Breast Cancer

Overview
Epidemiology Risk Factors Prevention Early diagnosis

Breast Cancer (BC) Epidemiology:

A. Incidence:
Breast cancer is the most common lethal neoplasm in women. The incidence varies among different populations 1 out of 8 women will have BC in her life-time. ~ 25 percent of women with cancer have BC. The incidence of male breast cancer is about 1 % of all breast cancer cases occur in men.

2009 Estimated US Cancer Cases

Men 766,130
Prostate Colon & rectum Urinary bladder NHL Leukemia Oral cavity Pancreas 25% 10% 7% 5% 3% 3% 3% Lung & bronchus 15%

Women 713,220
27% 14% 10% 6% 4% 4% 4% 3% 3% 3% Breast Lung & bronchus Colon & rectum Uterine corpus NHL Melanoma of skin Thyroid Kidney & renal pelvis Ovary Pancreas

Melanoma of skin 5%

Kidney & R. pelvis 5%

All Other Sites

19%

22%

All Other Sites

Jemal A et al, CA Cancer J Clin 2009

2009 Estimated US Cancer Deaths

Men 292,540 Lung & bronchus 30% Prostate 9% Women 269,800 26% 15% Lung & bronchus Breast

Colon & rectum

Pancreas Leukemia Liver & bile duct

9%
6% 4% 4%

9%
6% 5% 4%

Colon & rectum

Pancreas Ovary NHL

Esophagus
Urinary bladder NHL All other sites

4%
3% 3% 25%

3%
3% 2% 2% 25%

Leukemia
Uterine corpus Liver & bile duct Brain/ONS All other sites

Kidney & R. pelvis 3%

Jemal A et al, CA Cancer J Clin 2009

Lifetime Probability of Developing Cancer, Women, US, 2003-2005*

Site
All sites

Risk
1 in 3

Breast
Lung & bronchus Colon & rectum Uterine corpus

1 in 8
1 in 16 1 in 20 1 in 40

Non-Hodgkin lymphoma
Urinary bladder Melanoma Ovary

1 in 53
1 in 84 1 in 58 1 in 72

Pancreas
Uterine cervix

1 in 75
1 in 145
Includes invasive and in situ cancer cases Statistic for white women.

Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan

5 4.31

3.42

2.67

1.48

1 0 0 10--20 20-30 0.05

0.39

30-40

40-50

50-60

60-70

70-80

Life-time breast cancer risk 12.56% (1/8)

INCIDENCE OF BREAST CANCER IN PAKISTAN

There is no national-based data on incidence of breast cancer in Pakistan however limited studies have shown an alarmingly high incidencein fact highest in Asian countries. The ASR was reported to be as high as 51.7 per 100,000 per year in a report by American society of Human Genetics 2002.

Data of New Breast Cancer Patients

Total Breast Cases 4000 3500 3000 2500 2000 1500 1000 500 0 1998 2000 2002 2004 2006 Total Number of cases

Data of patients below 40 yrs.

patients below 40 yrs. 300 250 200 150 100 50 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

According to UICC and World Health Report 2005 47% of newly diagnosed breast cancers in Pakistan are already in advanced stage.

Risk Factors
Risk Factors do not cause breast cancer but are associated with an increased chance of getting breast cancer The number one risk factor for breast cancer is being a women Age is a risk; the chance of getting breast cancer increases with age

Age as a Risk Factor

By age 30 By age 40 By age 50 By age 60 By age 70 By age 80 Lifetime risk
NCI SEER Program, 1995-1997

RISK 1 out of 2,000 1 out of 233 1 out of 53 1 out of 22 1 out of 13 1 out of 9 1 out of 8

Risk Factors
Controllable Alcohol drinking Being overweight Never having children 1st child >30yrs of age Hormone Replacement Birth control pills (very slight)
ACS Breast Cancer Facts 2001-02

Uncontrollable Getting older First degree relative with breast cancer A previous breast biopsy showing atypical changes

Risk Factors
Controllable Uncontrollable Being exposed to Being young (<12) at the large amounts of time of menses radiation Starting menopause after age 55 Having an inherited mutation in the breast cancer genes (BRCA 1 or 2)
ACS Breast Cancer Facts 2001-02

PREVENTION OF BREAST CANCER

Best way of preventing breast cancer is to eliminate the controllable risk factors mentioned above by:

