Breast Cancer Awareness Prevention, Early Diagnosis and Treatment

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1 Breast Cancer Awareness Prevention, Early Diagnosis and Treatment Helena R. Chang, M.D., Ph.D Revlon/ UCLA Breast Center

2 Overview Statistics Demographics Risk Factors Risk Reduction Primary Prevention Breast Cancer Screening Treatment

3 Breast Cancer Statistics in U.S. & California Years New invasive Cases Deaths Total Female Total Female 2000 US 182,000 40, US 212, ,300 40,200 39,800 CA 21,100 4, US 217, ,990 40,580 40,110 CA 21,860 4, US 194, ,370 40,610 40,170 CA 21,740 4,030

4 Overview Demographics in Breast Cancer Statistics in Los Angeles County LA population 9,862,049 with 12.9% being Asian and 0.3% being Pacific Islanders Incidence of breast cancer for the county 113.7/100,000 population for white for African American for Asian/Pacific Islanders 94.6 for Hispanic 79.4

5 Overview Demographics in Breast Cancer Statistics in Los Angeles County (cont.) Asian dense areas, San Gabriel Valley and LA metro may be targeted for community profile to understand the breast cancer care needs.

6 Risk Factors for Breast Cancer Family history of breast &/or Ovarian Cancer BRCA mutation carriers Personal history of LCIS, ADH etc. Personal history of radiation to breast area Aging Postmenopausal weight gain Postmenopausal hormone replacement treatment

7 Risk Factors for Breast Cancer (cont.) Early menarche and late menopause Late first full term delivery (after 30) or no child bearing Multiple breast biopsies Mammographically dense breasts High soy diet Large alcohol consumption Low vitamin D level

8 Breast Cancer Risk Reduction Avoid postmenopausal obesity Keep alcohol consumption low Regular exercise Keep an adequate Vitamin D level Avoid long term hormone use

9 Breast Cancer Prevention for High Risk Women Tamoxifen Evista Surgery

10 Breast Cancer Screening for Early Detection Early: small &/or nonpalpable breast cancer without lymph node involvement Advanced: large breast mass with swollen lymph glands, possible skin &/or chest wall involvement by the tumor mass, or disease spread beyond breast and lymph nodes.

11 Breast Cancer Screening BSE- monthly, starting after 20 CBE- every 3 years after 20 yearly after 40 Screening mammography- yearly after 40

12 Mammographic Abnormalities Clustered or linear, branching or increasing small calcifications Speculated mass or mass with an irregular borders Architecture distorsion

13 Ultrasound Abnormality Solid mass- taller than wide Irregular or lobular borders Shadow behind mass Increased vascularity in mass Interval growth

14 Indications for Breast MRI HR family history BRCA mutation, Li-Fraumeni, Cowden Syndrome LCIS, Atypia Silicon mass/ implant with mass Axillary lymph node: unknown primary Breast cancer

15 Contraindications for MRI Pregnancy Allergy to MRI contrast Poor kidney function

16 Mammography vs MRI in Breast Cancer Screening Mammography 40 years of age lower sensitivity in dense breasts no contrast injection rapid imaging low cost MRI high risk women high sensitivity including dense breasts IV contrast lengthy study expansive

17 Signs and Symptoms of Breast Cancer Lump- new, hard, discrete and growing mass or new asymmetry Skin- dimpling, redness, swollen, or ulceration or nodules Nipple- newly developed inversion, eczema, bloody or clear nipple discharge Arm pit-swollen glands

18 Local Treatment for breast Cancer Small Tumor Lumpectomy and radiation Large Tumor Mastectomy ± reconstruction ± radiation

19 Lymph Node (LN) Surgery Clinically Negative LN Clinically Positive LN Sentinel LN biopsy Axillary LN dissection

20 Medications for Treating Breast Cancer For Hormone Receptor Positive Breast Cancer Tamoxifen for all ages Aromatase inhibitors for postmenopausal women 5 years usage for both, lifetime use for advanced stage

21 Medication for Treating Breast Cancer Chemotherapy for Triple negative breast cancer HER2 positive breast cancer Metastatic LN (s) Large tumor size Disease spread beyond breast and lymph nodes

22 Medication for Breast Cancer Target therapy Herceptin for HER2 positive tumor Many new drugs are being tested for different types of breast cancer.

23 Summary Statistics Demographics Risk Factors Risk Reduction Primary Prevention Breast Cancer Screening Treatment