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INTRODUCTION
 Breast cancer, the second-leading cause of cancer
deaths in women, is the disease women fear
most.
 Breast cancer can also occur in men, but it's far
less common.
 Yet there's more reason for optimism than ever
before.
 In the last 30 years, doctors have made great
strides in early diagnosis and treatment of the
disease and in reducing breast cancer deaths.
 80% of breast cancers occur in women older than
age 50. In 30s, have a one in 233 chance of
developing breast cancer. By age 85, chance is
one in eight.
 In 1975, a diagnosis of breast cancer usually
meant radical mastectomy – removal of the entire
breast along with underarm lymph nodes and
muscles underneath the breast.
 Today, radical mastectomy is rarely performed.
Instead, there are more and better treatment
options, and many women are candidates for
breast-sparing operations.
SIGNS AND SYMPTOMS
 When the disease is discovered early, have more
treatment options and a better chance for a cure.
 Most breast lumps aren't cancerous. Yet the most
common sign of breast cancer for both men and
women is a lump or thickening in the breast. Often,
the lump is painless.
 Spontaneous clear or bloody discharge from the
nipple, often associated with a breast lump
 Retraction or indentation of the nipple
 Change in the size or contours of the breast
 Any flattening or indentation of the skin over the
breast
 Redness or pitting of the skin over breast, like the skin
of an orange
 A number of conditions other than breast cancer can
cause the breasts to change in size or feel.
 Breast tissue changes naturally during pregnancy and the
menstrual cycle.
 Other possible causes of noncancerous (benign) breast
changes
include
fibrocystic
changes,
cysts,
fibroadenomas, infection or injury.
 If patient haven't yet gone through menopause, may
want to wait through one menstrual cycle before seeing
the doctor.
 If the change hasn't gone away after a month, have it
evaluated promptly.
CAUSES
 In breast cancer, some of the cells in the breast
begin growing abnormally.
 These cells divide more rapidly than healthy cells
do and may spread (metastasize) through the
breast, to lymph nodes or to other parts of the
body.
 The most common type of breast cancer begins in
the milk-producing ducts, but cancer may also
begin in the lobules or in other breast tissue.
 In most cases, it isn't clear what causes normal
breast cells to become cancerous.
 Only 5-10% of breast cancers are inherited.
 Families that do have genetic defects in one of
two genes, breast cancer gene 1 (BRCA1) or
breast cancer gene 2 (BRCA2), have a much
greater risk of developing both breast and ovarian
cancer.
 Other inherited mutations – including the ataxiatelangiectasia mutation gene, the cell-cycle
checkpoint kinase 2 (CHEK-2) gene and the p53
tumor suppressor gene – also make it more likely
that will develop breast cancer.
 If one of these genes is present in the family, will
have a 50 percent chance of having the gene.
 Yet most genetic mutations related to breast cancer
aren't inherited.
 These acquired mutations may result from radiation
exposure – women treated with chest radiation therapy
for lymphoma in childhood or during adolescence
when breasts are developing have a significantly
higher incidence of breast cancer than do women not
exposed to radiation.
 Mutations may also develop as a result of exposure to
cancer-causing chemicals, such as the polycyclic
aromatic hydrocarbons found in tobacco and charred
red meats.
 Each of breasts contains 15 to 20 lobes of
glandular tissue, arranged like the petals of a
daisy.
 The lobes are further divided into smaller lobules
that produce milk during pregnancy and breastfeeding.
 Small ducts conduct the milk to a reservoir that
lies just beneath the nipple.
 Supporting this network is a deeper layer of
connective tissue called stroma.
RISK FACTORS
 Some risk factors, such as age, sex and family
history, can't be changed
 Whereas others, including weight, smoking and a
poor diet, are under control.
 Age
 Personal history of breast cancer.
 Family history.
 Genetic predisposition.
 Radiation exposure.
 Excess weight.
 Early onset of menstrual cycles.
 Late menopause.
 First pregnancy at older age.
 Race.
 Hormone therapy.
 Birth control pills.
 Smoking.
 Excessive use of alcohol.
 Precancerous
breast
changes
(atypical
hyperplasia, lobular carcinoma in situ).
