Breast Health, Screening and Breast Cancer …...Breast cancer screening with a mammogram looks for...
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Presenter name: Center for Community Outreach and Engagement Columbia University Herbert Irving Comprehensive Cancer Center Breast Health, Screening and Breast Cancer Prevention
Breast Health, Screening and Breast Cancer …...Breast cancer screening with a mammogram looks for changes in the breast over time If the screening test identifies a problem, more
Presenter name: Center for Community Outreach and Engagement
Columbia University Herbert Irving Comprehensive Cancer Center
Breast Health, Screening and Breast
Cancer Prevention
What we’ll be talking about today…
Breast cancer facts What is cancer? What causes it? Breast anatomy – what’s inside of a breast?What is breast cancer?What is breast cancer risk? How to reduce breast cancer riskWhat is breast cancer screening?Breast cancer screening guidelines based on riskAdditional information
Important things to know about breast cancerBreast cancer is the most common cancer in women in New York State (after skin cancer) and the
second most common cause of cancer death
Age differences: Over 75% of women who are diagnosed with breast cancer are age 50 or older. Younger women (6%) get more aggressive types of breast cancer
Ethnic differences: Although Caucasian women have a slightly higher rate of breast cancer than African American, African American women get it at younger ages than Caucasian women. Hispanic women have a lower rate but tend to get diagnosed with more advanced cancers
More women are surviving breast cancer in recent years due to 1) early detection, 2) finding breast cancer before it spreads and 3) because of improvements in treatment
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Presentation Notes
Why are there differences in breast cancer rates? Women from different racial and ethnic groups have different prevalence rates of some risk factors for breast cancer [10]. This may be a reason behind differences in breast cancer rates between groups [10]. Known risk factors that vary by race and ethnicity include [239-240,242-243,560]: Age at first period Age at menopause Age at first childbirth Body weight Breastfeeding Number of childbirths Menopausal hormone therapy (postmenopausal hormone use) For example, compared to Hispanic/Latina women and Black/non-Hispanic black/African-American women, white/non-Hispanic white women are more likely to have children at a later age and to have fewer children [10,239,242-243,560]. Compared to Hispanic women, non-Hispanic white women are also more likely to use menopausal hormone therapy and less likely to breastfeed [560]. Each of these factors increases breast cancer risk [10].
What is cancer?Cancer cells are damaged cells that can multiply without stopping, creating tumors that
can spread into other parts of the body.
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Normal cells grow, divide and die in an orderly fashion. Cancer cells develop because of damage to DNA. Damage to cells may be inherited or due to environmental exposure. The difference between normal and cancer cells are that they continue to grow, divide and form abnormal cells. https://breastcancernow.org/about-breast-cancer/have-you-recently-been-diagnosed-with-breast-cancer/how-breast-cancer-starts-and-grows
What causes cancer?
It is thought that a combination of harmful exposures in the environment, gene mutations and lifestyle that can lead to cancer
There are hundreds of types of cancers and the causes of many of those cancers are still unknown
Ducts–tiny tubes that carry the milk from the lobules to the nipple
Stroma–fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels
Breast cancer most often begins with cell changes in the breast milk ducts and may grow and spread from there.
What is breast cancer?
Normal milk duct
Non invasive cancer: Cancer cells stay inside the duct
Invasive cancer:Cancer cells spread out of the duct to other parts of the breast
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Cancer spreads in three important ways: Damaged cells multiply, creating more damaged cells that become tumors. Our body’s hormones and chemicals can accelerate the growth of some tumors Cancer can travel to others areas of the body by way of lymph and blood vessels https://www.bci.org.au/breas t-cancer-information/fact-sheets/ductal-carcinoma-situ-dcis/
Recognizing the signs and symptoms of breast cancer
The most common symptom is a lumpor mass in the breast
One breast suddenly larger or misshapen as compared to the other (new breast asymmetry)Bloody nipple dischargeNipple inversionCrusting around nippleRedness, heat or swelling of the breastOrange peel skin
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Often there are no symptoms.
Something that can make you more likely to develop a condition, like breast cancer is called a risk factor.
What risk factors can make someone more likely to develop breast cancer?
Older age
Obesity & obesity after menopause
Inherited gene mutationLack of
exercise
Birth after 30Drinking Alcohol
Unhealthy diet
Breast density
Breast cancer in self/family
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http://womansvibe.com/five-important-risk-factors-breast-cancer/ THE LIGHT COLORED CIRCLES ARE MODIFIABLE RISK FACTORS.
Who is at high risk for breast cancer?
