1.
PLWC Slide Deck Series:PLWC Slide Deck Series:
Understanding Breast CancerUnderstanding Breast Cancer
PresentsPresents
20062006

2.
What is Cancer?
A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body

3.
What is Breast Cancer?
The most common type of cancer in women in the United
States (excluding cancers of the skin) and the second
most frequent cause of death from cancer in women
A disease in which normal cells in the breast begin to
change, grow without control, and no longer die
Cancer that has not spread is called in situ, meaning “in
place”
Cancer that has spread is called invasive or infiltrating

4.
What is the Structure of the Breast?
The breast is composed mainly of fatty
tissue, which contains a network of
lobes made up of tiny, tube-like
structures called lobules that contain
milk glands
Tiny ducts connect the glands, lobules,
and lobes, and carry the milk from the
lobes to the nipple
Blood and lymph vessels run
throughout the breast
About 90% of all breast cancers
originate in the ducts or lobes of the
breast

5.
What Are the Risk FactorsWhat Are the Risk Factors
for Breast Cancer?for Breast Cancer?
AgeAge
RaceRace
Individual or family history of breast cancerIndividual or family history of breast cancer
A history of ovarian cancerA history of ovarian cancer
A genetic predisposition (mutations to the BRCA1 or BRCA2A genetic predisposition (mutations to the BRCA1 or BRCA2
genes cause 2% to 3% of all breast cancers)genes cause 2% to 3% of all breast cancers)
Estrogen exposureEstrogen exposure
Atypical hyperplasia of the breastAtypical hyperplasia of the breast
Lobular carcinoma in situ (LCIS)Lobular carcinoma in situ (LCIS)
Lifestyle factors (obesity, lack of exercise, alcohol use)Lifestyle factors (obesity, lack of exercise, alcohol use)
RadiationRadiation

6.
Hereditary Breast Cancer
About 15% of breast cancers are inheritedAbout 15% of breast cancers are inherited
Approximately 80% of hereditary breast cancer is caused byApproximately 80% of hereditary breast cancer is caused by
mutations in the BRCA1 or BRCA2 genesmutations in the BRCA1 or BRCA2 genes
Women who inherit a BRCA mutation have a 50% to 85%Women who inherit a BRCA mutation have a 50% to 85%
chance of developing breast cancer in their lifetimechance of developing breast cancer in their lifetime
Women with especially strong family history may considerWomen with especially strong family history may consider
preventive surgery to remove breast tissue and/orpreventive surgery to remove breast tissue and/or
chemopreventionchemoprevention
Several other genetic syndromes can increase breast cancerSeveral other genetic syndromes can increase breast cancer
riskrisk
Genetic counseling and testing is available for mostGenetic counseling and testing is available for most
syndromessyndromes
For more information, www.plwc.org/geneticsFor more information, www.plwc.org/genetics

7.
Breast Cancer and Early Detection
Early diagnosis means a better chance of successfulEarly diagnosis means a better chance of successful
treatmenttreatment
Mammography is the best tool doctors have to screen forMammography is the best tool doctors have to screen for
breast cancerbreast cancer
Many organizations recommend that women obtain aMany organizations recommend that women obtain a
mammogram each year, starting at the age of 40mammogram each year, starting at the age of 40
Regular clinical breast examinations and breast self-Regular clinical breast examinations and breast self-
examinations are also recommendedexaminations are also recommended
Women are encouraged to discuss the frequency ofWomen are encouraged to discuss the frequency of
screening with their doctorsscreening with their doctors

8.
What Are the Symptoms of Breast Cancer?What Are the Symptoms of Breast Cancer?
New lumps or a thickening in the breast or under the armNew lumps or a thickening in the breast or under the arm
Nipple tenderness, discharge, or physical changesNipple tenderness, discharge, or physical changes
Skin irritation or changes, such as puckers, dimples, scaliness, orSkin irritation or changes, such as puckers, dimples, scaliness, or
new creasesnew creases
Warm, red, swollen breasts with a rash resembling the skin of anWarm, red, swollen breasts with a rash resembling the skin of an
orangeorange
Pain in the breast (usually not a symptom of breast cancer, butPain in the breast (usually not a symptom of breast cancer, but
should be reported to a doctor)should be reported to a doctor)
No visible or obvious symptoms (asymptomatic)No visible or obvious symptoms (asymptomatic)

9.
How is Breast Cancer Evaluated?How is Breast Cancer Evaluated?
Screening and/or diagnostic mammographyScreening and/or diagnostic mammography
UltrasoundUltrasound
Magnetic Resonance imaging (MRI) scanMagnetic Resonance imaging (MRI) scan
Biopsy is necessary to confirm a diagnosisBiopsy is necessary to confirm a diagnosis
Blood tests are often used to determine if the cancer hasBlood tests are often used to determine if the cancer has
spread outside the breastspread outside the breast
Additional tests may be used to determine stageAdditional tests may be used to determine stage

