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Breast Cancer

Breast Cancer. DR/FATMA AL-THOUBAITY ASSOCIATE PROFESSOR SURGICAL CONSULTANT. Introduction. Epidemiology. Risk factor. Clinical features. Screening. BSE. 18.8%. 30.6% less than 40 years. 73.5 % locally advanced disease. Breast cancer :a lot to be done’’. JKAU:Med Sci,vol 7,(1999).

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Breast Cancer

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  1. Breast Cancer DR/FATMA AL-THOUBAITY ASSOCIATE PROFESSOR SURGICAL CONSULTANT

  2. Introduction. • Epidemiology. • Risk factor. • Clinical features. • Screening. • BSE.

  3. 18.8%. • 30.6% less than 40 years. • 73.5 % locally advanced disease. • Breast cancer :a lot to be done’’. JKAU:Med Sci,vol 7,(1999).

  4. 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.

  5. 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 . • Inflammatory cancer.

  6. Types of breast cancer • In situ • Intraductal (DCIS) • Intralobular (LCIS) • Invasive • Infiltrating ductal carcinoma • Tubular carcinoma • Medullary carcinoma • Mucinous carcinoma

  7. Breast Cancer-Epidemiology • #1 noncutaneous cancer in U.S. women • >200,000 cases of invasive disease in 2002 • #2 cancer death (North American women) • (#1=lung cancer) • 40,000 deaths in 2002 • 1 in 8 lifetime incidence • 1 in 30 women will die of breast cancer • Incidence increases with age

  8. 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

  9. 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

  10. Risk Factors for Breast Cancer • Radiation exposure • Breast disease • Atpyical Hyperplasia • Intraductal carcinoma in situ • Intralobular carcinoma in situ • Obesity • Diet • Fat • Alcohol

  11. Genetics • BRCA-1 • BRCA-2 • P53, Rb-1 • Her-2/neu, c-erB2, c-myc

  12. Incidence of Breast CA Increases with Age

  13. Abnormal signs and symptoms • Puckering • Dimpling • Retraction • Nipple discharge • Thickening of skin or lump or “knot” • Retracted nipple

  14. 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

  15. Methods of Detection • Clinical exam by MD or nurse • Mammography • Monthly breast self-exam (BSE)

  16. Mammography-Sensitivity • Sensitivity is 77-95% overall • 54-58% in women < 40 • 81-94% in women > 65 • Depends on lesion size, conspicuity, tissue density, patient age, hormone status, image quality, and interpretive skill of the radiologist • There is inter- and intra-observer variability in the interpretation by the radiologist

  17. . Mammograms • Getting a mammogram is an effective way to detect breast cancer in its early stages. • It is recommended by the AMERICAN CANCER SOCIETY that all women over 40 get a yearly mammogram. • Its also recommended that women over 20 should get a mammogram every 2-5 years depending on your risk. • (picture courtesy of breast cancer.org)

  18. Mammography

  19. Why don’t women get MXR’s? • Factors that may discourage annual mammography among low-income women with access to free mammograms: a study using multi-ethnic, multiracial focus groups. Bobo JK, Psychol. Rep. Oct. 1999, 85(2). • Fear of radiation, anxiety that may not find CA, worry that CA might actually be detected, embarrassment, discomfort, pain • Factors assoc. w/ higher rates: • higher income, ages 65-74, non-white races • Also higher in women who obtain regular check ups or who are vitamin users

  20. 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

  21. Clinical Breast Exam (CBE) • Sensitivity is 40-69% • Specificity is 86-99% • PPV is 4-50% • In one study, only 4% of women with an abnormal CBE had cancer

  22. 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

  23. Monthly Self Exams • Its important to remember that monthly self exams are also a good tool for early detection. • Hereis a web site that has the complete monthly self-exam program @ .cyberus.ca/bse2.htm#bse2http://www.infobreastcancer Picture courtesy of Yahoo health

  24. Breast Self Exam (BSE) • Accuracy of BSE is unknown • Estimate of sensitivity: 26-41% • Specificity is unknown

  25. 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

  26. 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

  27. Why don’t more women practice BSE? • Fear • Embarrassment • Youth • Lack of knowledge • Too busy, forgetfulness

  28. Reference • httpbcra.nci.nih.gov/brc/ • Clinical surgery edited by Michael M.Henry Jeremy N.Thompson.second edition.

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