Health

Breast CancerScreening and Early Detection

Dr. Mohammed TarawnehConsultant Family Physician

What is Cancer?

A group of 100 different diseases

The uncontrolled, abnormal growth of cells

Cancer may spread to other parts of the body

What is Breast Cancer?The most common type of cancer in women in the Jordan and the second most frequent cause of death from cancer in women

A disease in which normal cells in the breast begin to change, grow without control, and no longer die

Cancer that has not spread is called in situ, meaning in place

Cancer that has spread is called invasive or infiltrating

Scope of Breast Cancer

Dr. Mohammed Tarawneh , Jordan-Amman, 26-28 / 4 / 2010**

Median Age at diagnosis of Female Breast cancer cases in some Arab Countries4953514847.649.646.44551Median Age in Developed Countries 65 years**Dr.Mohammed Tarawneh-NCD-MOH-2010

199650199750199850199951200051200151200250200349200449200550200651200750200851

Ten most common cancers among Jordanian Females, 2008 **Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart1

36.7

9.4

5.5

4.7

4.6

4

3.6

3.1

2.8

2.5

Sheet1

Breast36.7

Colo-rectal9.4

Corpus Uteri5.5

Thyroid4.7

NHL4.6

Leukemia4

Ovary3.6

Stomach3.1

Brain &CNS2.8

Lung2.5

Sheet1

0

0

0

0

0

0

0

0

0

0

Sheet2

Breast18.8

Colorectal11.9

Lung7.7

Lymphoma7.2

Leukemia5.3

Urinary Bladder4.3

Stomach3.6

Prostate3.5

Brain & CNS3.3

Thyroid3.2

Sheet2

0

0

0

0

0

0

0

0

0

0

Sheet3

Ten most common cancers among Jordanians ( both genders ) 2008 **Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart2

