1. Dilek Aygin Breast Cancer and Epidemiology Dilek Aygin

2. Breast Cancer ► The most common form of cancer among women ► The second most common cause of cancer related mortality ► 1 of 8 women (12.2%) ► One third of women with breast cancer die from breast cancer

3. ► Breast cancer, accounting for 23% of all female cancers around the globe. ► There is marked geographical variation in incidence rates, being highest in the developed world and lowest in the developing countries in Asia and Africa.

4. The breast cancer situation is no different in Turkey ► According to data provided by the Turkish Association for Cancer Research and Control (TKASK), 150,000 people are diagnosed with cancer each year in Turkey. ► Even though breast cancer can be treated successfully when diagnosed early, thousands of women still die from the disease each year, and experts say breast cancer awareness in Turkey is at an inadequate level. ► breast cancer is the most common cancer among Turkish women, which represents 26.5% of all female cancers. Ministry of Health: The most frequent ten cancers in females in Turkey. http:/ / www.saglik.gov.trhttp:/ / www.saglik.gov.tr

5. To the estimations of the Health Ministry resources (Tuncer, 2006, www.saglık.gov.tr), the number of breast cancer patients in the period of 2007-2012 has been seen in Table 1.

6. Global Differences in Breast Cancer Diagnosis and Outcomes: Survival ► Estimated mortality-to-incidence ratios are generally lower in developed regions 1 USA (83–88%) 2* Europe (60–83%) 2* Developing countries (45–72%) 3** Women diagnosed: * 1990–1994; ** 1982–1992 ASR 5-year survival 1 Shibuya, et al. BMC Cancer 2002;2:37; 2 Coleman, et al. Ann Oncol 2003;14 (Suppl 5):V128–V149; 3 Sankaranarayanan, et al. IARC Sci Publ 1998;145:135–73

7. 0.25 0.32 0.37 0.33 0.45 0.27 0.39 0.27 0.38 0.35 0.45 0.42 0.48 0.39 0.37 0. 32 GLOBAL STATISTICS: Breast cancer mortality in different countries SLIDE CREDIT:Gilberto Schwartsmann

8. GLOBAL STATISTICS: Mortality vs. Degree of economic development SLIDE CREDIT:Gilberto Schwartsmann

9. What is breast cancer? ► Breast cancer is where cancerous (malignant) cells are found in the breast tissue. ► There are several types of breast cancer. ► Ductal cancer (effects the ducts and also is the most common type) ► Lobular (which begins in the lobes of the breast and often is found in both breasts) ► Inflammatory cancer (its where the breast appears swollen and hot) its also very uncommon. ► Picture from WebMD.com

10. Risk Factors for Breast Cancer ► Female (1% male) ► Aging ► Relative (mother or sister) ► Menstrual history  early on set  late menopause ► Child birth  After the age of 30

11. Exogenous Estrogen ► Hormonal replacement therapy(HRT)  30% increased risk with long term use ► Oral Contraceptives(OC)  risk slight  risk returns to normal once the use of OC’s has been discontinued

12. Risk Factors for Breast Cancer ► Radiation exposure ► Breast disease  Atpyical Hyperplasia  Intraductal carcinoma in situ  Intralobular carcinoma in situ ► Obesity ► Diet  Fat  Alcoho l

13. Genetics ► BRCA-1 ► BRCA-2 ► P53, Rb-1 ► Her-2/neu, c-erB2, c-myc

14. Staging of Breast Cancer ► The American Joint Committee on Cancer (AJCC) has designated staging by TNM ► T= tumor size ► N = lymph node involvement ► M = metastasis

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

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

17. 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)

18. Stage IV (Metastatic breast cancer) ► Any T ► Any N ► Metastasis (M1)

19. Types of breast cancer ► In situ  Intraductal (DCIS)  Intralobular (LCIS) ► Invasive  Infiltrating ductal carcinoma  Tubular carcinoma  Medullary carcinoma  Mucinous carcinoma

20. Symptoms and Screening

23. Normal breast physiology and anatomy ► Symmetry and balance ► Size  weight  menstrual cycle  pregnancy and lactation ► Texture ► Shape  age

24. Abnormal signs and symptoms ► Puckering ► Dimpling ► Retraction ► Nipple discharge ► Thickening of skin or lump or “knot” ► Retracted nipple

25. Abnormal signs and symptoms ► Change in breast size ► Pain or tenderness ► Redness ► Change in nipple position ► Scaling around nipples ► Sore on breast that does not heal

26. Methods of Detection ► Clinical exam by MD or nurse ► Mammography ► Monthly breast self-exam (BSE)

27. Clinical examination ► Performed by doctor or trained nurse practitioner ► Annually for women over 40 ► At least every 3 years for women between 20 and 40 ► More frequent examination for high risk patients

28. Mammography ► X-ray of the breast ► Has been shown to save lives in patients 50-69 ► Data mixed on usefulness for patients 40-49 ► Normal mammogram does not rule out possibility of cancer completely

29. Mammography American Cancer Society recommends: Women (asymptomatic) 40 years of age and older should have a mammogram every year.

30. Mammography-more guidelines ► Mammogram facility guidelines ► Avoid mammogram week before period ► Don’t wear deodorant powder or cream ► Bring a list of the places and dates of other mammograms, biopsies you’ve had before ► If you don’t hear from the MD within 10 days, call the facility

31. 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

32. When to do BSE ► Menstruating women- 5 to 7 days after the beginning of their period their period ► Menopausal women - same date each month same date each month ► Pregnant women – same date each month same date each month ► Takes about 20 minutes ► Perform BSE at least once a month once a month ► Examine all breast tissue

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

34. Conclusion HEALTH PROFESSIONALS; have a responsibility as patient advocates for breast cancer awareness HEALTH PROFESSIONALS; have a responsibility as patient advocates for breast cancer awareness

35. THANK YOU

37. POYRAZLAR LAKE / SAKARYA / TURKEY

38. SAKARYA / TURKEY

39. SAKARYA UNIVERSITY CAMPUS