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Update in Breast Cancer

Ana Maria Lopez, MD, MPH, FACP Associate Dean, Outreach and Multicultural Affairs Professor of Medicine and Pathology Medical Director, Arizona Telemedicine Program

Educational Objectives

1

.

Learn what is breast cancer 2. Discuss risks to breast cancer 3. Outline prevention measures for breast cancer

What is breast cancer?

breastcancer.org

http://geneticpeople.com/?tag

=breast-cancer

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What causes breast cancer?

•

Causes and risk factors

Risk Factors

• • • • Age: • • 95% in women 40yo + highest in 70-74 yo FH Personal history Genetic risk: • BRCA 1/2, TP 53, ATM • • • • • • • Nulliparous 1 st full term pregnancy after 35 yo No lactation HRT Alcohol Overweight/obesity Physical inactivity

70% of breast cancers are in patients without identifiable risk factors

Risk Calculators

• www.cancer.gov/bcrisktool NCI/NSABP

Hereditary Breast Cancer Risks

• • • • • 5-10% of all breast cancers Ashkenazi Jewish descent 3 or more 1 1 st st or 2 nd degree relatives degree relative with bilateral breast cancer 2 or more 1 st or 2 ovarian cancer nd degree relatives with Male breast cancer

BRCA 1 and BRCA 2

• • • Code for DNA repair Presence of gene, increases the risk of getting breast cancer up to 80% in her lifetime BRCA1 or BRCA2 mutations make up about half of all cases of inherited breast cancer • • associated with ovarian cancer and prostate cancer can be inherited either from the mother or the father.

Other Inherited Genes

• • TP53 gene • codes for the tumor suppressor protein p53 • Mutations cause Li-Fraumeni syndrome: associated with early onset breast cancer Ataxia Telangiectasia (ATM) gene Females with one defective copy of the ATM gene and one normal copy of the gene are at increased risk for breast cancer.

concurringopinions.com

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ladycarehealth.com

pdahealthware.com

Prevention

Prevention: saves us from the pain of being sick --Unknown

health.usf.edu

Prevention Studies

• • Tamoxifen Raloxifen: STAR (Study of Tamoxifen and Raloxifene) • Raloxifene is as effective as tamoxifen in reducing invasive but not nonivasive (DCIS) BC risk • • Both drugs reduce invasive BC risk by about 50% Raloxifene: 36% fewer uterine cancers, 29% fewer blood clots • Both increase blood clots.

Aspirin

• In an epidemiologic study, aspirin appeared to lower breast cancer risk • Need prospective trial

Vitamin D

• Helps with calcium absorption to maintain bone density • In clinical trials

Fat

• • • • WINS Low fat diet (< 30%) 5Y FU: new breast cancers--9.8% low-fat diet; 12.4% standard diet (24% reduction) largest risk reduction – 42%--in ER negative tumors

What about soy? Flax? Phytoestrogens? • • • Eat what you like!

Eat healthy!

Do not change your diet drastically to include phytoestrogens. • There may be safety concerns re: pharmaceutically concentrated soy products

Lifestyle

• Maintain a healthy weight • Decrease intake overall. Increase vegetables in specific (2/3 of plate) • Increase activity: 3-4 hours of exercise per week • Decrease alcohol intake

Early Detection

Computer-aided detection and diagnosis (CAD)

kodak.com

Tomosynthesis (3D mammography)

canada.com

Treatment

ultimateboxingresults.com

riskofbreastcancer.net

indianapublicmedia.org

dailymail.co.uk