18.8

11.9

7.7

7.2

5.3

4.3

3.6

3.5

3.3

3.2

Sheet1

Breast36.7

Colo-rectal9.4

Corpus Uteri5.5

Thyroid4.7

NHL4.6

Leukemia4

Ovary3.6

Stomach3.1

Brain &CNS2.8

Lung2.5

Sheet1

Sheet2

Breast18.8

Colorectal11.9

Lung7.7

Lymphoma7.2

Leukemia5.3

Urinary Bladder4.3

Stomach3.6

Prostate3.5

Brain & CNS3.3

Thyroid3.2

Sheet2

Sheet3

4466623536062332**Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart1

27.6

9.5

7.7

5.8

4.7

44.7

Top Five female cancers-Palestine-WB-98-2005

26.7%

9.5%

7.7%

5.8%

4.7%

44.7%

Sheet1

Breast34.8

Colo-rectal9

Leukaemia7.8

Thyroid5.5

Uterus4.7

Others38.2

Breast40.2

Colo-rectal7.6

Lung6.6

Lymphoma-NH4.1

u.Bladder3.6

Others37.9

syria

Breast34

Uterus6.5

Colo-rectal6.4

Lymphoma-NH5.6

Stoamch2.9

Others44.6

PalestineBreast27.6

Colo-rectal9.5

Lymphoma-NH7.7

Leukemia5.8

Uterus4.7

Others44.7

KSA

Breast22.4

Thyroid9.4

Colo-rectal8

Lymphoma-NH6.4

leukemia5.6

Others48.2

Oman

Braest21.1

Thyroid8

Stomach7.5

Lymphoma-NH5.8

Cervix5.8

Others51.8

Sheet1

Top Five cancers -Jordan-Females-2005

Sheet2

Top Five Cancers-Lebanon-Females-2003

Sheet3

11.4

11.2

10.7

8.1

7.6

51

Top Five Cancers- Jordan-Males- 2005

Top Five Cancers-Syria-Females-2005

Top Five Cancers-Palestine-WB-Females-98-2005

Top Five-Cancers-KSA-Females-2004

16.5

16

15

7.9

4.8

39.8

Top Five Cancers- Lebanon-Males-2003

Top Five Cancers-Oman -Females-2005

Chart1

29.7

8.6

6.9

6.4

5.5

42.9

Top Five Female cancers -Syria -2006

oman-2007

Breast12.1

Thyroid4.1

NHL2.9

Cervix2.7

Ovary2.6

Others75.6

oman-2007

Top Five Female Cancers -Oman -2007

male-female

MF

UAE46.553.5

Bahrain4852

KSA50.449.6

Oman53.146.9

Qatar48.151.9

Kuwait43.556.5Jordan Male cases 2048 (47.3%) . Female cases 2284 ( 52.7%).

Jordan47.352.7Syria Male cases 7315 (53%) Females 6185 ( 43%)3088052.60%Females2786347.40%

Lebanon49.950.1Kuwait Male cases 2227 ( 43.5%) Female cases 2898 ( 56.5%)

Syriya52.647.4Oman - Male cases 533 ( 52.4%) Female cases 484 ( 47.6%)

Palestine4655KSA - Male cases 26016 ( 50.4 %) Female cases 25571 (49.6 %)

Bahrain - Male cases 1602 ( 48%) Female cases 1736 ( 52%)

