1 BREAST CANCER

Breast Cancer Breast cancer occurs when abnormal cells grow out of control in one or both breasts. They can invade nearby tissues and form a mass called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body. 2

Overview and Statistics: Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100times more common in women than in men, but survival rates are equal 3

26 females out of 100 females and 1 male for every 105 males may be diagnosed with breast cancer in the Philippines. Since the 1980s, breast cancer ranks 1st among the top leading cancers afflicting women in the Philippines and ranks 2nd to lung cancer if both sexes are considered. Its incidence starts to peak at the age of30 in women. (Source: Philippine Cancer Facts & Estimates, PCSI, 2005.) However, it was reported in 2004 that breast cancer cases in the Philippines exceeded lung cancer by 685 cases for both sexes (source: UP-DOH report) 4

Recently, more women are presenting with bilateral disease at an early age(30’s-40’s). Generally, the disease is still being diagnosed late in its course hence the survival rate of breast cancer in the Philippines is below 50%. Making the situation more difficult, an estimated seventy percent (70%) of breast cancer patients in the Philippines are indigents. 5

Alarmingly, the Philippines has the highest prevalence of breast cancer in Asia.(Source: International Agency for Research on Cancer, 2004). In addition to the successful reduction in fertility and westernization of the Filipino lifestyle, the limited access to breast health contributes significantly to its recorded highest prevalence in Asia. Among the reasons for the limited access to breast health in the Philippines include: location of health facilities, limited income, high prices of diagnostic tests and hospital care, low levels of education, and the lack of breast cancer awareness. 6

Breast Cancer Risk Factors that cannot be changed  Age  Family/Personal History  Race  Treatment with DES  Radiation  Genetic Factors  Menstrual History  Reproductive History 7

Breast Cancer Risk Factors controlled that can be controlled Obesity Exercise Breastfeeding Alcohol HRT Birth control pills Not having children 8

Signs and Symptoms 9 Most common: lump or thickening in breast. Often painless Change in color or appearance of areola Redness or pitting of skin over the breast, like the skin of an orange Discharge or bleeding Change in size or contours of breast

Staging of Breast Cancer T= tumor size N = lymph node involvement M = metastasis 10

Stage 1 Tumor < 2.0 cm in greatest dimension No nodal involvement (N0) No metastases (M0) 11

Stage II Tumor > 2.0 < 5 cm or Ipsilateral axillary lymph node (N1) No Metastasis (M0) 12

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) 13

Stage IV (Metastatic breast cancer) Any T Any N Metastasis (M1) 14

Types of breast cancer In situ Intraductal (DCIS) Intralobular (LCIS) Invasive Infiltrating ductal carcinoma Tubular carcinoma Medullary carcinoma Mucinous carcinoma 15

Diagnosis & Tests Breast Self Exam - The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings). It includes looking at and feeling your breast. Any unusual changes should be reported to your doctor. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved. 16

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 17

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 18

Diagnosis & Tests Clinical Breast Exam - A breast exam by a Health professional (such as your doctor, nurse, nurse practitioner, Or physician assistant) is an important part of routine physical checkups. You should have a clinical breast exam at least every three years starting at age 20 and every year starting at age 40. A clinical breast exam may be recommended more frequently if you have a strong family history of breast cancer. 19

Why don’t more women practice BSE? Fear Embarrassment Youth Lack of knowledge Too busy, forgetfulness 20

Diagnosis & Tests Mammogram - Mammograms are a good way of identifying abnormalities in the breast - Used for women over the age of 35 - In younger women the breast tissue is more dense, which makes it difficult to detect any changes on the mammogram. 21

Mammography Equipment 22

Diagnosis & Tests Breast Ultrasound - Breast ultrasound is a procedure that may be used to determine whether a lump is a cyst (sac containing fluid)or a solid mass which could be cancer. If it is found to be a cyst, fluid is typically withdrawn from it using a needle and syringe (a process called aspiration). If clear fluid is removed and the mass completely disappears, no further treatment or evaluation is needed. 23

Diagnosis & Tests OPEN BIOPSY - A biopsy is the only way to tell for sure if cancer is present. - an incisional biopsy takes a sample of a lump or abnormal area. - An excisional biopsy takes the entire lump or area. - This procedure is done either under local anaesthesia or general anaesthesia 24

OTHER INVESTIGATIONS CHEST X RAY ABDOMINAL ULTRASOUND  Needle tests (FNAC) CT OF THE BRAIN BONE SCINTIGRAPHY 25

Breast Cancer Treatments Surgery Radiation Therapy Chemotheraphy Hormone Theraphy Immunotherapy 26

LOCAL TREATMENT Surgery Lumpectomy: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it. Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. 27

LOCAL TREATMENT Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called simple mastectomy. Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles. 28

LOCAL TREATMENT Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy. Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6 weeks to a radiation therapy treatment center 29

SYSTEMATIC TREATMENT Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. Hormonal Therapy: When the pathologist examines your tumor specimen, he or she finds out if the tumor is expressing estrogen and progesterone receptors. Biologic Therapy: The pathologist also examines your tumor for the presence of HER-2/neu over expression. HER-2/neu is a receptor that some breast cancers express. A compound called Herceptin (or Trastuzumab) is a substance that blocks this receptor and helps stop the breast cancer from growing. 30

PREVENTION 1.Pass on that last call for alcohol. 2. Quitters DO prosper - when it comes to smoking. 3. Get physical/Regular aerobic exercise 4. Be aware of your family breast cancer history. 5. Avoid hormone replacement therapy if possible 31

PREVENTION 6. Check your breasts every month. 7. Try to keep a low fat diet/Your diet can play an important role in breast cancer prevention. 8. Don't forget to get a mammogram 9. Have children earlier in life, if possible 10. Consider breastfeeding instead of formula feeding. 32

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