Vida! Educational Series – Promoting Good Health
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Update in Breast Cancer
Ana Maria Lopez, MD, MPH, FACP
Associate Dean, Outreach and Multicultural Affairs
Professor of Medicine and Pathology
Medical Director, Arizona Telemedicine Program
Educational Objectives
1. Learn what is breast cancer
2. Discuss risks to breast cancer
3. Outline prevention measures for
breast cancer
What is breast cancer?
breastcancer.org
http://geneticpeople.com/?tag=breast-cancer
gatheringbasket.org
buyletrozole.eu
What causes breast cancer?
• Causes and risk factors
Risk Factors
• Age:
• 95% in women 40yo +
• highest in 70-74 yo
• FH
• Personal history
• Genetic risk:
• BRCA 1/2, TP 53,
ATM
• Nulliparous
• 1st full term pregnancy
after 35 yo
• No lactation
• HRT
• Alcohol
• Overweight/obesity
• Physical inactivity
70% of breast cancers
are in patients without
identifiable risk factors
Risk Calculators
• www.cancer.gov/bcrisktool
NCI/NSABP
Hereditary Breast Cancer Risks
5-10% of all breast cancers
• Ashkenazi Jewish descent
• 3 or more 1st or 2nd degree relatives
• 1st degree relative with bilateral breast
cancer
• 2 or more 1st or 2nd degree relatives with
ovarian cancer
• Male breast cancer
BRCA 1 and BRCA 2
• Code for DNA repair
• Presence of gene, increases the risk of getting breast
cancer up to 80% in her lifetime
• BRCA1 or BRCA2 mutations make up about half of all
cases of inherited breast cancer
• associated with ovarian cancer and prostate cancer
• can be inherited either from the mother or the father.
Other Inherited Genes
• TP53 gene
• codes for the tumor suppressor protein p53
• Mutations cause Li-Fraumeni syndrome: associated
with early onset breast cancer
• Ataxia Telangiectasia (ATM) gene
Females with one defective copy of the ATM gene and
one normal copy of the gene are at increased risk for
breast cancer.
concurringopinions.com
ph-insider.blogspot.com
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om
ladycarehealth.com
pdahealthware.com
Prevention
Prevention:
saves us from the pain of being sick
--Unknown
health.usf.edu
Prevention Studies
• Tamoxifen
• Raloxifen: STAR (Study of Tamoxifen and
Raloxifene)
• Raloxifene is as effective as tamoxifen in
reducing invasive but not nonivasive (DCIS) BC
risk
• Both drugs reduce invasive BC risk by about 50%
• Raloxifene: 36% fewer uterine cancers, 29%
fewer blood clots
• Both increase blood clots.
Aspirin
• In an epidemiologic study, aspirin
appeared to lower breast cancer risk
• Need prospective trial
Vitamin D
• Helps with calcium absorption to maintain
bone density
• In clinical trials
Fat
• WINS
• Low fat diet (< 30%)
• 5Y FU: new breast cancers--9.8% low-fat
diet; 12.4% standard diet (24% reduction)
• largest risk reduction – 42%--in ER
negative tumors
What about soy? Flax?
Phytoestrogens?
• Eat what you like!
• Eat healthy!
• Do not change your diet drastically to
include phytoestrogens.
• There may be safety concerns re:
pharmaceutically concentrated soy
products
Lifestyle
• Maintain a healthy weight
• Decrease intake overall. Increase vegetables
in specific (2/3 of plate)
• Increase activity: 3-4 hours of exercise per
week
• Decrease alcohol intake
Early Detection
Computer-aided detection and
diagnosis (CAD)
kodak.com
Tomosynthesis
(3D mammography)
canada.com
Treatment
ultimateboxingresults.com
riskofbreastcancer.net
indianapublicmedia.org
dailymail.co.uk