male-female

M

F

proportion-3-countries

M

F

Sheet2

70KSA

Kuwait2.713.533.827.415.57.12654.8

KSA4.822.731.82013.27.5124222.7

Jordan2.314.231.323.117.311.8173431.7

Lebanon4.716.128.326.316.97.7109420

72313.2

4097.5

546799.9

Sheet2

KSA

Kuwait

Lebanon

Jordan

Breast cancer:proportions by age group , Jordan , Lebanon,Kuwait and KSA

Syria

70

Kuwait2.713.533.827.415.57.1

KSA4.822.731.82013.27.5

Jordan2.314.231.323.117.311.8

Lebanon4.716.128.326.316.97.7

KSA

Breast29.7

Leukemia8.6

Uterus6.9

Thyroid6.4

CNS5.5

Others42.9

KSA


Breast21.4

Thyroid9.7

Colorectal7.3

NHL6.4

Leukemia2.9

Others52.3

Top-Five Female Cancers -KSA 98-2005

MBD0007688F.xls

Chart1

0.81535.331.613.53.8Kuwait

8.422.731.82013.27.5ksa

2.314.231.323.117.311.8Jordan

4.716.128.326.316.97.7Lebanon

70

Sheet1

196620

1983301966198319982003

199846.7203046.769.2

200369.2

Sheet1

Sheet4

70

Kuwait0.81535.331.613.53.8JordanLebanonKuwait

ksa8.422.731.82013.27.5

Jordan2.314.231.323.117.311.87011.87.73.8

Sheet4

70

Sheet2

70

Kuwait2.713.533.827.415.57.1

Jordan2.314.231.323.117.311.8

Lebanon4.716.128.326.316.97.7

Sheet2

Kuwait

Jordan

Lebanon

Sheet3

JordanLebanon

02.9

123.217

1130.547

11120.424

1V13.512

UK9.5

Sheet3

Jordan

Lebanon

Breast Cancer -Stage of Disease

MBD0007688E.xls

Chart12

22.4Breast

9.4Thyroid

8Colo-rectal

6.4Lymphoma-NH

5.6leukemia

48.2Others

Top Five Female cancers-KSA-2004

Sheet1

Breast34.8

Colo-rectal9

Leukaemia7.8

Thyroid5.5

Uterus4.7

Others38.2

Breast40.2

Colo-rectal7.6

Lung6.6

Lymphoma-NH4.1

u.Bladder3.6

Others37.9

syria

Breast34

Uterus6.5

Colo-rectal6.4

Lymphoma-NH5.6

Stoamch2.9

Others44.6

PalestineBreast27.6

Colo-rectal9.5

Lymphoma-NH7.7

Leukemia5.8

Uterus4.7

Others44.7

KSA

Breast22.4

Thyroid9.4

Colo-rectal8

Lymphoma-NH6.4

leukemia5.6

Others48.2

Oman

Braest21.1

Thyroid8

Stomach7.5

Lymphoma-NH5.8

Cervix5.8

Others51.8

Sheet1

0

0

0

0

0

0


Sheet2

0

0

0

0

0

0


Sheet3

11.4

11.2

10.7

8.1

7.6

51


0

0

0

0

0

0


0

0

0

0

0

0


00

00

00

00

00

00


16.5

16

15

7.9

4.8

39.8


0

0

0

0

0

0


Chart1

38.3

7.8

6

5.9

4.6

37.4

Top Five Female cancers -Lebanon-2004

oman-2007

Breast12.1

Thyroid4.1

NHL2.9

Cervix2.7

Ovary2.6

Others75.6

oman-2007

Top Five Female Cancers -Oman -2007

male-female

MF

UAE46.553.5

Bahrain4852

KSA50.449.6

Oman53.146.9

Qatar48.151.9palestinemales453650.40%females446649.60%

Kuwait43.556.5Jordan Male cases 2048 (47.3%) . Female cases 2284 ( 52.7%).

Jordan47.352.7Syria Male cases 7315 (53%) Females 6185 ( 43%)3088052.60%Females2786347.40%

Lebanon49.950.1Kuwait Male cases 2227 ( 43.5%) Female cases 2898 ( 56.5%)

Syriya52.647.4Oman - Male cases 533 ( 52.4%) Female cases 484 ( 47.6%)

Palestine50.449.6KSA - Male cases 26016 ( 50.4 %) Female cases 25571 (49.6 %)

Bahrain - Male cases 1602 ( 48%) Female cases 1736 ( 52%)

