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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
• 10% of women with breast cancer
have an inherited risk for cancer due
to genes passed on from their
Breast cancer: Steps in the
development of a tumor
• Cancers develop due to a series of
molecular changes in the the cells of the
• 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
• 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?
• Be aware of your personal risk for breast
• 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
Why are mammograms important?
• Mammograms can detect changes in
breast tissue that may be associated
with cancers and premalignant
• 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
• 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
• 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
• She may refer you for breast imaging - even if
you had a mammogram less than one year
• He may refer you to a Breast Center - or
specialist in breast care - a surgeon or medical
What if I feel a lump in my breast?
• A biopsy may be recommended,
depending on the features of the
• 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
• Features of the tumor:
– type of breast cancer - ductal,
lobular, etc
– grade of the tumor
– hormone receptor status
– indicators of biologic growth rate
– 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
TUMOR: Remove some of the lymph
nodes under the arm to look for tumor
How is breast cancer
3. ADJUVANT THERAPY: Medical therapy
to decrease the chance of tumor
recurrence - to improve the chances for
Chemotherapy - many different therapies
Hormonal therapy - tamoxifen, aromatase
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
– blood clots
Can breast cancer be prevented?
• Who should be offered
• How long should we give this
• Are the long term effects
STAR Chemoprevention Trial
(Study of Tamoxifen against
• 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.