breast cancer

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Breast Cancer Prevention at a Young Age: The LEGACY Girls Study

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Breast Cancer
stages




Breast cancer - Symptoms and treatment




Breast Cancer Surgery

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Treatment options for Breast Cancer





Cancer Treatment: Chemotherapy




(Cancer Treatment: IMRT (Radiation Therapy

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Breast Cancer


<FONT size=2 face=arial,helvetica> Breast cancer is the most common cancer in women, representing 183,000 newly diagnosed cases and 46,000 deaths per year in the United States. This accounts for one third of female cancer diagnoses. The risk of developing breast before age 50 is 1 in 50 and increases with age.
Nearly 70% of breast cancers are diagnosed in women age 55 and older. Over the course of a lifetime of 85 years, women have a 1 in 8 chance of developing breast cancer. The good news is that deaths from breast cancer are decreasing due to increased awareness and earlier detection of the cancer through screening mammograms.

The exact cause of breast cancer is unknown. Researchers have different theories about what causes breast cancer and most suspect that a combination of lifestyle, environmental and genetic factors can increase a woman’s risk of developing the disease.
There is also a pronounced variability in breast cancer rates in different countries around the world. There are roughly 100 cases of breast cancer per 100,000 women in western countries such as the United States compared to 10-15 cases per 100,000 women in Asian countries. This is thought to be in part due to the differences in diet between these two regions. Several studies have suggested that a diet high in fat may increase the risk of breast cancer.

The genetics of breast cancer are also intriguing. Any woman with a first-degree relative (mother, sister or daughter) with breast cancer is at increased risk of the disease herself. This familial tendency does not necessarily imply a genetic transmission of the disease.
The BRCA1 and BRCA2 genes have been mapped and are linked to the truly genetically transmitted cases. Genetically linked cases are thought to represent only 5-10% of all cases, however, and breast cancers occurring in some families probably represent common environmental risk factors. True BRCA1 cases typically occur at earlier ages and are also linked to ovarian cancer.

Carriers of a BRCA1 mutation apparently have roughly an 85% risk of developing breast cancer by age 70, and a 45% risk of developing ovarian cancer by the same age.
Several hormonal factors increase the risk of developing breast cancer. Beginning menstruation early, entering menopause late, or waiting until after age thirty to have your first child or not having children at all, increase a woman’s risk of developing breast cancer.
All of these factors are linked to the female hormone, estrogen. Breast cancer has also been associated with estrogen replacement therapy after menopause.
Most doctors strongly believe that this therapy does not cause breast cancer, but may accelerate the growth of a tumor that is already present.
Many women worry that the use of oral contraceptives ("the pill") may increase the risk of developing breast cancer.
After reviewing 54 studies, the conclusion of a panel of experts report that "the pill" did not appear to cause breast cancer. In fact, some doctors suspect that the use of "the pill" during a woman’s reproductive years may actually protect her from developing breast cancer after menopause.


Screening

<FONT size=2 face=arial,helvetica>Mammography is a very successful screening tool for breast cancer. There is considerable controversy in the medical community, however, over when mammographic screening should begin.
There is no doubt that annual mammographic screening in women over the age of fifty is beneficial. Some studies indicate that the routine use of screening mammograms in women over fifty is beneficial. Some studies indicate that the routine use of screening mammograms in women over fifty can decrease breast cancer deaths by one-third.
The American Cancer Society (ACS), the American College of Radiology and the American College of Obstetricians and Gynecologists all recommend annual mammograms for women in their forties. In March 1997, ****d on their review of scientific data, the National Cancer Advisory Board recommended that women should have a screening mammogram every one to two years beginning at age forty. Another group of experts gathered by the National Institutes of Health (NIH) in January of 1997 concluded that ****d on their review of the same studies, mammograms should be optional until age fifty. In view of this controversy, women should discuss their particular risk factors with their doctor and decide when they feel comfortable beginning a screening program.