 Mammographic breast density.
WHEN TO SEEK MEDICAL ADVICE
 Although most breast changes aren't cancerous,
it's important to have them evaluated promptly.
 Discover a lump or any of the other warning
signs of breast cancer, especially if the changes
persist after one menstrual cycle or they change
the appearance of the breast.
 If treated for breast cancer, report any new signs
or symptoms immediately.
 Possible warning signs include a new lump in the
breast or a bone ache or pain that doesn't go away
after three weeks.
Screening and diagnosis
 Screening – looking for evidence of disease
before signs or symptoms appear – is the key to
finding breast cancer in its early, treatable stages.
Depending on age and risk factors, screening
may
include
breast
self-examination,
examination by nurse or doctor, mammograms
(mammography) or other tests.
 Self breast examination is an option beginning at
age 20.
Screening
Breast self-exam
Clinical breast exam
 Mammogram - to check breast tissue
Other tests
 Computer-aided detection (CAD)
 Digital mammography
 Magnetic resonance imaging (MRI)
 Breast ultrasound (ultrasonography)
Experimental procedures
 Ductal lavage
 Molecular breast imaging (MBI)
CAD
Mammogram
Mammogram
Breast
Ultrasound
Digital
mammography
Diagnostic procedures
 Ultrasound
 Biopsy – Fine-needle aspiration biopsy, core
needle biopsy, sterotactic biopsy, wire
localization biopsy, surgical biopsy
 Estrogen and progesterone receptor tests
 Staging tests – Stage 0 to IV
 Genetic stage
Breast biopsy
Tamoxifen inhibits
estrogen receptor
activity
AE = antiestrogenic
E = estrogenic
TREATMENT
 In addition to coping with a potentially lifethreatening illness – must make complex
decisions about treatment.
 Treatments exist for every type and stage of
breast cancer.
 Most women will have surgery and an additional
(adjuvant)
therapy
such
as
radiation,
chemotherapy or hormone therapy.
 Experimental treatments are also available at
cancer treatment centers.
SURGERY
 Lumpectomy
 Partial or segmental mastectomy
 Simple mastectomy
 Modified radical mastectomy
 Sentinel lymph node biopsy
 Axillary lymph node dissection
 Radiation therapy
 Chemotherapy
Reconstructive surgery
 Reconstruction with implants
 Reconstruction with a tissue flap
 Deep inferior epigastric perforator
reconstruction
 Reconstruction of the nipple and areola
(DIEP)
Hormonal therapy
 Selective estrogen receptor modulators (SERMs)
 Aromatase inhibitors
Biological therapy
 Trastuzumab (Herceptin)
 Bevacizumab (Avastin)
 Lapatinib (Tykerb)
PREVENTION
Chemoprevention
 Tamoxifen (Nolvadex)
 Raloxifene (Evista)
Preventive surgery
 Prophylactic mastectomy
 Prophylactic oophorectomy
LIFE-STYLE FACTORS
 Taking aspirin
 No / limit alcohol
 Maintain a healthy weight
 Avoid long-term hormone therapy
 Stay physically active
 Eat foods high in fiber
 Emphasize olive oil
 Avoid exposure to pesticides
New directions in research
 Retinoids - Natural or synthetic forms of vit-A
have the ability to destroy the growth of cancer
cells. Effective in premenopausal women and in
those whose tumors aren't estrogen positive.
 Flaxseed – High in lignan, a naturally occurring
compound that lowers circulating estrogens in the
body. Decreases estrogen production – acts like
tamoxifen – inhibit the growth of breast cancer
tumors. Lignans are also antioxidants with weak
estrogen-like
characteristics.
These
characteristics may be the mechanism by which
flaxseed works to decrease hot flushes.
COPING SKILLS
 Telling others
 Maintaining a strong support system
 Dealing with intimacy
 Self-care taking
Thank you
 Breast tenderness is pain or discomfort in the
breasts. It is the most common breast symptom
women have. It is usually not a sign of breast
cancer.
 Most common cause of breast tenderness is
called fibrocystic breast changes.
