Breast cancer and lung cancer NCDs – Flashcards
Unlock all answers in this set
Unlock answersquestion
where do half of breast cancer cases occur?
answer
in economically developing countries
question
breast cancer incidence rates continued to ____ in 1990s but breast cancer mortality over the past 25 years has been ___ or decreasing
answer
increase stable in some North American and european countries
question
why are mortality rates increasing in asian countries such as Japan and Korea?
answer
most likely due to life style changes associated with westernization and delayed introduction of effective breast cancer screening programs
question
Why was there an dramatic drop in breast cancer incidence rates from 1999 and 2006 in US
answer
due to decrease use of post-menopausal HRT (estrogen+progesterone) following the WHI study which showed that there was an increase risk of breast cancer and heart disease with HRT use
question
why did breast cancer incidence rates between 1980s and 1990s rise 30% in westernized countries?
answer
-changes in reproductive patterns -increased screening
question
why did incidence rates in US, UK, france and Austrailia decrease between 1999 and 2006 ?
answer
due to lower use of postmenopausal combined hormone therapy
question
female breast cancer incidence rates varied internationally by more than ____ fold because?
answer
13 fold because low screening rates and incomplete reporting in developing countries
question
breast cancer incidence rates have been rising in many African and Asian countries for example
answer
japan-140% reasons for this rising trends are not completely understood but likely reflect changes in reproductive patterns, obesity, physical inactivity
question
breast cancer etiology is ___
answer
UNKNOWN
question
What may stimulate tumor initiation and progression in breast cancer?
answer
up regulation of the estrogen receptor to stimulate breast cell proliferation
question
what are the genetic risk factors for breast cancer
answer
-5-10% are hereditary caused by gene changes (mutations) inherited from parent -inherited mutations in BRCA1 and BRCA2 are the most cause of hereditary breast cancer -women with BRCA mutations have a high risk of developing cancer during their lifetime. when they do develop it they are often younger than other women with breast cancer who are not born with one of those gene mutations
question
Non modifiable risk factors of breast cancer
answer
-70% of pts have no identifiable risk -risk increases with increasing age (80% diagnosed >50 years of age) Gender (female>male) Race (White>African Americans>Asians) more frequent amongst women of higher socioeconomic status
question
Breast cancer Non-modifiable risk factors: Genetics
answer
carriers of BRCA1, BRCA2
question
Breast cancer Non-modifiable risk factors: family hx
answer
one 1st degree relative= 2x two 1st degree relative=4x
question
Breast cancer Non-modifiable risk factors: prolonged estrogen stimulation
answer
long menstrual hx (early menarche 50 years old)
question
Breast cancer Non-modifiable risk factors: long phase of uninterrupted ovulation
answer
nullparity (never giving birth) or first pregnancy after age 30
question
Breast Cancer Modifiable Risk Factors: exogenous estrogen
answer
>5 years of oral contraceptives ***remains controversial
question
Breast Cancer Modifiable Risk Factors: alcohol consumption
answer
(2-5 drinks/day)
question
Breast Cancer Modifiable Risk Factors:Diet
answer
high fat intake, but specific dietary factors are not firmly established
question
Breast Cancer Modifiable Risk Factors: obesity and BMI
answer
*complex association may be related to distribution of fat and or body composition, differs by age and menopausal status *premenopausal women: most studies have found no consistent association *postmenopausal women: increased incidence of breast cancer with increasing weight
question
Breast Cancer Modifiable Risk Factors: physical activity
answer
* both premenopausal and post menopausal women had lower risk with physical activity *unclear which provides the most benefit adolescent activity, adult activity or lifetime activity *smoking is NOT a risk factor for breast cancer
question
Is smoking a risk factor for breast cancer
answer
NO
question
ABCs of screening and detection
answer
Early screening and detection: -key to lowering risk of breast cancer -all suspicious lumps should be biopsied for a definitive diagnosis A- screening mammography B- breast self- examination (BSE) C- clinical breast exam (CBE)
question
breast awareness and self exam
answer
starting in their 20s, women should be told about the benefits and limitations of breast self exam (BSE) recommended monthly for high risk women> 20 years of age (best 1 week after menstrual period ends or same day each month if no regular periods) a woman can notice changes by: being aware of how her boobs normally look/feel and feeling for changes by choosing to use step by step approach and using a specific schedule to exam her breasts (BSE)
question
ACS recommendation for early breast cancer detection for women age 40 or older
answer
- women age 40 and older should have a screening mammogram every year and do so for as long as they are in good health -should be told about benefits, limitations, and potential harms linked with regular screening -mams for older women should be be based on individual, her health, and other serious illnesses she may have
question
ACS recommendation for early breast cancer detection for women age 20s and 30s
answer
-should have a clinical breast exam (CBE) as part of a regular health exam by a health professional, preferably every 3 years - after 4o, CBE every year
question
what is CBE complement to
answer
mammograms and chance for women to talk about breast health the exam should include instruction on how to do BSE
question
breast cancer prevention
answer
-early detection and screening is key to prevention -prevention trials ongoing (LCIS, DCIS)
question
LCIS and DCIS
answer
lobular carcinoma in situ ductal carcinoma in situ
question
Prevention trials for LCIS, DCIS
answer
NCCN guidelines recommend considering the use of tamoxifen for 5 years as a preventive measure in LCIS, DCIS (decreases risk 40-60%) women with an increased risk (family hx) may be eligible for chemoprevention or surgery
question
what are breast cancer prevention recommended health life style modifications
answer
- decrease alcohol intake -maintain healthy wait -engage in regular activity
question
what is the leading cause of cancer death in men
answer
lung
question
what is the second leading cause of cancer in women
answer
lung
question
what doe the international variations in lung cancer rates and trends largely reflect?
