Breast Cancer
Professor Arnold Hill
Wed 26th October 2011
Breast Cancer
• Breast Cancer in Ireland
• If you find a lump…
• Treatments for breast cancer
• Latest breast cancer treatments
• Reorganisation of breast cancer services
Breast Cancer in Ireland
• Each year over 2,300 women & 25 men
diagnosed with breast cancer in Ireland
• Each year nearly 700 people die from
breast cancer in Ireland
• Lifetime risk: 1 in 10 women
New symptoms to seek medical
opinion on…
• Breast lump
• Nipple discharge
• Nipple inversion
• Breast skin changes
• Strong family history
– Mother, sister, grandmother, aunt
Risk Factors
•
•
•
•
•
Increasing age
Exposure to estrogens
Environmental/lifestyle
Family History
Genetic abnormality (5-10%)
– BRCA1/2
• Sister Study
– National Institute of Environmental Health Sciences
– 50,000 women followed for 10 years
Screening
• 50-64 years
• Every 2 years
Imaging
• >35 years of age
• < 35 years of age
Breast Cancer
• Breast Cancer in Ireland
• If you find a lump…
• Treatments for breast cancer
• Latest breast cancer treatments
• Reorganisation of breast cancer services
What to do if you feel a lump?
• Check the other breast
• Don’t panic!
– 9 out of 10 lumps are not cancerous
• Attend GP as soon as possible for review
• Referral to triple assessment specialist
breast unit
Triple Assessment Breast Unit
Clinical exam
Pathological biopsy
Radiological assessment
TABC Accuracy
• Gold standard of breast
cancer diagnosis
• > 95% of symptomatic
breast cancers
diagnosed using
TABC¹,²,³
1) Merion Thomas J et al. Br Med J 1978; ii:1139 – 1141
2) Dixon JM et al. Br J Surg 1984; 71:593 – 596
3) Hermansen C et al. Cancer 1987; 60:1866 – 1871
Breast Cancer
• Breast Cancer in Ireland
• If you find a lump…
• Treatments for breast cancer
• Latest breast cancer treatments
• Reorganisation of breast cancer services
Treatments for breast cancer
• Surgery
• Chemotherapy
• Radiotherapy
• Hormonal therapy
• Biological therapy
Neoadjuvant
Versus
Adjuvant
Surgery
• Mastectomy
• Breast conservation
• Axillary lymph node clearance
• Sentinel Lymph node biopsy
• Breast Reconstruction
– DIEP, TRAM, LD
Reconstructive Surgery
Sentinel lymph node
Breast Cancer Cell
HER2
ER
Tumour
growth
Hormonal therapy
• ER positive breast cancer
– 75% of Breast Cancers are ER positive
– 150,000 EU women are on “hormonal
therapy”
– Tamoxifen, Arimidex, Femara, Aromasin
Biological therapy
• HER2 positive breast cancer
– 25% breast cancers overexpress HER2
– Herceptin, Tykerb (lapatinib)
Beaumont Breast Cancer Research
• Clinical Trials
– International
– Institutional
– Establishing ‘best treatment’
– Novel oncological drugs
• Molecular Research
• Audit & database review
Breast Cancer
• Breast Cancer in Ireland
• If you find a lump…
• Treatments for breast cancer
• Latest breast cancer treatments
• Reorganisation of breast cancer services
New diagnostic resources
• Gene expression studies
– Oncotype DX
– MammaPrint
New surgical techniques
• Skin sparing mastectomy
– Only used when immediate reconstruction
performed
• Oncoplastic Breast Reconstruction
– Immediate versus delayed
New radiotherapy techniques
• Hypofractionated radiation
– Larger doses over fewer days
• Accelerated partial breast irradiation
– Intraoperative radiation therapy
– Intracavitary brachytherapy
New Biological Treatments
• Targeting HER2
– Neratinib
– Tovok
– Pertuzumab
• Anti-angiogenesis
– Bevacizumab
• Targeting EGFR
– Gefitinib
– Erlotinib
– Cetuximab
• Other
– Vitamin D
– Bisphosphonates
The price tag of progress…
• Herceptin
– € 2,000 / month
• Lapatinib
– € 2,000 / month
• Bevacizumab
– € 3,000 / month
• Cetuximab
– € 3,400 / month
Breast Cancer
• Breast Cancer in Ireland
• If you find a lump…
• Treatments for breast cancer
• Latest breast cancer treatments
• Reorganisation of breast cancer services
Managed Cancer Control Networks
& Cancer Centres
Network
Cancer Centres
HSE Dublin – North East
Beaumont Hospital
Mater Misericordiae Hospital
Dublin – Mid Leinster
St. James’s Hospital
St. Vincent’s University Hospital
HSE South
Cork University Hospital
Waterford Regional Hospital
HSE West
UCH Galway
Limerick Regional Hospital
Letterkenny General Hospital
Breast Cancer update
Network
Cancer Centres
HSE Dublin – North East
Drogheda
James Connolly
Mullingar
Beaumont
Mater Misericordiae
Dublin – Mid Leinster
Portlaoise
AMNCH
St. James’s
St. Vincent’s University
HSE South
Tralee
South Infirmary Cork
Clonmel
St Luke’s, Kilkenny
Wexford
HSE West
Portiuncula
Castlebar
Sligo
Cork University
Waterford Regional
UCH Galway
Limerick Regional
Cancer Strategy
Hospitals providing initial
diagnosis + surgery for
breast cancer
June 2007
33
Sept 2007
20
June 2008
16
Dec 2008
12
Spring 2009
8
Summary
• Lifetime risk of breast cancer 1 in 10
women
• Surgery & chemoradiotherapy the
mainstay of treatment
• Hormonal and biological therapies
increasing in efficacy, but costly
• Irish NCCP – 8 designated breast cancer
centres
Thank you