Breast Cancer Awareness Prevention, Early Diagnosis and Treatment Helena R. Chang, M.D., Ph.D Revlon/ UCLA Breast Center

Overview • • • • • • •

Statistics Demographics Risk Factors Risk Reduction Primary Prevention Breast Cancer Screening Treatment

Breast Cancer Statistics in U.S. & California Years 2000 2003 2004 2009

US US CA US CA US CA

New invasive Cases Total Female 182,000 212,600 211,300 21,100 217,440 215,990 21,860 194,280 192,370 21,740

Deaths Total Female 40,800 40,200 39,800 4,000 40,580 40,110 4,500 40,610 40,170 4,030

Overview Demographics in Breast Cancer Statistics in Los Angeles County • LA population 9,862,049 with 12.9% being Asian and 0.3% being Pacific Islanders • Incidence of breast cancer for the county 113.7/100,000 population for white 142.5 for African American 124.4 for Asian/Pacific Islanders 94.6 for Hispanic 79.4

Overview Demographics in Breast Cancer Statistics in Los Angeles County (cont.) • Asian dense areas, San Gabriel Valley and LA metro may be targeted for community profile to understand the breast cancer care needs.

Risk Factors for Breast Cancer • • • • • • •

Family history of breast &/or Ovarian Cancer BRCA mutation carriers Personal history of LCIS, ADH etc. Personal history of radiation to breast area Aging Postmenopausal weight gain Postmenopausal hormone replacement treatment

Risk Factors for Breast Cancer (cont.) • Early menarche and late menopause • Late first full term delivery (after 30) or no child bearing • Multiple breast biopsies • Mammographically dense breasts • High soy diet • Large alcohol consumption • Low vitamin D level

Breast Cancer Risk Reduction • • • • •

Avoid postmenopausal obesity Keep alcohol consumption low Regular exercise Keep an adequate Vitamin D level Avoid long term hormone use

Breast Cancer Prevention for High Risk Women • Tamoxifen • Evista • Surgery

Breast Cancer Screening for Early Detection Early: small &/or nonpalpable breast cancer without lymph node involvement Advanced: large breast mass with swollen lymph glands, possible skin &/or chest wall involvement by the tumor mass, or disease spread beyond breast and lymph nodes.

Breast Cancer Screening • BSE- monthly, starting after 20 • CBE- every 3 years after 20 yearly after 40 • Screening mammography- yearly after 40

Mammographic Abnormalities • Clustered or linear, branching or increasing small calcifications • Speculated mass or mass with an irregular borders • Architecture distorsion

Ultrasound Abnormality • • • • •

Solid mass- taller than wide Irregular or lobular borders Shadow behind mass Increased vascularity in mass Interval growth

Indications for Breast MRI • HR family history • BRCA mutation, Li-Fraumeni, Cowden Syndrome • LCIS, Atypia • Silicon mass/ implant with mass • Axillary lymph node: unknown primary • Breast cancer

Contraindications for MRI • Pregnancy • Allergy to MRI contrast • Poor kidney function

Mammography vs MRI in Breast Cancer Screening Mammography • ≥40 years of age • lower sensitivity in dense breasts

• •

• no contrast injection • rapid imaging • low cost

• • •

MRI high risk women high sensitivity including dense breasts IV contrast lengthy study expansive

Signs and Symptoms of Breast Cancer • Lump- new, hard, discrete and growing mass or new asymmetry • Skin- dimpling, redness, swollen, or ulceration or nodules • Nipple- newly developed inversion, eczema, bloody or clear nipple discharge • Arm pit-swollen glands

Local Treatment for breast Cancer Small Tumor • Lumpectomy and radiation

Large Tumor • Mastectomy ± reconstruction ± radiation

Lymph Node (LN) Surgery Clinically Negative LN • Sentinel LN biopsy

Clinically Positive LN Axillary LN dissection

Medications for Treating Breast Cancer For Hormone Receptor Positive Breast Cancer • Tamoxifen for all ages • Aromatase inhibitors for postmenopausal women • 5 years usage for both, lifetime use for advanced stage

Medication for Treating Breast Cancer Chemotherapy for • Triple negative breast cancer • HER2 positive breast cancer • Metastatic LN (s) • Large tumor size • Disease spread beyond breast and lymph nodes

Medication for Breast Cancer Target therapy • Herceptin for HER2 positive tumor • Many new drugs are being tested for different types of breast cancer.

Summary • • • • • • •

Statistics Demographics Risk Factors Risk Reduction Primary Prevention Breast Cancer Screening Treatment