answer
differences in the stage and degree of the tobacco epidemic
question
lung cancer global trends in US versus china/korea
answer
US is decreasing China/Korea bc epidemic was established more recently and in the US less recently
question
What is the leading cause of lung cancer
answer
smoking
question
what is the risk of developing lung cancer ___in smokers compared to lifelong non smokers?
answer
25 times includes hookah and cigars
question
Risk factors for lung cancer (list)
answer
Radon Asbestos Diesel exhaust Air Pollution
question
Radon
answer
radioactive gas that results from the breakdown of uranium in soil and rocks according to EPA radon is the 2nd leading cause of lung cancer
question
what is the leading cause of lung cancer among NON smokers
answer
RADON
question
Asbestos
answer
workplace exposure to asbestos fibers is also a risk factor for lung cancer government regulations have greatly reduced the use of asbestos in commercial and industrial products in the US
question
Air pollution
answer
especially from heavily travel roads in cities --> slightly increased risk
question
Lung Cancer Screening
answer
NLST showed that low dose CT can help lower risk of lung cancer death
question
what kind of CT can help lower lung cancer risk death
answer
low dose CT
question
Which pts can be candidates for lung cancer screening
answer
Must meet ALL of the following -55 to 74 -in fairly good health -have at least a 30 pack year smoking history -are either still smoking or have quit smoking within the last 15 years
question
if qualify for lung cancer screening, how often should you get it?
answer
low dose CT every year until the age of 74 as long as you remain in good health ** the optimal frequency and duration of screening is unknown and the harm from screening, including frequent false-positive findings is unknown
question
What kind of facilities should lung cancer screening only be done at
answer
thats that have: -the right type of CT scan -experience in using low dose CT scans for lung cancer screening -a team of specialists that can provide the appropriate care and follow up of pts with abnormal scans
question
With lung cancer screening doctors should talk to pts who meet he criteria about
answer
1. benefits 2. limitations 3. potential harms of screening
question
lung cancer prevention
answer
- one of the most preventable -tobacco control has decreased smoking rates and reduction in lung cancer (particularly in California) - striking difference between smoking prevalence of men (50%) and women (9%) in the developing world. Preventing increases in smoking prevalence among women could have major impact on future lung cancer rates
question
interventions for cancer prevention and control
answer
- cancer control includes preventions, early detection and effective treatment - Who emphasizes focusing primarily primary prevention, early detection and SECONDARY prevention
question
primary prevention
answer
reduce exposure to cancer causing factors which include modifiable factors related to -tobacco use -nutrition -physical inactivity -occupational exposures -chronic exposures offers the greatest public health potential and the most cost effective, long term method of cancer control
question
primary prevention examples include
answer
-immunization against or treatment of infectious agents that cause cancers (HPV, HBV) -application of effective tobacco control measures -reduction of excessive alcohol consumption -maintenance of healthy body weight and physically active life styles -dietary intervention -avoidance of excess sun exposure -reduction in occupational exposure to carcinogens -pharmacological interventions
question
what is the Framwork convention on tobacco control
answer
created may 2003 in response to global tobacco pandemic with the objective of reducing the world-wide prevalence of tobacco use and exposure to smoke provides a framework for national legislation and enforcement of tobacco control measures a bunch of countries ratified the treaty
question
Framework convention on tobacco control provisions establish international standards for
answer
-tobacco taxation - tobacco advertising and sponsorship -regulation of tobacco products; tobacco product disclosure -packaging and labeling -education, communication, training and public awareness -cessation measures -measures to eliminate illicit trade -sale to minors -support for economically viable alternatives -liability issues -scientific and technical cooperation and exchange of information
question
secondary prevention is
answer
is to detect pre cancerous changes or early stage cancers when they can be treated most effectively
question
what are cancers that have proven early detection methods
answer
cervix colon rectum breast **wide implementation of screening for these cancers has not been fully achieved even in economically developed countries
question
how should low resource countries that cannot afford the infrastructure required for organized screenings do?
answer
focus on increasing awareness of signs and symptoms of cancer in the general population leading to earlier diagnosis and treatment
question
what drug is used as preventative measure in the LCIN/DCIN preventive breast cancer trial
answer
tamoxifen for five years
