Breast Cancer and Epidemiology

Dilek AyginDilek Aygin

Breast CancerBreast Cancer► The most common form The most common form

of cancer among womenof cancer among women► The second most The second most

common cause of common cause of cancer related mortalitycancer related mortality

► 1 of 8 women (12.2%)1 of 8 women (12.2%)► One third of women with One third of women with

breast cancer die from breast cancer die from breast cancerbreast cancer

►Breast cancer, accounting for 23% of Breast cancer, accounting for 23% of all female cancers around the globe.all female cancers around the globe.

►There is marked geographical There is marked geographical variation in incidence rates, being variation in incidence rates, being highest in the developed world and highest in the developed world and lowest in the developing countries in lowest in the developing countries in Asia and Africa. Asia and Africa.

The breast cancer situation is no The breast cancer situation is no different in Turkeydifferent in Turkey

► According to data provided by the Turkish Association According to data provided by the Turkish Association for Cancer Research and Control (TKASK), 150,000 for Cancer Research and Control (TKASK), 150,000 people are diagnosed with cancer each year in Turkey. people are diagnosed with cancer each year in Turkey.

► Even though breast cancer can be treated successfully Even though breast cancer can be treated successfully when diagnosed early, thousands of women still die when diagnosed early, thousands of women still die from the disease each year, and experts say breast from the disease each year, and experts say breast cancer awareness in Turkey is at an inadequate level. cancer awareness in Turkey is at an inadequate level.

► breast cancer is the most common cancer among breast cancer is the most common cancer among Turkish women, which represents 26.5% of all female Turkish women, which represents 26.5% of all female cancers.cancers.

Ministry of Health: The most frequent ten cancers in females in Turkey. http:/ / www.saglik.gov.tr

To the estimations of the Health Ministry resources To the estimations of the Health Ministry resources (Tuncer, 2006, www.saglık.gov.tr), the number of breast (Tuncer, 2006, www.saglık.gov.tr), the number of breast

cancer patients in the period of 2007-2012 has beencancer patients in the period of 2007-2012 has been

seen in Table seen in Table 11..

Global Differences in Breast Cancer Global Differences in Breast Cancer Diagnosis and Outcomes: SurvivalDiagnosis and Outcomes: Survival

► Estimated mortality-to-incidence ratios are Estimated mortality-to-incidence ratios are generally lower in developed regionsgenerally lower in developed regions11

USA (83–88%)2*

Europe (60–83%)2*

Developing countries (45–72%)3**

Women diagnosed: *1990–1994; **1982–1992 AS

R 5

-year

surv

ival

1Shibuya, et al. BMC Cancer 2002;2:37; 2Coleman, et al. Ann Oncol 2003;14(Suppl 5):V128–V149; 3Sankaranarayanan, et al. IARC Sci Publ 1998;145:135–73

0.250.25

0.320.32 0.370.37

0.330.33

0.450.45

0.270.27

0.390.39

0.270.27

0.380.38

0.350.35

0.450.450.420.42

0.480.48

0.390.39

0.370.37

00..3232

GLOBAL STATISTICS:GLOBAL STATISTICS:Breast cancer mortality in different Breast cancer mortality in different

countriescountries

SLIDE CREDIT:Gilberto SchwartsmannSLIDE CREDIT:Gilberto Schwartsmann

GLOBAL STATISTICS:GLOBAL STATISTICS:Mortality vs. Degree of economic Mortality vs. Degree of economic

developmentdevelopment

More developed countries0.33 (189 deaths / 579 cases )

Less developed countries0.39 (184 deaths / 471 cases)

SLIDE CREDIT:Gilberto SchwartsmannSLIDE CREDIT:Gilberto Schwartsmann

What is breast cancer?What is breast cancer?► Breast cancer is where cancerous Breast cancer is where cancerous

(malignant) cells are found in the (malignant) cells are found in the breast tissue.breast tissue.

► There are several types of breast There are several types of breast cancer.cancer.

► Ductal cancer (effects the ducts Ductal cancer (effects the ducts and also is the most common and also is the most common type)type)

► Lobular (which begins in the lobes Lobular (which begins in the lobes of the breast and often is found in of the breast and often is found in both breasts)both breasts)

► Inflammatory cancer (its where Inflammatory cancer (its where the breast appears swollen and the breast appears swollen and hot) its also very uncommonhot) its also very uncommon..

► Picture from WebMD.comPicture from WebMD.com

Risk Factors for Risk Factors for BreastBreast CancerCancer

► Female (1% male)Female (1% male)► AgingAging► Relative (mother or Relative (mother or

sister)sister)► Menstrual historyMenstrual history

early on setearly on set late menopauselate menopause

► Child birthChild birth After the age of 30After the age of 30

Exogenous EstrogenExogenous Estrogen►Hormonal replacement Hormonal replacement

therapy(HRT)therapy(HRT) 30% increased risk 30% increased risk

with long term use with long term use ►Oral Contraceptives(OC)Oral Contraceptives(OC)

risk slightrisk slight risk returns to normal risk returns to normal

once the use of OC’s once the use of OC’s has been discontinuedhas been discontinued

Risk Factors for Risk Factors for BreastBreast Cancer Cancer

► Radiation exposureRadiation exposure► Breast diseaseBreast disease

Atpyical HyperplasiaAtpyical Hyperplasia Intraductal carcinoma in situIntraductal carcinoma in situ Intralobular carcinoma in situIntralobular carcinoma in situ

► ObesityObesity► DietDiet

FatFat AlcohoAlcoholl

GeneticsGenetics

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

mycmyc

Staging of Breast CancerStaging of Breast Cancer

►The American Joint Committee on The American Joint Committee on Cancer (AJCC) has designated staging Cancer (AJCC) has designated staging by TNMby TNM

