ON9 Breast Cancer

Breast Cancer Epidemiology:
- Most common form of cancer in women globally​:
Leading cause of cancer ❌ in women worldwide​
Survival rates vary worldwide​; >80% in North America​, <❌% in low income countries ​

- Third most common cancer in New Zealand​:
600 deaths every year​
❌ women diagnosed each year, 25 men ​
❌% 10 year survival rate ​

Screening​ strategies depend on estimated risk of cancer​.
Mammogram​
❌ breast exam​
Breast ❌-exam​
❌ (high risk)​
Biopsy​
CT-scan

Follow B.R.A.S: BREAST ❌, REDUCE ❌, ACT ❌, SCREENING with mammograms ❌

Clinical Presentation is variable.
Asymptomatic​
Change in ❌ appearance​
New/persistent ❌ changes​
New nipple ❌​
Nipple ❌​
Pain​
Variable mass size, ❌ (nodular, thickened area)​
Classically hard, immovable, single lesion irregular borders ​

Pathophysiology​ -
Most common histological types of ❌ breast carcinoma:​
Infiltrating ❌ carcinoma (70-80%)​
Infiltrating ❌ carcinoma (~8%)​
❌ ductal/lobular carcinoma (~7%)​

Staging​:
Stage 0 – Only in ❌ (no spread)​
Stage 1 - Only in ❌, no nodes
Stage 2 - Early, tumour spread to ❌ nodes
Stage 3 - Locally advanced disease, spread to chest ❌, internal ❌ lymph nodes
Stage 4 - Advanced or metastatic disease present at ❌ sites such as bone, liver, lungs, brain

Treatment:
1. Surgery​ - Breast-conserving surgery (❌)​ or modified radial ❌ (removal of entire breast with or without breast reconstruction)​

2. Radiation - Mostly used in adjuvant setting​, can be targeted or generalized, dose determined by ❌ of disease​, may be used in Stage IV to palliate ❌ for metastases ​

3. Systemic Therapy​ - Adjucant: Chemotherapy​, endocrine / hormonal therapy, targeted therapy. Reason for ❌ reduction in developed countries.
Chemo:
- Chemo regimens ❌ regardless of hormonal status, but anti-HER2 therapy added on to those HER2 ❌​
- ❌ (if node positive) appear to have most evidence​
Endocrine:
- Used to decrease risk of ❌​, initiated ❌ chemotherapy complete​
Targeted Anti-HER2 Therapy​:
- All are ❌ – need baseline ECHO and follow up​

Endocrine therapy regimens/options:
1. Pre-menopausal -
High risk? = ❌ PO daily, for 5 years​
Low risk? = ❌ PO daily, for 10 years
Alternative is surgical oophorectomy or medical menopause ❌​

2. Post-menopausal​ -
❌ (Letrozole, Anastrozole, Exemestane) OR tamoxifen (❌) ​
Aromatase Inhibitors drugs of choice in metastatic disease

Match the stage to the general Tx:
Stage 0 - ❌
Early stage - ❌ +/- endocrine +/- targeted
Locally advanced - ❌ +/- endocrine +/- targeted
Metastatic - ❌ +/- endocrine +/- targeted

Rachel is a 42 year old pre-menopausal woman attending a breast cancer screening session. Her mother died of breast cancer at age 64. She eats a healthy diet, surfs at least twice weekly, does not smoke, and drinks approximately 3 glasses of wine per week. She works at Dunedin Hospital in the radiotherapy department but adheres to all safety precautions regarding radiation exposure. She has no history of any breast abnormalities. ​

Identify her risk factors:
- Female, estrogen, ❌

Identify two sctreening options for her:
- ❌