BREAST

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BREAST CANCER
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INTRODUCTION

• Breast cancer, the second-leading cause of cancer
  deaths in women, is the disease women fear most.
• Breast cancer can also occur in men, but it's far
  less common.
• Yet there's more reason for optimism than ever
  before.
• In the last 30 years, doctors have made great
  strides in early diagnosis and treatment of the
  disease and in reducing breast cancer deaths.

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• 80 of breast cancers occur in women older than
  age 50. In 30s, have a one in 233 chance of
  developing breast cancer. By age 85, chance is
  one in eight.
• In 1975, a diagnosis of breast cancer usually
  meant radical mastectomy removal of the entire
  breast along with underarm lymph nodes and
  muscles underneath the breast.
• Today, radical mastectomy is rarely performed.
  Instead, there are more and better treatment
  options, and many women are candidates for
  breast-sparing operations.

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SIGNS AND SYMPTOMS

• When the disease is discovered early, have more
  treatment options and a better chance for a cure.
• Most breast lumps aren't cancerous. Yet the most
  common sign of breast cancer for both men and
  women is a lump or thickening in the breast.
  Often, the lump is painless.
• Spontaneous clear or bloody discharge from the
  nipple, often associated with a breast lump
• Retraction or indentation of the nipple
• Change in the size or contours of the breast
• Any flattening or indentation of the skin over
  the breast

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• Redness or pitting of the skin over breast, like
  the skin of an orange
• A number of conditions other than breast cancer
  can cause the breasts to change in size or feel.
• Breast tissue changes naturally during pregnancy
  and the menstrual cycle.
• Other possible causes of noncancerous (benign)
  breast changes include fibrocystic changes,
  cysts, fibroadenomas, infection or injury.
• If patient haven't yet gone through menopause,
  may want to wait through one menstrual cycle
  before seeing the doctor.
• If the change hasn't gone away after a month,
  have it evaluated promptly.

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CAUSES

• In breast cancer, some of the cells in the breast
  begin growing abnormally.
• These cells divide more rapidly than healthy
  cells do and may spread (metastasize) through the
  breast, to lymph nodes or to other parts of the
  body.
• The most common type of breast cancer begins in
  the milk-producing ducts, but cancer may also
  begin in the lobules or in other breast tissue.
• In most cases, it isn't clear what causes normal
  breast cells to become cancerous.

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• Only 5-10 of breast cancers are inherited.
• Families that do have genetic defects in one of
  two genes, breast cancer gene 1 (BRCA1) or breast
  cancer gene 2 (BRCA2), have a much greater risk
  of developing both breast and ovarian cancer.
• Other inherited mutations including the
  ataxia-telangiectasia mutation gene, the
  cell-cycle checkpoint kinase 2 (CHEK-2) gene and
  the p53 tumor suppressor gene also make it more
  likely that will develop breast cancer.

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• If one of these genes is present in the family,
  will have a 50 percent chance of having the
  gene.
• Yet most genetic mutations related to breast
  cancer aren't inherited.
• These acquired mutations may result from
  radiation exposure women treated with chest
  radiation therapy for lymphoma in childhood or
  during adolescence when breasts are developing
  have a significantly higher incidence of breast
  cancer than do women not exposed to radiation.
• Mutations may also develop as a result of
  exposure to cancer-causing chemicals, such as the
  polycyclic aromatic hydrocarbons found in tobacco
  and charred red meats.

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• Each of breasts contains 15 to 20 lobes of
  glandular tissue, arranged like the petals of a
  daisy.
• The lobes are further divided into smaller
  lobules that produce milk during pregnancy and
  breast-feeding.
• Small ducts conduct the milk to a reservoir that
  lies just beneath the nipple.
• Supporting this network is a deeper layer of
  connective tissue called stroma.

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RISK FACTORS

• Some risk factors, such as age, sex and family
  history, can't be changed
• Whereas others, including weight, smoking and a
  poor diet, are under control.
• Age
• Personal history of breast cancer.
• Family history.
• Genetic predisposition.
• Radiation exposure.
• Excess weight.

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• Early onset of menstrual cycles.
• Late menopause.
• First pregnancy at older age.
• Race.
• Hormone therapy.
• Birth control pills.
• Smoking.
• Excessive use of alcohol.
• Precancerous breast changes (atypical
  hyperplasia, lobular carcinoma in situ).
• Mammographic breast density.