male-female

M

F

proportion-3-countries

M

F

Sheet2

70KSA

Kuwait2.713.533.827.415.57.12654.8

KSA4.822.131.82013.27.499.3124222.7

Jordan2.314.231.323.117.311.8173431.7

Lebanon4.716.128.326.316.97.7109420

72313.2

4097.5

546799.9

Sheet2

KSA

Kuwait

Lebanon

Jordan

Breast cancer:proportions by age group , Jordan , Lebanon,Kuwait and KSA

Syria

70

Kuwait2.713.533.827.415.57.1

KSA4.822.731.82013.27.5

Jordan2.314.231.323.117.311.8

Lebanon4.716.128.326.316.97.7

Lebanon

Breast29.7

Leukemia8.6

Uterus6.9

Thyroid6.4

CNS5.5

Others42.9

Lebanon


KSA

Breast38.3

Colorectal7.8

Lung6

NHL5.9

Ovary4.6

Others37.4

KSA

Top Five Female cancers -Lebanon-2004

Breast21.4

Thyroid9.7

Colorectal7.3

NHL6.4

Leukemia2.9

Others52.3

Top-Five Female Cancers -KSA 98-2005

MBD000768AE.xls

Chart1

0.81535.331.613.53.8Kuwait

8.422.731.82013.27.5ksa

2.314.231.323.117.311.8Jordan

4.716.128.326.316.97.7Lebanon

70

Sheet1

196620

1983301966198319982003

199846.7203046.769.2

200369.2

Sheet1

Sheet4

70

Kuwait0.81535.331.613.53.8JordanLebanonKuwait

KSA4.822.731.82013.27.5

Jordan2.314.231.323.117.311.87011.87.73.8

Sheet4

70

Sheet2

70

Kuwait2.713.533.827.415.57.1

Jordan2.314.231.323.117.311.8

Lebanon4.716.128.326.316.97.7

Sheet2

Kuwait

Jordan

Lebanon

Sheet3

JordanLebanon

02.9

123.217

1130.547

11120.424

1V13.512

UK9.5

Sheet3

Jordan

Lebanon

Breast Cancer -Stage of Disease

MBD000768AD.xls

Chart12

22.4Breast

9.4Thyroid

8Colo-rectal

6.4Lymphoma-NH

5.6leukemia

48.2Others

Top Five Female cancers-KSA-2004

Sheet1

Breast34.8

Colo-rectal9

Leukaemia7.8

Thyroid5.5

Uterus4.7

Others38.2

Breast40.2

Colo-rectal7.6

Lung6.6

Lymphoma-NH4.1

u.Bladder3.6

Others37.9

syria

Breast34

Uterus6.5

Colo-rectal6.4

Lymphoma-NH5.6

Stoamch2.9

Others44.6

PalestineBreast27.6

Colo-rectal9.5

Lymphoma-NH7.7

Leukemia5.8

Uterus4.7

Others44.7

KSA

Breast22.4

Thyroid9.4

Colo-rectal8

Lymphoma-NH6.4

leukemia5.6

Others48.2

Oman

Braest21.1

Thyroid8

Stomach7.5

Lymphoma-NH5.8

Cervix5.8

Others51.8

Sheet1

0

0

0

0

0

0


Sheet2

0

0

0

0

0

0


Sheet3

11.4

11.2

10.7

8.1

7.6

51


0

0

0

0

0

0


0

0

0

0

0

0


00

00

00

00

00

00


16.5

16

15

7.9

4.8

39.8


0

0

0

0

0

0


Chart1

36.7

9.4

5.5

4.7

4.6

39.1

Top-Five -Female cancers-Jordan-2008

Sheet1

Breast85536.7Breast36.736.7

Colo-rectal2199.4Colo-rectal9.49.4

Corpus Uteri1275.5Corpus Uteri5.55.5

Thyroid1094.7Thyroid4.74.7

Non- Hodgkin's Lymphoma1074.6NHL4.64.6

Leukemia944Others39.160.9

Ovary833.6

Stomach733.1

Brain &CNS652.8

Lung592.5

76.9

Sheet1

Sheet2

Sheet3

199619971998199920002001200220032004200520062007Number of registered Female breast cancer cases in Jordan, 1996-2008Projection !!! Breast Cancer in Jordan will increase by 1.5 every 10 yearsYear2008X 2

Chart2

455

466

478

513

551

566

503

551

646

674

749

817

855

Sheet1

1996199719981999200020012002200320042005200620072008

455466478513551566503551646674749817855

Sheet1

0

0

0

0

0

0

0

0

0

0

0

0

0

Sheet2

Sheet3

*

19962000200520062007Trend of Female breast cancer incidence (ASR) - JordanASR / 100.0002020YearProjectedX 1.72008XX

Chart2

29.4

35.2

41.4

45.6

48.9

50.4

62.4

Sheet1

1012353815-63489528756878417

1996199719981999200020012002200320042005200620072008

455466478513551566503551646674749817895

Sheet1

455

466

478

513

551

566

503

551

646

674

749

817

Sheet2

96200020052006200720082020

29.435.241.445.648.950.462.4

Sheet2

29.4

35.2

41.4

45.6

48.9

50.4

62.4

Sheet3

*

New Cases of Breast Cancer JNCR- JordanYearsNumber of Cases28.5%32.7%35.8%% of female breast cancer of all female cancers 90%36.2%46%34.8%Projected36.7%

Age-Standardized Rate of Female breast cancer Jordan -2008- compared with some countries 3 / 12**Dr.Mohammed Tarawneh-NCD-MOH-2010

Incidence Rate /100.000 of Female Breast cancer by Governorates , 2008 CentralNorthSouth**Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart4

