Download Breast Cancer 101

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.