A monthly breast self-exam is another part of a successful screening program. The best time for a woman to examine her breasts is during the week after her period when her breasts are the softest and the least tender. The following is the three-step technique for breast self-exam published by the Susan G. Komen


Breast Cancer Foundation:

In the shower: Raise one arm and place your hand on the back of your head. Slowly and methodically, move the pads of your fingertips over the breast in a circular pattern. Don’t forget to feel in the armpit area. Repeat on the other side.
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http://www.md4aa.com/vb/showthread.php?t=3736

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A 43 year old lady has recently undergone a wide local excision and sentinel lymph node biopsy for carcinoma of the breast.
? Of the factors listed below, which will provide the most important prognostic information

A. Mitotic number

B. Grade

C. Nodal status

D. Size

E. Oestrogen receptor status



--------------Correct Ans & Explanation With Notes------------------


C. Nodal status

Nodal status is the single most important prognostic factor in breast cancer.

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Nodal status is important because it serves as a marker of tumour metastatic potential. This translates to survival advantages of up to 40% at five years. Both grade and size are of secondary importance as they both less concerning in the absence of nodal involvement.

Breast cancer

• Commoner in the older age group
• Invasive ductal carcinomas are the most common type. Some may arise as a result of ductal carcinoma in situ (DCIS). There are associated carcinomas of special type e.g. Tubular that may carry better prognosis.
• The pathological assessment involves assessment of the tumour and lymph nodes, sentinel lymph node biopsy is often used to minimise the morbidity of an axillary dissection.
• Treatment, typically this is either wide local excision or mastectomy. There are many sub types of both of these that fall outside of the MRCS. Some key rules to bear in mind.
• Whatever operation is contemplated the final cosmetic outcome does have a bearing. A women with small breasts and a large tumour will tend to fare better with mastectomy, even if clear pathological and clinical margins can be obtained. Conversely a women with larger breasts may be able to undergo breast conserving surgery even with a relatively large primary lesion (NB tumours >4cm used to attract recommendation for mastectomy). For screen detected and impalpable tumour image guidance will be necessary.
• Reconstruction is always an option following any resectional procedure. However, its exact type must be tailored to age and co-morbidities of the patient. The main operations in common use include latissimus dorsi myocutaneous flap and sub pectoral implants. Women wishing to avoid a prosthesis may be offered TRAM or DIEP flaps.

Surgical options

Mastectomy vs Wide local excision
Mastectomy Wide Local Excision
Multifocal tumour Solitary lesion
Central tumour Peripheral tumour
Large lesion in small breast Small lesion in large breast
DCIS >4cm DCIS <4cm

Patient Choice Patient choice

Central lesions may be managed using breast conserving surgery where an acceptable cosmetic result may be obtained, this is rarely the case in small breasts

A compelling indication for mastectomy, a larger tumour that would be unsuitable for breast conserving surgery

Image sourced from Wikipedia


Whatever surgical option is chosen the aim should be to have a local recurrence rate of 5% or less at 5 years [1].

Nottingham Prognostic Index

The Nottingham Prognostic Index can be used to give an indication of survival. In this system the tumour size is weighted less heavily than other major prognostic parameters.

Calculation of NPI
Tumour Size x 0.2 + Lymph node score(From table below)+Grade score(From table below).

Score Lymph nodes involved Grade
1 0 1
2 1-3 2
3 >3 3

Prognosis
Score Percentage 5 year survival
2.0 to 2.4 93%
2.5 to 3.4 85%
3.5 to 5.4 70%
>5.4 50%


This data was originally published in 1992. It should be emphasised that other factors such as vascular invasion and receptor status also impact on survival and are not included in this data and account for varying prognoses often cited in the literature.

By Ss MRCS
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سامح87_Breast Cancer.zip
http://www.mediafire.com/download/vnt3p ... Cancer.zip

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Breast Cancer Patient

data recorded, demographic data, medical history, medication history, vital status, lab data, prescribed medication, ongoing patient file, if applicable: clinical study data (ICF, CRFs, etc.)
https://meducation.net/resources/36264- ... er-Patient

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Invasive Ductal Carcinoma (IDC) :: The National Breast Cancer Foundation
https://meducation.net/resources/36285- ... Foundation

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Fast Five Quiz: How Much Do You Know About the Genetics of Breast Cancer?
https://reference.medscape.com/viewarti ... 6884&faf=1