Download Hematopoetic Cancers

Breast Cancer
1
Leukemia & Lymphoma
New diagnoses each year in the US:
112, 610 Adults
5,720 Children
43,340 died of leukemia or lymphoma in 2010
2
Breast Cancer
New diagnoses each year in the US:
246,660 Women
2,600 Men
40,450 estimated deaths from breast cancer in 2016
3
Leukemia
Lifetime Risk: 1/77
Median age of diagnosis = 66 YOA
Median age of death = 73 YOA
5 year survival = 54.1%
4
Female Breast Cancer
Lifetime Risk: 1/8.1 Women
(12.3% of women will be diagnosed with
breast cancer in their lifetimes)
Median age of diagnosis = 61 YOA
Median age of death = 68 YOA
5 year survival = 89.4%
5
Male Breast Cancer
2,600 New diagnoses in 2015 year
440 Deaths
Fewer than 1% of new breast cancer cases are in men
Median age at diagnosis and prognosis similar to that
of women
Median age of death slightly lower due to tendency to
be diagnosed at a later stage
6
Risk Factors
Age
Breast Cancer
Family History
(greater if family member was diagnosed before age 50)
Genetic Predisposition
Radiation Therapy to the Chest
Reproductive History
First child when older
No children
First Menstrual Cycle before age 12
Menopause after age 55
Menopausal hormone replacement therapy
Dense Breasts
Post-menopausal obesity
Physical Inactivity
7
Alcohol Consumption
Symptoms
Change in breast size / shape / appearance
Dimpling or puckering skin on the breast
Scaly, red or swollen skin on the breast
Discharge from the nipple
8
Diagnosis-Age Distribution
9
Incidence by Race
10
Influence of Race on Deaths
11
Diagnosis
Needle Biopsy, Aspiration Biopsy or
Surgical excision
Pathologic Determination
12
Additional Tests
Hormone Receptor Profile
•Estrogen
•Progesterone
HER2/neu Expression
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Anatomy
14
The most common (~90%)
type of breast cancer is
ductal carcinoma.
Anatomy
15
5 Year Survival by Stage
16
Trends in Incidence vs. Survival
17
Staging
Stage 0: Dysplasia; non-invasive. Eg.,DCIS
Diagnosed by
mammography—
non-palpable
18
DCIS
Ductal carcinoma in situ [A.K.A., ductal intraepithelial neoplasia]
• Noninvasive condition that can evolve to invasive cancer, with
variable frequency and time course
• Most often diagnosed by mammography
 4,900 women were diagnosed with DCIS in 1983
 Approximately 64,000 diagnosed in 2013
• Natural history of DCIS is poorly understood because nearly all DCIS
cases are treated.
19
DCIS
28 confirmed (biopsy) DCIS
•
•
•
Untreated & followed for 30 years
9 (~30%) developed invasive breast cancer
4 (44%) died of the disease
98.1% 10-year disease-free survival for women
treated for DCIS (lumpectomy & radiation therapy)
Most cases of DCIS will not evolve to invasive
cancer; treatment of non-palpable DCIS represents
over-diagnosis & over-treatment
20
Staging
Stage 1: Neoplasia; invasive. Only breast tissue involvement.
Tumor < 2cm in diameter.
21
Tumor Size
22
Staging
Stage 2: Fits one of the
following criteria: a.) Tumor
is 2-5 cm in diameter; b.)
Tumor has disseminated to
the axillary, ipsilateral lymph
node + tumor is < 2 cm in
diameter; c.) Tumor is
confined to breast tissue +
tumor is > 5 cm.
23
Staging
Stage 3: Locally-advanced cancer. Divided
into the following categories: IIIA.) Tumor
has disseminated to the axillary, ipsilateral,
adjacent lymph nodes or to sternal lymph
nodes + tumor is < 5 cm in diameter OR
Tumor has disseminated to the axillary,
ipsilateral lymph nodes (adjacent or not) +
tumor is > 5 cm in diameter IIIB.) Tumor is
any size and has grown into the chest wall
or the skin. Lymph nodes may or may not
be involved OR Tumor is confined to breast
tissue + tumor is > 5 cm. IIIC.) Tumor is any
size and has disseminated to the axillary
lymph nodes and the sternal lymph nodes
OR the tumor is any size and has
disseminated to the supraclavicular lymph
nodes.
IIIA
IIIC
24
Inflammatory Breast Cancer
Rare (~ 1%)
Breast is red and swollen
Staged = at least IIIB.
25
Staging
Stage 4: Metastatic cancer.
Tumor is any size but has
spread to distant organs.
26
Surgical Treatment
Stage 0
Stages I and II
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Other Treatments
Radiation Therapy
Chemotherapy
Biological Therapy
Targeted Therapy
28
http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/allpages#3
http://seer.cancer.gov/statfacts/html/breast.html
29
Screening
30
Screening
Clinical Breast Exam
Self Breast Exam
Mammography
MRI, Sonography
31
Biopsy
(with other Clinical Finding)
Screening
Mammography vs. Physical Exam
PE:
27.6% Sensitive
99.4% Specific
Mammography:
77.6% Sensitive*
98.8% Specific*
*effectiveness declined significantly with increasing breast density.
Conclusion: 11, 130 patients; Mammography significantly increases
detection of small cancers and lower-stage cancers than does PE.
32
Kolb, et al., 2002. Radiology 225:165-175.
Screening
33
Screening: New Directives (2016)
Preventive Services Task Force (USPSTF) Guidelines*:
Screening for women aged 40-49 is not supported
Biennial (versus annual) screening supported for women aged 50-74.
*Against the advice of the national cancer advisory board—1st time in history.
34
Kopans, 2010. Radiol Clin N Am. 48: 843-57.
Screening
http://www.cancer.org/healthy/informationforhealthcareprofessionals/acsguid
elines/breastcancerscreeningguidelines/index
http://screeningforbreastcancer.org/read-the-materials
http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=103278
35
Kopans, 2010. Radiol Clin N Am. 48: 843-57.