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WHEN TO SEEK MEDICAL ADVICE

• Although most breast changes aren't cancerous,
  it's important to have them evaluated promptly.
• Discover a lump or any of the other warning signs
  of breast cancer, especially if the changes
  persist after one menstrual cycle or they change
  the appearance of the breast.
• If treated for breast cancer, report any new
  signs or symptoms immediately.
• Possible warning signs include a new lump in the
  breast or a bone ache or pain that doesn't go
  away after three weeks.

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Screening and diagnosis

• Screening looking for evidence of disease
  before signs or symptoms appear is the key to
  finding breast cancer in its early, treatable
  stages. Depending on age and risk factors,
  screening may include breast self-examination,
  examination by nurse or doctor, mammograms
  (mammography) or other tests.
• Self breast examination is an option beginning at
  age 20.

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Screening
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Breast self-exam
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Clinical breast exam

• Mammogram - to check breast tissue

Other tests

• Computer-aided detection (CAD)
• Digital mammography
• Magnetic resonance imaging (MRI)
• Breast ultrasound (ultrasonography)

Experimental procedures

• Ductal lavage
• Molecular breast imaging (MBI)

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CAD Mammogram
Mammogram
Breast Ultrasound
Digital mammography
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Diagnostic procedures

• Ultrasound
• Biopsy Fine-needle aspiration biopsy, core
  needle biopsy, sterotactic biopsy, wire
  localization biopsy, surgical biopsy
• Estrogen and progesterone receptor tests
• Staging tests Stage 0 to IV
• Genetic stage

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Breast biopsy
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• Tamoxifen inhibits estrogen receptor activity
• AE antiestrogenic
• E estrogenic

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TREATMENT

• In addition to coping with a potentially
  life-threatening illness must make complex
  decisions about treatment.
• Treatments exist for every type and stage of
  breast cancer.
• Most women will have surgery and an additional
  (adjuvant) therapy such as radiation,
  chemotherapy or hormone therapy.
• Experimental treatments are also available at
  cancer treatment centers.

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SURGERY

• Lumpectomy
• Partial or segmental mastectomy
• Simple mastectomy
• Modified radical mastectomy
• Sentinel lymph node biopsy
• Axillary lymph node dissection
• Radiation therapy
• Chemotherapy

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Reconstructive surgery

• Reconstruction with implants
• Reconstruction with a tissue flap
• Deep inferior epigastric perforator (DIEP)
  reconstruction
• Reconstruction of the nipple and areola

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Hormonal therapy

• Selective estrogen receptor modulators (SERMs)
• Aromatase inhibitors

Biological therapy

• Trastuzumab (Herceptin)
• Bevacizumab (Avastin)
• Lapatinib (Tykerb)

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PREVENTION

• Chemoprevention
• Tamoxifen (Nolvadex)
• Raloxifene (Evista)

• Preventive surgery
• Prophylactic mastectomy
• Prophylactic oophorectomy

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LIFE-STYLE FACTORS

• Taking aspirin
• No / limit alcohol
• Maintain a healthy weight
• Avoid long-term hormone therapy
• Stay physically active
• Eat foods high in fiber
• Emphasize olive oil
• Avoid exposure to pesticides

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New directions in research

• Retinoids - Natural or synthetic forms of vit-A
  have the ability to destroy the growth of cancer
  cells. Effective in premenopausal women and in
  those whose tumors aren't estrogen positive.
• Flaxseed High in lignan, a naturally occurring
  compound that lowers circulating estrogens in the
  body. Decreases estrogen production acts like
  tamoxifen inhibit the growth of breast cancer
  tumors. Lignans are also antioxidants with weak
  estrogen-like characteristics. These
  characteristics may be the mechanism by which
  flaxseed works to decrease hot flushes.

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COPING SKILLS

• Telling others
• Maintaining a strong support system
• Dealing with intimacy
• Self-care taking

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Thank you
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BREAST TENDERNESS

• Breast tenderness is pain or discomfort in the
  breasts. It is the most common breast symptom
  women have. It is usually not a sign of breast
  cancer.
• Most common cause of breast tenderness is called
  fibrocystic breast changes.
• These changes are caused by the swelling of very
  tiny fluid-filled cysts in fibrous tissue in the
  breast.
• The changes usually happen 7-10 days before the
  menstrual period and go away when period ends.

