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Professor Arnold Hill Wed 26th October 2011

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Presentation on theme: "Professor Arnold Hill Wed 26th October 2011"— Presentation transcript:

1 Professor Arnold Hill Wed 26th October 2011
Breast Cancer Professor Arnold Hill Wed 26th October 2011

2 Breast Cancer Breast Cancer in Ireland If you find a lump…
Treatments for breast cancer Latest breast cancer treatments Reorganisation of breast cancer services

3 Breast Cancer in Ireland
Each year over 2,300 women & 25 men diagnosed with breast cancer in Ireland Each year nearly 700 people die from breast cancer in Ireland Lifetime risk: 1 in 10 women

4 New symptoms to seek medical opinion on…
Breast lump Nipple discharge Nipple inversion Breast skin changes Strong family history Mother, sister, grandmother, aunt

5 Risk Factors Increasing age Exposure to estrogens
Environmental/lifestyle Family History Genetic abnormality (5-10%) BRCA1/2 Sister Study National Institute of Environmental Health Sciences 50,000 women followed for 10 years

6 Screening 50-64 years Every 2 years

7 Imaging >35 years of age < 35 years of age

8 Breast Cancer Breast Cancer in Ireland If you find a lump…
Treatments for breast cancer Latest breast cancer treatments Reorganisation of breast cancer services

9 What to do if you feel a lump?
Check the other breast Don’t panic! 9 out of 10 lumps are not cancerous Attend GP as soon as possible for review Referral to triple assessment specialist breast unit

10 Triple Assessment Breast Unit
Clinical exam Pathological biopsy Radiological assessment

11 TABC Accuracy Gold standard of breast cancer diagnosis
> 95% of symptomatic breast cancers diagnosed using TABC¹,²,³ 1) Merion Thomas J et al. Br Med J 1978; ii:1139 – 1141 2) Dixon JM et al. Br J Surg 1984; 71:593 – 596 3) Hermansen C et al. Cancer 1987; 60:1866 – 1871

12 Breast Cancer Breast Cancer in Ireland If you find a lump…
Treatments for breast cancer Latest breast cancer treatments Reorganisation of breast cancer services

13 Treatments for breast cancer
Surgery Chemotherapy Radiotherapy Hormonal therapy Biological therapy Neoadjuvant Versus Adjuvant

14 Surgery Mastectomy Breast conservation Axillary lymph node clearance
Sentinel Lymph node biopsy Breast Reconstruction DIEP, TRAM, LD

15 Reconstructive Surgery

16 Sentinel lymph node

17 Breast Cancer Cell HER2 ER Tumour growth

18 Hormonal therapy ER positive breast cancer
75% of Breast Cancers are ER positive 150,000 EU women are on “hormonal therapy” Tamoxifen, Arimidex, Femara, Aromasin

19 Biological therapy HER2 positive breast cancer
25% breast cancers overexpress HER2 Herceptin, Tykerb (lapatinib)

20 Beaumont Breast Cancer Research
Clinical Trials International Institutional Establishing ‘best treatment’ Novel oncological drugs Molecular Research Audit & database review

21 Breast Cancer Breast Cancer in Ireland If you find a lump…
Treatments for breast cancer Latest breast cancer treatments Reorganisation of breast cancer services

22 New diagnostic resources
Gene expression studies Oncotype DX MammaPrint

23 New surgical techniques
Skin sparing mastectomy Only used when immediate reconstruction performed Oncoplastic Breast Reconstruction Immediate versus delayed

24 New radiotherapy techniques
Hypofractionated radiation Larger doses over fewer days Accelerated partial breast irradiation Intraoperative radiation therapy Intracavitary brachytherapy

25 New Biological Treatments
Targeting HER2 Neratinib Tovok Pertuzumab Anti-angiogenesis Bevacizumab Targeting EGFR Gefitinib Erlotinib Cetuximab Other Vitamin D Bisphosphonates

26 The price tag of progress…
Herceptin € 2,000 / month Lapatinib Bevacizumab € 3,000 / month Cetuximab € 3,400 / month

27 Breast Cancer Breast Cancer in Ireland If you find a lump…
Treatments for breast cancer Latest breast cancer treatments Reorganisation of breast cancer services

28 Managed Cancer Control Networks & Cancer Centres
HSE Dublin – North East Beaumont Hospital Mater Misericordiae Hospital Dublin – Mid Leinster St. James’s Hospital St. Vincent’s University Hospital HSE South Cork University Hospital Waterford Regional Hospital HSE West UCH Galway Limerick Regional Hospital Letterkenny General Hospital

29 Breast Cancer update Network Cancer Centres HSE Dublin – North East
Drogheda James Connolly Mullingar Beaumont Mater Misericordiae Dublin – Mid Leinster Portlaoise AMNCH St. James’s St. Vincent’s University HSE South Tralee South Infirmary Cork Clonmel St Luke’s, Kilkenny Wexford Cork University Waterford Regional HSE West Portiuncula Castlebar Sligo UCH Galway Limerick Regional

30 Hospitals providing initial diagnosis + surgery for breast cancer
Cancer Strategy Hospitals providing initial diagnosis + surgery for breast cancer June 2007 33 Sept 2007 20 June 2008 16 Dec 2008 12 Spring 2009 8

31 Summary Lifetime risk of breast cancer 1 in 10 women
Surgery & chemoradiotherapy the mainstay of treatment Hormonal and biological therapies increasing in efficacy, but costly Irish NCCP – 8 designated breast cancer centres

32 Thank you

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