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Breast Cancer 101 Barbara Lee Bass, MD, FACS Professor of Surgery Associate Chair for Academic Affairs and Research University of Maryland School of Medicine What is Breast Cancer? • Abnormal cells develop from normal cells in the breast to form tumors • Tumor cells have genetic defects that allow the cells to grow too rapidly and to invade normal tissues • 90% of women with breast cancer have tumors due to spontaneous new mutations arising in their breast tissue as they age What is Breast Cancer? • The cause of these mutations is not known • 10% of women with breast cancer have an inherited risk for cancer due to genes passed on from their parents Breast cancer: Steps in the development of a tumor • Cancers develop due to a series of molecular changes in the the cells of the breast • These cellular changes lead to premalignant tissues in the breast that can be identified in a biopsy • Cancers develop from a microscopic group of cells that grow into larger tumors over time Stages of breast cancer? • The rate at which a cancer will grow is not predictable - some tumors grow slowly, others rapidly • The earlier a tumor is identified, the better the chance for cure • 95% of women with cancers less than 1/2 inch in size are cured Breast Cancer: Statistics • Breast cancer is the most common cancer in American women • 185,000 new cases this year • 41,000 American women will die of breast cancer - second only to lung cancer as a cause of cancer death among women • Lifetime risk for the average woman; approximately one in nine will develop breast cancer What is my risk for developing breast cancer? • Age greater than 50 years • History of breast cancer in a close relative (mother/sister/daughter) • 90% of women with breast cancer have no relatives with the disease Risks • Finding of premalignant changes in your breast tissue • Never having children • Having your first child after age 30 • Obesity - Alcohol - Estrogen therapy What is my best defense against breast cancer? EARLY DETECTION • Be aware of your personal risk for breast cancer • Have a screening mammogram every year once you are 40 years old • Have an annual breast exam every year after age 40 Early Detection • Practice monthly breast self exam • See your doctor promptly if you note a new breast lump or thickening • Enjoy a healthy life: control your weight, minimize alcohol, don’t smoke, exercise Why are mammograms important? • Mammograms are sensitive xrays of the breast • Small, safe dose of radiation is used • Minor discomfort due to pressure on the breast is noted by some women EARLY DETECTION LEADS TO CURE Why are mammograms important? • Mammograms can detect changes in breast tissue that may be associated with cancers and premalignant changes • Mammograms are the best means to find early curable cancers - cancers too small to be detected by touch • 85% of cancers will show up on a mammogram - 15% will not What if I have an abnormal mammogram? • See your doctor for a breast examination • Special mammogram will be done to confirm if the finding is real • Additional imaging tests - ultrasound for better definition • Close follow-up imaging may be recommended at 6 months or: What if I have an abnormal mammogram? • Biopsy may be recommended – Needle biopsy - Ultrasound directed – Needle biopsy - mammogram directed – Surgical biopsy • The tissue diagnosis is the most important information in planning treatment • Most mammogram abnormalities are not cancer; most are due to benign changes What if I feel a lump in my breast? • Go to you health care provider promptly for a physical examination; don’t wait for your annual examination • She may refer you for breast imaging - even if you had a mammogram less than one year previously • He may refer you to a Breast Center - or specialist in breast care - a surgeon or medical oncologist EARLY DETECTION LEADS TO CURE What if I feel a lump in my breast? • A biopsy may be recommended, depending on the features of the lump • Many lumps in the breast are NOT cancer; benign fibrocystic disease and benign tumors are common How is the diagnosis of breast cancer made? • A suspicious sign on a mammogram or a lump in the breast will indicate the need for a tissue biopsy • A biopsy of the abnormal tissue is required to make the diagnosis of breast cancer • A careful physical examination will give signs about the stage of the cancer – size of tumor in breast – lymph node enlargement under arm – status of the opposite breast How is the diagnosis of breast cancer made? • Features of the tumor: – type of breast cancer - ductal, lobular, etc – grade of the tumor – hormone receptor status – indicators of biologic growth rate potential – c-erb How is breast cancer treated? 1. SURGERY: to remove all the tumor Breast preserving surgery - most patients Removal of the full breast - mastectomy may be required for some patients 2. DETERMINE THE STAGE OF THE TUMOR: Remove some of the lymph nodes under the arm to look for tumor metastases How is breast cancer treated? 3. ADJUVANT THERAPY: Medical therapy to decrease the chance of tumor recurrence - to improve the chances for cure Chemotherapy - many different therapies Hormonal therapy - tamoxifen, aromatase inhibitors 4. RADIATION THERAPY - to prevent tumor recurrence in the remaining breast tissue; required for breast preserving therapy Can breast cancer be prevented? • NSABP P1 Trial: showed that women with an increased risk for breast cancer can have that risk decreased by 40 - 50% by taking the anti-estrogen medication tamoxifen • Tamoxifen benefited women with: – the breast cancer gene – age greater than 55 years – premalignant changes in previous biopsies • Side effects – very small increase in risk of cancer of the uterus – blood clots Can breast cancer be prevented? • Who should be offered chemoprevention? • How long should we give this medication? • Are the long term effects satisfactory? STAR Chemoprevention Trial (Study of Tamoxifen against Raloxifene) • National clinical study that will enroll 22,000 women to test the effectiveness of 2 different anti-estrogens for the prevention of breast cancer STAR Chemoprevention Trial (Study of Tamoxifen against Raloxifene) • Tamoxifen vs. Raloxifene – both are approved medications that selectively block estrogen receptors – estrogen receptors are present on many tissues - breast, bone, uterus, blood vessels, and many others – Tamoxifen - breast cancer medication – Raloxifene - anti-osteoporosis medication • Compare the 2 groups of women for development of breast cancer, possible side effects or other benefits STAR Chemoprevention Trial (The Study of Tamoxifen against Raloxifene) • Eligibility for participation is based on a 5 year predicted risk for developing breast cancer. The following factors contribute to this calculated risk: – Age: post-menopausal women over the age of 35 – positive family history of breast cancer – history of benign breast biopsies – history of lobular carcinoma is situ on previous breast biopsy STAR Chemoprevention Trial (The Study of Tamoxifen against Raloxifene) • The Breast Evaluation Program of the Greenebaum Cancer Center is a participating site for this trial. If you would like to be considered for participation please call 410-328-7855 for an appointment.