Breast Cancer

ACS Breast Cancer Screening Guidelines

• Women (40-44 years) have the option to start screening with a mammogram every year
• Women (45-54 years) should get yearly mammograms
• Women (> 55 years) choose to get a mammogram yearly or every other year
• Screening should continue as long as in good health with a 10+ year life expectancy
• Clinical and self breast exams not recommended for screening

Breast Cancer

• Location:
  • ANYWHERE but usually in the upper outer quad
     
• Risk Factors:
  • Female (1% in males)
  • Increasing age: Over 55
  • Personal history: Breast cancer in one breast increases the risk of getting it in the other breast
  • Family history
  • Genetic mutation (BRCA1 and BRCA2)
  • Early menarche or late menopause
  • Nulliparity or late age first pregnancy
  • Hormone therapy
  • Radiation exposure during adolescence
  • Benign breast disease
  • Obesity
  • High-fat diet
  • Increased alcohol intake
• Presentation:
  • Lesions:
    • non-tender
    • fixed
    • hard with irregular borders (as they grow)
      
  • Other signs:
    • skin dimpling (pulling as the lesion or tumor grows)
    • nipple retraction
    • skin ulceration (especially in inflammatory cancers)
• Diagnosis:
  • Clinical breast exam
    
  • Mammography
    
  • Ultrasonography
    
  • MRI
    
  • Biopsy with tissue analysis
    • -Percutaneous biopsy
      
      • · Fine needle aspiration
        
      • · Local anesthesia
        
      • · Obtain cells
    • -Core needle biopsy
      
      • · Local anesthesia
        
      • · Needle
        
      • · Core of the tissue
        
      • · Under ultrasound or MRI guidance
    • -Surgical biopsy
      • · Incisional biopsy
        
      • · Whole tumor or lesion is removed
        
      • · Excisional biopsy for those close to the surface

Breast Cancer Staging

Breast Cancer Treatment

• -Surgery
  
  • Goal:
    • -Remove the tumor and save as much of the healthy breast tissue as possible
      
    • -Primary treatment
  • Types:
    • -Lumpectomy
      
      • · Breast-conserving procedure
        
      • · Removal of tumor and surrounding margins
        
      • · Largest portion of the breast tissue is in tact
        
      • · Accompanied by radiation therapy
    • -Simple mastectomy
      
      • · Removal of breast tissue including the nipple, areola, and skin
        
      • · Lymph nodes are not dissected or a limited resection
    • -Modified radical mastectomy
      • ·Removes the ENTIRE breast
        
      • · Extensive dissection of the underarms and axillary lymph nodes
• -Chemo
  
  • -Adjuvant chemotherapy (in combination or/with surgery)
    
  • -Node negative, > 1 cm, and node-positive disease
    
  • -Drug combinations over 3-6 months in cycles
  • SE:
    • N/V, myelosuppression, taste changes, alopecia, mucositis (irritation of the lining of the mouth and GI tract), neuropathy, fatigue, cardiotoxicity
• -Radiation
  
  • -Usually done combined with surgery
    
  • -External beam RT initiated 6 weeks after surgery
    
  • -If used with chemotherapy, RT usually begins after chemotherapy completed
    
  • -Brachytherapy sometimes used
  • Schedule:
    • 5 day/week for 5-6 weeks; may receive a “boost” at end of therapy
  • SE:
    • erythema (redness), radiation dermatitis, breast edema, fatigue
  • Long term SE:
    • pneumonitis, rib fracture, heart disease, breast fibrosis
• -Hormone Therapy
  
  • Types:
    • R/PR receptor-positive tumor: Responds or is stimulated by ER/PR
    • -Estrogen receptor antagonists
      • SE:
        • · Menstrual irregularities: Cessation
          
        • · Hot flashes
          
        • · Vaginal dryness
          
        • · Decreased libido
          
        • · Thromboembolism
          
        • · Stroke
          
        • · Endometrial changes
          
        • · Nausea and vomiting
          
        • · Cataracts
          
        • · Joint and muscle pain (Ais)
    • -Selective estrogen receptor modulators (SERM)
      • Ex: 
        • -Tamoxifen (Nolvadex)
          
        • -Raloxifene (Evista)
      •  SE:
        • -Thromboembolism
          
        • -Stroke
          
        • -Endometrial changes
          
        • -Nausea and vomiting
          
        • -Cataracts
    • -Aromatase inhibitors
    • -Selective estrogen receptor down-regulators (SERD)
    • -Use meds for 5 years and then continue for 5 years if there is no recurrence of the tumor
• -Biological (targeted) therapy