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PLWC Slide Deck Series: Understanding Breast Cancer

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1 PLWC Slide Deck Series: Understanding Breast Cancer
Presents PLWC Slide Deck Series: Understanding Breast Cancer 2006

2 What is Cancer? A group of 100 different diseases
The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

3 What is Breast Cancer? The most common type of cancer in women in the United States (excluding cancers of the skin) and the second most frequent cause of death from cancer in women A disease in which normal cells in the breast begin to change, grow without control, and no longer die Cancer that has not spread is called in situ, meaning “in place” Cancer that has spread is called invasive or infiltrating

4 What is the Structure of the Breast?
The breast is composed mainly of fatty tissue, which contains a network of lobes made up of tiny, tube-like structures called lobules that contain milk glands Tiny ducts connect the glands, lobules, and lobes, and carry the milk from the lobes to the nipple Blood and lymph vessels run throughout the breast About 90% of all breast cancers originate in the ducts or lobes of the breast

5 What Are the Risk Factors for Breast Cancer?
Age Race Individual or family history of breast cancer A history of ovarian cancer A genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers) Estrogen exposure Atypical hyperplasia of the breast Lobular carcinoma in situ (LCIS) Lifestyle factors (obesity, lack of exercise, alcohol use) Radiation

6 Hereditary Breast Cancer
About 15% of breast cancers are inherited Approximately 80% of hereditary breast cancer is caused by mutations in the BRCA1 or BRCA2 genes Women who inherit a BRCA mutation have a 50% to 85% chance of developing breast cancer in their lifetime Women with especially strong family history may consider preventive surgery to remove breast tissue and/or chemoprevention Several other genetic syndromes can increase breast cancer risk Genetic counseling and testing is available for most syndromes For more information,

7 Breast Cancer and Early Detection
Early diagnosis means a better chance of successful treatment Mammography is the best tool doctors have to screen for breast cancer Many organizations recommend that women obtain a mammogram each year, starting at the age of 40 Regular clinical breast examinations and breast self-examinations are also recommended Women are encouraged to discuss the frequency of screening with their doctors

8 What Are the Symptoms of Breast Cancer?
New lumps or a thickening in the breast or under the arm Nipple tenderness, discharge, or physical changes Skin irritation or changes, such as puckers, dimples, scaliness, or new creases Warm, red, swollen breasts with a rash resembling the skin of an orange Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor) No visible or obvious symptoms (asymptomatic)

9 How is Breast Cancer Evaluated?
Screening and/or diagnostic mammography Ultrasound Magnetic Resonance imaging (MRI) scan Biopsy is necessary to confirm a diagnosis Blood tests are often used to determine if the cancer has spread outside the breast Additional tests may be used to determine stage

10 Breast Cancer Staging Staging is a way of describing a cancer, such as the depth of the tumor and where it has spread Staging is the most important tool doctors have to determine a patient’s prognosis Staging is described by the TNM system: the size of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to organs such as the liver or lungs) The type of treatment a person receives depends on the stage of the cancer

11 Stage 0 Breast Cancer Known as “cancer in situ,” meaning the cancer has not spread past the ducts or lobules of the breast (the natural boundaries) Also called noninvasive cancer Ductal carcinoma in situ (DCIS) is the most common in situ breast cancer

12 Stage I Breast Cancer The tumor is small and has not spread to the lymph nodes

13 Stage IIa Breast Cancer
Stage IIa breast cancer describes a smaller tumor that has spread to the axillary lymph nodes (lymph nodes under the arm), or a medium-sized tumor that has not spread to the axillary lymph nodes Stage IIa may also describe cancer in the axillary lymph nodes with no evidence of a tumor in the breast

14 Stage IIb Breast Cancer
Stage IIb breast cancer describes a medium-sized tumor that has spread to the axillary lymph nodes Stage IIb may also describe a larger tumor that has not spread to the axillary lymph nodes

15 Stage IIIa Breast Cancer
Stage IIIa breast cancer describes any size tumor that has spread to the lymph nodes

16 Stage IIIb Breast Cancer
Stage IIIb breast cancer has spread to the chest wall, or caused swelling or ulceration of the breast, or is diagnosed as inflammatory breast cancer

17 Stage IIIc Breast Cancer
Stage IIIc breast cancer has spread to distant lymph nodes but has not spread to distant parts of the body

