breast cancer

Question 1

Risk for breast cancer

Answer 1

female (99%)
1 in 8 women
risk increases with age
genetic factors
importance of early detection/treatment

Question 2

Age as a risk factor

Answer 2

overall risk 1/8

Age 20: 1 in 1667
Age 30: 1 in 227
Age 40: 1 in 68
Age 50: 1 in 42
Age 60: 1 in 28
Age 70: 1 in 27
Age 80: 1 in 33

Increased risk: 
earlier menarche (<12)
late menopause (>55) -- postmenopausal hormone therapy

Pregnancy
1st child older than 30
never been pregnant

Question 3

genetic factors

Answer 3

5-10% of cases in US

BRCA genes

• tumor suppressor genes
• mutations of BRCA1 and BRCA2 contribute to cancer
• genetic testing available for detection of BRCA mutation

Family and personal history

Question 4

Other factors

Answer 4

Exposure to radiation
-chest x-rays as child/young adult

Lifestyle

• alcohol
• obesity

Question 5

Exposure to estrogen (less)

Answer 5

Fewer cycles = less estrogen = decreased risk

• later menarche
• earlier menopause
• pregnancies (7% decrease in risk with each bc of activation of p53 which is a cancer fighting protein in the breat tissue)
• breast feeding (4% decrease for each year)

Question 6

Exposure to estrogen (more)

Answer 6

More estrogen = higher risk

• more menstrual cycles
• females born > 8 pounds (more in utero exposure?)
• contraceptive exposure
• hormone replacement therapy exposure
• environments xenoestrogens (synthetic)

Question 7

Reduce risk

Answer 7

healthy diet an exercise
-reduce body fat

limit alcohol consumption
-affects circulating estrogens

Screening

Question 8

Symptoms

Answer 8

Cancerous tissue

• most: cells that line the ducts (ductal carcinoma)
• also: glandular cells (invasive lobular carcinoma)

Lump or thickening different from surrounding tissue

Chang in size, shape, appearance of breast

Breat pain or tenderness

Changes to skin

• over the breast dimpling
• areola (peeling, scaling, crusting, flaking)
• redness or pitting (like an orange)

Changes to nipple

• inversion
• discharge

Question 9

Diagnosis

Answer 9

Physical examination

• breast self examination
• once per month starting at 20-25
• same time every month

-clinical examination

Mammogram
-start screening at 40

ultrasounds

MRIs

Needle biopsies

Question 10

Surgical removal of tissue

Answer 10

Lumpectomy = removal of cancerous and surrounding tissue and lymph nodes

Simple mastectomy = removal of breast

Modified mastectomy = removal of breast and surrounding lymph nodes

Radical mastectomy = removal of breast, pectoral muscle, axillary lymph nodes

Prophylactic mastectomy = preventive surgery for high risk

Question 11

Radiation and chemotherapy

Answer 11

used to prevent cancerous tissue from reappearing

decrease size of tumor or decrease presence of lymph nodes

radiation targets and kills cancer cells in defined area

chemotherapy is systemic approach

Question 12

Hormone therapy

Answer 12

Tamoxifin

• antiestrogen
• 50% of breast cancers require estrogen
• limits blood vessel proliferation required for cell growth
• side effects are generally minor –> evidence of increased risk of liver and endometrial cancer

Letrozole

• aromatase inhibitor (remember: converts androgens to estrogens)
• blocks estrogen synthesis