Breast Cancer

By: Edzarae, Ahlam, Blake, Brian and Anthony

What we will discuss:

 What breast cancer is.

 Who gets breast cancer.
 How common it is
 What causes it
 Hereditary factors
 Prevention
 Treatments
 Risk factors
 Self exams
 Joni Abdul Center
What is Breast Cancer

 Breast cancer starts when cells in the breast begin to grow out
of control. These cells usually form a tumor that can often be
seen on an x-ray or felt as a lump.

 The tumor is cancerous if the cells can grow into surrounding

tissues or spread to distant areas of the body. Breast cancer
occurs almost entirely in women, but men can get it, too.

 Breast cancers can start from different parts of the breast. Most
breast cancers begin in the ducts that carry milk to the nipple.

 Most women will have lumps in their breast, most are of the
lumps are noncancerous.
 Who gets breast cancer

 Overall, breast cancer incidence among African-

American women is lower than among white
women. However, for women younger than 45,
incidence is higher among African-American
women than white women
 Breast cancer is the second leading cause of
cancer death among African-American women
(lung cancer is the major cause of cancer death)
 Risk Factors

 Being female
 Getting older
 All women are at risk for breast cancer.
 The risk of getting breast cancer increases as
you age. Most breast cancers and breast
cancer deaths occur in women aged 50 and
older
 What Causes Breast Cancer

 We do not know the cause of most breast

cancers.
 Most likely cause is related to changes in
the genetic material (DNA) in our cells.
 DNA changes are often related to our
lifestyle, but some can be due to age and
other factors.
 How common is Breast Cancer

 In the United States:

 Except for skin cancer, breast cancer is the most
common cancer among women.
 In 2016, more than 240,000 cases of invasive breast
cancer will be diagnosed in women and 2,600 in
men.
 Every 2 minutes, one case of breast cancer is
diagnosed in women.
 Currently there are more than 3 million breast
cancer survivors.
 1 in 8 women will be diagnosed with breast cancer
in her lifetime.
 Hereditary Breast Cancer

Hereditary Breast Cancer is suspected when:

 Several close family members have been diagnosed with breast or

ovarian cancer
 A number of generations are involved
 Family members have been diagnosed at a young age
 Both breasts have been involved in the diagnosis
Only 5-10% of breast cancers are hereditary !
 Preventing Breast Cancer

How all women can lower their risk:

 Get to and stay at a healthy weight
 Be physically active
 Limit alcohol use

Some women can also think about things like:

 Birth control options that don’t use hormones
 Not using hormone therapy to deal with the symptoms
of menopause
 If a women is known to be at increased risk (due to personal or family
history, or a known gene mutation) there are some other things she can
consider to decrease her chances of getting breast cancer such as:

 Chemoprevention: The use of drugs to reduce the

risk of breast cancer

 Preventive surgery for women with very high breast

cancer risk

 But, There is no sure way to prevent

breast cancer overall.
 Be “Pink” to Reduce Your Risks

 Practice what you know:

 Eat Healthy
 Be active
 Don’t smoke
 One drink per day or less

 Investigate the information

 Know the facts from Fiction

 N know what Normal for your body and breasts

 Knowledge is power
 Breast Cancer Treatments

 Treatment for breast cancer is often a combination

of the following treatments:

 Surgery
 Chemotherapy
 Radiation
 Hormone Treatment
 Surgery

 Removing the area of concern and some normal

tissue surrounding it is called a Lumpectomy.

 This surgery is sometimes referred to as a

“breast conserving surgery” because doctors remove
smaller tumors locally without removal of the entire breast.

 Removing the breast is called a Mastectomy,

however most women with breast cancer will
not need to have their breast removed

 Surgeons often perform a mastectomy on larger tumors

 Also, Lymph Nodes from under the arm may

be removed with either surgery
 Chemotherapy

 Chemotherapy is the use of a combination of intravenous drugs which kill

or disable breast cancer cells. Chemotherapy is a treatment option for
most types of breast cancer.