EAT HEALTHY

EXERCISE

What You Can Do Now to Prevent Breast Cancer

Reduce alcohol: less than 1 / day Avoid overuse of antibiotics Probiotics 10-20 mil org bid w/o food Supplement with flaxseed oil, omega 3 fatty acids, antioxidants (C, E, and selenium), vitamin D3, Co Q10 and iodine, I3C or DIM Increase fiber intake

What You Can Do Now to Prevent Breast Cancer

Avoid use of birth control pills, synthetic hormone replacement therapy Avoid exposure to radiation, pesticides, cigarette smoke Avoid using plastic containers for drinking and food preparation Replace antiperspirant w/ natural deodorant

What You Can Do Now to Prevent Breast Cancer

Maintain ideal body weight Daily aerobic exercise Manage and decrease stress effects in your life Get adequate rest and sleep Get help to deal with emotional issues

What can be done? Early Detection---A Challenging Field Of Endeavour

We can save lives--MANY LIVES

Screening Recommendations
A.C.R, A.M.A and A.C.S all recommend :-

Beginning at age 20, monthly self examination and clinical examination by a health care provider at least every three years Base line at age 35-40 years and then annual mammography Earlier screening for high risk women

Early Detection
Self breast examination.

Clinical examination by physician or surgeon.

By imaging MAMMOGRAPHY, BREAST ULTRASOUND, BREAST MRI.

Self Breast Examination

Should be started at the age of 20 It should be done monthly several days after periods end when breasts are least likely to be swollen. The women should be well aware of the technique of self examination and any change noted in the breast should be further evaluated by a clinician.

STEPS IN PERFORMING BSE

This procedure can be also be done in lengthwise direction

Trouble Signs That Should Not Be Ignored

1. 2. 3. 4. 5. Finding a lump, hard knot or thickening Unusual swelling, warmth, redness or darkening Change in size or shape of your breast Dimpling or puckering of the skin of your breast Finding an itchy, scaly sore or rash on the nipple 6. Pulling in of the nipple or other parts of the breast 7. Nipple discharge that starts suddenly 8. Pain in one spot that does not vary with cycle

When you discover a breast lump What do you do?

1. Dont Panic most breast lumps are not cancer (Benign Breast Changes - Cysts and Fibroadenomas) 2. See your primary health care provider for a full assessment and recommendations 3. You may need a fine needle aspiration procedure and or a diagnostic mammogram or ultrasound

Mammography
A special kind of X-Ray of the breasts done by a dedicated machine. A non invasive test. Involves insignificant radiation hazard. Takes only about half an hour. ACR recommends screening mammogram every year starting at age 40. Cancers below 1cm can be detected.

Mammography

Always bring previous mammography films and imaging reports whenever you come for a mammogram. Do not wear talcum powder or any deodorants as they cause artifacts.

Indications of Mammography
To assess signs and symptoms of breast disease such as lump, nipple discharge, change in shape of breast or mastalgia.

Indications of Mammography
Preoperative mammogram is done To establish multifocality and to plan type of surgery. To examine contralateral breast.

Breast Ultrasound
It is used as a prime modality to investigate women with breast symptoms who are younger than 40. It is safe and very informative but always should be done by trained Radiologist as breast ultrasound is a super speciality and cannot be performed on ordinary ultrasound units.

Breast Ultrasound
Can only be done with high resolution dedicated ultrasound units. Safe test with no ionizing radiation involved. Should only be performed by trained radiologists who are experienced in doing breast sonography.

Indications of Ultrasound
Mostly complimentary to mammography. Helps in further charachterizing the type of lesion whether solid or cystic.

Indications of Ultrasound
Also helps in predicting whether a lesion is benign or malignant. Primary modality in women below thirty five years of age, pregnant or lactating women.

Tissue Diagnosis
Needle biopsy.needle tests are essential to diagnose cancer sometimes image guidance is used.Biopsy is a technique in which a small amount of breast tissue is taken and examined under the microscope. General misconceptionneedle biopsies DO NOT help in spreading the tumour.

It includes: Fine Needle Aspiration Fine needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass. Core Needle Biopsy Core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle.

Early Detection
THE EARLIER A CANCER IS DETECTED THE MORE ARE THE CHANCES OF CURE.
Breast cancers less than 1.5cm in size have a cure rate of about 94%.

Breast Cancer
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