1. Breast cancer prevention By Julian Kunz

2. What is Breast cancer? Also known as mammacarcinoma A malign tumor spreading from the lobar epithelium (lobar carcinoma) or the lactiferous ducts (ductal carcinoma)

3. Etiology Most common malign tumor in the female population (~ 25%) In women between 30 and 60 it is the most common cause of death in the western world In germany 17000 women die of it every year Even though it is very rare men can be affeceted too

4. Cause of death „mammacarcinoma“ Age2003200420052006 0 – 300.40.5 0.4 30 – 4010111011 40 – 501314 13 50 – 6014 1314 60 – 70910 70 – 804545 80 >2222

5. Risks and Causes Genetic factors: play a big rule in the type of breast cancer affecting young women Breast cancer virus: Since the 1930s researchers have been looking for a virus analogous to the mamma-tumor-virus causing benign cancer in mice Birth control pills: The adverse effect of these drugs hasn‘t been completely discovered; however there is a moderate risk increase if the medication has been taken for longer than 5 years

6. Risks and Causes Hormone therapy: to reduce symptoms menopause Pregnancy: an early first pregnancy reduces the risk of breast cancer Osteoporosis prevention: calcium and vitamin D therapy also decrease the risk of breast cancer markedly

7. Prevention and Screening 80 – 90% of all changes are discovered by women themselves even though only 20% examine themselves The examination should be done on a monthly basis 5-7 days after menorrhoea In case of a palpated anomaly women should consult their physician for a more detailed examination

8. „Discovering Hands“ Blind people have a highly developed sense of touch This special ability might be put to use in North Rhine-Westfalia (NRW) In case of success it would create a new profession for blind women Training programs will begin in 2008

9. Mammography Is an x-ray examination with a special apparatus The breast is comprimed between two plates of plexiglass to keep the breast in position (might result in bruises) The applied x-rays are rather soft (26-30 keV) to increase the contrast  small neoplasmatic tissue formations can be seen

10. Sonography Ultrasound-based technique done after palpation of an anomaly to rule out possible cysts and to estimate the size of the tumor Only in addition to mammography as neither microcalcium nor tumors smaller than 5mm can be detected

11. MRI An important imaging technique to find out if the breast has been affected by more than one tumor Multifocality: more than one tumor in the same quadrant Multicentrality: other tumors in other quadrants

12. Computer Assisted Detection (CAD) CAD systems help searching digital images for typical structures and also to point out possibly diseased regions It is a relatively young interdisciplinary technology combining elements of artificial intelligence and digital image processing It serves mostly as a second opinion to the report of the responsible physician

13. Mammography-Screening- Centers Currently a network of quality assured screening centers is being build up in Germany Woman between the age 50 and 70 are invited once a year to get a mammography In case of a report of an anomaly in the scan they are send for a biopsy of the suspicious tissue formation

14. Punching Biopsy A needle is shot at high velocity into the neoplasmatic tissue Done in locally sedated state (At least 3 samples are taken to avoid mistakes

15. Needle Biopsy With a syringe and a special needle tissues are drawn from a palpable tissue formation As painful as venipuncture In case of a malign tumor the result is sure wheras it is only 90% sure for a benign tumor

16. Advanced Breast Biopsy Instrumentation (ABBI) Biopsy with relatively large probe (6-20 mm) Done with x-ray to ensure localisation of target Mostly used for analysis of microcalcification Has only been in use for a few years  many unexperienced physicians