Transcript Breast Cancer Presentation-2x

Breast Cancer
DRYDEN TANNER & ALEX DOIRON
Overview

Introduction

Signs & Symptoms

History

Diagnosis

What is it?

Risk Factors

Pathophysiology

Treatment

Facts & Stats

Future Research
Introduction

Breast cancer refers to a malignant tumor that has developed from cells in
the breast.

Two possible locations to develop within the breast

Breast Cancer can develop in BOTH women and men however,
predominantly in women
Introduction

Most common cancer diagnosis in Canadian women over 20

1 in 9 Canadian women is expected to develop breast cancer

1 in 29 Canadian women will die from breast cancer
History
History

Known since ancient time

Long been a stigma towards the disease

Recent phenomenon with women actively bringing out the disease into
the open

Pink Ribbon introduced as a symbol for breast cancer in 1990’s
What Is Breast Cancer?
What is it?

Breast cancer is a malignant tumour that starts in the lobes or ducts of the
breast.

Our Friends in the UK can help explain
https://www.youtube.com/watch?v=wXuWkGYmzUY
What is it?
Anatomy
What is it?
Distinguishing Between Sites of Origin.
Ductal Carcinoma (invasive or non-invasive):

Breast cancer starts in cells that line the ducts; tubes that carry milk from
the glands to the nipple.
Lobular Carcinoma (invasive or non-invasive):

Cancer can also start in the cells of the lobules; the groups of glands that
make milk.
Pathophysiology
Pathophysiology:
Inherited Genes, Mutations or Defects

5-10% breast cancer cases are considered directly related mutations in
BRCA1 or BRCA2.

Classified as Tumor suppressor genes.

Carrying mutations in BRCA1/2 genes have a 50-80% lifetime risk of breast
cancer.
Pathophysiology:
Types of Breast Cancer
Breast Cancer can also be triggered by problems with:

Hormone Reception

HER2 Protein Synthesis
These problems distinguish the four types of breast cancer.
Pathophysiology:
Endocrine Reception

Cancers that are estrogen or progesterone receptor positive (ER/PRpositive) have a significant number of that hormone receptor

The cancer responds and grows to that hormone respectively.
Pathophysiology:
Protein Synthesis

Human Epidermal Growth Factor Receptor 2 (HER2)

Cells make too much of a protein known as HER2.

These breast cancers tend to be much more aggressive and fast-growing.
Pathophysiology:
Types of Breast Cancer

Endocrine receptor (estrogen or progesterone receptor) positive

HER2 positive

Triple negative, not positive to receptors for estrogen, progesterone, or
HER2

Triple positive, positive for estrogen receptors, progesterone receptors and
HER2
Facts & Stats
Facts & Stats
New breast cancer cases diagnose in Canadian women
2013 (#)
Annually
23, 800
Weekly (average)
456
Daily (average)
65
Facts & Stats
Estimated new breast cancer cases by province in Canada in 2013
Canada
#
23,800
%
100%
BC
AB
3,100 2,100
13%
9&
SK
MB
690
820
3%
3%
ON
QC
9,300 6,000
39%
25%
NB
NS
PE
NL
550
750
100
330
2%
3%
0.4%
1%
Facts & Stats
New breast cancer
cases diagnosed in
Canada, by age group
2013 (#)
2013 (%)
80+
2,900
12%
70 – 79
4,300
18%
60 – 69
6,400
27%
50 – 59
5,900
25%
40 – 49
3,300
14%
Under 40
1,055
4%
Facts & Stats
Five-year relative survival rates for breast cancer by age group (men and women)
All
15 - 39
40 - 49
50 - 59
60 - 69
70 - 79
80 - 99
88%
85%
90%
89%
90%
88%
80%
• The current five-year survival rate (88%) has been improving since Canada’s worst breast
cancer mortality rate (79%) in 1986.
Facts & Stats

Breast Cancer mortality rates in Canada were at their highest in 1986

42% decrease since then

Result of increased and better screening technologies, early detection
through mammography screening and improved treatments
Facts & Stats

157,000 Canadian women wo had breast cancer diagnosis in the last ten
years are living