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CAUSES

• Puberty (boys / girls)
• Pregnancy
• Infection of the breast
• Hormone imbalance too much estrogen
• Birth control pills
• Breast-feeding when breasts engorged (milk)
• Injury of the breast
• Noncancerous tumor in the breast (fibroma)
• Breast cyst
• Condition called hyperprolactinemia
• Breast cancer, but often cancer does not cause
  any pain.

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DIAGNOSIS

• Mammogram (a special x-ray of the breasts)
• Ultrasound scan of the breasts (a scan with sound
  waves)
• Thermography of the breasts (a heat test that
  outlines the breast in a color pattern)
• Biopsy (removal of a small piece of tissue or
  fluid from the breast).
• Examination of discharge from a nipple
• Blood test.

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TREATMENT

• Drink fewer or no beverages with caffeine.
• Add vitamins E and A to the diet.
• Reduce salt intake 1-2 weeks before
  menstruation.
• Put heat on the breast with a heating pad or warm
  water bottle.
• Diuretics.
• Surgery is rarely needed.

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SELF-CARE

• Follow the physicians recommendations for
  preventing and treating breast tenderness.
• Learn how to examine the breasts after the
  menstrual period every month.

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NIPPLE DISCHARGE

• Nipple discharge is any kind of fluid that comes
  out of the nipple.
• Nipples contain tiny openings through which fluid
  can pass.
• Although most nipple discharge is not serious,
  any discharge should be evaluated.
• The color and consistency of the discharge will
  help in diagnosis.

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• A clear, straw-colored discharge sometimes
  develops in early pregnancy.
• A whitish or greenish discharge occurring in
  nonpregnant women is galactorrhea cause
  birth control pills, hormone imbalance, pituitary
  tumor, or cyst under the areola.
• Pus discharge indicates a breast infection.

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DIAGNOSIS

• No menstrual periods
• Headaches
• Visual problems.
• Lab tests of the discharge
• Blood tests
• Mammogram (x-ray of the breasts)
• Ultrasound scan of the breasts
• CT scan of the brain.

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TREATMENT

• Surgery
• Radiation therapy
• Chemotherapy.

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GALACTORRHEA

• Galactorrhea is a milklike discharge of fluid
  from the breast nipples.
• Usually the discharge is from both breasts rather
  than just one.
• A discharge like this is called galactorrhea
  unless pregnant or breast-feeding.
• Galactorrhea usually occurs when the body
  produces too much prolactin. Prolactin is a
  hormone produced by the pituitary gland.
  Normally, prolactin helps a woman make milk when
  she has a baby.

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ETIOLOGY

• Birth control pills and other medicines
• Underactive thyroid gland
• Problems with the pituitary gland
• Some brain diseases, such as meningitis
• Cyst under the darkened area around the nipple
  (galactocele)
• Shingles caused by the chickenpox virus in the
  chest wall
• Surgery on the chest
• Other medical problems kidney failure, liver
  disease, sarcoidosis, or Cushing's disease.

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DIAGNOSIS

• Medical history stopped having menstrual
  periods, having trouble getting pregnant, or
  having headaches or vision problems. OTC
  medicines if any. Sample of the discharge may be
  tested in the lab.
• Blood tests
• Mammogram (x-ray of the breasts)
• Ultrasound scan of the breasts
• CT scan of the brain to look at the pituitary
  gland.

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TREATMENT

• If a galactocele is causing the galactorrhea, the
  cyst will be removed.
• If the discharge is caused by drugs, it will
  clear up when stop taking the drugs. However,
  stopping drugs is not always necessary.
• If the galactorrhea is caused by a pituitary
  gland tumor, needs surgery, radiation, or drug
  treatments. Can treat with bromocriptine (stops
  production of prolactin).

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How long will the effects last?

• Once the cause of the discharge is diagnosed and
  treated, she should no longer have the discharge.
  However, if pituitary tumor is present, may need
  long-term treatment with bromocriptine or
  radiation because the tumor could come back.

SELF-CARE

• Follow-up tests.
• Take drugs as prescribed.
• If the galactorrhea is mild and a cause cannot be
  found, breast binders can help stop the discharge
  by preventing stimulation of the nipples.

