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For Breast Cancer. A program of the UAMS College of Pharmacy. Funded through unrestricted educational grants by Susan G. Komen Breast Cancer Foundation Arkansas Affiliate. Overview of Breast Cancer. Jan K. Hastings, Pharm.D. Breast Cancer. The most common form of cancer among women

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For breast cancer l.jpg

For Breast Cancer

A program of the

UAMS College of Pharmacy

Funded through unrestricted educational grants

by Susan G. Komen Breast Cancer Foundation

Arkansas Affiliate


Overview of breast cancer l.jpg

Overview of Breast Cancer

Jan K. Hastings, Pharm.D.


Breast cancer l.jpg
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


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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


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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


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Risk Factors for Breast Cancer

  • Radiation exposure

  • Breast disease

    • Atpyical Hyperplasia

    • Intraductal carcinoma in situ

    • Intralobular carcinoma in situ

  • Obesity

  • Diet

    • Fat

    • Alcohol


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Genetics

  • BRCA-1

  • BRCA-2

  • P53, Rb-1

  • Her-2/neu, c-erB2, c-myc


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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


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Stage 1

  • Tumor < 2.0 cm in greatest dimension

  • No nodal involvement (N0)

  • No metastases (M0)


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Stage II

  • Tumor > 2.0 < 5 cm

    or

  • Ipsilateral axillary lymph node (N1)

  • No Metastasis (M0)


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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)


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Stage IV (Metastatic breast cancer)

  • Any T

  • Any N

  • Metastasis (M1)


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Types of breast cancer

  • In situ

    • Intraductal (DCIS)

    • Intralobular (LCIS)

  • Invasive

    • Infiltrating ductal carcinoma

    • Tubular carcinoma

    • Medullary carcinoma

    • Mucinous carcinoma



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Normal breast physiology and anatomy

  • Symmetry and balance

  • Size

    • weight

    • menstrual cycle

    • pregnancy and lactation

  • Texture

  • Shape

    • age


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Abnormal signs and symptoms

  • Puckering

  • Dimpling

  • Retraction

  • Nipple discharge

  • Thickening of skin or lump or “knot”

  • Retracted nipple


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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


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Methods of Detection

  • Clinical exam by MD or nurse

  • Mammography

  • Monthly breast self-exam (BSE)


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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


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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


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Mammography

American Cancer Society recommends:

Women (asymptomatic) 40 years of age and older should have a mammogram every year.


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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


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Free Mammograms

  • Medicare

  • Arkansas Breast Cancer Control Program

  • Breast and Cervical Cancer Control Program of the Arkansas Department of Health


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Medicare

  • Women over 65


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Arkansas Breast Cancer Control Program

  • Started in 1999

  • Eligibility

    • Women 40 or older

    • No insurance

    • Income at or below 2 times the poverty level

    • Call county or state heath department

      • 1-800-482-5400


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Eligibility for ABCCCP Mammogram

  • 50 years or older and

  • At or below 200 percent poverty

    OR

  • Between 40 and 49 and

  • A breast cancer survivor or have a mother, daughter, or sister who has breast cancer and

  • At or below 200 percent poverty


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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


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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


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Why don’t more women practice BSE?

  • Fear

  • Embarrassment

  • Youth

  • Lack of knowledge

  • Too busy, forgetfulness


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Conclusion

Pharmacists have a responsibility as patient advocates for breast cancer awareness


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