Women with breast cancer are living for longer periods of time following
their cancer diagnosis compared to other types of cancer.
Facts & Stats:
US Males’ Statistic

In 2015, predicted to be:

About 2,350 new cases of invasive breast cancer will be diagnosed

About 40 men will die from breast cancer

Breast cancer is about 100 times less common among men than among
women

The lifetime risk for men to get breast cancer is about 1 in 1,000
Signs & Symptoms
Signs & Symptoms:
Video

https://www.youtube.com/watch?v=yTHyMNBkbOY
Signs & Symptoms:
For Women

a lump in the breast – the most common first sign

a lump in the armpit (axilla)

changes in breast shape or size

skin changes

nipple changes
Signs & Symptoms:
For Men

Breast swelling and tenderness

All others are identical as the ones for women
Diagnosis
Diagnosis
Diagnostic tests Take place after:

Symptoms of breast cancer are present.

A doctor suspects breast cancer after discussing health and completing a
physical examination.
Diagnosis:
Steps for Diagnosing Breast Cancer
Diagnosis follow’s a multi-step process

Step 1: Patients are identified by screening or symptoms.

Step 2: Imaging is done by either ultrasound or mammography.

Step 3: Biopsy or fine needle aspiration is done if a lump is detected by
imaging or if clinically it appears suspicious.

Step 4: Pathological diagnosis distinguishes benign and malignant breast
disease.
Diagnosis:
Step 1

Patients are identified by screening or symptoms.
Screening takes place as:

Mammogram

Clinical or self breast examination
Diagnosis:
Step 2

Imaging is done by either ultrasound or mammography.
Mammogram:

Accurate in detecting calcifications as well as small non-palpable lesion in
postmenopausal women with non-dense breast tissue.
Ultrasound:

Better at detecting fluid-filled lesions (cysts) and small tumours in dense
breast tissue
Diagnosis:
Step 3

Biopsy or fine needle aspiration is done if a lump is detected by imaging or
if clinically it appears suspicious.
Diagnosis:
Step 4

Pathological diagnosis distinguishes benign and malignant breast disease.

Staging is done using the TNM system, but molecular markers correlate
better with prognosis.
Diagnosis:
Staging
Reflects the size of the primary tumour and the extent of local and
distant spread.
TNM System:
T = tumour size and local invasion.

T0 = carcinoma in situ (no local invasion), followed by T1-T4
N = regional lymph node involvement.

N0 = no nodes, following by N1-N3 in increasing number of nodes
M = distant metastases.

M0 = no metastasis, follow by M1 for metastasis
Diagnosis:
Stages

Stage 0—non-invasive carcinomas (LCIS or DCIS). Cancer cells have not invaded the surrounding
breast tissue.

Stage I—the tumor is no more than 2 cm in size and cancer cells have not spread beyond the breast.

Stage II—either the tumor has spread to the lymph nodes under the arms but the tumor is less than 2 cm

in size, or the tumor has not spread to the lymph nodes under the arms but is greater than 5 cm in size,
or the tumor is between 2 and 5 cm and may or may not have spread to the nodes.

Stage III—the tumor is greater than 5 cm in size and has spread to the lymph nodes under the arms.

Stage IV—the cancer has spread to other parts of the body (metastatic cancer).
Risk Factors
Risk Factors:
Known Factors

Personal history of breast cancer

Family history of breast and other cancers

BRCA gene mutations

Dense Breasts

Ashkenazi Jewish ancestry

Rare genetic Conditions

Reproductive History

Exposure to Ionizing radiation
Risk Factors:
Known Factors Cont’d

Being Obese

High Socio-economic Status

Tall Adult Height

Hormone Replacement Therapy

Oral Contraceptives

Atypical Hyperplasia

Alcohol
Risk Factors:
Possible Factors

Physical Inactivity

Adult Weight Gain

Smoking and Second Hand Smoke

Birth Weight

Night Shift Work

Some Benign Breast Conditions
Risk Factors:
Myths

Antiperspirants

Deodorants

Abortion

Breast Implants

Bras

There is significant evidence showing that there is no association between
these factors and breast cancer.
Risk Factors:
Reducing Risk via Lifestyle Changes

