Transcript Breast Cancer An Overview - University of San Francisco

Breast Cancer
An Overview
Dr. Christina Tzagarakis-Foster
November 9, 2006
Breast Cancer Statistics
-Breast cancer is the second leading cause of cancerrelated deaths in women today
-Most common cancer among women worldwide
(excluding nonmelanoma skin cancers)
- Male breast cancers account for approximately 1% of
all breast cancer cases.
-The American Cancer Society estimates that in 2006,
approximately 212,920 women in the United States
will be diagnosed invasive breast cancer.
Life-time risks of developing
BC
Age Specific Probabilities of Developing Breast Cancer
Probability of Developing Breast Cancer Within 10 Years
Age
20
30
40
50
60
Within 10 Years
0.04%
0.43%
1.55%
2.44%
3.44%
or 1 in:
2500
233
65
41
29
REF: American Cancer Society. Breast cancer facts & figures 2001-2002. Atlanta, GA: ACS, Inc., 2001.
Ethnic Profile
• White, Hawaiian, and African-American women have the
highest incidence of invasive breast cancer in the US
• Korean, American Indian, and Vietnamese women have the
lowest incidence of invasive breast cancer in the United
States.
• African-American have the highest death rate from breast
cancer and are more likely to be diagnosed with a later stage
of breast cancer than White women.
Cases of BC Worldwide
• Top 3 countries - Iceland, Denmark,
Netherlands
• The risk of getting breast cancer worldwide is
lowest in western Africa and eastern Asia. But
studies show women can take on the breast
cancer risk of the country they move to within
as little as one generation.
What is Cancer?
• Abnormal cell division
• Due to mutations in DNA
dominant
recessive
REF: Alberts, Molecular Biology of the Cell
Types of Breast Cancer
• Majority (over 80%) begins in either the milk ducts or the lobular
(milk-producing) tissue.
• Either type, if diagnosed early enough, may be called “in situ”
(IDC).
•
*
Lobular carcinoma in situ (LCIS): It
is a lesion found in the milk-glands that
has not spread. Although not a true
cancer, it may increase the risk of
developing into cancer later.
•
*
Ductal carcinoma in situ (DCIS):
This is breast cancer at its earliest stage
that has not spread. Nearly 100% of
women with cancer at this stage can be
cured.
•
*
Invasive lobular carcinoma (ILC):
This cancer starts in the milk glands
(lobules), breaks through the wall of the
gland and invades the fatty tissue of the
breast.
•
*
Invasive ductal carcinoma (IDC):
This cancer starts in the milk ducts,
breaks through the wall of the duct, and
invades the fatty tissue of the breast.
IDC is the most common type of breast
cancer, as it accounts for nearly 80% of
breast cancer.
Stages of Breast Cancer
Stage 0 (called carcinoma in situ)
refers to abnormal cells lining a gland in the breast (Lobular carcinoma in situ or LCIS) or
abnormal cells lining a duct (Ductal carcinoma in situ or DCIS).
Stage I
early stage breast cancer where the tumor is less than 2 cm across and hasn't spread beyond
the breast.
Stage II
early stage breast cancer where the tumor is either less than 2 cm across and has spread to
the lymph nodes under the arm; or the tumor is between 2 and 5 cm; or the tumor is greater
than 5 cm and hasn't spread outside the breast
Stage III
locally advanced breast cancer where the tumor is greater than 5 cm across and has spread
to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes;
or the cancer has spread to lymph nodes near the breastbone or to other tissues near the
breast
Stage IV
metastatic breast cancer where the cancer has spread outside the breast to other organs in
the body
Detection of BC
• BSE/CSE
• Mammogram
• Ultrasound
• MRI
REF:http://familydoctor.org/018.xml
Inherited BC
• 5-10% of all breast cancers are
inherited
• BRCA1 and BRCA2 most
common genes related to
hereditary BC
• autosomal dominant pattern
**It is estimated that 86
percent of the women with a
mutation in the BRCA-1 gene
will develop breast cancer by
age 70.
REF: http://ghr.nlm.nih.gov/condition=breastcancer
Other Genetic Factors
• Variations of the ATM, CHEK2, and RAD51
genes increase the risk of developing breast
cancer.
Spontaneous BC
• p53
• HER2/cerbB-2/neu
• ER/ER
BC Treatments & Therapies
• Surgery and radiation treatment
• Chemotherapy
Estrogen Receptors Bind
Estrogen
BC Therapies (con’t)
• SERMS (Tamoxifen)
• Aromatase Inhibitors
BC therapies (con’t)
• Herceptin
(Trastuzumab)
Genetech
Risk Factors
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•
•
•
•
•
•
Age
Gender
Race
Genetic
Long menstrual history
Environmental
Reproductive
REF: * From the Environmental Epidemiology Branch, Division of Cancer Etiology, National Cancer Institute, Bethesda, Maryland
Risk Factors (con’t)
•
•
•
•
•
HRT
Ionizing Radiation
Obesity
Alcohol
Physical Activity
REF: http://www.cancer.org/docroot/CRI/content
Social Impact of BC
•
•
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•
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Alters the woman’s self image
Impacts the woman’s sexuality
Impacts her relationships
Isolates her from her peers
Imposes financial burdens
Causes changes in lifestyle
Sammarco A. Psychosocial stages and quality of life of women with breast cancer. Cancer Nurs. 2001 Aug;24(4):272-7.
Shapiro SL, Lopez AM, Schwartz GE, et al. Quality of life and breast cancer: relationship to psychosocial variables. J Clin Psychol. 2001 Apr;57(4):501-19.
Breast Cancer Rates in Marin County
“Marin County Breast Cancer Rates Flawed” (dateline June 1, 2003)
REF: http://imaginis.com/breasthealth/news/news6.01.03.asp
References:
• http://www.cancer.org
• http://ghr.nlm.nih.gov/condition=breast
cancer#genes
• http://www.hologic.com/lc/brhealthrf.ht
m#rf
• www.komen.org
• www.nci.org