 These changes are caused by the swelling of very
tiny fluid-filled cysts in fibrous tissue in the
breast.
 The changes usually happen 7-10 days before the
menstrual period and go away when period ends.
CAUSES
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Puberty (boys / girls)
Pregnancy
Infection of the breast
Hormone imbalance – too much estrogen
Birth control pills
Breast-feeding – when breasts engorged (milk)
Injury of the breast
Noncancerous tumor in the breast (fibroma)
Breast cyst
Condition called hyperprolactinemia
Breast cancer, but often cancer does not cause any pain.
DIAGNOSIS
 Mammogram (a special x-ray of the breasts)
 Ultrasound scan of the breasts (a scan with sound
waves)
 Thermography of the breasts (a heat test that
outlines the breast in a color pattern)
 Biopsy (removal of a small piece of tissue or
fluid from the breast).
 Examination of discharge from a nipple
 Blood test.
TREATMENT
 Drink fewer or no beverages with caffeine.
 Add vitamins E and A to the diet.
 Reduce salt intake – 1-2 weeks before
menstruation.
 Put heat on the breast with a heating pad or warm
water bottle.
 Diuretics.
 Surgery is rarely needed.
SELF-CARE
 Follow the physician’s recommendations for
preventing and treating breast tenderness.
 Learn how to examine the breasts after the
menstrual period every month.
 Nipple discharge is any kind of fluid that comes
out of the nipple.
 Nipples contain tiny openings through which
fluid can pass.
 Although most nipple discharge is not serious,
any discharge should be evaluated.
 The color and consistency of the discharge will
help in diagnosis.
 A clear, straw-colored discharge sometimes
develops in early pregnancy.
 A whitish or greenish discharge occurring in
nonpregnant women is galactorrhea – cause –
birth control pills, hormone imbalance, pituitary
tumor, or cyst under the areola.
 Pus discharge indicates a breast infection.
DIAGNOSIS
 No menstrual periods
 Headaches
 Visual problems.
 Lab tests of the discharge
 Blood tests
 Mammogram (x-ray of the breasts)
 Ultrasound scan of the breasts
 CT scan of the brain.
TREATMENT
 Surgery
 Radiation therapy
 Chemotherapy.
 Galactorrhea is a milklike discharge of fluid from
the breast nipples.
 Usually the discharge is from both breasts rather
than just one.
 A discharge like this is called galactorrhea unless
pregnant or breast-feeding.
 Galactorrhea usually occurs when the body
produces too much prolactin. Prolactin is a
hormone produced by the pituitary gland.
Normally, prolactin helps a woman make milk
when she has a baby.
ETIOLOGY
 Birth control pills and other medicines
 Underactive thyroid gland
 Problems with the pituitary gland
 Some brain diseases, such as meningitis
 Cyst under the darkened area around the nipple
(galactocele)
 Shingles caused by the chickenpox virus in the
chest wall
 Surgery on the chest
 Other medical problems – kidney failure, liver
disease, sarcoidosis, or Cushing's disease.
DIAGNOSIS
 Medical history – stopped having menstrual
periods, having trouble getting pregnant, or
having headaches or vision problems. OTC
medicines if any. Sample of the discharge may be
tested in the lab.
 Blood tests
 Mammogram (x-ray of the breasts)
 Ultrasound scan of the breasts
 CT scan of the brain to look at the pituitary
gland.
TREATMENT
 If a galactocele is causing the galactorrhea, the
cyst will be removed.
 If the discharge is caused by drugs, it will clear
up when stop taking the drugs. However,
stopping drugs is not always necessary.
 If the galactorrhea is caused by a pituitary gland
tumor, needs surgery, radiation, or drug
treatments. Can treat with bromocriptine (stops
production of prolactin).
How long will the effects last?
 Once the cause of the discharge is diagnosed and
treated, she should no longer have the discharge.
However, if pituitary tumor is present, may need
long-term treatment with bromocriptine or
radiation because the tumor could come back.
SELF-CARE
 Follow-up tests.
 Take drugs as prescribed.
 If the galactorrhea is mild and a cause cannot be
found, breast binders can help stop the discharge
by preventing stimulation of the nipples.