Women known to be at high risk for breast cancer have;1) genetic mutations 2) previous breast cancer3) family history of breast cancer
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Acs and ncnn guidelines https://ww5.komen.org/BreastCancer/BreastCancerScreeningForWomenAtHigherRisk.html
Learn your family history of breast cancer and share with doctorsGet regular screening- mammograms
There is no sure way to prevent breast cancer but there are lifestyle changes all women can make to reduce their breast cancer risk
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According to the federal government’s Dietary Guidelines for Americans 2015-2020, individuals who do not drink alcohol should not start drinking for any reason. It recommends that if alcohol is consumed, it should be done in moderation and defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men. Heavy alcohol drinking is defined as having 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more drinks on any day or 15 or more drinks per week for men. Binge drinking is defined as consuming 4 or more drinks for women and 5 or more drinks for men in one sitting (typically in about 2 hours). Breast cancer: Epidemiologic studies have consistently found an increased risk of breast cancer with increasing alcohol intake. Pooled data from 118 individual studies indicates that light drinkers have a slightly increased (1.04-fold higher) risk of breast cancer, compared with nondrinkers. The risk increase is greater in moderate drinkers (1.23-fold higher) and heavy drinkers (1.6-fold higher) (4, 9). An analysis of prospective data for 88,000 women participating in two US cohort studies concluded that for women who have never smoked, light to moderate drinking was associated with a 1.13-fold increased risk of alcohol-related cancers (mostly breast cancer) (5). https://www.breastcancer.org/risk/factors/smoking Smoking causes a number of diseases and is linked to a higher risk of breast cancer in younger, premenopausal women. Research also has shown that there may be link between very heavy second-hand smoke exposure and breast cancer risk in postmenopausal women. Smoking also can increase complications from breast cancer treatment, including: damage to the lungs from radiation therapy difficulty healing after surgery and breast reconstruction higher risk of blood clots when taking hormonal therapy medicines
What is breast cancer screening?Breast cancer screening with a mammogram looks for
changes in the breast over time
If the screening test identifies a problem, more testing may be needed
A mammogram may find cancer before someone can feel a lump or have any signs or symptoms of the disease
American Cancer Society recommendations for breast cancer screening for average risk
Age 40-44 years Discuss with doctor on when to begin screening
Age 45 to 54 years
Have a mammogram every year
55 years andolder
Have a mammogram every other year
Mammogram A 2D digital mammogram is a low
dose x-ray of the breast
The breast is pressed between 2 plates to flatten and spread the tissue for better visualization of the structures
This produces an image most often seen on a computer screen
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Although this may be uncomfortable for a moment, squeezing is necessary to get a good, "readable" mammogram. The compression only lasts a few seconds. The entire procedure for a screening mammogram takes about 20 minutes. This procedure produces a picture of the breast tissue either on a large sheet of film or as a digital computer image that is read, or interpreted, by a radiologist (a doctor trained to interpret images from x-rays, ultrasound, MRI, and related tests). A screening mammogram is used to identify signs of breast cancer in women who don’t have any breast symptoms or problems. X-ray images of each breast are taken from 2 different angles. A diagnostic mammogram utilizes exaggerated and focal views to better visualize abnormalities seen on screening mammograms.
How to prepare for a mammogram
Do not use deodorants or body powders on the day of the mammogram
Wear two piece clothing
Make a mammogram appointment the week after your menstrual period
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(Bullet 1) You should not wear deodorant or body powder on the day of your appointment. These products may show up on the mammography films as calcium spots and create a false image. (Bullet 2) A two-piece outfit makes undressing for the exam easier. (Bullet 3) It is best if you go for your mammogram at least a week after your period, because most women experience breast tenderness during their menses. (Added note) Prior mammograms are also important and used for comparison to observe subtle differences.
Regular screening with mammogram is important because…
It can find breast cancer early, before it has had time to spreadwhich means:
the cancer is easier to treat
it reduces the risk of dying from breast cancer
What is mammographic breast density?
Mammographic breast density is a measure used to describe the amount of glandular and connective tissue in the breast as compared with fat
High breast density finds a greater amount of glandular and connective tissue compared to fat.
Low breast density finds a greater amount of fat compared to breast and connective tissue.
Breast density does NOT describe how a breast feels to touch
Higher breast density is linked to an increased breast cancer risk
What does mammographic breast density look like?
