Breast

Surgery (Dr. Enriquez) Breast 2 December 10-13, 2007

BREAST CANCER Risk factors Hormonal  Inc exposure to estrogen – inc risk 1. Early Menarche 2. Nulliparity 3. Late pregnancy 4. Late menopause 5. HRT 6. obesity  Reduced exposure to estrogen – protective 1. Pregnancy 2. Longer lactation 3. exercise Nonhormonal  Radiation exposure  Alcohol intake  Diet  History of breast cancer Table 16-8 Percent Incidence of Sporadic, Familial, and Hereditary Breast Cancer Sporadic breast cancer 75% Familial breast cancer 30% Hereditary breast cancer BRCA-1a BRCA-2

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2. Breast and ovarian CA in the same individual 3. Male breast CA Screening recommendation 1. BSE every month 2. Clinical breast exam every 6 months 3. Mammography every 12 months beginning at 25 y/o 4. Transvaginal ultrasound/CA125 every 12 months beginning at 25 y/o Risk Management Strategies for BRCA – 1 and BRCA- 2 carriers 1. Prophylactic mastectomy w/ or w/o reconstruction 2. Prophylactic oophorectomy 3. Intensive surveillance for breast and ovarian CA 4. Chemoprevention

FEMALE/CANCER STATISTICS

65205-10% 45% 35%

BRCA – 1 and BRCA -2 - Tumor suppressor genes - Mutation, one becomes carriers of breast cancer susceptible gene • BRCA – 1 (chromosome 17q) - 45% of hereditary breast cancer - 90% lifetime risk of developing breast cancer - 40% lifetime risk of developing ovarian cancer - 50% of children of carriers inherit the trait • BRCA – 2 (chromosome 13q) - Biological function is not well defined, but plays a role in DNA damage response pathways - 35% of hereditary breast cancer - 85% lifetime risk of developing breast cancer - 20% lifetime risk of developing ovarian cancer - 50% of children of carriers inherit the trait Hereditary risk of breast cancer is considered 1. Family with 2 or more women developing breast/ovarian CA 5cms)

Surgery – Breast 2 by Dra. Enriquez

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3. 4 or more positive axillary nodes

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Principles of radiotherapy I

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Principles of radiotherapy II

Adjuvant therapy: - Postoperative treatment in a patient - at high risk of microscopic metastases after - the removal of the primary tumor Neoadjuvant therapy: - Primary treatment of patients with a clinically - localized tumor

STANDARD CHEMOTHERAPY REGIMENS

BREAST CANCER / HORMONAL THERAPY Regulation of cell proliferation

Examples of Hormonal Therapy  Hormone receptors – detectable in more than 90% of well differentiated breast CA 1. Estrogen receptors 2. Progesterone receptors  TAMOXIFEN – binds to estrogen receptors in the cytosol to block uptake of estrogen by breast tissue - >60% clinical response if ER/PR + -