10.
Breast Cancer StagingBreast Cancer Staging
Staging is a way of describing a cancer, such as the depthStaging is a way of describing a cancer, such as the depth
of the tumor and where it has spreadof the tumor and where it has spread
Staging is the most important tool doctors have toStaging is the most important tool doctors have to
determine a patient’s prognosisdetermine a patient’s prognosis
Staging is described by the TNM system: the size of theStaging is described by the TNM system: the size of the
TTumor, whether cancer has spread to nearby lymphumor, whether cancer has spread to nearby lymph
NNodes, and whether the cancer hasodes, and whether the cancer has MMetastasized (spreadetastasized (spread
to organs such as the liver or lungs)to organs such as the liver or lungs)
The type of treatment a person receives depends on theThe type of treatment a person receives depends on the
stage of the cancerstage of the cancer

11.
StageStage 00 Breast CancerBreast Cancer
Known as “cancer in situ,” meaning the cancer has notKnown as “cancer in situ,” meaning the cancer has not
spread past the ducts or lobules of the breast (the naturalspread past the ducts or lobules of the breast (the natural
boundaries)boundaries)
Also called noninvasive cancerAlso called noninvasive cancer
Ductal carcinoma in situ (DCIS) is the most common inDuctal carcinoma in situ (DCIS) is the most common in
situ breast cancersitu breast cancer

12.
Stage I Breast CancerStage I Breast Cancer
The tumor is small andThe tumor is small and
has not spread to thehas not spread to the
lymph nodeslymph nodes

13.
Stage IIa Breast CancerStage IIa Breast Cancer
Stage IIa breast cancerStage IIa breast cancer
describes a smaller tumordescribes a smaller tumor
that has spread to thethat has spread to the
axillary lymph nodesaxillary lymph nodes
(lymph nodes under the(lymph nodes under the
arm), or a medium-sizedarm), or a medium-sized
tumor that has not spreadtumor that has not spread
to the axillary lymph nodesto the axillary lymph nodes
Stage IIa may also describeStage IIa may also describe
cancer in the axillarycancer in the axillary
lymph nodes with nolymph nodes with no
evidence of a tumor in theevidence of a tumor in the
breastbreast

14.
Stage IIb Breast CancerStage IIb Breast Cancer
Stage IIb breast cancerStage IIb breast cancer
describes a medium-sizeddescribes a medium-sized
tumor that has spread totumor that has spread to
the axillary lymph nodesthe axillary lymph nodes
Stage IIb may alsoStage IIb may also
describe a larger tumordescribe a larger tumor
that has not spread to thethat has not spread to the
axillary lymph nodesaxillary lymph nodes

15.
Stage IIIa Breast CancerStage IIIa Breast Cancer
Stage IIIa breast cancerStage IIIa breast cancer
describes any sizedescribes any size
tumor that has spreadtumor that has spread
to the lymph nodesto the lymph nodes

16.
Stage IIIb Breast CancerStage IIIb Breast Cancer
Stage IIIb breast cancerStage IIIb breast cancer
has spread to the chesthas spread to the chest
wall, or caused swelling orwall, or caused swelling or
ulceration of the breast, orulceration of the breast, or
is diagnosed asis diagnosed as
inflammatory breastinflammatory breast
cancercancer

17.
Stage IIIc Breast CancerStage IIIc Breast Cancer
Stage IIIc breast cancerStage IIIc breast cancer
has spread to distanthas spread to distant
lymph nodes but haslymph nodes but has
not spread to distantnot spread to distant
parts of the bodyparts of the body

18.
Stage IV Breast CancerStage IV Breast Cancer
Stage IV breast cancer can be any size and hasStage IV breast cancer can be any size and has
spread to distant sites in the body, usually thespread to distant sites in the body, usually the
bones, lungs or liver, or chest wallbones, lungs or liver, or chest wall

19.
How is Breast Cancer Treated?How is Breast Cancer Treated?
Treatment depends on stage of cancerTreatment depends on stage of cancer
More than one treatment may be usedMore than one treatment may be used
SurgerySurgery
Radiation therapyRadiation therapy
ChemotherapyChemotherapy
Hormone therapyHormone therapy
Targeted therapyTargeted therapy

