Elizabeth Murray Clinical and Radiation Oncology

Margin Probe

Endomagnetics

APBI: POSTOP – INTERSTITIAL BRACHTHERAPY

16 vs 25

ASTRO GUIDELINE FOR WHOLE BREAST HYPOFRACTIONATION Age >/=50 pT1-2 No CT Good homogeneity (7% CA plane/size issue) 42.5Gy in 16 Exclude heart from primary treatment field Boost???? Not necessarily contraindicated in others, task force not in agreement

APBI: POSTOP – INTERSTITIAL BRACHTHERAPY

APBI: POSTOP – INTERSTITIAL BRACHYTHERAPY

RISK

Can I Modify My Patient’s Breast Cancer Risk ? 1.Yes 2.No 3.Sometimes 4.Don’t know

Risk Management and Surveillance

What Are Breast Cancer Risk Factors?

Risk Factors Female Older age (>50) Family history Overweight (postmenopausal) All women: Maintain BMI kg/m² Alcohol (Add folic acid if drink alcohol) Smoking

Risk Factors cont’d HRT and OC Nulliparity or first child over 30 Probably red meat / animal fats Reduce risk with: o Vigorous exercise o Breast feeding ≥ 6/12 o ?Vit D and calcium supplements and low-fat dairy products

MENOCAL Vit D and Calcium CALCIFEROL iu

Screening / Surveillance Use Gail Model to assess risk

Average Risk ≤1.7% risk in 5 years

Risk Management and Surveillance

Is It worth Doing a Surveillance Mammogram ? 1.Never 2.Only with strong Family History 3.Over 50 years in most patients 4.Over 40 years in most patients

Should I teach my patients BSE? 1.No, does not improve mortality rates 2.Yes, may help

Mammogram

Screening / Surveillance contd Normal Risk >20 to 40: CBE each 1 to 3 years >/=40: CBE and ? Mammo annually (share decision-making) 50-69: CBE annually and mammo every year or 2 years >/=70Continue while life expectancy ≥ 7 to 10y

Screening / Surveillance contd High Risk High risk women should have screening recommendation from a specialist o LCIS o Previous breast cancer o Strong family history breast, ovary, prostate Consider genetic counselling

When Is It Worth Doing Gene Testing? 1.Everyone who can afford it 2.5% risk of carrying gene 3.10% risk 4.20% risk 5.50% risk

Screening / Surveillance contd High Risk High risk woman should have screening recommendation from a specialist o LCIS o Previous breast cancer o Strong family history breast, ovary, prostate Consider genetic counselling

Questions?

Diagnosis

Early Diagnosis of Breast Cancer Never ignore complaint/ finding of a lump Investigate change in one breast Inflammatory Ca (or recurrence of Ca) may mimic cellulitis – looks like inflammation Cancer may mimic an abscess

Early Diagnosis of Breast Cancer cont’d Suspicious signs: Skin dimpling Nipple discharge Change in shape or appearance of breast Axillary glands New nipple inversion

Early Diagnosis of Breast Cancer cont’d PREGNANCY DOES NOT PRECLUDE BREAST CANCER

Tests Imaging before biopsy Mammo +/- ultrasound (or ultrasound only <35)

Aspiration of a Breast Lump

Tests cont’d Biopsies Must be experienced operator with training and regular practice Radiologist Pathologist at FNAC clinic GSH ( ) Surgeon

Management of Findings cont’d Err on the side of caution Must find a reason for a breast lump Refer to a surgeon or oncologist if cancer or suspicion of cancer (surgeon)

Cancer prevention healthy lifestyle Oncologist / Specialist Domain Primary Care Domain POPULATION RISK MNGT Risk Assessment Primary prevention Counselling Health promotion Risk assessment Screening POPULATION RISK MNGT Risk Assessment Primary prevention Counselling Health promotion Risk assessment Screening INDIVIDUALMNGT Detection & Diagnosis Treatment Survivorship INDIVIDUALMNGT Detection & Diagnosis Treatment Survivorship TERMINAL CARE Primary Care Domain Multi-disciplinary team approach

Very Early Breast Cancer Stage 0/ DCIS Stage 1

Breast cancer Stages 1-3

Where Does Breast Cancer Spread?

Breast Cancer

Questions?

Treatment of Breast Cancer

Treatment of Stages 1-3 Surgery Radiotherapy Hormones/Endocrine Rx Biologicals Chemotherapy

Oestrogen Receptors Oestrogen Target Cell (e.g. Breast, Uterine lining, Liver, etc.) Non-Target Cell (contains no oestrogen receptor)

How Do We Treat HR positive Breast Cancer in Premenopausal Women?

Pathway in Premenopausal Women Pituitary Oophorectomy OestrogenOvariesHypothalamus LHRH Agonist FSH LH

How Do We Treat HR positive Breast Cancer in Postmenopausal Women?

Oestrogen Receptors Oestrogen Target Cell (e.g. Breast, Uterine lining, Liver, etc.) Non-Target Cell (contains no oestrogen receptor)