46.1

25.4

22.8

21.1

21.8

14.1

12.1

9.1

17.7

14.9

5.7

5.3

Sheet1

female breast 2008

%No

in situ3.227

Stage 123.3199

Stage 1128.8246

Stage 11123.1198

Stage 1V14.1121

Not known7.564

100855

Female breast 2007

stage%No

in situ2.924

Stage 123.7193

Stage 1131.4257

Stage 11121.1172

Stage 1V13.9114

Not known757

100817

Sheet1

3.2

23.3

28.8

23.1

14.1

7.5

Percentage Distribution of Female Breast Cancer cases by stage - 2008

Sheet2

2.9

23.7

31.4

21.1

13.9

7

Percentage Distribution of Female Breast Cancer cases by stage -2007

Sheet3

Amman46.1

Zarqa25.4

Balqa22.8

Madaba21.1

Irbid21.8

Jarash14.1

Mafraq12.1

Ajlun9.1

Karak17.7

Tafiela14.9

Ma'an5.7

Aqaba5.3

0

0

0

0

0

0

0

0

0

0

0

0

CentralNorthSouthPercentages of Female Breast Cancer cases by Governorates -2008**Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart6

59.3

12.5

5

1.8

13

1.4

1.9

0.7

2.3

0.7

0.4

0.4

Sheet1

female breast 2008

%No

in situ3.227

Stage 123.3199

Stage 1128.8246

Stage 11123.1198

Stage 1V14.1121

Not known7.564

100855

Female breast 2007

stage%No

in situ2.924

Stage 123.7193

Stage 1131.4257

Stage 11121.1172

Stage 1V13.9114

Not known757

100817

Sheet1

3.2

23.3

28.8

23.1

14.1

7.5

Percentage Distribution of Female Breast Cancer cases by stage - 2008

Sheet2

2.9

23.7

31.4

21.1

13.9

7

Percentage Distribution of Female Breast Cancer cases by stage -2007

Sheet3

Amman59.3

Zarqa12.5

Balqa5

Madaba1.8

Irbid13

Jarash1.4

Mafraq1.9

Ajlun0.7

Karak2.3

Tafiela0.7

Ma'an0.4

Aqaba0.4

Sheet3

0

0

0

0

0

0

0

0

0

0

0

0

Amman46.1

Zarqa25.4

Balqa22.8

Madaba21.1

Irbid21.8

Jarash14.1

Mafraq12.1

Ajlun9.1

Karak17.7

Tafiela14.9

Ma'an5.7

Aqaba5.3

0

0

0

0

0

0

0

0

0

0

0

0

% Female Breast Cancer Jordan as compared with some countries 3**Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart1

32.3

16.2

18.4

19.6

21.1

23.5

28.2

29.7

35.7

36.7

38.4

42.3

36.7

35.7

Sheet1

US SEER 1999-200132.3

Oman16.2

UAE18.4

Tunisia19.6

KSA21.1

Algeria23.5

Qatar28.2

Kuwait29.7

Egypt35.7

Jordan36.7

Bahrain38.4

Lebanon42.3

Sheet2

Sheet3

% of Female Breast Cancer cases By Age-group during 1996-2008Age- group**Dr. Mohammed Tarawneh-NCD-MOH-2010

Chart6

0.1

15.9

30.2

23.9

18.7

9.3

Sheet1

1996199719981999200020012002200320042005200620072008

455466478513551566503551646674749817855

Sheet1

Sheet2

199621.4

199721.4

199821.3

199921.9

200022.9

200123.1

200223.2

200323.4

200424.9

200525.4

200627.6

200729.5

200830.2

Sheet2

Sheet4

< 2020-3940-4950-5960-6970+

20-3915.90-400.115.930.223.918.79.3

40-4930.25-0

50-5923.99-0

60-6918.715-190

70+9.320-2410.10.1

25-29182.12.1

30-34384.44.415.920-2914.74.7

35-39799.39.315.54.6

40-4412514.715.930.29.3

45-4913315.530.2

50-5411213.123.9

55-599310.818.7

60-6410412.2

65-69566.5

70-74534.79.3

75-79404.6

97.9

852

Sheet4

Sheet3

0-0

5-0

14-0

15-0

20-0.3

25-7.3

30-17.3

35-44.4

40-93

45-139.6

50-154.1

55-139.8

60-193.3

65-139.9

70-198.3

75-171.9

80- 84116.7

85+133.6

Sheet3

45.4%48.4%1.4%4.8%Percentages of Breast Cancer cases by laterality 1996-2008**Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart3

