GERO 416 – Breast Cancer 1 – Flashcards
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What is the number 2 cause of death in the US?
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cancer - 6000 people a year die from some kind of cancer
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What percentage of death do heart disease and cancer account for in the US?
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~70%
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cancer
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a term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.
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Carcinogenesis
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The process by which normal cells are transformed into cancer cells
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Metastasize
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To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor.
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risk
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estimated chance of getting a disease during a certain time period (how likely am I to get this disease) •based on large population studies
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Is risk a cause?
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no, it is a predictive likelihood
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multifactorial aspect of risk
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•biology •environment •lifestyle
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Leading causes of cancer deaths for females (all ages)?
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2004 estimates 1. lung and bronchus 2. breast 3. colon and rectum
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What is the risk of tobacco smoke for lung cancer?
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the carcinogens in the tobacco and nicotine that are added to the cigarette •tobacco has carcinogens itself (chewing tobacco) but vaping and such do not have the same chemicals in them •depends on what your put in other devices (hookah, vaping, etc. have different things you can put in) [ex. herbal]
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what gender does breast cancer primarily occur in?
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women, but it can occur in men
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what cancer occurs most in men?
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prostate cancer
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breast cancer survival rates (5 year)
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87% survival rate (ppl surviving 5 years from diagnosis)
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prostate cancer survival rate
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98% survival rate (ppl surviving 5 years from diagnosis)
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why do some cancers have lower survival rates?
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by the time you develop symptoms, it may have progressed to far (symptomatic) •don't have the best diagnostic tools (ex. pancreatic cancer)
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Progress in Reducing Cancer Deaths
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death rates from cancer have been dropping an average of 2.1 percent a year •accelerating a downward trend that began in 1993 •Much of the progress comes from improved prevention and early detection
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cumulative lifetime risk of developing breast cancer
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1 in 9 (11%)
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major risk factors for breast cancer
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•age •family history •ashkenazi Jewish heritage •lifestyle factors
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age as risk factor for breast cancer
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prevalence increases with age
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Most common cancer among women in developed world
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breast cancer
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who is most likely to die from breast cancer
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African Americans
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what is the median age at diagnosis
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61 years
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What percentage of women are diagnosed older than 65 years
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56%
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What percentage of women are dying from breast cancer after age 65
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42%
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diagnosis and death trends with age
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percentage increases with age [look at slides for breakdown]
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Who has less incidence in california
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lowest: •asian/pacific islander •hispanic
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What area has the lowest breast cancer rates
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Asia
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What area has the highest breast cancer rates
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North America and Western Europe
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What causes these differences?
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maybe multiple factors •lifestyle •early detection •better treatment •etc
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Breast Cancer Stages (0)
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cells start to divide in the breast tissue •are not able to see or detect changes
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Breast Cancer Stages
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the higher the number, the more aggressive the disease
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Breast Cancer Stages (4)
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metastasis
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Breast Cancer Stages (3)
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spread to local tissue
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Breast Cancer Stages (2)
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localized - has not spread
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Breast Cancer Stages (1)
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breast mass is being developed
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Invasive breast cancer
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Stages 2-4 •when we find cancer at older ages, it is more advanced
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regional stage
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•lymph nodes become swollen •about a third have already spread into the lymph nodes same with lung cancer •lymph nodes are trying to clear the abnormality •33% diagnosed •83.6% survival
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What happens when you have lymph node spread?
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you decrease your survival rate to 84% (5 year)
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What is the survival rate when breast cancer has metastasized (stage 4)?
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23% survival rate
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Breast Cancer survival
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lower the stage, the better the survival rate (5 year)
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direct risk factors
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•radiation (especially during puberty) - [ex. Japanese from the bombings] •inherited mutations
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contributing risk factors
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•lack of exercise •excess of alcohol •deficiencies of Vitamin D, fiber, melatonin? •harmful xenohormones (some plastics, fuels, pesticides) •increased insulin-like growth factor
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Vulnerability factors
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•early menses •late menopause •no pregnancy or lactation
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vulnerability factors
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increase your risk
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Breast cancer screening (early detection)
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•Self Breast Examination (SBE) •Mammogramy
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breast cancer screening (prevention)
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•lifestyle modification •chemoprevention •surgery
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lumpy breasts
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have lumps that are not dangerous (fibroadenoma, other benign) •more common <20 years
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percentage of women with breast cancer (20-29)
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3% chance it is cancer
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When does the cancer risk start to increase
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age 40 •35% chance that a breast mass will be cancer
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Percent of breast masses that are cancerous (55+)
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85%
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Breast cancer risk (pre-menopause)
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•age •breast density •family history of breast cancer •prior cancer diagnosis
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Breast cancer risk (post-menopausal)
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same as pre •ethnicity •BMI •Age at menopause •prior false-positive mammogram
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Relative risk of developing breast cancer
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•for women with 0 or 1 affected relative, risks increase with age at first live birth. •For women with 2 or more first degree relatives, risks decrease with age at first live birth.