 Chemotherapy is also known as a Systemic Treatment because it will affect

the whole body. Some people will experience symptoms such as:
 Hair Loss (Alopecia)
 Nausea and Vomiting
 Fingernail and Toenail weakness
 Muscle Pain (Myalgia)
 Mouth & Throat sores
 Sleep Disorders
 Leukopenia, Neutropenia
 Radiation
 Radiation is a standard treatment after a Lumpectomy to reduce
the chance of the breast cancer returning in the same breast.

 Radiation typically uses targeted, high energy x-rays to kill cancer

cells.

 Radiation is also known as a Local Treatment because it affects

only the area being treated.

Goal of Radiation: To kill any cancer

that might be left in or around the
breast after surgery.
 Hormone Treatments

 The growth of many breast cancers can be blocked by taking

hormone therapy.

 This treatment is in the form of a pill which is taken over the

course of 5 years.

 All tumors are checked for hormone receptors, a pathologist

determines the receptor status by testing the tumor tissue
removed during a biopsy.
 Most breast cancers are hormone receptor positive, however hormone therapies
are only used to treat hormone receptor positive breast cancers.

 If tests come back receptor negative this method of treatment can not be used.
 Some Breast Changes To Check Out With
Your Doctor

If Any of these changes are present it would be best to check

them out with your HCP

 A new lump
 A change in size, shape or color of your breast
 A change in appearance of the nipple, or if there's blood or
discharge present in that area.
 Dimpling of the skin that looks like an “orange peel” or if the skin
feels very thick.
Risk Factors
The average lifetime
risk for developing
breast cancer is
approximately?
1 in 8
Common Risk factors

 Age (over 50)

 Personal or family history ( first degree relative)
 High breast tissue density
 High dose radiation to the chest during medical
procedures
 First pregnancy after 30 yrs of age
 Having no children
 Menarche before age 12
 Menopause after age 50
 One of the biggest causes of early menarche is?
 Childhood obesity.
Common risk factors

 Postmenopausal obesity
 Alcohol consumption (more than 1 or 2 drinks per
day)
 Personal history of breast, ovarian, or endometrial
cancer
 Ashkenazi Jewish heritage
 Oophorectomy
 BRCA1 and BRCA2 gene mutations
 Smoking
 How many students have tried smoking or have
been around people smoking?
Did you know…

 Tobacco use is responsible for nearly one in five

deaths in the United States.
 It is estimated that about 438,000 deaths each year
in the united states are attributable to smoking
Ashkenazi Jewish Heritage

 Women of this decent are at an increased risk for

breast cancer

 There is a higher prevalence of women that have

the BRCA1/2 gene mutations in this heritage

 The BRCA1/2 genes are proven to be well linked to

breast cancer
Case study of the BRCA1/2
genes

 The risk of breast cancer among women who carry

a BRCA1 or BRCA2 gene mutation is approximately
70% to age 80.
 3920 women were studied with the BRCA1 or BRCA2
gene mutations to find out if cancer in one breast
was a risk factor for breast cancer in the
contralateral breast.
 Out of the 3920 women 2077 had cancer of the left
breast and were matched with woman who did not
have breast cancer by age (within one year),
country of origin, and gene mutation present
(BRCA1 or BRCA2)
 14.8% of women with left breast cancer in the study
were diagnosed with breast cancer of the
contralateral breast.
 The study indicated that among carriers of the
BRCA1/2 gene mutations, the risk of cancer in the
two breasts is not independent.
 Looking at this study will help inform women with the
BRCA1/2 gene mutations about removing both
breast if cancer is found one, to reduce their
chance of cancer in the future.
What celebrity was in the news for
reducing her risk of breast cancer
by having a double masectomy?
Angelina Jolie
Calcium levels

 The AMORIS study (apolipoprotein mortality risk

study)
 Was conducted in Stockholm and yielded data
from over 800000 men and women.
 The study was originally conducted for other
research and found to have relevance with cancer
research
 The AMORIS study showed that there is an inverse
association between serum calcium and breast
cancer risk, the women with high calcium intake
had a 19% reduction in breast cancer as oppossed
to the women that had low levels of calcium
NSAID’s

