Breast cancer screening dr.ayman jafar

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Text of Breast cancer screening dr.ayman jafar

  • Good evening,I will be presenting breast cancer screening. I am going to speak on incidence, risk factors, discuss the screening guidelines and available modalities of screeningAs you all know that breast cancer of great concern for women all over the world*

  • ObjectivesDemonstrate the incidence of breast cancer, facts and statistics

    Review the risk factors of breast cancer and the tools of risk estimation

    Outline the various current screening guidelines and related controversy

    Discuss the available modalities for breast cancer screening ( indication, benefits, harms)

  • Introduction Worldwide, breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death in women.

    In the United States, breast cancer accounts for 29% of all cancers in women and is second only to lung cancer as a cause of cancer deaths

    1 in 8 U.S. women (about 12%) will develop breast cancer over the course of her lifetime.Because of early detection, intervention, and postoperative treatment, breast cancer mortality has been decreasing.

    Mammography for screening has largely contributed to early detection

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  • Incidence

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  • Incidence rates breast cancer vary greatly worldwide

    This map shows the incidence of breast cancer in the world.The highest incidence is in western Europe, northern America and Australia.and the lowest incidence in Africa and Asia

    Belgium had the highest rate of breast cancer, followed by Denmark and France.*

  • Incidence

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  • Incidence

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  • Incidence

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  • Incidence

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  • Incidence

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  • Incidence

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  • Incidence

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  • Incidence: Year

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  • Incidence: Age

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  • Incidence: Race

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  • Mortality

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  • Mortality

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  • Mortality Percent of Deaths by Age GroupThe percent of breast cancer deaths is highest among women aged 55-64.Median Age at death68

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  • Mortality

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  • Risk Factors

  • RISK FACTORSRisk Factors

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  • Risk Factors

    Risk FactorsEstimated Relative RiskAdvanced age>4Family history Family history of ovarian cancer in women < 50y>5 One first-degree relative>2Two or more relatives (mother, sister)>2Personal historyBreast cancer history3-4PositiveBRCA1/BRCA2mutation>4Breast biopsy with atypical hyperplasia4-5Breast biopsy with LCIS or DCIS8-10

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  • Risk Factors

    Con. Risk FactorsEstimated Relative RiskReproductive historyEarly age at menarche (< 12 y)2Late age of menopause1.5-2Late age of first pregnancy (>30 y)/Nulliparity2Use of combined estrogen/progesterone HRT1.5-2Current or recent use of oral contraceptives1.25Lifestyle factorsAdult weight gain1.5-2Sedentary lifestyle1.3-1.5Alcohol consumption1.5

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  • Risk Factors

    BRCA1, BRCA2: genes produce tumor suppressor proteinsthat help repair damagedDNA and stabilize the cells genetic material.

    When mutated, or altered, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

    Specificinherited mutations inBRCA1andBRCA2increase the risk of breastand ovarian cancers

    Together,BRCA1andBRCA2mutations account for 20 to 25% of hereditary breast cancers and 5 to 10% ofallbreast cancers.

    Breast and ovarian cancers associated tend to develop at younger agesA harmfulBRCA1orBRCA2mutation can be inherited from a persons mother or father.

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  • Risk Factors

    BRCA1 mutation increases the risk 55 to 65%, and BRCA2 45%

    Genetic testing considered

    Breast cancer diagnosed before age 50 years Bilateral breast cancer Both breast and ovarian cancers in either the same woman or the same family Multiple breast cancers Male breast cancer Ashkenazi Jewish ethnicity

    Management of positive genetic test:

    1. Enhanced Screening; at younger ages, CBE, mammogram and MRI 2. Chemoprevention: Tamoxifen, Raloxifene 3. Prophylactic (Risk-reducing) Surgery.

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  • Risk Factors

    Risk estimation models

    Gail model Claus model BRCAPRO model CuzickTyrer model BOADICEA model

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  • Risk Factors

    Risk Assessment Model (Gail)

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  • Risk Factors

    Risk Assessment Model

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  • What is screening?