►T= tumor sizeT= tumor size►N = lymph node involvementN = lymph node involvement►M = metastasisM = metastasis

Stage 1Stage 1

►Tumor Tumor << 2.0 cm 2.0 cm in greatest in greatest dimensiondimension

►No nodal No nodal involvement (N0)involvement (N0)

►No metastases No metastases (M0)(M0)

Stage IIStage II

►Tumor > 2.0 Tumor > 2.0 << 5 5 cmcm

oror►Ipsilateral axillary Ipsilateral axillary

lymph node (N1)lymph node (N1)►No Metastasis (M0)No Metastasis (M0)

Stage IIIStage III

►Tumor > 5 cm (T3)Tumor > 5 cm (T3)►or ipsilateral axillary lymph nodes or ipsilateral axillary lymph nodes

fixed to each other or other fixed to each other or other structures (N2)structures (N2)

►involvement of ipsilateral internal involvement of ipsilateral internal mammary nodes (N3)mammary nodes (N3)

►Inflammatory carcinoma (T4d)Inflammatory carcinoma (T4d)

Stage IV (Metastatic breast Stage IV (Metastatic breast cancercancer))

►Any TAny T►Any NAny N►Metastasis (M1)Metastasis (M1)

Types of breast cancerTypes of breast cancer

► In situIn situ Intraductal (DCIS)Intraductal (DCIS) Intralobular (LCIS)Intralobular (LCIS)

► InvasiveInvasive Infiltrating ductal carcinomaInfiltrating ductal carcinoma Tubular carcinomaTubular carcinoma Medullary carcinomaMedullary carcinoma Mucinous carcinomaMucinous carcinoma

Symptoms and Symptoms and ScreeningScreening

Normal breast physiology and Normal breast physiology and anatomyanatomy

►Symmetry and balanceSymmetry and balance►SizeSize

weightweight menstrual cyclemenstrual cycle pregnancy and lactationpregnancy and lactation

►TextureTexture►ShapeShape

ageage

Abnormal signs and symptomsAbnormal signs and symptoms

►PuckeringPuckering►DimplingDimpling►RetractionRetraction►Nipple dischargeNipple discharge►Thickening of skin or lump or “knot”Thickening of skin or lump or “knot”►Retracted nippleRetracted nipple

Abnormal signs and Abnormal signs and symptomssymptoms

►Change in breast sizeChange in breast size►Pain or tendernessPain or tenderness►RednessRedness►Change in nipple positionChange in nipple position►Scaling around nipplesScaling around nipples►Sore on breast that does not healSore on breast that does not heal

Methods of DetectionMethods of Detection

►Clinical exam by MD or nurseClinical exam by MD or nurse►MammographyMammography►Monthly breast self-exam Monthly breast self-exam

(BSE)(BSE)

Clinical examinationClinical examination►Performed by doctor or Performed by doctor or

trained nurse practitionertrained nurse practitioner►Annually for women over Annually for women over

4040►At least every 3 years for At least every 3 years for

women between 20 and 40women between 20 and 40►More frequent examination More frequent examination

for high risk patientsfor high risk patients

MammographyMammography► X-ray of the breastX-ray of the breast► Has been shown to Has been shown to

save lives in patients save lives in patients 50-6950-69

► Data mixed on Data mixed on usefulness for usefulness for patients 40-49patients 40-49

► Normal mammogram Normal mammogram does not rule out does not rule out possibility of cancer possibility of cancer completelycompletely

MammographyMammography

American Cancer Society recommends:American Cancer Society recommends:

Women (asymptomatic) 40 Women (asymptomatic) 40 years of age and older should years of age and older should have a mammogram every have a mammogram every yearyear..

Mammography-more Mammography-more guidelinesguidelines

►Mammogram facility guidelinesMammogram facility guidelines►Avoid mammogram week before periodAvoid mammogram week before period►Don’t wear deodorant powder or creamDon’t wear deodorant powder or cream►Bring a list of the places and dates of Bring a list of the places and dates of

other mammograms,other mammograms, biopsies you’ve biopsies you’ve had beforehad before

► If you don’t hear from the MD within 10 If you don’t hear from the MD within 10 days, call the facilitydays, call the facility

Breast Self ExaminationBreast Self Examination►Opportunity for woman to Opportunity for woman to

become familiar with her become familiar with her breastsbreasts

►Monthly exam of the Monthly exam of the breasts and underarm breasts and underarm areaarea

►May discover any May discover any changes earlychanges early

►Begin at age 20, continue Begin at age 20, continue monthlymonthly

When to do BSEWhen to do BSE► Menstruating women- 5 to 7 days Menstruating women- 5 to 7 days

after the beginning of after the beginning of their periodtheir period► Menopausal women - Menopausal women - same date each monthsame date each month► Pregnant women – Pregnant women – same date each monthsame date each month► Takes about 20 minutesTakes about 20 minutes► Perform BSE at least Perform BSE at least once a monthonce a month► Examine all breast tissueExamine all breast tissue

Why don’t more women Why don’t more women practice BSE?practice BSE?

►FearFear►EmbarrassmentEmbarrassment►YouthYouth►Lack of knowledgeLack of knowledge►Too busy, Too busy,

forgetfulnessforgetfulness

ConclusionConclusion

HEALTH HEALTH PROFESSIONALS;PROFESSIONALS;

have a have a responsibility as responsibility as

patient advocates patient advocates for breast cancer for breast cancer

awarenessawareness

THANK YOUTHANK YOU

POYRAZLAR LAKE / SAKARYA / TURKEY

SAKARYA / TURKEY

SAKARYA UNIVERSITY CAMPUS

SAKARYA UNIVERSITY CAMPUS

SAKARYA UNIVERSITY CAMPUS