1. Breast Cancer Adriana Padilla, MD Family Medicine Douglas Wong, MD Radiation Oncology Michael Moffitt, MD Oncology Rebecca Stickler, MD Surgery

2. By the time the Lord/Higher Power made woman, he was into his sixth day of working overtime. An angel appeared and said, "Why are you spending so much time on this one?“ And the Lord/Higher Power answered, "Have you seen the spec sheet on her? She has to be completely washable, but not plastic, have over 200 movable parts, all replaceable, run on diet coke and leftovers, have a lap that can hold four children at one time, have a kiss that can cure anything from scraped knee to a broken heart and have two pairs of hands.“ The angel was astounded at the requirements. "Two pairs of hands! No way! And that's just on the standard model? That's too much work for one day. Wait until tomorrow to finish.“ "But I can't," the Lord/Higher Power protested. "I am so close to finishing this creation that is so close to my own heart. She already heals herself when she is sick AND can work 18 hour days.“ The angel moved closer and touched the woman. "But you have made her so soft, Lord/Higher Power." "She is soft," the Lord/Higher Power agreed, "but I have also made her tough. You have no idea what she can endure or accomplish." "Will she be able to think?", asked the angel. The Lord/Higher Power replied, "Not only will she be able to think, she will be able to reason and negotiate.“

3. The angel then noticed something, and reaching out, touched the woman's cheek. "Oops! It looks like you have a leak in this model. I told you that you were trying to put too much into this one..“ "That's not a leak," the Lord/Higher Power corrected, "that's a tear!" "What's the tear for?" the angel asked. The Lord/Higher Power said, "The tear is her way of expressing her joy, her sorrow, her pain, her disappointment, her love, her loneliness, her grief and her pride.“ The angel was impressed. "You are a genius, Lord/Higher Power. You thought of everything! Woman is truly amazing.“ And she is!...... Women have strengths that amaze men. They bear hardships and they carry burdens,but they hold happiness, love and joy. They smile when they want to scream. They sing when they want to cry. They cry when they are happy and laugh when they are nervous. They fight for what they believe in. They stand up to injustice.

4. They don't take "no" for an answer when they believe there is a better solution. They go without so their family can have. They go to the doctor with a frightened friend. They love unconditionally. They cry when their children excel and cheer when their friends get awards. They are happy when they hear about a birth or a wedding. Their hearts break when a friend dies. They grieve at the loss of a family member, yet they are strong when they think there is no strength left. They know that a hug and a kiss can help to heal a broken heart. Women come in all sizes, in all colors and shapes. They'll drive,fly, walk, run or e-mail you to show how much they care about you. The heart of a woman is what makes the world keep turning! They bring joy and hope.They have compassion and ideals.They give moral support to their family and friends. Women have vital things to say and everything to give. Pass this along to your women friends to remind them how amazing they are because if there's one flaw in women, it is that they tend to forget about themselves.

5. Breast Cancer Women Are Amazing!

6. Breast Cancer Take home goals: Understand Breast Cancer Risk Factors Be comfortable with Breast Cancer screening methods What to do if you or your physician has found a new breast lump

7. Breast Cancer Take home goals: Understand the difference between non-cancer and cancerous lumps

8. Breast Cancer Take home goals: Understand the basic principals of treatment options Local Treatments: Surgery, Radiation Systemic (Adjuvant) Therapy Chemotherapy Hormone therapy Other options

9. Breast Cancer Take home goals: Coping with your diagnosis Talking with your doctor Accessing breast exams and mammogram services

10. Breast Cancer Risk Factors Risk Factors do not cause breast cancer but are associated with an increased chance of getting breast cancer The number one risk factor for breast cancer is being a women Age is a risk; the chance of getting breast cancer increases with age

11. Age as a Risk Factor RISK By age 301 out of 2,000 By age 401 out of 233 By age 501 out of 53 By age 601 out of 22 By age 701 out of 13 By age 801 out of 9 Lifetime risk1 out of 8 NCI SEER Program, 1995-1997

12. Risk Factors Controllable Alcohol drinking Being overweight Never having children 1st child >30yrs of age Hormone Replacement Birth control pills (very slight) ACS Breast Cancer Facts 2001-02 Uncontrollable Getting older First degree relative with breast cancer A previous breast biopsy showing atypical changes

13. Risk Factors Controllable Being exposed to large amounts of radiation Uncontrollable Being young (<12) at the time of menses Starting menopause after age 55 Having an inherited mutation in the breast cancer genes (BRCA 1 or 2) ACS Breast Cancer Facts 2001-02

15. Breast Cancer Screening Methods For Healthy Women 1. Breast Self Exam — Status Guiding principal “Know your breasts — they are not land mines” 2. Clinical Breast Exam Age 20-39: every 3 years Age after 40: every year 3. Mammography Age after 40: every year

16. Trouble Signs That Should Not Be Ignored 1.Finding a lump, hard knot or thickening 2.Unusual swelling, warmth, redness or darkening 3.Change in size or shape of your breast 4.Dimpling or puckering of the skin of your breast 5.Finding an itchy, scaly sore or rash on the nipple 6.Pulling in of the nipple or other parts of the breast 7.Nipple discharge that starts suddenly 8.Pain in one spot that does not vary with cycle

17. Breast Cancer Screening Methods For Healthy Women How do you do a Breast Self Exam? What is a mammogram and is it enough to screen for Breast Cancer?

18. When you discover a breast lump What do you do? 1. Don’t Panic — most breast lumps are not cancer (Benign Breast Changes - Cysts and Fibroadenomas) 2. See your primary health care provider for a full assessment and recommendations 3. You may need a fine needle aspiration procedure and or a diagnostic mammogram or ultrasound

19. When you discover a breast lump What do you do? 4. If the breast lump turns out to be solid, what happens then? 5. If after a biopsy, the tissue is found to be cancerous, what happens then? 6. If after a biopsy the tissue is found to not be cancerous, but not entirely normal, what happens then?

20. When the Diagnosis is Cancer — What then? Types of Breast Cancer? Types of Treatment: Local and Systemic Local Surgery Radiation Therapy Systemic Chemotherapy Hormone Therapy Biological Therapy

31. Radiation Treatment Conventional whole breast treatment: mastectomy or radiation therapy Recent innovations Revisit the concept of partial breast treatment only Smaller volumes Shorter treatment course Balloon catheter / multi-catheters / IORT / IMRT

33. Balloon and lumpectomy

36. When the Diagnosis is Cancer — What then? With the help of your family, friends and your medical team, you can: 1. Understand your diagnosis and prognosis 2. Make treatment decisions from the best and latest research and clinical trials 3. Become comfortable with your treating “team” (primary health care provider, surgeon, oncologist, radiation oncologist and others) 4. Know what to expect

37. Coping with your Diagnosis Express your emotions Develop a fighting spirit Build a strong support group Trust your health care team

38. Working with your Health Care Team Communication is key Be prepared Write down your questions Explain your situation and concerns Give feedback to your health care team

39. Accessing Breast Health Care 1.HMO, PPO, Medi-Cal, Medicare covers services 2.Breast Cancer Early Detection Programs: Free services to individuals who do not have nor qualify for health care. You must qualify on an intake assessment

40. Women Are Amazing! Remember Yourself During Breast Cancer Awareness Month!

41. Important Information Sites www.komen.org www.cancer.gov for the National Institute of Health www.cancer.org for the American Cancer Society www.ahcpr.gov for the US Preventive Health Task Force recommendations