Breast canser

Overview of
Breast Cancer
Jan K. Hastings, Pharm.D.

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

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

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

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

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

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

Stage 1
Tumor < 2.0 cm in greatest dimension
No nodal involvement (N0)
No metastases (M0)

Stage II
Tumor > 2.0 < 5 cm
or
Ipsilateral axillary lymph node (N1)
No Metastasis (M0)

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)

Stage IV (Metastatic breast cancer)
Any T
Any N
Metastasis (M1)

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

Symptoms and Screening

Normal breast physiology and anatomy
Symmetry and balance
Size
weight
menstrual cycle
pregnancy and lactation
Texture
Shape
age

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

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

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

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

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

Mammography
American Cancer Society recommends:
Women (asymptomatic) 40 years of age and older should have a mammogram every year.

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

Free Mammograms
Medicare
Arkansas Breast Cancer Control Program
Breast and Cervical Cancer Control Program of the Arkansas Department of Health

Medicare
Women over 65

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

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

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

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

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