIS Depend on Size of the tumor Invasive or in situ Histologic type - ductal (85%) vs. lobular Estrogen/progesterone receptors (60-70%positive) Her-2/ neu status (receptor for epidermal growth f.) tm size increases- chance decreases SURVIVAL

Lymph node status Spread to other parts of the body (bones, liver, lung, brain) Age (premenopausal = poor prognostic factor)

TREATMENT Surgery Radiation Therapy (local) Chemotherapy (systemic) Goals Cure, Control, Palliation Surgery Radiation Therapy (local) Chemotherapy (systemic) Hormonal Therapy (systemic) Immunotherapy 􀂄 Therapy is individualized

SURGERY Mastectomy (complete/radical) Breast conservation (partial)

RECONSTRUCTION

RADIATION THERAPY Local control of disease Indications: Adjuvant (after partial mastectomy) Young patients with DCIS High risk of local recurrence High energy rays used to kill cancer cells

CHEMOTHERAPY Anticancer drugs = systemic control of disease Indications: After surgery to reduce risk of recurrence Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant) Metastatic - to reduce cancer that has spread + relieve symptoms & prolong life

HORMONAL THERAPY Hormones (blood stream) → attach ca. cells, promote their growth Block the receptor or production of hormones ! Side effects: hot flashes, depression, ↑ risk of uterine cancer, induced manopause, blood clots Tamoxifen, aromatase inhibitors...

IMMUNOTHERAPY Monoclonal antibodies Trastuzumab/Herceptin Patients whose cancer cells over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30% of patients)

Through early detection and improved treatments more women than ever are surviving breast cancer...

Questions ? THANK YOU FOR YOUR ATTENTION!

References: Kusić Z.Onkologija.Zagreb,2008 Damjanov I, Jukić S, Nola M.Patologija.Medicinska naklada,Zagreb, 2008 Kumar P, Clark M.Clinical Medicine.Saunders Elsevier,London,2007 www.cancer.org www.cancer.gov