Breast Cancer An Overview Dr. Christina Tzagarakis-Foster November 9, 2006

Breast Cancer Statistics -Breast cancer is the second leading cause of cancer- related deaths in women today -Most common cancer among women worldwide (excluding nonmelanoma skin cancers) - Male breast cancers account for approximately 1% of all breast cancer cases. -The American Cancer Society estimates that in 2006, approximately 212,920 women in the United States will be diagnosed invasive breast cancer.

Life-time risks of developing BC Age Specific Probabilities of Developing Breast Cancer Probability of Developing Breast Cancer Within 10 Years Age Within 10 Years or 1 in: % % % % % 29 REF: American Cancer Society. Breast cancer facts & figures Atlanta, GA: ACS, Inc., 2001.

Ethnic Profile White, Hawaiian, and African-American women have the highest incidence of invasive breast cancer in the US Korean, American Indian, and Vietnamese women have the lowest incidence of invasive breast cancer in the United States. African-American have the highest death rate from breast cancer and are more likely to be diagnosed with a later stage of breast cancer than White women.

Cases of BC Worldwide Top 3 countries - Iceland, Denmark, Netherlands The risk of getting breast cancer worldwide is lowest in western Africa and eastern Asia. But studies show women can take on the breast cancer risk of the country they move to within as little as one generation.

What is Cancer? Abnormal cell division Due to mutations in DNA dominant recessive REF: Alberts, Molecular Biology of the Cell

Types of Breast Cancer Majority (over 80%) begins in either the milk ducts or the lobular (milk-producing) tissue. Either type, if diagnosed early enough, may be called “in situ” (IDC).

*Lobular carcinoma in situ (LCIS): It is a lesion found in the milk-glands that has not spread. Although not a true cancer, it may increase the risk of developing into cancer later. *Ductal carcinoma in situ (DCIS): This is breast cancer at its earliest stage that has not spread. Nearly 100% of women with cancer at this stage can be cured. *Invasive lobular carcinoma (ILC): This cancer starts in the milk glands (lobules), breaks through the wall of the gland and invades the fatty tissue of the breast. *Invasive ductal carcinoma (IDC): This cancer starts in the milk ducts, breaks through the wall of the duct, and invades the fatty tissue of the breast. IDC is the most common type of breast cancer, as it accounts for nearly 80% of breast cancer.

Stages of Breast Cancer Stage 0 (called carcinoma in situ ) refers to abnormal cells lining a gland in the breast ( Lobular carcinoma in situ or LCIS) or abnormal cells lining a duct ( Ductal carcinoma in situ or DCIS). Stage I early stage breast cancer where the tumor is less than 2 cm across and hasn't spread beyond the breast. Stage II early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm; or the tumor is greater than 5 cm and hasn't spread outside the breast Stage III locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast Stage IV metastatic breast cancer where the cancer has spread outside the breast to other organs in the body

Detection of BC BSE/CSE Mammogram Ultrasound MRI REF:

Inherited BC 5-10% of all breast cancers are inherited BRCA1 and BRCA2 most common genes related to hereditary BC autosomal dominant pattern **It is estimated that 86 percent of the women with a mutation in the BRCA-1 gene will develop breast cancer by age 70. REF:

Other Genetic Factors Variations of the ATM, CHEK2, and RAD51 genes increase the risk of developing breast cancer.

Spontaneous BC p53 HER2/cerbB-2/neu ER  /ER 

BC Treatments & Therapies Surgery and radiation treatment Chemotherapy

Estrogen Receptors Bind Estrogen

BC Therapies (con’t) SERMS (Tamoxifen) Aromatase Inhibitors

BC therapies (con’t) Herceptin (Trastuzumab) Genetech

Risk Factors Age Gender Race Genetic Long menstrual history Environmental Reproductive REF: * From the Environmental Epidemiology Branch, Division of Cancer Etiology, National Cancer Institute, Bethesda, Maryland

Risk Factors (con’t) HRT Ionizing Radiation Obesity Alcohol Physical Activity REF:

Social Impact of BC Alters the woman’s self image Impacts the woman’s sexuality Impacts her relationships Isolates her from her peers Imposes financial burdens Causes changes in lifestyle Sammarco A. Psychosocial stages and quality of life of women with breast cancer. Cancer Nurs Aug;24(4): Shapiro SL, Lopez AM, Schwartz GE, et al. Quality of life and breast cancer: relationship to psychosocial variables. J Clin Psychol Apr;57(4):

Breast Cancer Rates in Marin County “Marin County Breast Cancer Rates Flawed” (dateline June 1, 2003) REF:

References: cancer#geneshttp://ghr.nlm.nih.gov/condition=breast cancer#genes tm#rfhttp:// tm#rf