40.9

45.6

6.4

7.1

Chart1

1111

40.9

45.6

6.4

7.1

Sheet1

Right breast40.9

Left Breast45.6

Bilateral6.4

Unknown7.1

Sheet1

0

0

0

0

Sheet2

Sheet3

Percentages of Breast cancer cases by Histopathological type- Jordan/2008Infiltrating Duct Carcinoma IDCMedularyInfiltrating LobularAdenocarcinomaAll other Types Lebanon 82.6% Palestine 78.1% Kuwait 79.4% KSA 78.9% Oman 60% Egypt 74% US SEER (1999-2001 ) 70.2%% IDC4.81.45.984.7**Dr.Mohammed Tarawneh-NCD-MOH-2010

Chart1

77.4

8.5

7.1

3.2

8.8

84.7

Sheet1

Infiltrating Duct CarcinomaMedulary CarcinomaInfiltrating Lobular CarcinomaAdenocarcinomaOthers

77.48.57.13.28.8

Sheet1

0

0

0

0

0

0

0

0

0

0

Sheet2

Sheet3

*

2008Stage II 30.5%Stage I23.2%Stage III 20.4%Stage 0 2.9%9.5% unknownStage IV, 13.5%2007Stage I23.3%Stage II 28.8%Stage III 23.1%Stage IV, 14.1%Stage 0 3.2%7.5% unknownStage II 23.7%Stage 0, 0.5%Stage III 56.2%Stage 1 6.7%Stage IV, 12.9%2005Stages of Breast Cancer in Jordan based on JCR data69%37.2%

Stages 111-IV

What is the Structure of the Breast?

The breast is composed mainly of fatty tissue, which contains a network of lobes made up of tiny, tube-like structures called lobules that contain milk glands

Tiny ducts connect the glands, lobules, and lobes, and carry the milk from the lobes to the nipple

Blood and lymph vessels run throughout the breast

About 90% of all breast cancers originate in the ducts or lobes of the breast

Biology of the development of breast cancer

2) Risk factors for breast cancer (in light of biology)

3) Potential for modification of breast cancer riskOverview

InitiationPromotionProgressionProliferationIndependenceStages of Cancer FormationUnspecializedCellInitiatedCellBenignTumorMalignantTumorLatency Period, 20 years or more

Development of the Breast Ductal TreeDifferentiation Occurs With Pregnancy2 yearsAfter PubertyAfterPregnancyProliferationProliferationDifferentiationProliferationBirth

Cells at Risk Are Analogous to a Targets Bulls-eyeA larger number of cells at risk produces a larger (and easier to hit) bulls-eye.

Interaction of a Cell at Risk with a Carcinogen Can Produce an Initiated CellAn initiated cell is the first step in formation of a tumorFor an initiated cell to become a tumor both the Promotion and Progression stages have to occurThe larger the number of initiated cells the higher the breast cancer risk

What Are the Risk Factors for Breast Cancer?AgeRaceIndividual or family history of breast cancerA history of ovarian cancerA genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers)Estrogen exposureAtypical hyperplasia of the breastLobular carcinoma in situ (LCIS)Lifestyle factors (obesity, lack of exercise, alcohol use)Radiation

Hereditary Breast Cancer

About 15% of breast cancers are inheritedApproximately 80% of hereditary breast cancer is caused by mutations in the BRCA1 or BRCA2 genesWomen who inherit a BRCA mutation have a 50% to 85% chance of developing breast cancer in their lifetimeWomen with especially strong family history may consider preventive surgery to remove breast tissue and/or chemoprevention

Risk factorsAgeGenderFamily historyBenign breast diseaseReproductive factorsEndogenous hormonesExogenous hormones

