Breast Cancer

Symptoms? (3)

1. breast thickening, swelling, tenderness

2. skin irritation

3. nipple changes and discharge or ulceration

What are some treatment options?`(3)

1. surgery

2. chemotherapy

3. radiation

What are risk factors for breast cancer? (19) **exam - familiarize yourself with these

1. genetics

• BRCA-1 and BRCA-2 are most common mutated genes

• these account for 5-10% of all breast cancer

2. early menses before age 12 (or menses after age 50)

• more estrogen exposure for longer period

3. late menopause after age 55

• more estrogen exposure for longer period

4. nullipara: no children at all

5. first child after age 30

• if subsequent children after 30 that’s fine

• Earlier and multiple pregnancies decrease risk

6. obesity

• Estrogen is cholesterol based – with higher adipose levels, more estrogen can be produced (after menopause estrogen mainly starts coming from adipose tissue)

• Obesity before menopause may affect estrogen and cause irregular periods – could actually decrease the risk?

7. racial/ethnic background

• white women have more incidents

• black women have more aggressive cancer

• asian and hispanic less risk

• Ashkenazi Jewish have the BRCA-2 gene commonly

8. Family history

• first degree relatives with breast cancer (mom, sister, yourself)

• higher risk with more relatives and if they developed at an early age

• second-degree relatives can also pose risk

• other relatives with ovarian, cervical cancers

9. Breastfeeding

• can decrease risk by suppressing estrogen so if you don’t do it then at risk

10. Birth control pill

• Increases risk if taken within the last 10 years, or for longer than 10 years

11. Hormone replacement therapy (HRT)

• estrogen or estrogen/progesterone increases risk

• has major effects by causing more aggressive cancer and increasing death rate

12. Age

• as you got older, risk increases (after 55 ish)

13. being born female

14. personal history of breast cancer

15. chronic breast disease

16. being taller…

17. having dense breast tissue

18. smoking not sure but best to avoid

19. alcohol if severe i guess (high alcohol)

20. stress

21. bra wear time maybe (definitely underwires)

What recommendations can a patient receive? (4)

1. lifestyle changes

• healthy diet

• exercise

2. monitoring

• mammograms at certain age or doing it regularly if family history

3. genetic testing if family history

4. treating other cancers if they can affect breast cancer

What are types of breast cancer? (3)

1. non-invasive (in situ - in original place)

• lobular or ductal

2. invasive

• lobular or ductal

3. others

• paget’s disease of nipple/areola

• inflammatory

• rare types

• in men

Explain the types? (3)

Ductal carcinoma

• Pre-invasive or non-invasive

Invasive

• Has invaded the breast tissue

• Ductal carcinoma

  • 70-80% of all breast cancers

• Lobular carcinoma

Less common

• Angiosarcoma – originating in the blood vessels

• Paget – starts in ducts – spreads to nipple

• Inflammatory - 1-5% (often no lump – just pain)

• Triple negative – most invasive – 15% of cancers

How to diagnose? (3)

1. palpitation (breast examination)

2. radiology (ultrasound, mammography, mri)

3. fine-needle aspiration

What is important for classification of breast cancer type?

Estrogen and progesterone receptor statuses are also important for classification and treatment

2 out of 3 breast cancers are hormone receptor +ve

• cancer cells have receptors for estrogen or progesterone

• Higher hormone levels promote cancer growth

What can be treatment for hormone receptor +ve cancers? (2)

Drugs that block receptors for these hormones

• Eg. Tamoxifen

Drugs that reduce hormone release

• Eg. Aromatase inhibitors, testes or ovary suppression

What is tamoxifen?

Is an estrogen antagonist

• Binds to estrogen receptors and stops estrogen effects – “starves” the cells of estrogen

What do the stages look like for breast cancer?

Stage 0:

• ductal carcinoma in situ

• non-invasive pre-cancerous change

Stage 1:

• cancer small and within breast

• some microscopic involvement in lymph nodes

• early breast cancer

Stage 2:

• cancer larger and in nearby lymph nodes

• early breast cancer

Stage 3:

• cancer larger and in skin of breast or chest wall

• spreading

• locally advanced breast cancer

Stage 4:

• cancer spreading to other parts of the body

• advanced breast cancer

What is the breast self-exam?

Monthly check for

• Lumps

• Discharge

• Swelling

• Hardness

• Abnormal shape

What is peak diagnosis time for breast cancer?

Peak age at Diagnosis – 65 years

While diagnosis rates drop off – death rates continue to rise with age