Breast Cancer
Adriana Padilla, MD
Family Medicine
Douglas Wong, MD
Radiation Oncology
Michael Moffitt, MD
Oncology
Rebecca Stickler, MD
Surgery
By the time the Lord/Higher Power made woman, he was into his sixth day of
working overtime. An angel appeared and said, "Why are you spending so much
time on this one?“
And the Lord/Higher Power answered, "Have you seen the spec sheet on her?
She has to be completely washable, but not plastic, have over 200 movable
parts, all replaceable, run on diet coke and leftovers, have a lap that can hold
four children at one time, have a kiss that can cure anything from scraped knee
to a broken heart and have two pairs of hands.“
The angel was astounded at the requirements. "Two pairs of hands! No way!
And that's just on the standard model? That's too much work for one day. Wait
until tomorrow to finish.“
"But I can't," the Lord/Higher Power protested. "I am so close to finishing this
creation that is so close to my own heart. She already heals herself when she is
sick AND can work 18 hour days.“
The angel moved closer and touched the woman. "But you have made her so
soft, Lord/Higher Power."
"She is soft," the Lord/Higher Power agreed, "but I have also made her tough.
You have no idea what she can endure or accomplish."
"Will she be able to think?", asked the angel.
The Lord/Higher Power replied, "Not only will she be able to think, she will be
able to reason and negotiate.“
The angel then noticed something, and reaching out, touched the woman's cheek.
"Oops! It looks like you have a leak in this model. I told you that you were trying to
put too much into this one..“
"That's not a leak," the Lord/Higher Power corrected, "that's a tear!"
"What's the tear for?" the angel asked.
The Lord/Higher Power said, "The tear is her way of expressing her joy, her sorrow,
her pain, her disappointment, her love, her loneliness, her grief and her pride.“
The angel was impressed. "You are a genius, Lord/Higher Power. You thought of
everything! Woman is truly amazing.“
And she is!......
Women have strengths that amaze men.
They bear hardships and they carry burdens,but they hold happiness, love and joy.
They smile when they want to scream.
They sing when they want to cry.
They cry when they are happy and laugh when they are nervous.
They fight for what they believe in.
They stand up to injustice.
They don't take "no" for an answer when they believe there is a better solution.
They go without so their family can have.
They go to the doctor with a frightened friend.
They love unconditionally.
They cry when their children excel and cheer when their friends get awards.
They are happy when they hear about a birth or a wedding.
Their hearts break when a friend dies.
They grieve at the loss of a family member, yet they are strong when they think
there is no strength left.
They know that a hug and a kiss can help to heal a broken heart.
Women come in all sizes, in all colors and shapes. They'll drive,fly, walk, run or
e-mail you to show how much they care about you. The heart of a woman is
what makes the world keep turning! They bring joy and hope.They have
compassion and ideals.They give moral support to their family and friends.
Women have vital things to say and everything to give.
Pass this along to your women friends to remind them how amazing they are
because if there's one flaw in women, it is that they tend to forget about
themselves.
Breast Cancer
Women Are Amazing!
Breast Cancer
Take home goals:



Understand Breast Cancer Risk Factors
Be comfortable with Breast Cancer
screening methods
What to do if you or your physician has
found a new breast lump
Breast Cancer
Take home goals:

Understand the difference between
non-cancer and cancerous lumps
Breast Cancer
Take home goals:
 Understand the basic principals of
treatment options


Local Treatments: Surgery, Radiation
Systemic (Adjuvant) Therapy
 Chemotherapy
 Hormone therapy
 Other options
Breast Cancer
Take home goals:
 Coping with your diagnosis
 Talking with your doctor
 Accessing breast exams and mammogram
services
Breast Cancer Risk Factors



Risk Factors do not cause breast cancer but
are associated with an increased chance of
getting breast cancer
The number one risk factor for breast
cancer is being a women
Age is a risk; the chance of getting breast
cancer increases with age
Age as a Risk Factor
By age 30
By age 40
By age 50
By age 60
By age 70
By age 80
Lifetime risk
NCI SEER Program, 1995-1997
RISK
1 out of 2,000
1 out of 233
1 out of 53
1 out of 22
1 out of 13
1 out of 9
1 out of 8
Risk Factors
Controllable
 Alcohol drinking
 Being overweight
 Never having children
 1st child >30yrs of age
 Hormone Replacement
 Birth control pills
(very slight)
ACS Breast Cancer Facts 2001-02
Uncontrollable
 Getting older
 First degree relative
with breast cancer
 A previous breast
biopsy showing
atypical changes
Risk Factors


Controllable
Being exposed to
large amounts of
radiation




Uncontrollable
Being young (<12) at the
time of menses
Starting menopause after
age 55
Having an inherited
mutation in the breast
cancer genes (BRCA 1 or 2)
ACS Breast Cancer Facts 2001-02
Radiation Exposure
•
Risk Vs benefit
– Same decision making for surgery, chemotherapy, ERT: benefit > risk?
– Woman choosing lumpectomy, XRT benefit >>>> risk
•
Uncontrolled vs controlled
– Warfare, industrial, environmental: total body, mixed radiations, variable
distances and time
maximum risks
– Diagnostic, therapeutic: collimated, pure radiations, measured distances
and time
minimum risks
•
Secondary malignancies in women surviving breast cancer
– Occurs with or without use of radiation therapy
– Observed to occur as frequently in women that received no XRT as in
women that received XRT
Breast Cancer Screening Methods
For Healthy Women
1. Breast Self Exam — Status