AdiposityDietPhysical activityAlcoholRadiation

Age at menarcheLater age - lower riskAge 15 vs age 11 gives 30% lower risk to age 70Lack of physical activity associated with earlier menarcheDiet may play a role as might fewer childhood infections

MenopauseEarly menopause reduces riskHigh circulating hormones levels after menopause increase risk, as does use of postmenopausal hormonesAnti-estrogens may have a rolewho is target populationhow are they identified, counseled, etc.balance risks vs. benefits

Hormonal exposure after menopauseObesity is related to poor survivalTamoxifen reduces mortality among women with breast cancerTamoxifen and Raloxifene reduce risk of breast cancer in randomized controlled trials of breast cancer prevention

Weight and weight gainAdult weight gain increases risk of breast cancerRelation seen most clearly among postmenopausal women who never have used hormones20 kg gain from age 18 associated with doubling in risk of breast cancer vs. stable weight

Physical activityEvidence from more than 30 studiesTypical reduction in risk with 4 hours per week = 20% decrease in riskEvidence present for pre and postmenopausal womenBarriers to physical activity include neighborhood safety, time and family responsibilities, social pressures

Breast Cancer and Early DetectionEarly diagnosis means a better chance of successful treatmentMammography is the best tool doctors have to screen for breast cancerMany organizations recommend that women obtain a mammogram each year, starting at the age of 40Regular clinical breast examinations and breast self-examinations are also recommendedWomen are encouraged to discuss the frequency of screening with their doctors

What Are the Symptoms of Breast Cancer?

New lumps or a thickening in the breast or under the arm

Nipple tenderness, discharge, or physical changes

Skin irritation or changes, such as puckers, dimples, or new creases

Warm, red, swollen breasts with a rash resembling the skin of an orange

Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor)

No visible or obvious symptoms (asymptomatic)

How is Breast Cancer Evaluated?Screening and/or diagnostic mammography

Ultrasound

Magnetic Resonance imaging (MRI) scan

Biopsy is necessary to confirm a diagnosis

Blood tests are often used to determine if the cancer has spread outside the breast

Additional tests may be used to determine stage

Breast Cancer StagingStaging is a way of describing a cancer, such as the depth of the tumor and where it has spreadStaging is the most important tool doctors have to determine a patients prognosis Staging is described by the TNM system: the size of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to organs such as the liver or lungs)The type of treatment a person receives depends on the stage of the cancer

Stage 0 Breast CancerKnown as cancer in situ, meaning the cancer has not spread past the ducts or lobules of the breast (the natural boundaries)

Also called noninvasive cancer

Ductal carcinoma in situ (DCIS) is the most common in situ breast cancer

Stage I Breast CancerThe tumor is small and has not spread to the lymph nodes

Stage IIa Breast CancerStage IIa breast cancer describes a smaller tumor that has spread to the axillary lymph nodes (lymph nodes under the arm), or a medium-sized tumor that has not spread to the axillary lymph nodesStage IIa may also describe cancer in the axillary lymph nodes with no evidence of a tumor in the breast

Stage IIb Breast CancerStage IIb breast cancer describes a medium-sized tumor that has spread to the axillary lymph nodesStage IIb may also describe a larger tumor that has not spread to the axillary lymph nodes

Stage IIIa Breast CancerStage IIIa breast cancer describes any size tumor that has spread to the lymph nodes

Stage IIIb Breast CancerStage IIIb breast cancer has spread to the chest wall, or caused swelling or ulceration of the breast, or is diagnosed as inflammatory breast cancer

Stage IIIc Breast CancerStage IIIc breast cancer has spread to distant lymph nodes but has not spread to distant parts of the body

Stage IV Breast CancerStage IV breast cancer can be any size and has spread to distant sites in the body, usually the bones, lungs or liver, or chest wall

Diet, Lifestyle and Breast Cancer Risk

Vegetables and FruitsEating large amounts of vegetables, in general, may be linked to a small decrease in breast cancer riskSupplements do not appear to offer the same protection as foodEvidence is stronger for a decrease in risk with dark green and yellow vegetablesEating fruit, in general, is unrelated to breast cancer riskVegetables may have a greater effect for women with a family history of breast cancer