    Test and exam used to find a disease like cancer in people who do not have any symptoms. i.e. early detection

    Aiming at reduction of reduction of morbidity and mortality

    screeningis looking forcancerbefore a person has anysymptoms. This can help find cancer at an earlystage. Whenabnormaltissueor cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.Early detection remains the primary defense available to patients in preventing the development of life-threatening breast cancer, although advances in imaging technology and disagreements over recommended schedules have complicated the issue of screening.*

  • What is screening?

  • What benefit to screening?

    Early detection remains the primary defense available to patients in

    preventing the development of life-threatening breast cancer

    For 50-74 year group, there is an intimated 30% reduction in mortality

    For 40-49 year group, there is an intimated 17% reduction in mortality

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  • Guidelines

  • Guidelines

    For women younger than 40 years, monthly breast self-examination (BSE) and clinical breast exams every 3 years have been recommended, beginning at age 20 years. The most widely recommended screening approach in the United States has been annual mammography beginning at age 40 years*

  • Guidelines

  • Guidelines

    We can conclude the recommendations of ACS *

  • Guidelines(controversy)November, 2009

    In November 2009, however, the US Preventive Services Task Force (USPSTF) issued updated breast cancer screening guidelines that recommend against routine mammography before age 50 years. The specific USPSTF guidelines can be summarized as follows:No requirement for clinicians to teach women how to perform BSE (grade D recommendation); this recommendation is based on studies that found that teaching BSE did not reduce breast cancer mortality but instead resulted in additional imaging procedures and biopsies[2]No requirement for routine screening mammography in women aged 40-49 years (grade C recommendation); the decision to start regular, biennial screening mammography before age 50 years should be an individual one and should take into account patient context, including the patient's values regarding specific benefits and harmsBiennial screening mammography for women between age 50 and 74 years (grade B recommendation)Insufficient current evidence to assess the additional benefits and harms of screening mammography in women aged 75 years or olderInsufficient current evidence to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women aged 40 years or older

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  • Guidelines(controversy)

  • Guidelines(controversy)

  • Guidelines(controversy)

    Despite the USPSTF recommendations, the American College of Obstetricians and Gynecologists (ACOG) continues to recommend counseling patients that BSE has the potential to detect palpable breast cancer and can be performed.[3]ACOG also continues to recommend adherence to its current guidelines, which include the following[3]:Screening mammography every 1-2 years for women aged 40-49 yearsScreening mammography every year for women aged 50 years or older*

  • At the end of recommendations it valuable to mention that Abu Dhabi Health Authority recommends mammography every 2 years for women 40 and above*

  • Screening Modalities

    Moving to discuss the modalities of screening. In fact there are 5 screening modalities *

  • Breast Self-Examination (BSE)Potential Benefits

    Simple and non-invasive testWomen gain a sense of control over their healthBecome comfortable with their own breasts Some breast cancer has been detected with BSEIncreased awareness of breast changesLumps can be palpated with a BSE

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  • Breast Self-Examination (BSE)Potential Harms

    Increased number of healthcare visitsTwice the number of benign breast biopsies Increased healthcare costsIncreased levels of cancer-related anxiety No change in mortality from breast

    cancer with detection from BSE

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  • Breast Self-Examination (BSE)

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  • Breast Self-Examination (BSE)

    Organizations that recommend BSEACOG Recommends monthly BSEAMARecommends BSE, no age specifiedSusan G. Komen FoundationRecommends monthly BSEOrganization that recommends against BSECanadian Task Force for Preventive HealthcareOrganizations that recommend further discussion or indicate insufficient evidenceACSStarting at age 20, pros and cons of BSE should be reviewed; it is the individual's choiceUS PSTFInsufficient evidence to recommend for or against BSENCINo specific recommendation

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  • Clinical Breast Examination (CBE)

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  • Clinical Breast Examination (CBE)Benefits Not tested independentlyClinical trial support combining CBE with mammography to enhance screening sensitivity, particularly in younger women in whom mammography may be less effective and in women who r