1. Vida! Educational Series – Promoting Good Health Welcome! - We will begin shortly If viewing by internet: for technical help: 520-626-0167 Please complete surveys: http://streaming.biocom.arizona.edu/ http://streaming.biocom.arizona.edu/

2. Update in Breast Cancer Ana Maria Lopez, MD, MPH, FACP Associate Dean, Outreach and Multicultural Affairs Professor of Medicine and Pathology Medical Director, Arizona Telemedicine Program

3. Educational Objectives 1. Learn what is breast cancer 2. Discuss risks to breast cancer 3. Outline prevention measures for breast cancer

4. What is breast cancer?

5. breastcancer.org

6. http://geneticpeople.com/?taghttp://geneticpeople.com/?tag=breast-cancer

7. gatheringbasket.org

8. buyletrozole.eu

9. What causes breast cancer? Causes and risk factors

10. Risk Factors Age: 95% in women 40yo + highest in 70-74 yo FH Personal history Genetic risk: BRCA 1/2, TP 53, ATM Nulliparous 1 st full term pregnancy after 35 yo No lactation HRT Alcohol Overweight/obesity Physical inactivity

11. 70% of breast cancers are in patients without identifiable risk factors

12. Risk Calculators www.cancer.gov/bcrisktool NCI/NSABP

13. Hereditary Breast Cancer Risks 5-10% of all breast cancers Ashkenazi Jewish descent 3 or more 1 st or 2 nd degree relatives 1 st degree relative with bilateral breast cancer 2 or more 1 st or 2 nd degree relatives with ovarian cancer Male breast cancer

14. BRCA 1 and BRCA 2 Code for DNA repair Presence of gene, increases the risk of getting breast cancer up to 80% in her lifetime BRCA1 or BRCA2 mutations make up about half of all cases of inherited breast cancer associated with ovarian cancer and prostate cancer can be inherited either from the mother or the father.

15. Other Inherited Genes TP53 gene codes for the tumor suppressor protein p53 Mutations cause Li-Fraumeni syndrome: associated with early onset breast cancer Ataxia Telangiectasia (ATM) gene Females with one defective copy of the ATM gene and one normal copy of the gene are at increased risk for breast cancer.

16. concurringopinions.com

17. ph-insider.blogspot.com

19. presstv.ir

20. ecosnobberysucks.c om

21. ladycarehealth.com

22. pdahealthware.com

23. Prevention

24. Prevention: saves us from the pain of being sick --Unknown

25. health.usf.edu

26. Prevention Studies Tamoxifen Raloxifen: STAR (Study of Tamoxifen and Raloxifene) Raloxifene is as effective as tamoxifen in reducing invasive but not nonivasive (DCIS) BC risk Both drugs reduce invasive BC risk by about 50% Raloxifene: 36% fewer uterine cancers, 29% fewer blood clots Both increase blood clots.

27. Aspirin In an epidemiologic study, aspirin appeared to lower breast cancer risk Need prospective trial

28. Vitamin D Helps with calcium absorption to maintain bone density In clinical trials

29. Fat WINS Low fat diet (< 30%) 5Y FU: new breast cancers--9.8% low-fat diet; 12.4% standard diet (24% reduction) largest risk reduction – 42%--in ER negative tumors

30. What about soy? Flax? Phytoestrogens? Eat what you like! Eat healthy! Do not change your diet drastically to include phytoestrogens. There may be safety concerns re: pharmaceutically concentrated soy products

31. Lifestyle Maintain a healthy weight Decrease intake overall. Increase vegetables in specific (2/3 of plate) Increase activity: 3-4 hours of exercise per week Decrease alcohol intake

32. Early Detection

33. kodak.com Computer-aided detection and diagnosis (CAD)

34. canada.com Tomosynthesis (3D mammography)

35. Treatment

36. ultimateboxingresults.com

37. riskofbreastcancer.net

38. indianapublicmedia.org

39. dailymail.co.uk