 The Spanish Multi-Case-Control (MCC) study

 The MCC study set out to associate NSAID use with
reduced rates of breast cancer
 The cyclooxygenase-prostaglandin inflammation
pathway has been shown to play a relevant role in
carcinogenesis mainly via inhibition of the COX-2
isoform.
 Experimental studies have demonstrated that COX-2
blockade inhibits breast tumor formation in mice.
 The study reflected that NSAID use was associated with
a 24% reduction in breast cancer risk
BMI

 Studies have shown that high BMI is associated with

a reduced risk of breast cancer in premenopausal
women but an increased risk in postmenopausal
women
 The women in a particular study were predicted to
genetically have a high BMI, this was done to rule
out other risk factors from being obese due to
environmental causes
 The study concluded that the genetically predicted
high BMI was associated with decreased breast
cancer risk for both pre and postmenopausal
women
The Nurses’ Health Studies
Exposures across the life course

 The NHS originated with the goal of examining use of

oral contraceptives and other potential risk factors for
breast cancer.
 The studies found that current Oral contraceptive users
have an elevated risk for breast cancer.
 Hormone Therapy current users have a 36% higher risk
of breast cancer than women who have never used
them.
 Physical activity has been hypothesized to decrease
breast cancer risk by lowering ovarian hormone levels,
women who reported at least 7 hours of vigorous
activity a week had a 18% lower risk of breast cancer
 Women who consume more that 1-2 drinks a day
have an elevated risk of breast cancer
 The NHS suggest that aspirin use after a breast
cancer diagnosis may improve survival, women who
used aspirin 7 days per week had a 64% lower risk of
breast cancer death.
 Occupational exposure to rotating night shifts may
influence breast cancer risk through suppression of
melatonin, this study found a positive correlation
between number of years working night shifts +30
and breast cancer
 The percentage of mammographic density is one of
the strongest risk factors for breast cancer and a
potential intermediate marker of risk.
What are some risk factors
associated with breast
cancer?
Breast Self Exam

• DETECTS THE MAJORITY OF BREAST ABNORMALITIES

• POTENTIALLY LIFE-SAVING
Inspect for:

 Skin changes
 Redness
 Visible bumps
 Nipple crusting
 Symmetry
Raise Arms Up

 Breasts should rise evenly.

 Watch for dimpling or retraction.
Feel for Lumps:

 Raise the arm

 Feel with opposite hand
 Feel for a “marble in a bag of rice”
Use the Middle of Your Fingers

 Fingertips are too sensitive (all breasts are

somewhat lumpy)
 Palm is too insensitive
 Middle portion of fingers is just right
Move your hand in small circles

 Stay in one place

 Press in while circling with your hand
 Feel for thickenings the size of a marble
 Then move to another location

 Work your way around the breast in a clockwise fashion, using small
circles of the hand as you go.
 Make sure the entire breast is felt.
The “Tail” of the Breast

 Breast is not perfectly round.

 A “Tail” of breast tissue normally extends into the
armpit.
 Make sure to feel for lumps in that portion of the
breast.
Feel the Armpit

 Use the same circular motions.

 Feel for breast lumps and lymph nodes.
 Normal lymph nodes cannot be felt.
 Enlarged lymph nodes are about the size of a pencil
eraser, but longer and thinner.
Try to Express Nipple Discharge

 Strip the ducts towards the nipple.

 Normally, one or two drops of clear, milky or green-
tinged secretions.
 Should not be bloody or in large quantity, squirting
out or staining the inside of a bra.
Now Check the Other Side

 Follow same maneuvers.

 Raise the arm above your head.
 Feel for lumps or masses.
Have a Professional Breast Exam
Each Year

 Basically the same maneuvers

 Ask questions
Mammograms

 Age 40-50: Every other year

 Over Age 50: Annually
 Might be more often in special circumstances such
as breast problems, family history of breast cancer.
If you find something in your
breast...