 Paget's disease is a slowly growing cancer of the
nipple. It is a rare form of breast cancer. It mainly
affects women and very rarely men.
 When abnormal cells grow uncontrollably, they
are called tumors. It is not known why they
occur. In Paget's disease, the tumor starts in the
milk ducts of the nipple.
SYMPTOMS
 Symptoms seem harmless. It is often thought to
be a skin inflammation or infection, which can
delay its diagnosis and treatment.
 Redness, oozing, and crusting of the nipple and
the circular, dark area around the nipple (areola),
which causes itching and burning.
 Sore on the nipple that will not heal.
 Usually only 1 nipple is affected. Sometimes no
changes in the skin can be seen. May have a
lump in the breast, which may or may not be able
to feel.
DIAGNOSIS
 Sample of discharge from the nipple may be
examined under a microscope.
 Biopsy – to remove the sample of breast tissue to
test for cancer.
 Mammogram of both breasts to look for cancer in
other parts of the breasts.
 Ultrasound scan or MRI - both of these tests
create pictures of the breasts.
TREATMENT
If the cancer is only in the nipple and not any other
part of the breast:
 Radiation treatments
 Surgery to remove just the nipple and
surrounding tissue.
If a mass is found deep in the breast:
 Surgery to remove all or part of the breast
 Chemotherapy.
How long will the effects last?
 Without treatment, the cancerous sore will
remain on the nipple and may spread deeper into
the breast.
PREVENTION
 Check monthly for any lumps, sores, or oozing
from the breasts and report any breast changes to
the physician right away.
 Breast-feeding should be a comfortable and
enjoyable experience.
 Sore nipples are a common problem among
breast-feeding mothers.
 Often mothers quit nursing their babies early
because of sore nipples, but this doesn't have to
happen.
 Sore nipples usually can be prevented or treated.
 Mild nipple discomfort at the beginning of
feedings during the first few days of breastfeeding usually needs no treatment.
 Nipple pain that is severe or lasts throughout a
single or for more than a week is not normal and
should be evaluated by doctor or a lactation
consultant.
• Protects sore nipples
during breast-feeding
• Shaped to allow skin
contact with baby
• Made with odorless,
tasteless, ultra-fine
silicone
Nipple protectors
CAUSES
 Position of the baby's mouth on the breast.
 Size and shape of the nipples and the baby's
mouth can affect how the baby latches on the
breast.
 Also, infant's sucking habits can cause nipple
discomfort.
 Other possible causes of nipple pain are an
infection of the nipples (yeast or bacterial), breast
infection or improper nipple skin care.
PROBLEMS CAUSED
 If baby is not latching on to the breast correctly,
he may not be getting enough milk.
 Also, nipple pain may cause to put off nursings
or not let the baby suck long enough when he
nurses.
 Sucking is important because this is what triggers
the milk to begin to flow (let-down reflex).
 Nipple pain can cause a drop in the milk supply.
 As a result, baby may not gain weight well.
 Sore nipples and low milk supply problems often
go hand-in-hand.
TREATMENT
 Make sure the baby is positioned correctly to nurse
 Begin a feeding on the less sore nipple to trigger
the let-down reflex and start milk flowing
 Frequent shorter feedings are better than less
frequent lengthy feedings
 Keep the nipples dry
 If any cracks or other breaks in the skin, keep the
nipples covered with a soothing ointment
 Use a pump to express the milk if the pain is so
severe that cannot nurse the baby
 Watch for signs of a breast infection
WHEN TO SEEK MEDICAL ADVICE
 Immediate – following symptoms additional to sore
nipples: chills, fever, headache, flu-like symptoms,
or pain or redness in the breast.
 OB/GYN – Nipples sting or burn and have shooting
pains in the breast, especially after nursing. Nipple
pain keeps from nursing long enough to trigger letdown reflex.
 Pediatrician – baby unsatisfied after most nursings.
Baby may not be satisfied because milk supply is
low or baby is not emptying breasts. Nipples – yeast
infection, see white patches in the baby's mouth, or
baby has had a diaper rash for 3 or more days.
Thank you