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    An Introduction To Breast Cancer

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    giovanna2004
    This document provides an introduction to breast cancer, including risk factors and prevention strategies. It discusses that breast cancer is an uncontrolled growth of abnormal cells. Risk factors include gender, age, genetics, benign breast disease, hormones, alcohol, obesity, and radiation exposure. Prevention strategies with varying levels of risk reduction include frequent surveillance, chemoprevention drugs like tamoxifen which reduce risk by around 50%, prophylactic oophorectomy which reduces risk by around 50%, and prophylactic mastectomy which reduces risk by around 95%. Eligibility for and side effects of prevention strategies are also reviewed.

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    An Introduction To Breast Cancer

    Uploaded by

    giovanna2004
    131 views22 pages
    This document provides an introduction to breast cancer, including risk factors and prevention strategies. It discusses that breast cancer is an uncontrolled growth of abnormal cells. Risk factors include gender, age, genetics, benign breast disease, hormones, alcohol, obesity, and radiation exposure. Prevention strategies with varying levels of risk reduction include frequent surveillance, chemoprevention drugs like tamoxifen which reduce risk by around 50%, prophylactic oophorectomy which reduces risk by around 50%, and prophylactic mastectomy which reduces risk by around 95%. Eligibility for and side effects of prevention strategies are also reviewed.

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    Cancer mama

    Original Title

    An Introduction to Breast Cancer

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    This document provides an introduction to breast cancer, including risk factors and prevention strategies. It discusses that breast cancer is an uncontrolled growth of abnormal cells. Risk factors include gender, age, genetics, benign breast disease, hormones, alcohol, obesity, and radiation exposure. Prevention strategies with varying levels of risk reduction include frequent surveillance, chemoprevention drugs like tamoxifen which reduce risk by around 50%, prophylactic oophorectomy which reduces risk by around 50%, and prophylactic mastectomy which reduces risk by around 95%. Eligibility for and side effects of prevention strategies are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    131 views22 pages

    An Introduction To Breast Cancer

    Uploaded by

    giovanna2004
    This document provides an introduction to breast cancer, including risk factors and prevention strategies. It discusses that breast cancer is an uncontrolled growth of abnormal cells. Risk factors include gender, age, genetics, benign breast disease, hormones, alcohol, obesity, and radiation exposure. Prevention strategies with varying levels of risk reduction include frequent surveillance, chemoprevention drugs like tamoxifen which reduce risk by around 50%, prophylactic oophorectomy which reduces risk by around 50%, and prophylactic mastectomy which reduces risk by around 95%. Eligibility for and side effects of prevention strategies are also reviewed.

    Copyright:

    © All Rights Reserved
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    of 22

    Introduction to Breast Cancer

    Anees B. Chagpar, MD, MSc, MA, MPH, MBA, FRCSC, FACS


    @AneesChagpar
    #breastcamooc

    Associate Professor of Surgery, Yale School of Medicine


    Director, The Breast Center – Smilow Cancer Hospital at Yale-New Haven
    Assistant Director – Global Oncology, Yale Comprehensive Cancer Center
    Program Director, Multidisciplinary Breast Fellowship, Yale University
    What is Cancer?

    • The disease caused by an


    uncontrolled division of abnormal cells
    in a part of the body

    • A practice or phenomenon perceived


    to be evil or destructive and hard to
    contain or eradicate
    Cancer in the US in 2015
    Global Breast Cancer Incidence
    Risk Factors

    • Non-modifiable: • Modifiable:
    – Gender – Exogenous hormones
    – Age – Breast feeding
    – Genetics – Alcohol
    – Benign breast disease – Obesity
    (e.g., atypical ductal – High dose radiation (?)
    hyperplasia)
    – Endogenous
    hormones (?)
    Calculate your risk

    • http://www.cancer.gov/bcrisktool/Default.aspx
    Breast Cancer Prevention

    Anees B. Chagpar, MD, MSc, MA, MPH, MBA, FRCSC, FACS


    @AneesChagpar
    #breastcamooc

    Associate Professor of Surgery, Yale School of Medicine


    Director, The Breast Center – Smilow Cancer Hospital at Yale-New Haven
    Assistant Director – Global Oncology, Yale Comprehensive Cancer Center
    Program Director, Multidisciplinary Breast Fellowship, Yale University
    Risk and Prevention

    • Lung cancer
    – Smoking → Don’t smoke!
    • Cervical cancer
    – HPV → HPV vaccine
    • Breast cancer
    – ???
    Risk Factors

    • Non-modifiable: • Modifiable:
    – Gender – Exogenous hormones
    – Age – Breast feeding
    – Genetics – Alcohol
    – Benign breast disease – Obesity
    (e.g., atypical ductal – High dose radiation (?)
    hyperplasia)
    – Endogenous
    hormones (?)
    Risk Reducing Strategies

    • Frequent surveillance 0%

    • “Chemoprevention” ~50%
    • Prophylactic oophorectomy

    • Prophylactic mastectomy ~95%


    Surveillance

    • Self breast exam

    • Clinical breast exam

    • Mammography +/- ultrasound

    • MRI
    MRI

    • BRCA 1 or 2 gene mutation carriers

    • Family history of BRCA 1 or 2 gene mutation

    • Lifetime risk of 20-25% or greater by


    BRCAPRO or similar model
    Chemoprevention

    • Selective Estrogen Receptor Antagonists


    – Tamoxifen
    – Raloxifene

    • Aromatase Inhibitors
    – Exemestane

    • Other agents?
    Mechanism of Action

    Ovary

    Adrenal gland Aromatase in


    Peripheral fat
    Chemoprevention Trials
    Tamoxifen
    NSABP P-1 IBIS-1 Italian Royal
    Marsden
    Follow up 7 yrs 10 yrs 13 yrs 20 yrs
    N 13,207 7154 5408 2471
    RR (95% CI) 0.57 0.74 0.80 0.78
    (0.46-0.70) (0.58-0.94) (0.56-1.15) (0.58-1.04)
    Raloxifene Exemestane
    CORE MORE RUTH MAP3
    Follow up 8 yrs 4 yrs 7 yrs 3 yrs
    N 7705 7682 10,101 4550
    RR (95% CI) 0.33 0.28 0.56 0.35
    (0.21-0.49) (0.17-0.46) (0.38-0.83) (0.18-0.70)
    Eligibility/Side Effects

    • Women > 35 years of age


    • 5 year risk > 1.66 or history of LCIS
    Tamoxifen Raloxifene Exemestane
    Eligibility Premenopausal Post-menopausal
    Side Effects
    DVT/PE ↑↑ ↑ =
    Endometrial cancer ↑↑ ↑ =
    Cataracts ↑ = =
    Fracture = ↓ =
    Prophylactic Oopherectomy

    • Reduce risk of breast cancer ~50%

    • Reduce risk of ovarian cancer ~80%


    Prophylactic Mastectomy

    • Reduce breast cancer risk ~95%

    • Newer surgical techniques

    • Reconstruction

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