 Don’t panic.
 Most (90%) of breast lumps are benign.
 Do see a physician or other qualified health care
provider right away
 Symptoms
 Change in how the breasts feel, such a lump or thickening in or near breast or the
underarm area

 Change in appearance of breast or nipple

 Includes size and shape of breast
 Nipple turned inward

 Changes in the skin of the breast, areola or nipple

 Scaly, red, swollen, rippling

 Nipple tenderness or discharge

 Generally, breast cancer does not cause pain, women should see physician about any
breast pain
Joanie Abdu Comprehensive
Breast Care Center
 Breast Cancer Facts

 Ohio has the 4th highest mortality rate

 Washington D.C., Louisiana and Mississippi

Through early detection and improved treatments

more women are surviving breast cancer!
Ohio Columbiana Mahoning Trumbull
120.3 128.3 122 105.1
 Who is Joanie Abdu?

 Served as a St. Elizabeth’s nurse for more than 20 years

 In 1993, she was diagnosed with an aggressive type of breast cancer

 Just 15 months to the day, Joanie lost her battle on June 2, 1994

 Her husband, Dr. Abdu was committed to

researching, planning and the development
of a comprehensive breast care center where
diagnosis time is shortened to eliminate
the agonizing wait for patients and
family members
 “Our Mission”

 The Joanie Abdu Comprehensive Breast Care Center

provides the most accurate prevention, early detection,
diagnosis and support with compassionate, coordinated
care. The center provides the entire spectrum of
diagnostic breast care services using the most advanced
imaging technology available for the detection and
diagnosis of breast disease.
 Awards

 The Valley’s only Accredited Breast Care Center by the National Accreditation Program
for Breast Care Centers

 American College of Radiology Breast Imaging Center of Excellence

 Pink Ribbon Facility for Exceptional Commitment and Community Support

 2014, 2015, 2016 Women’s Choice Award

 2013 & 2014 Press Ganey Guardian of Excellence

 Above Average National Scores for Medicare and Medicaid Patient Services

 Recognitions by the Ohio State Senate, Secretary of the State of Ohio, and the City of
Youngstown
 Complete Diagnostic Breast Care Services
 Our center delivers the most accurate prevention, early detection, diagnosis and
support services

 We strive to lessen the fear and anxiety of uncertainty

 Interdisciplinary approach for patients diagnosed with breast cancer in a weekly

conference of oncologists, pathologists, radiologists, plastic surgeons and palliative
medicine specialists for optimum plan of care

 Breast Health Navigator

 Guides Patients through diagnostic process
 Provides emotional support and one-on-one education
 Explains clinical information and treatment options
 Coordinates referrals and appointments to other medical and support services
 Patient Advocate
 Breast Care Services

 Screening and diagnostic mammography

 Biopsy services including ultrasound guided, stereotactic and MRI biopsies;

cyst and fine needle aspirations

 Ultrasound

 MRI

 Nuclear Medicine

 Needle Localizations

 Bone Density testing

 Our Newest Addition
• Joanie3Don
Eastern Ohio’s first mobile the Go! unit
mammography
• Clinically proven to detect 41% more invasive breast cancers
• Reduces false positives up to 40%
• Provides state-of-the-art
technology and same high
standard of care in the
convenience of your
community
• Radiation-free bone
density screenings
• In the 4 weeks of service
4 breast cancers were
detected
 Molecular Breast Imaging

 Highly effective diagnostic tool particularly for women with

dense breast tissue

 Only two centers in Ohio offer this technology

 50% reduction of biopsies in women with dense breast tissue

 Functional study of the breast

 400% increase in detection rates

 3-D Digital Mammography

 Breast Tomosynthesis

 Latest and most accurate mammogram imaging available

 Combination of 2-D and 3-D image

 Results are in a stack of thin high

resolution image slices
 No distortion of images caused by
density or shadowing
 Separates benign lesions from
suspicious lesions
Digital Technology vs. Analog

3D Mammography Video
 Joanie’s Promise

 Grant-funded program supported by the Panerathon and generous contributions from

our community

 Our mission is to provide all women that are uninsured or underinsured with breast
care services and diagnostics as well as any other barriers to care
 “Through my ears, Joanie hears the voices of grateful women for the care they will
receive in this magnificent facility. Through my eyes, she sees the reality of what once
was only a dream. Through our souls, we both see the beauty, the love, the
compassion and the generosity of a caring community that has made that dream come
true. We are, and will always be eternally grateful.”
 -Dr. Rashid Abdu