1. EPIDEMIOLOGY AND PREVENTION OF BREAST CANCER
Dr. MUSTAQUE AHMED
MBBS,MD(Community Medicine), Fellowship in HIV

2. LEARNING OBJECTIVE
Describe the magnitude of breast cancer as public health problem
To study the clinical feature, risk factors and diagnosis of breast cancer.
To know the management and prevention of breast cancer.

3. Cancer Problem - World Common cancers Lung cancer ( 12.3% )
In 2013 GLOBALLY there were 14.9 million cancer cases AND 8.2 million deaths.
Common cancers
Lung cancer ( 12.3% )
Breast cancer ( 10.4% )
Colorectal cancer ( 9.4% )
Cancer stomach
Cancer oesophagus
Cancer liver
Cancer prostrate
Cancer cervix

4. Breast Cancer as Public health problem
Commonest cause of death in developed countries and developing countries in women.High in US, Canada and Low in Japan.
All women are vulnerable to breast cancer, especially women aged 40 and older.
Breast cancer is the most common cancer in females. In Saudi Arabia, breast cancer accounted to 30.6% .
Around 73% of cases in the Kingdom of Saudi Arabia decide to consult the doctor at a very advanced stage of disease that cannot be cured, compared with 30% of cases in developed countries.

5. Cancer Incidence Report Saudi Arabia 2013 Saudi Cancer Registry

6. An illustration of the distribution in number of breast cancer (BC) cases in the Kingdom of Saudi Arabia by: A) different age groups from the year ; B) the overall mean number; C) total number from ; and D) percentage distribution by age group from

7. CANCER IS A GROUP OF DISEASES CHARACTERISED BY
A) Abnormal growth of cells
B) Ability to invade adjacent tissues and even distant organs
C) The eventual death of the affected patient if the tumour has progressed beyond the stage when it can be successfully removed.
The term "primary tumour" is used to denote cancer in the
organ of origin, while "secondary tumour" denotes cancer
that has spread to regional lymph nodes and distant organs.
When cancer cells multiply and reach a critical size, the cancer
is clinically evident as a lump or ulcer localized to the organ of
origin in early stages. As the disease advances, symptoms and
signs of invasion and distant metastases becomes clinically
evident .

8. RISK FACTORS FOR BREAST CANCER
Age.-Uncommon below 35y.common in unmarried women.
A family history of breast cancer.
Age at menarche and menopause-early menarche and late manopause is risk for getting breast cancer
Nutritional factors- seen more in fat women, eating a lot of meat and saturated fat, lacking both fruits and vegetables and lacking exercise and sport.
Taking birth control pills (OCP), especially those containing estrogen, for a long period can increases the risk of breast cancer.
Postmenopausal hormone therapy.
Benign mammary dysplasia.
Environmental factors and pollution.

9. Symptoms that women should look for
A breast lump or thickening that feels different from the surrounding tissue.
Change in the size, color, or shape of a breast.
Changes to the skin over the breast, such as dimpling.
Redness or pitting of the skin over the breast or the nipple.
Bloody discharge from the nipple.
A change in the skin of the nipple (inverted nipples or retracted nipples).

12. DIAGNOSIS/SCREENING 1.BREAST SELF EXAMINATION(BSE)
2.PALPATION BY A PHYSICIAN
3.MAMMOGRAPHY/MAMMOGRAM
1. Breast self–examination, carried out once monthly, between the 7th and 10th day of the menstrual cycle, goes a long way in detecting breast cancer at the early stages of growth that when the breast is less congestion.
it will not take more than 10 minutes of time. This test detects 25% of cases.
02. Periodic breast examination by a health professional is an important step in early detection, that can helps to detects 40% of cases.
 03. Regular mammograms (once every one or two years) starting at the age of 40 detects 90% of cases.

13. How to perform breast self-examination?
Taking a few minutes to do a breast self-exam a minimum of once a month can make a lifetime of difference.
Just follow the steps below, and you should keep it constantly in mind:

16. Reassuring Words
Breast examination should be done once a month, a few days after the end of the menstrual cycle.
check breasts by viewing and touching, following the above steps .
Few facts you should keep in mind:
Over 80% of all breast lumps are not cancer.
About 90% of women who catch breast cancer early survive.
Initial treatment in breast cancer might include surgical intervention, be it mastectomy or the excision of lymph nodes without removal of the breast.

17. Mammograms what are screening mammograms?
Screening mammogram is an x-ray exam of the breast on a woman who has no symptoms. USED to find cancer when it is still too small to be felt by a woman or her doctor.
During mammogram, breast is compressed or squeezed between 2 plates attached to the mammogram machine -- a plastic plate (on top) and an x-ray plate (on the bottom). The technologist compresses breast to avoid it from moving, and to make the layer of breast tissue thinner.

18. It is definitely painless, but the compression can feel uncomfortable for some women. IT takes only few seconds .
 It is recommended to begin mammograms, for premenopausal women, between 3 and 5 days after the end of a menstrual period to avert the congestion accompanying the menstrual.
It is also advisable to take analgesics an hour before the rays if you already suffer from chronic congestion of your breast.

19. Remember, the periodic screening by mammography is the most important and the only test to detect breast cancer early before you or your doctor can detect it. Therefore, the U.S. and European Oncology and Radiology Institutes have repeatedly recommended performing the periodic screening by mammography, even in the absence of any complaint.
The recommendations for screening are as follows:
All women aged 50 to 69 should have regular mammograms once every 1-2 years.
All women aged 40 to 50 should have regular mammograms every 2 years.
Mammography is not harmful and there are no side effects because it uses very LOW dose of X-RAY COMPARED TO CHEST X-RAY ,DENTISTARY X-RAY.

20. Management

21. Prevention of breast cancer
PRIMARY PREVENTION-
Promotion of cancer education
Health education-nutrition(reduce fat),exercise
SECONDARY PREVENTION-
Early diagnosis and treatment-breast screening.
TERTIARY PREVENTION
Rehabilitation

22. Steps to Preserve Breast Health:
Like most cancers, the risk of developing breast cancer increases as women get older, but this does not mean that young women should forget about their breast health.
In case you are/over 50 years old:
Conduct monthly breast self-examination.
An annual breast examination by your physician or a qualified health care practitioner.
Undergo mammography screening once every 1-2 years.
In case you are/over 40 years old:
Undergo mammography screening once every 2 years.
In case you are/over 20 years old:
Do monthly breast self-examination.
Undergo a clinical breast examination by your healthcare provider at least every three years.
THANK YOU