Breast Cancer Awareness Quiz

Presentation Overview

• Topic: Breast Cancer
• Presenter: Jonathan Brack
• Date: 15/11/2024
• University: University of the West of England, Bristol

Learning Outcomes

• Anatomy of the breast revision
• Epidemiology and etiology of breast cancer
• Breast cancer signs, symptoms, and clinical imaging

Anatomy Revision

• Diagram of breast anatomy showing various lymph nodes (e.g., subclavian, anterior axillary, lateral axillary, posterior axillary, circumareolar - plexus of Sappey) , jugular vein, lactiferous ducts, adipose tissue, lobules, pectoral muscle, and connective tissue.
• Diagram labels included.

Breast Cancer Prevalence

• Figure 5.3.2 shows the ten most frequent cancers in females (2011-2015)
• Breast cancer ranks highest with 29.1%
• Key statistics on breast cancer cases (56,822 new cases annually), deaths (11,499 annually), survival rate (76% 10+ year survival), and preventable cases (23% in 2015).

Breast Cancer Figures

• Approximately 55,000 women and 370 men are diagnosed with breast cancer annually in the UK.
• England: ~46,000 cases annually
• Scotland: ~4,700 cases annually
• Wales: ~2,800 cases annually
• Northern Ireland:~ 1,500 cases annually
• ~7,000 cases of DCIS in the UK annually.

Breast Cancer Stats Continued

• 5-year survival rate of breast cancer is 85%.
• Survival rates have doubled in the UK over the past 40 years.
• An estimated 600,000 people are alive in the UK after a breast cancer diagnosis.
• The prediction for the number of survivors in 2030 is 1.2 million.

Risk Factors for Breast Cancer

• Age: Relative risk increases significantly with age ( >10)
• Geographical Location: Developed countries show a higher relative risk (relative risk =5).
• Age at menarche: Early menarche (<11) shows an increased risk (relative risk = 3).
• Age at menopause: Late menopause (> 54) shows an increased risk (relative risk = 2).
• Age at first full pregnancy: Delayed first pregnancy (> 40) is associated with an increased risk (relative risk =3).
• Family history: Risk is increased with multiple relatives having breast/ovarian cancer (≥2, 4-5 in case of benign disease).
• Socioeconomic group: Group I and II show a higher relative risk.
• Diet: High saturated fat intake is a risk factor (relative risk = 1.5).
• Body weight: Increased body mass index (BMI) >35 shows an increased risk, particularly after menopause.
• Alcohol: High consumption (>2-5 drinks/day) is a risk factor
• Exposure to ionising radiation: Early age exposure ( >10) for females poses an increased risk.
• Taking exogenous hormones: Oral contraceptive use shows an increased risk (relative risk =1.24).
• Hormonal replacement therapy (HRT) use for ≥10 years raises the risk (relative risk = 1.35).
• Diethylstilbestrol (DES) use during pregnancy carries a high risk (relative risk= 2).

Familial Breast Cancer Criteria

• Criteria for identifying women with a significantly increased risk of breast cancer (3x or more the population risk).
• Criteria focus on family history, number of relatives, age at diagnosis, and breast/ovarian cancer prevalence within the family.

Breast Cancer: Risk Factors, Causes and Types Diagram

• Diagram illustrating risk factors (Genetics/Family History, Demographics, Prolonged Estrogen Exposure, Medical history, Lifestyle)
• Genetic risks (mutations in genes like BRCA1/BRCA2 and ↑ proto-oncogenes like HER2).
• Demographic factors (age, gender).
• Prolonged estrogen exposure (Nulliparity, early menarche).
• Medical history (previous breast cancer).
• Lifestyle factors (alcohol, high BMI, smoking).

Breast Cancer Signs & Symptoms

• Overview slide with graphic depicting common breast cancer symptoms.

Identifying Breast Cancer: Imaging

• Mammogram, Ultrasound, MRI and Biopsy techniques to identify breast cancer.

Breast Cancer Referral Process

• NICE guidance for breast cancer referral, focusing on:
• Referral criteria: age 30+ with unexplained breast lump, pain, discharge, or breast changes; or age 50+ with any of these symptoms or skin changes suggestive of cancer.
• Urgent referral timeframes (within 2 weeks)

Sentinel Node Breast Cancer

• Technique to detect and diagnose breast cancer spread including the use of radioisotopes and blue dye to track sentinel lymph nodes(SLN).

Biopsy of Lymph Node

• Methods of sampling, diagnosing infection or tumor, and histologic analysis of cells from lymph nodes.

Sentinel Node Biopsy

• Diagram showing the procedure.

Diagnostic Tools

• Identifying predictable lymph node patterns potentially avoiding unnecessary surgery.

Main Types of Breast Cancer

• Overview of categories:
  • Ductal carcinoma in situ (DCIS)
  • Invasive breast cancer (Invasive ductal and lobular), Inflammatory breast cancer
  • Triple negative breast cancer
  • HER2 positive breast cancer
  • Rarer types (medullary, mucinous, tubular breast cancer, malignant phyllodes tumor).

Breast Cancer Treatment

• Treatment options based on cancer stage (hormonal, chemotherapy, surgery, radiation).
• Therapies for estrogen/Her2 receptors.

Staging and Grading

• Breast cancer staging system.
  • Low grade (slow-growing)
  • Intermediate grade
  • High grade (faster growing)

Breast Cancer TNM Staging

• Detailed explanation of the TNM classification system including descriptions of:
• T (Tumor): size and extent
• N (Node): presence and location of lymph node involvement
• M (Metastasis): spread of cancer to distant sites.

Rationale for Radiotherapy

• Radiotherapy (RT) is used to reduce the risk of loco-regional recurrence in breast cancer.

MDT (Multidisciplinary Team) Members

• Description of core and extended members of the MDT:
• Designated breast surgeon(s)
• Radiologist
• Histopathologist
• Oncologist
• Breast care nurse
• Plastic & Reconstructive Surgeons
• Data Management Personnel
• Research Nurses
• Clinical Psychologist
• Palliative Care Team