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Mammographic breast density is a measure used to describe the amount of glandular and connective tissue in the breast as compared with fat High breast density finds a greater amount of glandular and connective tissue compared to fat. Low breast density finds a greater amount of fat compared to breast and connective tissue. Breast density does NOT describe how a breast feels to touch Higher breast density is linked to an increased breast cancer risk
Recommendations for women at high risk for breast cancer
Women at high risk for breast cancer include those with a family or personal history, genetic mutation for the breast cancer genes BRCA 1 and BRCA2.
They should speak with their doctor about:Screening with mammography before age 40Getting additional breast imaging with breast ultrasound or MRIGenetic counseling and testingReferral to high risk clinic to talk further with doctors
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(Bullet 1)These are steps that may be taken to be proactive regarding your breast health. (Bullet 2)Women that meet these criteria may undergo screening examinations more frequently and or additional tests such as an ultrasound and a MRI.
Breast ultrasound
A breast ultrasound is used to see whether a breast lump is filled with fluid (a cyst) or if it is a solid mass
An ultrasound is used in women with mammographic breast density
Breast MRI (Magnetic Resonance Imaging)An MRI uses magnets and radio waves to image organs of the body. A breast MRI is
most commonly used once breast cancer is diagnosed to determine spread of disease.The benefits and risks of screening high risk women with breast MRI is still beingstudied.
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MRI is recommended for women who: • Have a known BRCA1 or BRCA2 gene mutation • Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, but have not had genetic testing themselves • Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (see below) • Had radiation therapy to the chest when they were between the ages of 10 and 30 years • Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes ACS doesn’t recommend for or against MRI for women who: • Have a moderately increased risk of breast cancer (lifetime risk of breast cancer of 15% to 20%) according to risk assessment tools that are based mainly on family history (see below) • Are at increased risk of breast cancer because they have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH) • Have extremely or “heterogeneously” dense breasts as seen on mammograms If MRI is used, it should be in addition to, not instead of, a screening mammogram. For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%. Risk assessment tools Several risk assessment tools, with names such as the Claus model and the Tyrer-Cuzick model, are available to help health professionals estimate a woman's breast cancer risk. These tools give approximate, rather than precise, estimates of breast cancer risk based on different combinations of risk factors and different data sets. (Some of these tools can be found online, if anyone wants to look.) Some risk assessment tools, such as the Gail Model, are not based mainly on family history and so are not appropriate
Genetic counseling and family history
Women who have close family members diagnosed with breast cancer, and who have themselves been diagnosed with breast cancer can benefit from consultation with a genetic counselorThe counselor will chart who in the family has been diagnosed with
breast cancer and determine the level of risk for the women developing breast cancer. Women at high risk will be recommended for genetic testing
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Genetic testing
Genetic testing, done by providing a small blood sample The genes in the blood sample are tested for known genetic mutations
such as BRCA 1 and BRCA2Women with either of these BRCA mutations receive more counselling
and consultation to decide if risk lowering breast surgery is appropriateThese women can also be enrolled into high risk clinics and be monitored
more frequently
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Free cancer screening for uninsured New Yorkers
Manhattan Cancer Services ProgramNew York Presbyterian, Columbia University Medical
Center
212.851.4516
To call for genetic counseling/testing
Columbia DoctorsGenetic Counseling
212-305-6731
THANK YOUWhat are your
questions?
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Presentation Notes
Malignancies in Women with HIV Infection Nora T. Oliver1 and Elizabeth Y. Chiao2 Breast cancer remains the most common cancer type (23% of total new cancer cases) in women living in industrialized and non-industrialized countries [3]. It also is the most common cause of cancer-related deaths among women, accounting for 15% of total cancer deaths [3]. Breast cancer has previously been described as occurring less frequently in women with AIDS compared to the general population [48–50]. One large retrospective US study of women with AIDS followed for 665,987 pys showed a SIR 0.69 (95% CI, 0.62–0.77); however, increases over the follow-up period of locally/regionally-disseminated disease approached that of the general population [51]. Breast cancer treatment in HIV-infected women remains challenging because chemotherapeutic agents can also pose significant drug interactions with anti-retroviral therapies. Standard guideline-based therapies based on stage at diagnosis should be implemented for eligible HIV-infected women[54]. Rates of estrogen, progesterone, or HER-2/neu receptor status of breast tumors in HIV-infected women are not well established, but estrogen-receptor positivity has been reported in nearly 50% of cases [54, 55]. Close attention should be paid to drug interactions between breast cancer therapies, including hormonal therapies and antiretroviral therapies. Cancer-specific mortality in women with HIV in the post-cART era remains higher than in the general population (HR 3.43, 95% CI, 2.35–5.01) [2]. In one case series, progression free-survival at 5 years was 50% and median overall survival was 52 months [54, 55].
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