Anti-cancer Agents in Vegetables & Fruits Inhibition of Initiation Stage of Cancer Formation

Anti-cancer Agents in Vegetables & Fruits Inhibition of Initiation Stage of Cancer Formation Block carcinogen activationFlavonoids and isoflavonoidsCoumarinsIsothiocyanates in cruciferous vegetablesOrganosulfur compounds in garlic & onions Enhance carcinogen detoxificationAntioxidants in plantsIsothiocyanates in cruciferous vegetablesOrganosulfur compounds in garlic & onions C) Increase DNA repair

Polyphenols in green tea Selenium

Anti-cancer Agents in Fruits & VegetablesInhibition of Promotion Stage of Cancer Formation Scavenge reactive oxygen speciesAntioxidants in plants Alter proliferation & differentiationPhytoestrogens (+/-)Retinoids

Physical ActivityMay be associated with decreased breast cancer risk for women of all ages

Thought to possibly act by changing:Menstrual activityExercise may increase age at menarche2) Body characteristicsExercise can decrease body fat3) Hormone levelsExercise may decrease estrogen levels

Smoking TobaccoEffect of adult smoking (active & passive) is unclearAge beginning smoking may be importantHeavy smokers below age 20 have a 30% to 80% increase in breast cancer riskCigarette smoke contains numerous chemical which can initiate and promote cancerBreast fluids of smokers contain chemicals from cigarette smoke

Alcohol Use

Adult use associated with risk (about 10% increase for each drink per day) All studies have reported impact of early age alcohol use on breast cancer riskAbout twice the risk of breast cancer for women below 35 yearsAlcohol use increases estrogen levelsAdequate folic acid (B vitamin) may decrease risk in women who have more than 1 drink per day

Obesity

Associated with decreased premenopausal breast cancer risk (25% decrease)Interferes with regular menstrual cyclingLess proliferation in breastAssociated with increased postmenopausal breast cancer risk (about 200% increase)Increases estrogen exposureFat cells form estrogen from other hormones

InitiationPromotionProliferationIndependenceUnspecializedCellInitiatedCellBenignTumorDecrease Initiation Process1) Minimize Exposures2) Childbirth3) Diet4) Avoid radiation exposureDecrease cells at risk ChildbirthDiet?Eliminate Initiated CellsChildbirth?Diet?Decrease Promotion ProcessDecrease estrogenic exposuresChildbirthDietPhysical Activity

PreventionPrevention today refers mainly to lowering the risk of disease. Risk of most chronic diseases can't be totally eliminated, it can still be significantly reduced. If everyone in the US led a healthy lifestyle, 80% of the cases of heart disease and diabetes could be avoided, as could 70% the cases of stroke and over 50% of cancer.

How is Breast Cancer Treated?Treatment depends on stage of cancer

More than one treatment may be used

Surgery

Radiation therapy

Chemotherapy

Hormone therapy

Targeted therapy

End

*

In all Sham countries breast cancer ranked the first among female cancers .

The highest proportion reported from Lebanon 40% compared with 27% from Palestine.

In Jordan and Syria , breast cancer accounted one third of all female cancers The trend of ASR by years Its increased from 29.4per 100.000 women in 1996 to 48.9/100.00 in 2007 So the increment is about one and half Incidence doubled in 40 years20 / 100.000 women per year in 1966(Abou Daoud: Cancer 1966)30 / 100.000 women/year for 1983-2000(El Saghir et al: LMJ 2002)46.7 / 100.000 women per year for 1998Incidence higher in 2003 study: Reported on MOH website (SAdib et al: MOH Lebanon Website)How to read this slide ?1- 1/3 of the cases were at the age-group-40-49 years2- Approximately of the cases at the age-group 20-493- 70% of the cases below 60 years******************

Documents

Health