1. PLWC Slide Deck Series: Understanding Breast Cancer
Presents
PLWC Slide Deck Series:
Understanding Breast Cancer
2006

2. What is Cancer? A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body

3. What is Breast Cancer?
The most common type of cancer in women in the United States (excluding cancers of the skin) and the second most frequent cause of death from cancer in women
A disease in which normal cells in the breast begin to change, grow without control, and no longer die
Cancer that has not spread is called in situ, meaning “in place”
Cancer that has spread is called invasive or infiltrating

4. What is the Structure of the Breast?
The breast is composed mainly of fatty tissue, which contains a network of lobes made up of tiny, tube-like structures called lobules that contain milk glands
Tiny ducts connect the glands, lobules, and lobes, and carry the milk from the lobes to the nipple
Blood and lymph vessels run throughout the breast
About 90% of all breast cancers originate in the ducts or lobes of the breast

5. What Are the Risk Factors for Breast Cancer?
Age
Race
Individual or family history of breast cancer
A history of ovarian cancer
A genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers)
Estrogen exposure
Atypical hyperplasia of the breast
Lobular carcinoma in situ (LCIS)
Lifestyle factors (obesity, lack of exercise, alcohol use)
Radiation

6. Hereditary Breast Cancer
About 15% of breast cancers are inherited
Approximately 80% of hereditary breast cancer is caused by mutations in the BRCA1 or BRCA2 genes
Women who inherit a BRCA mutation have a 50% to 85% chance of developing breast cancer in their lifetime
Women with especially strong family history may consider preventive surgery to remove breast tissue and/or chemoprevention
Several other genetic syndromes can increase breast cancer risk
Genetic counseling and testing is available for most syndromes
For more information,

7. Breast Cancer and Early Detection
Early diagnosis means a better chance of successful treatment
Mammography is the best tool doctors have to screen for breast cancer
Many organizations recommend that women obtain a mammogram each year, starting at the age of 40
Regular clinical breast examinations and breast self-examinations are also recommended
Women are encouraged to discuss the frequency of screening with their doctors

8. What Are the Symptoms of Breast Cancer?
New lumps or a thickening in the breast or under the arm
Nipple tenderness, discharge, or physical changes
Skin irritation or changes, such as puckers, dimples, scaliness, or new creases
Warm, red, swollen breasts with a rash resembling the skin of an orange
Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor)
No visible or obvious symptoms (asymptomatic)

9. How is Breast Cancer Evaluated?
Screening and/or diagnostic mammography
Ultrasound
Magnetic Resonance imaging (MRI) scan
Biopsy is necessary to confirm a diagnosis
Blood tests are often used to determine if the cancer has spread outside the breast
Additional tests may be used to determine stage

10. Breast Cancer Staging
Staging is a way of describing a cancer, such as the depth of the tumor and where it has spread
Staging is the most important tool doctors have to determine a patient’s prognosis
Staging is described by the TNM system: the size of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to organs such as the liver or lungs)
The type of treatment a person receives depends on the stage of the cancer

11. Stage 0 Breast Cancer
Known as “cancer in situ,” meaning the cancer has not spread past the ducts or lobules of the breast (the natural boundaries)
Also called noninvasive cancer
Ductal carcinoma in situ (DCIS) is the most common in situ breast cancer

12. Stage I Breast Cancer
The tumor is small and has not spread to the lymph nodes

13. Stage IIa Breast Cancer
Stage IIa breast cancer describes a smaller tumor that has spread to the axillary lymph nodes (lymph nodes under the arm), or a medium-sized tumor that has not spread to the axillary lymph nodes
Stage IIa may also describe cancer in the axillary lymph nodes with no evidence of a tumor in the breast

14. Stage IIb Breast Cancer
Stage IIb breast cancer describes a medium-sized tumor that has spread to the axillary lymph nodes
Stage IIb may also describe a larger tumor that has not spread to the axillary lymph nodes

15. Stage IIIa Breast Cancer
Stage IIIa breast cancer describes any size tumor that has spread to the lymph nodes

16. Stage IIIb Breast Cancer
Stage IIIb breast cancer has spread to the chest wall, or caused swelling or ulceration of the breast, or is diagnosed as inflammatory breast cancer

17. Stage IIIc Breast Cancer
Stage IIIc breast cancer has spread to distant lymph nodes but has not spread to distant parts of the body

18. Stage IV Breast Cancer
Stage IV breast cancer can be any size and has spread to distant sites in the body, usually the bones, lungs or liver, or chest wall

