Department of oncology UWM Epidemiology Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death The American Cancer Society has estimated that 279100 Americans will be diagnosed with breast cancer and 42690 ID: 913511
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Slide1
Dawid Sigorski, Ph.D .Department of oncology UWM
Slide2Epidemiology
Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death.
The American Cancer Society has estimated that 279,100 Americans will be diagnosed with breast cancer and 42,690 will die of disease in the United States in 202
0.
Slide3Slide4Breast cancer- Predisposing risk factors
Female
gender
Age Late
age
of
menopause
Hormonal
contraceptise methodsPostmenopausal hormone therapyGenetic factors Positive famility history of breast cancerBenign breast disordesObesity and overweightAlkohol consumptionSmokingDietSocioeconomic statusDiabetesRadiation
Slide5Primary prevention Breast cancer
Control of weightLimit
hormonal
therapyTabacco cessationAlcohol limitation
Slide6Sympthoms
Slide7Slide8Slide9BIRADS
Slide10a
- The breast are almost entirely fatty.Mammography is highly sensitive in this setting.b- There are scattered areas of
fibroglandular
density.
The term density describes the degree of x-ray attenuation of breast tissue but not discrete mammographic findings.
c
- The breasts are heterogeneously dense,
which may obscure small masses.
Some areas in the breasts are sufficiently dense
to obscure small masses.
d
- The breasts are extremely dense, which lowers the sensitivity of mammography.
Slide11Slide12WHO- precursor lesions
Non
invasive
lobular
neoplasia
Atypical
lobular
hyperplasia
Lobular
carcinoma in situ NST
Classic
lobular
carcinoma in situ
Florid
lobular
carcinoma in situ
Lobular
carcinoma in situ,
pleomorphic
Ductal
carcinoma in situ (DCIS)
Ductal
carcinoma, non
infiltrating
, NST
DCIS of
low
nuclear
grade
DCIS of
intermediate
nuclear
grade
DCIS of high
nuclear
grade
Slide13WHO- breast cancer
Infiltrating duct
carcinoma (NST
)
Oncocytic carcinomaLipid rich carcinoma
Glycogen
rich
carcinoma
Sebaceous
carcinoma
Lobular carcinoma NSTTubular carcinomaCribriform carcinoma NSTMucinous adenocarcinomaMucinous cystadenocarcinoma NSTInvasive micropapillary carcinoma of breastMetaplastic carcinoma NST
Slide14WHO breast tumors…
Mesenchymal tumors (ex.
Angiosarcoma
)
Malignant lymphomaMetastatic tumors
…
Slide15Slide16Slide17Slide18Slide19Slide20Prognostic factor
Age
S
tage
(tumor
size
,
lymph
node
involvment) Tumor grade Tumor type Lymphovascular status. ER, PR status HER2 status Proliferation index
Slide21Slide22Slide23Slide24Slide25Slide26Slide27Early breast cancer
Early stage breast cancer is defined as disease confined to the breast with or without regional lymph node involvement, and the absence of distant metastatic disease.
Slide28Slide29SurgeryBreast
- BCT or MastectomyLymph
node
- SLNB-
Sentinel Lymph Node Biopsy or Lymphadenectomy
Slide30BCT !Breast conserving
therapy (BCT) refers to breast
conserving
surgery (BCS), followed by moderate-dose radiation therapy.The
goals
of BCT
are
to
provide
the
survival equvalent of mastectomy, a cosmetically acceptable breast, and a low rate of recurrence in the treated breast
Slide31Slide32Slide33Slide34Radiotherapy
Slide35Radiotherapy-
BCT- After Mastectomy,
if
:
pT4Tumor size ≥ 5cm> 4 positive lymph node
1-3
lymph
node
metastases
and additional risk factorsR1
Slide36Slide37Slide38Slide39Slide40Slide41Slide42Slide43Slide44Slide45Slide46Slide47Slide48T2N1 ER-PR-HEr2+NST BC
Slide49ADVANCED breast cancer
Advanced breast cancer comprises inoperable locally advanced breast cancer, which has not spread to distant organs, and metastatic (stage IV) breast cancer; common sites of spread are bone, the lungs and the liver
.
