Download For Breast Cancer

Breast Cancer and
Epidemiology
Dilek Aygin
Breast Cancer
► The
most common form
of cancer among women
► The second most
common cause of cancer
related mortality
► 1 of 8 women (12.2%)
► One third of women with
breast cancer die from
breast cancer
► Breast
cancer, accounting for 23% of all
female cancers around the globe.
► There
is marked geographical variation in
incidence rates, being highest in the
developed world and lowest in the
developing countries in Asia and Africa.
The breast cancer situation is no
different in Turkey
►
According to data provided by the Turkish Association for Cancer
Research and Control (TKASK), 150,000 people are diagnosed
with cancer each year in Turkey.
►
Even though breast cancer can be treated successfully when
diagnosed early, thousands of women still die from the disease
each year, and experts say breast cancer awareness in Turkey is
at an inadequate level.
►
breast cancer is the most common cancer among Turkish women,
which represents 26.5% of all female cancers.
Ministry of Health: The most frequent ten cancers in females in Turkey. http:/ / www.saglik.gov.tr
To the estimations of the Health Ministry resources (Tuncer,
2006, www.saglık.gov.tr), the number of breast cancer
patients in the period of 2007-2012 has been
seen in Table 1.
Global Differences in Breast Cancer
Diagnosis and Outcomes: Survival
mortality-to-incidence ratios are generally
lower in developed regions1
USA (83–88%)2*
Europe (60–83%)2*
Developing countries
(45–72%)3**
Women diagnosed: *1990–1994;
1Shibuya,
**1982–1992
et al. BMC Cancer 2002;2:37; 2Coleman, et al. Ann Oncol 2003;14
(Suppl 5):V128–V149; 3Sankaranarayanan, et al. IARC Sci Publ 1998;145:135–73
ASR 5-year survival
► Estimated
GLOBAL STATISTICS:
Breast cancer mortality in different countries
0.38
0.39
0.35
0.39
0.25
0.27
0.37
0.32
0.37
0.33
0.45
0.42
0.45
0.48
0.27
0.32
SLIDE CREDIT:Gilberto Schwartsmann
GLOBAL STATISTICS:
Mortality vs. Degree of economic development
More developed countries
0.33 (189 deaths / 579 cases )
Less developed countries
0.39 (184 deaths / 471 cases)
SLIDE CREDIT:Gilberto Schwartsmann
What is breast cancer?
►
Breast cancer is where cancerous
(malignant) cells are found in the
breast tissue.
►
There are several types of breast
cancer.
►
Ductal cancer (effects the ducts and
also is the most common type)
►
Lobular (which begins in the lobes of
the breast and often is found in both
breasts)
►
Inflammatory cancer (its where the
breast appears swollen and hot) its
also very uncommon.
►
Picture from WebMD.com
Risk Factors for Breast Cancer
► Female
(1% male)
► Aging
► Relative
(mother or
sister)
► Menstrual history
 early on set
 late menopause
► Child
birth
 After the age of 30
Exogenous Estrogen
► Hormonal
replacement
therapy(HRT)
 30% increased risk with
long term use
► Oral Contraceptives(OC)
 risk slight
 risk returns to normal
once the use of OC’s has
been discontinued
Risk Factors for Breast Cancer
► Radiation
exposure
► Breast disease
 Atpyical Hyperplasia
 Intraductal carcinoma in situ
 Intralobular carcinoma in situ
► Obesity
► Diet
 Fat
 Alcohol
Genetics
► BRCA-1
► BRCA-2
► P53,
Rb-1
► Her-2/neu, c-erB2, c-myc
Staging of Breast Cancer
► The
American Joint Committee on Cancer
(AJCC) has designated staging by TNM
► T= tumor size
► N = lymph node involvement
► M = metastasis
Stage 1
► Tumor
< 2.0 cm in
greatest dimension
► No nodal
involvement (N0)
► No metastases (M0)
Stage II
► Tumor
> 2.0 < 5 cm
or
► Ipsilateral axillary
lymph node (N1)
► No Metastasis (M0)
Stage III
► Tumor
> 5 cm (T3)
► or ipsilateral axillary lymph nodes fixed to
each other or other structures (N2)
► involvement of ipsilateral internal
mammary nodes (N3)
► Inflammatory carcinoma (T4d)
Stage IV (Metastatic breast cancer)
► Any
T
► Any N
► Metastasis (M1)
Types of breast cancer
► In
situ
 Intraductal (DCIS)
 Intralobular (LCIS)
► Invasive




Infiltrating ductal carcinoma
Tubular carcinoma
Medullary carcinoma
Mucinous carcinoma
Symptoms and Screening
Normal breast physiology and
anatomy
► Symmetry
and balance
► Size
 weight
 menstrual cycle
 pregnancy and lactation
► Texture
► Shape
 age
Abnormal signs and symptoms
►Puckering
►Dimpling
►Retraction
►Nipple
discharge
►Thickening of skin or lump or “knot”
►Retracted nipple
Abnormal signs and symptoms
►Change
in breast size
►Pain or tenderness
►Redness
►Change in nipple position
►Scaling around nipples
►Sore on breast that does not heal
Methods of Detection
►Clinical
exam by MD or nurse
►Mammography
►Monthly breast self-exam (BSE)
Clinical examination
► Performed
by doctor or trained
nurse practitioner
► Annually for women over 40
► At least every 3 years for
women between 20 and 40
► More frequent examination for
high risk patients
Mammography
► X-ray
of the breast
► Has been shown to save
lives in patients 50-69
► Data mixed on usefulness
for patients 40-49
► Normal mammogram
does not rule out
possibility of cancer
completely
Mammography
American Cancer Society recommends:
Women (asymptomatic) 40 years of
age and older should have a
mammogram every year.
Mammography-more guidelines
► Mammogram
facility guidelines
► Avoid mammogram week before period
► Don’t wear deodorant powder or cream
► Bring a list of the places and dates of other
mammograms, biopsies you’ve had before
► If you don’t hear from the MD within 10
days, call the facility
Breast Self Examination
► Opportunity
for woman to
become familiar with her
breasts
► Monthly exam of the
breasts and underarm area
► May discover any changes
early
► Begin at age 20, continue
monthly
When to do BSE
► Menstruating
women- 5 to 7
days after the beginning of
their period
► Menopausal women same date each month
► Pregnant women –
same date each month
► Takes about 20 minutes
► Perform BSE at least
once a month
► Examine all breast tissue
Why don’t more women practice
BSE?
► Fear
► Embarrassment
► Youth
► Lack
of knowledge
► Too busy,
forgetfulness
Conclusion
HEALTH
PROFESSIONALS;
have a responsibility
as patient advocates
for breast cancer
awareness
THANK YOU
POYRAZLAR LAKE / SAKARYA / TURKEY
SAKARYA / TURKEY
SAKARYA UNIVERSITY CAMPUS
SAKARYA UNIVERSITY CAMPUS
SAKARYA UNIVERSITY CAMPUS