Limit alcohol intake

Control weight, particularly after menopause

Breast feed

Exercise

Discontinue Hormone Therapy

Avoid exposure to carcinogens
Risk Factors:
For Men

Some men with breast cancer do not have any identifiable risks

Most men diagnosed with breast cancer are over the age of 60

Family History

Certain Genetic Mutations

Radiation Exposure
Risk Factors:
Possible Factors for Men

Being Obese

Alcohol

Estrogen Treatment
Treatment
Treatment:
Surgery
In most cases, choice of what type of breast surgery the patient would
prefer:

Breast-conserving Surgery

Mastectomy

Axillary lymph node dissection

Adjuvant therapy
Treatment:
Radiation Therapy
External beam radiation therapy:

Always given after breast-conserving surgery, sometimes given after a
mastectomy.

Systemic radiation therapy may be offered with breast cancer that has
spread to large areas of the bone (bone metastases).
Treatment:
Endocrine Therapy
Hormonal therapy is offered for hormone receptor–positive breast cancer
(ER+, PR+ or both) that is:

Early stage with a low risk of recurrence

Locally advanced, advanced or recurrent
Treatment:
Chemotherapy
Chemotherapy is offered for breast cancer that is:

Early stage with a high risk of recurrence

Locally advanced, advanced or recurrent
Drugs used depend on the stage of breast cancer.
May include a combination or a single drug
Treatment:
Study - Harder (2015)

Looked at women with early-stage breast cancer.

Randomised to Standard care plus or minus a yoga DVD for 10-weeks.

Patient-reported outcomes were collected at baseline, 10 weeks and 6
months.
Treatment:
Study - Harder (2015) cont’d
Results:

69% improvement from baseline arm morbidity subscale,

Numbness in the affected arm was greater in the standard care group
lacking yoga

74% of women would definitely recommend following the yoga DVD after
surgery.

Practising post-operative exercises does improve arm and shoulder
morbidity following breast cancer surgery.
Future Research
Future Research:
Awareness
Ads and commercials that are:

Sentimental

Funny

Sexualized
This to increase awareness
To show the value of early detection via self-examination.
Future Research:
Study – Burgess and Murray (2014)

Surveyed 255 college students

Investigated the relationship of awareness of breast cancer campaign
and their knowledge of the risk factors, symptoms and detection of breast
cancer.

The two campaigns observed were the Susan G. Komen campaign and
the “I <3 BOOBIES” campaign

Used a multiple-choice questionnaire to assess their knowledge about
breast self-exam, mammography and breast health
Future Research:
Study – Burgess and Murray (2014)

Results:

Knowledge of breast self-exam and mammography did differ depending on
which campaign students were aware of.

The scores of the survey were greater in the students who were aware of the
Susan G. Komen campaign compared to the “I <3 BOOBIES” campaign.

The more campaigns students could identify, the more symptoms the could
identify and were more knowledgeable about mammography and breast selfexam.

However, campaign identification was not related to risk factor identification.
Future Research:
Awareness Ad

https://www.youtube.com/watch?v=VsyE2rCW71o
References
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http://www.news-medical.net/health/History-of-Breast-Cancer.aspx

http://www.cbcf.org/central/AboutBreastCancerMain/AboutBreastCancer/Pages/BreastCancerinCan
ada.aspx
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http://www.breastcancer.org/symptoms/understand_bc/what_is_bc
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http://www.pathophys.org/breast-cancer/#Diagnosis

http://ylb1.bol.ucla.edu/Pathophysiology.htm

http://www.breastcancer.org/research-news/20120517

https://myhealth.alberta.ca/health/Pages/conditions.aspx?hwid=zm2706

http://www.cancer.org/cancer/breastcancerinmen/detailedguide/breast-cancer-in-men-key-statistics

Harder, Helena, et al. "Post-operative exercises after breast cancer surgery: Results of a RCT evaluating
standard care versus standard care plus additional yoga exercise." European Journal of Integrative
Medicine (2015).

Burgess, Melinda C. R., and Ashley B. Murray. “Sexualization of Awareness: Catchy, but does it Actually
Increase Knowledge of Breast Cancer?” College Student Journal 48.2 (2014): 234-42. Web