BY DR RUBY BAZEER a.k.a DR. RUBZ

Presented on Charity Dinner

Date: 29th March 2014

Venue: Paradox Art Cafe

BREAST CANCER

Supported by

Commonest cancer affecting women (White American > African American, Chinese >Indian>Malay) 24:16:1

1.5 million new cases diagnosed every year

1200 new patients/year

14% of all cancer deaths annually

But there is hope……

……breast cancer is

CURABLE

when detected in EARLY stages!

! ! !

1. Chest wall.

2. Pectoral muscles.

3. Lobules (glands that make milk).

4. Nipple surface.

5. Areola.

6. Lactiferous duct tube that carries milk to the nipple

7. Fatty tissue.

8. Skin.

THE ANATOMY OF BREAST

THE LYMPHATIC SYSTEM

Lymphatic System which consists of vessels and

organs plays two vital roles in our lives:

1. The vessels essentially maintain interstitial fluid levels by carrying excess fluids as well as any plasma proteins, back into the CVS.

2. The organs, house critical immune cells such as lymphocytes which carry out our body defense against infection.

Most of the lymph vessels of the breast drain into:

Lymph nodes under the arm (auxiliary nodes).

Lymph nodes around the collar bone (supraclavicular and infraclavicular lymph nodes)

Lymph nodes inside the chest near the breast bone (internal mammary lymph nodes)

PHYSIOLOGY Estrogen

- Development of the breast and

lactiferous ducts

Progesterone

- Together with estrogen causes lobular and

alveolar growth

Prolactin

- Synergizes the effect of estrogen and

progesterone

WHAT IS CANCER ?

Cancer is the abnormal, uncontrollable , continuous replication of cells which will

inevitably lead to the formation of a tumor.

• A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous.

• Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

BENIGN??? MALIGNANT???? ? ?

BENIGN TUMORS

• Not cancerous.

• Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening.

• Most lumps are caused by the combination of cysts and fibrosis

• Cysts are fluid-filled sacs.

• Fibrosis is the formation of scar - like tissue.

• These changes can cause breast swelling and pain.

WHAT IS BREAST CANCER ?• The term “breast cancer” refers to a

malignant tumor that has developed from cells in the breast.

• It is found mostly in women, but men can get breast cancer, too.

• Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

• Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes,(lymph nodes are : small organs that filter out foreign substances in the body).

• If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body.

RISK FACTORS OF BREAST CANCER(WHAT INCREASES THE RISK OF HAVING BREAST CANCER ? )

• Sex (female > male) 1 in every 150 cases (male).

• Age (Over 80% of all female breast cancers occur among women aged 50+ years)

• Personal History (Previous cancer history or benign breast lump)

• Family History (Breast cancer risk is higher among women whose close blood relatives have this disease.)

• The Breast Cancer Genes (Women who carry the BRCA1 and BRCA2 genes has 40- 85% risk )

• Early menarche ( <12 years old)

• Late menopause (> 55 years old)

• Having no children

• Having a first full term pregnancy after age 25

• Not breast feeding

• Certain kind of birth control (Progesteron only)

• Use of Hormone Replacement Therapy

• Increased daily fat intake (especially saturated or hydrogenated fats)

• Obese

• Breast radiation early in life: (Women who have had radiation treatment to the chest area as a child or young adult have a greatly risk)

• Tobacco smoke

• Night work: (A few studies have suggested that women who work at night have a higher risk of breast cancer.)

• studies show that eating a lot of red and/or processed meats is associated with a higher risk of breast cancer. A low-fat diet rich in fruits and vegetables is generally recommended.

• Being overweight is associated with increased risk of breast cancer, especially for women after menopause. Fat tissue is the body’s main source of estrogen after menopause, when the ovaries stop producing the hormone. Having more fat tissue means having higher estrogen levels, which can increase breast cancer risk.

RISK FACTORS YOU CAN CONTROL

Weight

Diet.

• Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk

• Evidence is growing that exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.

RISK FACTORS YOU CAN CONTROL

Exercise

Alcohol consumption

RISK FACTORS YOU CAN’T CONTROL

• Gender. Being a woman is the most significant risk factor for developing breast cancer. Although men can get breast cancer, too, women’s breast cells are constantly changing and growing, mainly due to the activity of the female hormones estrogen and progesterone. This activity puts them at much greater risk for breast cancer.

• Age. Simply growing older is the second biggest risk factor for breast cancer. From age 30 to 39, the risk is 1 in 233, or .43%. That jumps to 1 in 27, or almost 4%, by the time you are in your 60s.

FACTORS NOT LINKED TO BREAST CANCER

• Antiperspirant

• Bras

• Induced Abortion

• Breast implants

RISK FACTORS FOR MEN

• High levels of estrogen (due to cirrhosis of the liver, for example) or estrogen-related drugs (such as for prostate cancer)

• Exposure to radiation

• Over age 60

• High alcohol consumption

• Obesity

• Inherited gene mutations

• Family history of breast cancer

SIGN AND SYMPTOMS

• Painless lump or swelling

• Pitting or redness of the skin of the breast; like the skin of an orange.

• An area of thickening of skin

• Nipple retraction (pulled inward)

• Nipple discharge

• Swelling/ pain in the armpit or breast • (not related to menstrual cycle)

EARLY DETECTION/ SCREENING

• Self examination

• Clinical breast examination

• Ultrasound

• Mammography

• BREAST SELF EXAMINATION (90% of the breast lump are found by patients themselves. Encourage female have regular self breast examination.)

What am I looking for when I do a breast self-exam?You are looking for a lump or change that stands out as different from the rest of your breast tissue. If you discover a lump or other change in your breast, either during breast self examination or by chance, you should examine the other breast. If both breasts feel the same, the lumpiness is probably normal.

What should you look for?

. How often should I do a self-exam?

A breast self-exam is recommended every month a few days after your period ends. During this time, your breasts are less tender or swollen. It is important to do your breast self-exam at the same time during your

menstrual cycle.

All women >20 years

Breast Self Examination every month

Clinical Breast Examination every 2 to 3 years

All women > 40 years

Clinical Breast Examination yearly

Mammography yearly

MAMMOGRAMWhat is a mammogramph and why should I have one?

the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool. The goal of mammography is the early detection of breast cancer typically through detection of characteristic masses and/or microcalcifications.

You simply stand in front of an x-ray machine. Your breast is placed between two plastic plates to flatten it. This helps in getting a more clear picture and subsequently a more accurate diagnosis. A mammogram takes only a few seconds.

INVESTIGATION AND STAGING

• When a patient detects a lump in the breast, a specialist opinion should be sought to confirm if the lump is cancerous or not. The doctor will perform a through physical examination before requesting for mammography and ultra sound scan of the breast.

• A tissue sample in the form of needle suction or biopsy may be obtained. Upon confirmation of the cancer, the patient will be staged with x-rays or scans of the lungs and liver. A bone or brain scan may be ordered to evaluate any spread (metastasis) to the bones or the brain.

STAGES OF BREAST CANCER

• Stage 0 - Cancer in Situ(non invasive)

• Stage I - Cancer is less than 2 cm.

• Stage II - Cancer is between 2 to 5 cm with or without involvement of the glands in the armpit

• Stage III - Cancer is larger than 5 cm or there is extensive involvement of the glands in the armpit

• Stage IV - Cancer has spread outside the breast and involves other organs in the body

• Stage I & II are considered early and curable (80 per cent and above)

• Stage III ( percentage of cure is much lower than Stage I and II)

• Stage IV disease is not curable.(aim of the treatment is palliative (control of symptoms).

TREATMENT OF BREAST CANCER

• Treatment plans for breast cancer are developed based on a several factors.