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PAGET'S DISEASE OF THE NIPPLE

• Paget's disease is a slowly growing cancer of the
  nipple. It is a rare form of breast cancer. It
  mainly affects women and very rarely men.
• When abnormal cells grow uncontrollably, they are
  called tumors. It is not known why they occur. In
  Paget's disease, the tumor starts in the milk
  ducts of the nipple.

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SYMPTOMS

• Symptoms seem harmless. It is often thought to be
  a skin inflammation or infection, which can delay
  its diagnosis and treatment.
• Redness, oozing, and crusting of the nipple and
  the circular, dark area around the nipple
  (areola), which causes itching and burning.
• Sore on the nipple that will not heal.
• Usually only 1 nipple is affected. Sometimes no
  changes in the skin can be seen. May have a lump
  in the breast, which may or may not be able to
  feel.

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DIAGNOSIS

• Sample of discharge from the nipple may be
  examined under a microscope.
• Biopsy to remove the sample of breast tissue to
  test for cancer.
• Mammogram of both breasts to look for cancer in
  other parts of the breasts.
• Ultrasound scan or MRI - both of these tests
  create pictures of the breasts.

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TREATMENT

• If the cancer is only in the nipple and not any
  other part of the breast
• Radiation treatments
• Surgery to remove just the nipple and surrounding
  tissue.
• If a mass is found deep in the breast
• Surgery to remove all or part of the breast
• Chemotherapy.

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How long will the effects last?

• Without treatment, the cancerous sore will remain
  on the nipple and may spread deeper into the
  breast.

PREVENTION

• Check monthly for any lumps, sores, or oozing
  from the breasts and report any breast changes to
  the physician right away.

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SORE NIPPLES

• Breast-feeding should be a comfortable and
  enjoyable experience.
• Sore nipples are a common problem among
  breast-feeding mothers.
• Often mothers quit nursing their babies early
  because of sore nipples, but this doesn't have to
  happen.
• Sore nipples usually can be prevented or treated.

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Nipple protectors

• Mild nipple discomfort at the beginning of
  feedings during the first few days of
  breast-feeding usually needs no treatment.
• Nipple pain that is severe or lasts throughout a
  single or for more than a week is not normal and
  should be evaluated by doctor or a lactation
  consultant.

• Protects sore nipples during breast-feeding
• Shaped to allow skin contact with baby
• Made with odorless, tasteless, ultra-fine
  silicone

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CAUSES

• Position of the baby's mouth on the breast.
• Size and shape of the nipples and the baby's
  mouth can affect how the baby latches on the
  breast.
• Also, infant's sucking habits can cause nipple
  discomfort.
• Other possible causes of nipple pain are an
  infection of the nipples (yeast or bacterial),
  breast infection or improper nipple skin care.

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PROBLEMS CAUSED

• If baby is not latching on to the breast
  correctly, he may not be getting enough milk.
• Also, nipple pain may cause to put off nursings
  or not let the baby suck long enough when he
  nurses.
• Sucking is important because this is what
  triggers the milk to begin to flow (let-down
  reflex).
• Nipple pain can cause a drop in the milk supply.
• As a result, baby may not gain weight well.
• Sore nipples and low milk supply problems often
  go hand-in-hand.

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TREATMENT

• Make sure the baby is positioned correctly to
  nurse
• Begin a feeding on the less sore nipple to
  trigger the let-down reflex and start milk
  flowing
• Frequent shorter feedings are better than less
  frequent lengthy feedings
• Keep the nipples dry
• If any cracks or other breaks in the skin, keep
  the nipples covered with a soothing ointment
• Use a pump to express the milk if the pain is so
  severe that cannot nurse the baby
• Watch for signs of a breast infection

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WHEN TO SEEK MEDICAL ADVICE

• Immediate following symptoms additional to sore
  nipples chills, fever, headache, flu-like
  symptoms, or pain or redness in the breast.
• OB/GYN Nipples sting or burn and have shooting
  pains in the breast, especially after nursing.
  Nipple pain keeps from nursing long enough to
  trigger let-down reflex.
• Pediatrician baby unsatisfied after most
  nursings. Baby may not be satisfied because milk
  supply is low or baby is not emptying breasts.
  Nipples yeast infection, see white patches in
  the baby's mouth, or baby has had a diaper rash
  for 3 or more days.

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Thank you