1. Breast cancer Not a single disease. Type and stage. Grade/Lympho-vascular invasion Molecular biology. ER\PR Her-2-neu Other. Gene expression profiling. (Tumor and Patient)

2. What causes cancer? DNA damage. WHY? Always! Radiation, random, metabolic, toxins. Free radicals, adducts, breaks. Incomplete DNA repair. Error transmission. Failure to recognize damage. Failure to initiate programmed cell death. Lack of immune response. Suppression of normal genes Promotion of cellular proliferation

3. Genetic Issues BRCA 1 and 2. Other p53, AT. PTEN Cancer susceptibility genes. –Polymorphisms. –Polygenic risk (the individual’s genetic fingerprint)

4. Breast Cancer Types Basal-like Luminal A ER+ “good outcome” Luminal B ER+ “bad outcome” Normal breast-like HER2+/ER-

11. The Future Microarrays Proteomics Positron Emission Mammography ?Percutaneous Lesion Destruction Personalized Therapy

12. Microarrays Amsterdam 70 Oncotype Dx20 Estrogen-regulated gene set 1E 2E

13. The Butterfly Effect Small initial changes can result in major variations in final conditions.