1. 1- The type and stage of the cancer,

2. 2-the sensitivity of the cancer to certain hormones

3. 3-the medical history of the patient

• The World Health Organisation [WHO] related that two components of early detection have been shown to improve cancer mortality:

1. 1- Education, which in turn helps people recognize early signs of cancer and seek prompt medical attention for symptoms.

2. 2-Screening programs, which are a great tool in helping identify early cancer or pre-cancer before signs are recognizable, including mammography for breast cancer.

TREATMENT OF BREAST CANCER• Surgery can be conservative (removing the lump or a segment

of the breast only) or may be in the form of a mastectomy (removing the whole breast). In both cases, the glands in the armpit need to be removed and checked for the presence of cancer cells.

• Radiotherapy uses high doses of radiation to kill cancer cells. It is a localised form of treatment and is mandatory after conservative surgical treatment. It is only given after a mastectomy if the breast tumour is locally extensive. Radiotherapy reduces the risk of local recurrence rate. Radiotherapy is sometimes used as a palliative treatment to control bone pain, bleeding or pressure symptoms.

• Chemotherapy involves the use of drugs given by injection or, occasionally, orally. It treats the cancer by penetrating the tissues and organ via the bloodstream. These drugs are toxic to the cancer cells but they may also cause some side effects to the normal tissues.

TREATMENT OF BREAST CANCER

• For early stage diseases, chemotherapy is used as an added treatment to improve the outcome and cure rates. It is used to "mop-up" the potential micro spread of cells that may have escaped from the breast to the other parts of the body.

• For late stage disease, chemotherapy is used to "control" the rate of growth of the tumour and to downsize the bulk of the disease. The use of chemotherapy may also help to control symptoms, prolong survival and improve the quality of life.

• Hormone or anti-hormone treatment is only given to patients whose cancer cells are positive to oestrogen or progesterone receptors. By blocking these receptors the growth of the cancer cells can be curtailed. Drugs such as Tamoxifen and the new generation of aromatase inhibitors may help to control the cancer for many years after primary treatment.

FACTS ABOUT BREAST CANCER• One in eight women will be diagnosed with breast cancer in their

lifetime.

• Breast cancer is the most commonly diagnosed cancer in women.

• Breast cancer is the second leading cause of death among women.

• Each year it is estimated that over 220,000 women in the United States will be diagnosed with breast cancer and more than 40,000 will die.

• Although breast cancer in man is rare, an estimated 2,150 men will be diagnosed with breast cancer and approximately 410 will die each year.

COMMON MISCONCEPTION • Common Misconception

• Breast cancer is a fatal disease that kills all patients.

• Reality Check!

• There has been a noticeable increase in the number of women diagnosed with Breast Cancer each year, but the mortality rate is significantly decreasing. Some reasons for this phenomenon comprise the enhanced availability and nature of resources for treatment and early detection of tumors through both Breast Self-examination and various technologies including X-Ray Mammography.

• Common Misconception

• Breast Cancer is a contagious disease since it can occur in families with many members affected over time or many women can be diagnosed in single communities at the same time.

• Reality Check!

• Breast Cancer is not passed from person to person like an infectious disease. Contagiousness has nothing to do with genetic mutations or inheritance patterns of disease

• Common Misconception

• Finding an unnatural lump on the breasts means that a woman has Breast Cancer.

• Reality Check!

• While you are undergoing a Breast-Self-examination if unnatural lumps, infections, or any irregularities are detected, you should immediately consult a specialist doctor. It is possible that detected irregularities are not cancerous, however it is only a specialist doctor that can identify and determine its nature..

• Common Misconception

• Breast cancer is a disease that is only found in women and not in men.

• Reality Check!

• Statistics in the United States of America have proven that women are only more susceptible to the disease than men, where for every 135 cases of Breast Cancer in women, one man is diagnosed. Men should also take a proactive approach to their Breast health to encourage early detection and curability if irregularities are present

GO HOME

AND

EXAMINE

YOUR

BREASTS!