Guiding principal “Know your breasts —
they are not land mines”
2. Clinical Breast Exam


Age 20-39:
every 3 years
Age after 40: every year
3. Mammography

Age after 40: every year
Trouble Signs That Should Not
Be Ignored
1.
2.
3.
4.
5.
6.
7.
8.
Finding a lump, hard knot or thickening
Unusual swelling, warmth, redness or darkening
Change in size or shape of your breast
Dimpling or puckering of the skin of your breast
Finding an itchy, scaly sore or rash on the nipple
Pulling in of the nipple or other parts of the breast
Nipple discharge that starts suddenly
Pain in one spot that does not vary with cycle
Breast Cancer Screening Methods
For Healthy Women

How do you do a Breast Self Exam?

What is a mammogram
and is it enough to screen
for Breast Cancer?
When you discover a breast lump
What do you do?
1. Don’t Panic — most breast lumps are not
cancer (Benign Breast Changes - Cysts and
Fibroadenomas)
2. See your primary health care provider for a
full assessment and recommendations
3. You may need a fine needle aspiration
procedure and or a diagnostic mammogram
or ultrasound
When you discover a breast lump
What do you do?
4. If the breast lump turns out to be solid,
what happens then?
5. If after a biopsy, the tissue is found to be
cancerous, what happens then?
6. If after a biopsy the tissue is found to not
be cancerous, but not entirely normal, what
happens then?
When the Diagnosis is Cancer —
What then?
Types of Breast Cancer?
 Types of Treatment: Local and Systemic



Local
 Surgery
 Radiation Therapy
Systemic
 Chemotherapy
 Hormone Therapy
 Biological Therapy
The Role of Surgery in Breast
Cancer
Rebecca Stickler, M.D., F.A.C.S.
Suspicion for breast cancer
based on
• Physical exam
• Imaging studies
– Mammogram
– Ultrasound
Diagnostic Procedures
• Closed surgical techniques
• Open surgical techniques
Closed surgical techniques
• FNA: Fine needle
•
•
aspiration cytology
Core needle biopsy
Stereotactic biopsy
Open surgical techniques
• Excisional biopsy
• Incisional biopsy
• Needle or wire localized excisional biopsy
Types of cancer
• Non-invasive
• Invasive
Surgical treatments
• Usually part of a combined treatment
approach
– Multi-modality treatment
• Radiation
• Chemotherapy
• Hormonal therapy
Objective of surgical treatment
• Identify extent of tumor
– Staging
• Obtain local control of the
cancer
– Sometimes in combination
with radiation treatments
• Assess whether the
breast cancer is present
in the lymph nodes
– Axillary lymph node
dissection
– Sentinel lymph node
dissection
Surgical options
• Mastectomy
– With or without lymph
node dissection
– With or without
immediate
reconstruction
• Partial mastectomy
– With or without lymph
node dissection
– With or without
radiation treatments
Why surgery in breast cancer
• Required to verify the diagnosis
• Stages the tumor so that treatment can be
appropriately directed
• May be the definitive treatment in some
cases
• Needed to confirm a recurrence or disease
outside the breast
Radiation Treatment


Conventional whole breast treatment:
mastectomy or radiation therapy
Recent innovations


Revisit the concept of partial breast treatment
only
 Smaller volumes
 Shorter treatment course
Balloon catheter / multi-catheters / IORT /
IMRT
Balloon and lumpectomy
A dose of 34 Gy was delivered at a depth of 1 cm over the
course of 5 days. CT scans were used to assess the
conformance of the resection cavity tissue to the
MammoSite® RTS balloon.
Balloon on CT
When the Diagnosis is Cancer —
What then?
With the help of your family, friends and your
medical team, you can:
1. Understand your diagnosis and prognosis
2. Make treatment decisions from the best and
latest research and clinical trials
3. Become comfortable with your treating
“team” (primary health care provider, surgeon,
oncologist, radiation oncologist and others)
4. Know what to expect
Coping with your Diagnosis




Express your emotions
Develop a fighting spirit
Build a strong support group
Trust your health care team
Working with your Health
Care Team
Communication is key
 Be prepared
 Write down your questions
 Explain your situation and concerns
 Give feedback to your health care team
Accessing Breast Health Care
1. HMO, PPO, Medi-Cal, Medicare covers
services
2. Breast Cancer Early Detection Programs:
Free services to individuals who do not
have nor qualify for health care. You must
qualify on an intake assessment
Women
Are Amazing!
Remember
Yourself During
Breast Cancer
Awareness
Month!
Important Information Sites




www.komen.org
www.cancer.gov for the National Institute
of Health
www.cancer.org for the American Cancer
Society
www.ahcpr.gov for the US Preventive
Health Task Force recommendations