20.
Factors Considered in Treatment DecisionsFactors Considered in Treatment Decisions
The stage and grade of the tumorThe stage and grade of the tumor
The tumor’s hormone receptor status (ER, PR)The tumor’s hormone receptor status (ER, PR)
Factors that may signify an aggressive tumor, such as HER-2/neuFactors that may signify an aggressive tumor, such as HER-2/neu
amplificationsamplifications
The presence of known mutations to breast cancer genesThe presence of known mutations to breast cancer genes
The patient’s menopausal statusThe patient’s menopausal status
The patient’s age and general healthThe patient’s age and general health

21.
Cancer Treatment: SurgeryCancer Treatment: Surgery
Generally, surgery to remove the tumor with or withoutGenerally, surgery to remove the tumor with or without
radiation therapy is initial treatmentradiation therapy is initial treatment
For invasive cancer, lymph nodes are removed andFor invasive cancer, lymph nodes are removed and
evaluatedevaluated
More invasive surgery (such as mastectomy) is notMore invasive surgery (such as mastectomy) is not
always better; discuss with your doctoralways better; discuss with your doctor
Breast reconstruction is an option after mastectomyBreast reconstruction is an option after mastectomy

22.
Cancer Treatment: Adjuvant TherapyCancer Treatment: Adjuvant Therapy
Treatment given in addition to surgery to reduce the riskTreatment given in addition to surgery to reduce the risk
of recurrenceof recurrence
May include radiation therapy, chemotherapy, biologicMay include radiation therapy, chemotherapy, biologic
therapy, and hormone therapytherapy, and hormone therapy

23.
Cancer Treatment: Radiation TherapyCancer Treatment: Radiation Therapy
The use of high-energy x-rays or other particles to destroyThe use of high-energy x-rays or other particles to destroy
cancer cellscancer cells
Usually used to treat breast cancer after surgeryUsually used to treat breast cancer after surgery
Different methods of deliveryDifferent methods of delivery
External-beam: outside the bodyExternal-beam: outside the body
Internal: uses implants inside the bodyInternal: uses implants inside the body
Side effects may include fatigue, swelling, and skin changesSide effects may include fatigue, swelling, and skin changes

24.
Cancer Treatment: ChemotherapyCancer Treatment: Chemotherapy
Drugs used to kill cancer cellsDrugs used to kill cancer cells
May be given before surgery to shrink a large tumorMay be given before surgery to shrink a large tumor
(neoadjuvant chemotherapy) or after surgery to reduce(neoadjuvant chemotherapy) or after surgery to reduce
the risk of recurrence (adjuvant chemotherapy)the risk of recurrence (adjuvant chemotherapy)
A combination of medications is often usedA combination of medications is often used

25.
Cancer Treatment: Hormone TherapyCancer Treatment: Hormone Therapy
Used to manage tumors that test positive for either estrogen orUsed to manage tumors that test positive for either estrogen or
progesterone receptorsprogesterone receptors
May be used alone or together with chemotherapyMay be used alone or together with chemotherapy
Tamoxifen (Nolvadex) is a common hormone therapy and isTamoxifen (Nolvadex) is a common hormone therapy and is
effective in many premenopausal and postmenopausal womeneffective in many premenopausal and postmenopausal women
Aromatase inhibitors are also used alone or followingAromatase inhibitors are also used alone or following
tamoxifen use as treatment for postmenopausal women,tamoxifen use as treatment for postmenopausal women,
including anastrozole (Arimidex), letrozole (Femara), andincluding anastrozole (Arimidex), letrozole (Femara), and
exemestane (Aromasin)exemestane (Aromasin)

26.
New Therapies: Targeted TherapyNew Therapies: Targeted Therapy
Treatment designed to target cancer cells while minimizingTreatment designed to target cancer cells while minimizing
damage to healthy cellsdamage to healthy cells
Used to stop the action of abnormal proteins that cause cellsUsed to stop the action of abnormal proteins that cause cells
to grow and divide out of controlto grow and divide out of control
Trastuzumab (Herceptin) for women with a HER-2/neu-Trastuzumab (Herceptin) for women with a HER-2/neu-
positive breast cancer either with or after adjuvantpositive breast cancer either with or after adjuvant
chemotherapychemotherapy
Bevacizumab (Avastin) blocks angiogenesis (the formation ofBevacizumab (Avastin) blocks angiogenesis (the formation of
new blood vessels) and is under evaluation in clinical trialsnew blood vessels) and is under evaluation in clinical trials

27.
The Role of Clinical Trials for theThe Role of Clinical Trials for the
Treatment of Breast CancerTreatment of Breast Cancer
Clinical trials are research studies involving peopleClinical trials are research studies involving people
They test new treatment and prevention methods toThey test new treatment and prevention methods to
determine whether they are safe, effective, and betterdetermine whether they are safe, effective, and better
than the best known treatmentthan the best known treatment
The purpose of a clinical trial is to answer a specificThe purpose of a clinical trial is to answer a specific
medical question in a highly structured, controlledmedical question in a highly structured, controlled
processprocess
Clinical trials can evaluate methods of cancer prevention,Clinical trials can evaluate methods of cancer prevention,
screening, diagnosis, treatment, and/or quality of lifescreening, diagnosis, treatment, and/or quality of life