18 Stage IV Breast Cancer Stage IV breast cancer can be any size and has spread to distant sites in the body, usually the bones, lungs or liver, or chest wall

19 How is Breast Cancer Treated?
Treatment depends on stage of cancer More than one treatment may be used Surgery Radiation therapy Chemotherapy Hormone therapy Targeted therapy

20 Factors Considered in Treatment Decisions
The stage and grade of the tumor The tumor’s hormone receptor status (ER, PR) Factors that may signify an aggressive tumor, such as HER-2/neu amplifications The presence of known mutations to breast cancer genes The patient’s menopausal status The patient’s age and general health

21 Cancer Treatment: Surgery
Generally, surgery to remove the tumor with or without radiation therapy is initial treatment For invasive cancer, lymph nodes are removed and evaluated More invasive surgery (such as mastectomy) is not always better; discuss with your doctor Breast reconstruction is an option after mastectomy

22 Cancer Treatment: Adjuvant Therapy
Treatment given in addition to surgery to reduce the risk of recurrence May include radiation therapy, chemotherapy, biologic therapy, and hormone therapy

23 Cancer Treatment: Radiation Therapy
The use of high-energy x-rays or other particles to destroy cancer cells Usually used to treat breast cancer after surgery Different methods of delivery External-beam: outside the body Internal: uses implants inside the body Side effects may include fatigue, swelling, and skin changes

24 Cancer Treatment: Chemotherapy
Drugs used to kill cancer cells May be given before surgery to shrink a large tumor (neoadjuvant chemotherapy) or after surgery to reduce the risk of recurrence (adjuvant chemotherapy) A combination of medications is often used

25 Cancer Treatment: Hormone Therapy
Used to manage tumors that test positive for either estrogen or progesterone receptors May be used alone or together with chemotherapy Tamoxifen (Nolvadex) is a common hormone therapy and is effective in many premenopausal and postmenopausal women Aromatase inhibitors are also used alone or following tamoxifen use as treatment for postmenopausal women, including anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin)

26 New Therapies: Targeted Therapy
Treatment designed to target cancer cells while minimizing damage to healthy cells Used to stop the action of abnormal proteins that cause cells to grow and divide out of control Trastuzumab (Herceptin) for women with a HER-2/neu-positive breast cancer either with or after adjuvant chemotherapy Bevacizumab (Avastin) blocks angiogenesis (the formation of new blood vessels) and is under evaluation in clinical trials

27 The Role of Clinical Trials for the Treatment of Breast Cancer
Clinical trials are research studies involving people They test new treatment and prevention methods to determine whether they are safe, effective, and better than the best known treatment The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

28 Clinical Trials: Patient Safety
Informed consent: Participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks Informed consent is an ongoing process; participants are constantly updated as new information becomes available Participation is always voluntary, and patients can leave the trial at any time

29 Clinical Trials: Phases
Phase I trials determine safety and dose of a new treatment in a small group of people Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a given form of cancer Phase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the current, standard treatment for that disease; phase III trials involve a large number of patients

30 Clinical Trials Resources
Coalition of Cancer Cooperative Groups ( CenterWatch ( National Cancer Institute (

31 Coping With the Side Effects of Cancer and its Treatment
Side effects are treatable; talk with the doctor or nurse Fatigue is a common, treatable side effect Pain is treatable; non-narcotic pain relievers are available Antiemetic drugs can reduce or prevent nausea and vomiting Lymphedema following breast cancer surgery can often be managed with help from your doctor For more information, visit

32 Follow-Up Care Important to detect possible recurrence at the earliest stage Monthly breast self-examinations Physical examinations Mammograms Pelvic examinations More information can be found in the ASCO Patient Guide: Follow-Up Care for Breast Cancer

33 Where to Find More Information: PLWC Guide to Breast Cancer (www. plwc
Where to Find More Information: PLWC Guide to Breast Cancer ( Overview Medical Illustrations Risk Factors Prevention Symptoms Diagnosis Staging With Illustrations Treatment Side Effects of Cancer and Cancer Treatment Questions to Ask the Doctor Current Research Patient Information Resources Clinical Trials Resources

34 People Living With Cancer (
PLWC is the cornerstone of ASCO’s patient resources program Visitors to PLWC will find: PLWC Guides to more than 90 types of cancer Coping resources Ask the ASCO Expert Series, including chats, Q&A forums, and event transcripts Cancer information in Spanish The latest cancer news For patient information resources, please call

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