Currently, it is a treatable but virtually incurable dis-ease, with metastases being the cause of death in almost all patients, and a median overall survival of 2–3 years
Patients with metastatic breast cancer receive treatments that aim to relieve their symptoms and to prolong quality- adjusted life expectancy.
De novo metastatic disease (which presents as metastatic at initial diagnosis) and recurrent metastatic disease (which presents after initial diagnosis and treatment of early breast cancer) are somewhat different biologically and some differences exist in management. Recurrent disease is more aggressive and more resistant to therapy, whereas de novo metastatic disease poses the problem of how to treat the primary
tumour
Slide50Slide51Slide52Slide53Slide54ABC- Surgery
In patients with metastatic breast cancer, resec-tion
of metastases remains controversial, but may be an option for selected patients based on the pattern and
metachronicity
of the disease
I
n general, surgery of the primary tumor is not recommended although it may be discussed on a case- by-case basis for patients with excellent responses to systemic therapy and a low burden of distant disease
Palliative surgery is also of
impor
-tant value in individual situations of locally advanced breast cancer to achieve adequate locoregional control, as well as a frequent treatment tool in resource-limited environments
Slide55ABC- Radiotherapy
Radiation therapy, which has a crucial role in alleviating symptoms from bone, brain and soft tissue metastases, among others, should be prescribed in a multidisciplinary and individualized approach with dose and fractionation schedules depend-
ing
on the severity of the lesions and the remaining life expectancy
For most patients with bone metastases, a single dose of 8
Gy
is sufficient. This approach provides sufficient tumor volume reduction for resto-ration of the invaded or compressed surrounding normal structures.
Slide56ABC- systemic therapy
Slide57Breast
concerving
surgery - Brachytherapy -
Tamoxifen
-
antracycline
- anty HER2
Mastectomy
-
Teletherapy - AI - taxanePalliative vs. Radical treatment
Slide58Antracyclines
Slide59Slide60HER 2
Slide61Her2- Trastuzumab
Trastuzumab is a monoclonal antibody against human epidermal growth factor receptor 2 (HER2).Trastuzumab
has an established role in daily clinical practice in patients with HER2-positive breast cancer
Trastuzumab binds to an extracellular domain of this receptor and inhibits HER2 homodimerization, thereby preventing HER2-mediated signaling.
Cardiotoxicity of trastuzumab is major concern
The incidence of cardiac damage due to trastuzumab ranged from 0.4% to 4.1% in the different randomized trials (cumulative incidence of congestive hearth failure, New York Heart Association class 3–4)
Slide62Slide63Slide64Breast cancer- summary
Breast cancer is the most frequent malignancy in women worldwide and is curable in ~70–80% of patients with early- stage, non- metastatic disease.
Advanced breast cancer with distant organ metastases is considered incurable with currently available therapies.
On the molecular level, breast cancer is a heterogeneous disease; molecular features include activation of human epidermal growth factor receptor 2 (HER2, encoded by ERBB2), activation of hormone receptors (
oestrogen
receptor and progesterone receptor) and/or BRCA mutations.
Slide65Breast cancer- summary
Treatment strategies differ according to molecular subtype. Management of breast cancer is multidisciplinary ; it includes locoregional (surgery and radiation therapy) and systemic therapy approaches.
Systemic
therapies
include
endocrine
therapy
for hormone receptor- positive disease, chemotherapy , anti- HER2 therapy for HER2-positive disease, bone stabilizing agents, poly(ADP- ribose) polymerase inhibitors for BRCA mutation
carriers
and,
quite
recently
,
immunotherapy
.
Future therapeutic concepts in breast cancer aim at individualization of therapy as well as at treatment de- escalation and escalation based on
tumour
biology and early therapy response. Next to further treatment innovations, equal worldwide access to therapeutic advances remains the global challenge in breast cancer care for the future