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who has the greatest risk for breast cancer
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<20 years with 2 or more relatives with breast cancer
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Breast Cancer Genes
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BRCA 1 BRCA 2
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BRCA 1
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codes for breast cancer
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BRCA 2
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breast cancer or ovarian cancer
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Genes and Familial breast cancer
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2 defective BRCA1 genes that increase risk of breast, ovarian, and colon cancer in women and prostate, breast and colon cancer in men
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Lifetime genetic risk
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Breast cancer: 11-13.2% Ovarian: 1.7%
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BRCA 1 or BRCA 2 genetic risk
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•breast - 36-85% •ovarian - 16-60% •askenazi jewish - 2.3%
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Gail Model Risk Assessment
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take all these into account to come up with risk number •age •age @ menarche •age at first live birth • # first degree relatives with hx breast ca • # breast biopsies • breast pathology with hyperplaisa • does not include paternal family history breast cancer or age onset affected relatives
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risk reduction options - Gail Risk >1.67
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Tamoxifen - 49%
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risk reduction options - BRCA 1/2
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•mastectomy - 90-95% •oophrectomy - depends on age •ovarian suppression - similar to ooph. •tamoxifen - 50%
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risk reduction options - Atypia
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Tamoxifen - 86%
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risk reduction options - all women
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lifestyle changes - 30-40%
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Birth Control Pills Risk - Premenopause
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high does estrogen pills •4+ years use •4.7/10,000 rate of cases of breast cancer
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Women's Health Initiative (WHI)
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used prempro (combination therapy)
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WHI Initial findings
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small increased risk for invasive breast cancer •HT longer than 5 years
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WHI Secondary Results
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av. 11 yr f/u •mortality marginally higher randomized to HT vs placebo •histology of breast cancer similar in the HT and placebo groups -tumors in women randomized to combination HT more likely to be node-positive
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Lifestyle reduction breast cancer
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•increased exercise •decrease alcohol consumption •avoid/stop hormone replacement •optimal weight post-menopause •low fat diet (limit animal fat) reduced breast cancer recurrence with weight loss and low fat diet shown in most studies
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alcohol and breast cancer
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•increased exposure of breast tissue to hormones - alcohol causes rise in estrogen and progesterone levels •3+ drinks/day = heavy drinking - 30% increased risk of breast cancer (similar to 1 pk cig/day, similar to HRT use)) •limit alcohol to 2.5 oz. a day (half a glass of wine)
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prophylactic mastectomy
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•high risk women - positive family history - positive genetic test (BRCA1, BRCA2) •risk/benefit - 95% lifetime risk reduction breast cancer - surgical risk and cost - reconstruction risk and cost - quality of life
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Tamoxifen (Novaldex) - approved indications
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•treat breast tumors •prevent breast cancer recurrence •prevent tumors in women who not yet diagnosed with the disease •pre-menopausal
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Tamoxifen (Novaldex)
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Estrogen blocker
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Tamoxifen (Novaldex) - side effects
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•hot flashes •endometrial blood clots •blood clots
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Tamoxifen (Novaldex) - Chemopreventions
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•2000 and 2005 large national survey (10,000 women/year) -2000 - 0.2 percent of U.S. women aged 40 to 79 took tamoxifen to prevent breast cancer -2005, 0.08 percent
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Radiation Therapy (Medicare Pop. USA study)
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•8000 women >70 yrs (w/ favorable breast cancer) •results -radiation therapy reduced statistical risk of recurrent >high competing causes of mortality eliminate the benefit of radiation treatment - subset analysis > lower competing mortality causes make benefit of radiation significant
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Radiation therapy study - what does it mean?
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•Over the age of 85, with diabetes and heart disease radiation not very beneficial •72 year old without any medical illnesses is going to live longer, and the risk without radiation becomes much higher, and the benefits of radiation become much greater.
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breast cancer rate in older age
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about half of all women in the US with breast cancer are over 65 at the time of diagnosis - approx. 90,000
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treatment considerations with age
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•chronological vs. functional/state-of-mind - co-morbidities - quality of life •evidence - based data - exclusion of women >65/70 yrs in clinical trials
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risk factors for breast cancer
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•gender - female •race - whites •age - older •relative - mother or sister •menstrual history - early onset or late menopause •childbirth - first child after 30 yrs or no children at all
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Dr. Ann's 10 steps to prevent breast cancer
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1. healthy body weight - BMI <25 2. minimize/avoid etoh 3. high fruit and vegetable diet 4. exercise regularly 5. eat right fat (Omega-3-fats, monosaturated oil) 6. good carbs (whole grains, beans, legumes) 7. food soy products 8. minimize estrogen exposure 9. daily supplement (Vit C, Vit E, selenium) 10. positive mental outlook
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Risk factor assessments
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Susan G. Komen - breast cancer relative risk table - www.komen.org • NCI - Breast cancer risk assessment tool
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what is the age-adjusted incidence rate?
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122.9 per 100,000 women per year
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what is the lifetime risk?
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12.5% (1 in 8 women)
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localized stage
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confined to primary site •60% diagnosed •98% 5 year survival
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distant stage
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cancer has metastasized •5% diagnosed •23.4% survival
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breast cancer screening (Am Cancer Society)
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•breast exam - >40 years •SBE - optional •mammogram - annual >40
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breast cancer screening (USPSTF)
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•SBE - against •mammogram - 2 yrs 50-74yrs
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breast cancer screening (Am College Obstetrics and Gynecology)
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•breast exam - part of annual exam •SBE - recommended •mammogram - 40-49 q 1-2 yrs; yearly >50yrs
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breast cancer screening (Am Geriatrics Society)
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•mammogram - 2 rs with >5yr life expectancy to 85; individualize
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breast cancer screening (oupt. clinical pathways)
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• breast exam - annually with > 2yr life expectancy • mammogram - 2 yrs with >5 yr life expectancy to age 80