19. How is Breast Cancer Treated?
Treatment depends on stage of cancer
More than one treatment may be used
Surgery
Radiation therapy
Chemotherapy
Hormone therapy
Targeted therapy

20. Factors Considered in Treatment Decisions
The stage and grade of the tumor
The tumor’s hormone receptor status (ER, PR)
Factors that may signify an aggressive tumor, such as HER-2/neu amplifications
The presence of known mutations to breast cancer genes
The patient’s menopausal status
The patient’s age and general health

21. Cancer Treatment: Surgery
Generally, surgery to remove the tumor with or without radiation therapy is initial treatment
For invasive cancer, lymph nodes are removed and evaluated
More invasive surgery (such as mastectomy) is not always better; discuss with your doctor
Breast reconstruction is an option after mastectomy

22. Cancer Treatment: Adjuvant Therapy
Treatment given in addition to surgery to reduce the risk of recurrence
May include radiation therapy, chemotherapy, biologic therapy, and hormone therapy

23. Cancer Treatment: Radiation Therapy
The use of high-energy x-rays or other particles to destroy cancer cells
Usually used to treat breast cancer after surgery
Different methods of delivery
External-beam: outside the body
Internal: uses implants inside the body
Side effects may include fatigue, swelling, and skin changes

24. Cancer Treatment: Chemotherapy
Drugs used to kill cancer cells
May be given before surgery to shrink a large tumor (neoadjuvant chemotherapy) or after surgery to reduce the risk of recurrence (adjuvant chemotherapy)
A combination of medications is often used

25. Cancer Treatment: Hormone Therapy
Used to manage tumors that test positive for either estrogen or progesterone receptors
May be used alone or together with chemotherapy
Tamoxifen (Nolvadex) is a common hormone therapy and is effective in many premenopausal and postmenopausal women
Aromatase inhibitors are also used alone or following tamoxifen use as treatment for postmenopausal women, including anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin)

26. New Therapies: Targeted Therapy
Treatment designed to target cancer cells while minimizing damage to healthy cells
Used to stop the action of abnormal proteins that cause cells to grow and divide out of control
Trastuzumab (Herceptin) for women with a HER-2/neu-positive breast cancer either with or after adjuvant chemotherapy
Bevacizumab (Avastin) blocks angiogenesis (the formation of new blood vessels) and is under evaluation in clinical trials

27. The Role of Clinical Trials for the Treatment of Breast Cancer
Clinical trials are research studies involving people
They test new treatment and prevention methods to determine whether they are safe, effective, and better than the best known treatment
The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process
Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

28. Clinical Trials: Patient Safety
Informed consent: Participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks
Informed consent is an ongoing process; participants are constantly updated as new information becomes available
Participation is always voluntary, and patients can leave the trial at any time

29. Clinical Trials: Phases
Phase I trials determine safety and dose of a new treatment in a small group of people
Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a given form of cancer
Phase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the current, standard treatment for that disease; phase III trials involve a large number of patients

30. Clinical Trials Resources
Coalition of Cancer Cooperative Groups (
CenterWatch (
National Cancer Institute (

31. Coping With the Side Effects of Cancer and its Treatment
Side effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain relievers are available
Antiemetic drugs can reduce or prevent nausea and vomiting
Lymphedema following breast cancer surgery can often be managed with help from your doctor
For more information, visit

32. Follow-Up Care
Important to detect possible recurrence at the earliest stage
Monthly breast self-examinations
Physical examinations
Mammograms
Pelvic examinations
More information can be found in the ASCO Patient Guide: Follow-Up Care for Breast Cancer

33. Where to Find More Information: PLWC Guide to Breast Cancer (www. plwc
Where to Find More Information: PLWC Guide to Breast Cancer (
Overview
Medical Illustrations
Risk Factors
Prevention
Symptoms
Diagnosis
Staging With Illustrations
Treatment
Side Effects of Cancer and Cancer Treatment
Questions to Ask the Doctor
Current Research
Patient Information Resources
Clinical Trials Resources

34. People Living With Cancer (www.plwc.org)
PLWC is the cornerstone of ASCO’s patient resources program
Visitors to PLWC will find:
PLWC Guides to more than 90 types of cancer
Coping resources
Ask the ASCO Expert Series, including chats, Q&A forums, and event transcripts
Cancer information in Spanish
The latest cancer news
For patient information resources, please call