Transcript Screening For Breast Cancer - Spire Healthcare, UK Private

Breast Cancer Screening,
Family History Assessment and
New Innovations
Miss Karina Cox
Consultant Breast
and Oncoplastic Surgeon
Introduction
• NHSBSP/ ABS Audit 2012/2013
• Patients outside NHSBSP age
• Family History services including testing
for breast cancer susceptibility genes
• Tomosynthesis
• Intra-operative Radiotherapy
• Microbubble Project Update
NHSBSP History
• The NHSBSP began in
1988.
• By 2005, the
programme was
screening 1.3 million
women aged 50–70
years annually.
• 10 000 breast cancers
diagnosed.
• Age extension
NHSBSP/ABS Audit
2012/2013
• 2 million women screened • Proportion of cancers
diagnosed in women
• 20,000 cancers detected
47-49 and 71-73 has
• 79% invasive, 20% nonincreased
from
6.2%
invasive and 1% microin
2010/11
to
9.9%
in
invasive
2012/13.
• Cancer detection rates 8.4
per 1000 women screened
(approximately half are
<15mm)
NHSB SP/ ABS Audit – 5 year Survival
(women screened in 2007)
• All invasive cancers 98.5% (was 93.7% in
1990).
• Tumours <15mm more than 100%
• Tumours >50mm 89.8%
• Grade 1 more than 100%
• Grade 3 – 92.6%
• Node negative – 100%
• Node positive – 93%
Patients outside of screening age
• Breast Cancer becomes
more common as women
age
• Breast Cancer in the elderly
can be an aggressive disease
• Women above the age of 73
can request screening
mammograms from the
NHSBSP
• Healthy, fit women should
continue to have screening
mammograms
Family History and Genetic
Testing
• A significant family history is the
strongest individual risk factor for the
development of breast cancer.
• The vast majority of breast cancer in the
UK is sporadic and inheritance of cancerpredisposing genes only contributes to 45% of all breast cancer cases.
Risk Assessment
• Several risk
assessment tools
• Developed by
Clinical Genetics
units
• Aim to identify
women at risk
because of their
family history
BRCA-1/2 – Gene mutations
• The BRCA 1 and 2 genes
are large and sited on
the long arms of
chromosomes 17 and 13
respectively.
• Autosomal dominant
• Some ethnic groups,
such as Ashkenazi Jews/
Icelanders have
persistent mutations.
BRCA-1/2- Gene Carriers
• Once identified
can opt for
screening (MRI) or
risk-reducing
surgery
• Variant of
unknown
significance?
Identifying BRCA-1/2 gene carriers
when diagnosed with breast cancer
•
• Future risk of a
second ipsilateral
breast cancer and 2030% risk of
contralateral breast
•
cancer.
• ‘Fast-track’ genetic
testing
BCS and radiotherapy
result in poorer cosmetic
outcomes with
subsequent mastectomy
and radiotherapy.
Autologous free flaps can
often be used to fashion
2 breasts
Tomosynthesis
• It is a newly developed
form of three
dimensional imaging with
the potential to improve
the accuracy of
mammography by
reducing the tissue
overlap and therefore to
differentiate malignant
features from nonmalignant ones
Tomosynthesis
Intra-operative Radiotherapy
(Results of TARGIT Trial)
• RCT - either a single dose
of IORT or EBRT.
• All the patients were over
the age of 45, ER +, IDC
and <3.5cm.
• The rate of local recurrence
in the conserved breast at
5 years was 3·3% (95% CI
2·1–5·1) for TARGIT versus
1·3% (0·7–2·5) for EBRT
(p=0·042).
Intra-operative Radiotherapy
(Results of TARGIT Trial 2014)
• If IORT given at same time as surgery then
2.1% (95% CI 1.1 – 4.2) for IORT and 1.1%
(95% CI 0.5 -2.5) for EBRT with an absolute
difference of 1%. Not statistically significant.
• There were no differences in breast cancer
related death between the 2 groups but the
EBRT group had a significantly higher risk of
non-breast cancer death as well as higher
radiation associated toxicity.
Microbubbles Update
Breast Cancer Kent
• Formerly the Mid Kent Breast Cancer Research Appeal.
• www.breastcancerkent.org.uk
Questions?