For Breast Cancer

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Breast Cancer and EpidemiologyDilek Aygin
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Breast Cancer

• The most common form of cancer among women
• The second most common cause of cancer related
  mortality
• 1 of 8 women (12.2)
• One third of women with breast cancer die from
  breast cancer

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• Breast cancer, accounting for 23 of all female
  cancers around the globe.
• There is marked geographical variation in
  incidence rates, being highest in the developed
  world and lowest in the developing countries in
  Asia and Africa.

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The breast cancer situation is no different in
Turkey

• According to data provided by the Turkish
  Association for Cancer Research and Control
  (TKASK), 150,000 people are diagnosed with cancer
  each year in Turkey.
• Even though breast cancer can be treated
  successfully when diagnosed early, thousands of
  women still die from the disease each year, and
  experts say breast cancer awareness in Turkey is
  at an inadequate level.
• breast cancer is the most common cancer among
  Turkish women, which represents 26.5 of all
  female cancers.

Ministry of Health The most frequent ten cancers
in females in Turkey. http/ / www.saglik.gov.tr
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To the estimations of the Health Ministry
resources (Tuncer, 2006, www.saglik.gov.tr), the
number of breast cancer patients in the period of
2007-2012 has beenseen in Table 1.
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Global Differences in Breast Cancer Diagnosis and
Outcomes Survival

• Estimated mortality-to-incidence ratios are
  generally lower in developed regions1

USA (8388)2
Europe (6083)2
ASR 5-year survival
Developing countries (4572)3
Women diagnosed 19901994 19821992
1Shibuya, et al. BMC Cancer 2002237 2Coleman,
et al. Ann Oncol 200314(Suppl 5)V128V149
3Sankaranarayanan, et al. IARC Sci Publ
199814513573
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GLOBAL STATISTICSBreast cancer mortality in
different countries
SLIDE CREDITGilberto Schwartsmann
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GLOBAL STATISTICSMortality vs. Degree of
economic development
SLIDE CREDITGilberto Schwartsmann
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What is breast cancer?

• Breast cancer is where cancerous (malignant)
  cells are found in the breast tissue.
• There are several types of breast cancer.
• Ductal cancer (effects the ducts and also is the
  most common type)
• Lobular (which begins in the lobes of the breast
  and often is found in both breasts)
• Inflammatory cancer (its where the breast appears
  swollen and hot) its also very uncommon.
• Picture from WebMD.com

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Risk Factors for Breast Cancer

• Female (1 male)
• Aging
• Relative (mother or sister)
• Menstrual history
• early on set
• late menopause
• Child birth
• After the age of 30

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Exogenous Estrogen

• Hormonal replacement therapy(HRT)
• 30 increased risk with long term use
• Oral Contraceptives(OC)
• risk slight
• risk returns to normal once the use of OCs has
  been discontinued

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Risk Factors for Breast Cancer

• Radiation exposure
• Breast disease
• Atpyical Hyperplasia
• Intraductal carcinoma in situ
• Intralobular carcinoma in situ
• Obesity
• Diet
• Fat
• Alcohol

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Genetics

• BRCA-1
• BRCA-2
• P53, Rb-1
• Her-2/neu, c-erB2, c-myc

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Staging of Breast Cancer

• The American Joint Committee on Cancer (AJCC) has
  designated staging by TNM
• T tumor size
• N lymph node involvement
• M metastasis

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Stage 1

• Tumor lt 2.0 cm in greatest dimension
• No nodal involvement (N0)
• No metastases (M0)

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Stage II

• Tumor gt 2.0 lt 5 cm
• or
• Ipsilateral axillary lymph node (N1)
• No Metastasis (M0)

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Stage III

• Tumor gt 5 cm (T3)
• or ipsilateral axillary lymph nodes fixed to
  each other or other structures (N2)
• involvement of ipsilateral internal mammary nodes
  (N3)
• Inflammatory carcinoma (T4d)

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Stage IV (Metastatic breast cancer)

• Any T
• Any N
• Metastasis (M1)

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Types of breast cancer

• In situ
• Intraductal (DCIS)
• Intralobular (LCIS)
• Invasive
• Infiltrating ductal carcinoma
• Tubular carcinoma
• Medullary carcinoma
• Mucinous carcinoma

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Symptoms and Screening
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Normal breast physiology and anatomy

• Symmetry and balance
• Size
• weight
• menstrual cycle
• pregnancy and lactation
• Texture
• Shape
• age

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Abnormal signs and symptoms

• Puckering
• Dimpling
• Retraction
• Nipple discharge
• Thickening of skin or lump or knot
• Retracted nipple

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Abnormal signs and symptoms

• Change in breast size
• Pain or tenderness
• Redness
• Change in nipple position
• Scaling around nipples
• Sore on breast that does not heal

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Methods of Detection

• Clinical exam by MD or nurse
• Mammography
• Monthly breast self-exam (BSE)

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Clinical examination

• Performed by doctor or trained nurse practitioner
• Annually for women over 40
• At least every 3 years for women between 20 and
  40
• More frequent examination for high risk patients

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Mammography

• X-ray of the breast
• Has been shown to save lives in patients 50-69
• Data mixed on usefulness for patients 40-49
• Normal mammogram does not rule out possibility of
  cancer completely

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Mammography

• American Cancer Society recommends
• Women (asymptomatic) 40 years of age and older
  should have a mammogram every year.

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Mammography-more guidelines

• Mammogram facility guidelines
• Avoid mammogram week before period
• Dont wear deodorant powder or cream
• Bring a list of the places and dates of other
  mammograms, biopsies youve had before
• If you dont hear from the MD within 10 days,
  call the facility

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Breast Self Examination

• Opportunity for woman to become familiar with her
  breasts
• Monthly exam of the breasts and underarm area
• May discover any changes early
• Begin at age 20, continue monthly

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When to do BSE

• Menstruating women- 5 to 7 days after the
  beginning of
• their period
• Menopausal women -
• same date each month
• Pregnant women
• same date each month
• Takes about 20 minutes
• Perform BSE at least
• once a month
• Examine all breast tissue

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Why dont more women practice BSE?

• Fear
• Embarrassment
• Youth
• Lack of knowledge
• Too busy, forgetfulness

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Conclusion

• HEALTH PROFESSIONALS have a responsibility as
  patient advocates for breast cancer awareness

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THANK YOU
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POYRAZLAR LAKE / SAKARYA / TURKEY
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SAKARYA / TURKEY
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SAKARYA UNIVERSITY CAMPUS
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SAKARYA UNIVERSITY CAMPUS
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SAKARYA UNIVERSITY CAMPUS