28.
Clinical Trials: Patient SafetyClinical Trials: Patient Safety
Informed consent: Participants should understand whyInformed consent: Participants should understand why
they are being offered entry into a clinical trial and thethey are being offered entry into a clinical trial and the
potential benefits and riskspotential benefits and risks
Informed consent is an ongoing process; participants areInformed consent is an ongoing process; participants are
constantly updated as new information becomesconstantly updated as new information becomes
availableavailable
Participation is always voluntary, and patients can leaveParticipation is always voluntary, and patients can leave
the trial at any timethe trial at any time

29.
Clinical Trials: PhasesClinical Trials: Phases
Phase I trials determine safety and dose of a newPhase I trials determine safety and dose of a new
treatment in a small group of peopletreatment in a small group of people
Phase II trials provide more detail about the safety of thePhase II trials provide more detail about the safety of the
new treatment and determine how well it works fornew treatment and determine how well it works for
treating a given form of cancertreating a given form of cancer
Phase III trials take a new treatment that has shownPhase III trials take a new treatment that has shown
promising results when used to treat a small number ofpromising results when used to treat a small number of
patients with cancer and compare it with the current,patients with cancer and compare it with the current,
standard treatment for that disease; phase III trialsstandard treatment for that disease; phase III trials
involve a large number of patientsinvolve a large number of patients

30.
Clinical Trials ResourcesClinical Trials Resources
Coalition of Cancer Cooperative GroupsCoalition of Cancer Cooperative Groups
(www.CancerTrialsHelp.org)(www.CancerTrialsHelp.org)
CenterWatch (www.centerwatch.com)CenterWatch (www.centerwatch.com)
National Cancer InstituteNational Cancer Institute
(www.cancer.gov/clinical_trials)(www.cancer.gov/clinical_trials)

31.
Coping With the Side Effects of CancerCoping With the Side Effects of Cancer
and its Treatmentand its Treatment
Side effects are treatable; talk with the doctor or nurseSide effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effectFatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain relievers are availablePain is treatable; non-narcotic pain relievers are available
Antiemetic drugs can reduce or prevent nausea and vomitingAntiemetic drugs can reduce or prevent nausea and vomiting
Lymphedema following breast cancer surgery can often be managedLymphedema following breast cancer surgery can often be managed
with help from your doctorwith help from your doctor
For more information, visit www.plwc.org/sideeffectsFor more information, visit www.plwc.org/sideeffects

32.
Follow-Up CareFollow-Up Care
Important to detect possible recurrence at the earliest stageImportant to detect possible recurrence at the earliest stage
Monthly breast self-examinationsMonthly breast self-examinations
Physical examinationsPhysical examinations
MammogramsMammograms
Pelvic examinationsPelvic examinations
More information can be found in theMore information can be found in the ASCO Patient Guide: Follow-ASCO Patient Guide: Follow-
Up Care for Breast CancerUp Care for Breast Cancer

33.
Where to Find More Information:
PLWC Guide to Breast Cancer
(www.plwc.org/breast)
OverviewOverview
Medical IllustrationsMedical Illustrations
Risk FactorsRisk Factors
PreventionPrevention
SymptomsSymptoms
DiagnosisDiagnosis
Staging With IllustrationsStaging With Illustrations
TreatmentTreatment
Side Effects of Cancer andSide Effects of Cancer and
Cancer TreatmentCancer Treatment
Questions to Ask theQuestions to Ask the
DoctorDoctor
Current ResearchCurrent Research
Patient InformationPatient Information
ResourcesResources
Clinical Trials ResourcesClinical Trials Resources

34.
People Living With Cancer (www.plwc.org)People Living With Cancer (www.plwc.org)
PLWC is the cornerstone of ASCO’s patient resources programPLWC is the cornerstone of ASCO’s patient resources program
Visitors to PLWC will find:Visitors to PLWC will find:
 PLWC Guides to more than 90 types of cancerPLWC Guides to more than 90 types of cancer
 Coping resourcesCoping resources
 Ask the ASCO Expert Series, including chats, Q&A forums,Ask the ASCO Expert Series, including chats, Q&A forums,
and event transcriptsand event transcripts
 Cancer information in SpanishCancer information in Spanish
 The latest cancer newsThe latest cancer news
For patient information resources, please call 888-651-3038For patient information resources, please call 888-651-3038