I made this e-grandroud presentation at the European School of Oncology on Thursday 11 July 2013. The recorded session is available on their web site.
Thanks for watching.
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Lifestyle modification and prevention of breast cancer
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2. Expert: Dr. Abdul Basit,
University Hospital of North Staffordshire, Stoke-on-Trent,
United Kingdom
Discussant: Dr. Fatima Cardoso,
Champalimaud Cancer Center, Lisbon, Portugal
e-grandround
Lifestyle modification and prevention of breast cancer
4. How Does Breast Cancer Develop ?
A multistep process taking many years in most
cases
Cell Proliferation
Oestrogen Hormone breast cell division
Cancer causing agents bind more strongly to
maturing cells of girls and young women.
From the Cornell University Program on Breast Cancer
and Environmental Risk Factors in New York State 1997
4
5. How Does Breast Cancer Develop ?
Puberty – First pregnancy
After first full term pregnancy, breast cells
are mature and are less sensitive to DNA
damage.
Breast feeding further reduces the
breast cells’ sensitivity to mutations
5
8. How does the breast cancer develop ?
Prof. Michael Baum University College , London
ER
Aromatase 8
9. 0 10,000 20,000 30,000 40,000 50,000
Other
Mesothelioma
Cervix
Liver
Multiple myeloma
Brain with CNS
Oral
Ovary
Leukaemias
Uterus
Pancreas
Stomach
Oesophagus
Kidney
Bladder
Malignant melanoma
N-H-L
Prostate
Colorectal
Lung
Breast
Number of new cases
Male Female
Figure 1.1: The 20 most commonly diagnosed cancers
(excluding non-melanoma skin cancer), UK, 2007
The largest group of survivors are those of breast cancer
9
10. Your views are important!
Remember that you can ask questions
and send comments at any time.
10
11. Breast cancer is not
the number one killer
Cause of Death in Females 2009
0
5000
10000
15000
20000
25000
30000
35000
IH
D
C
VA
D
enentia
Influenza
Lung
C
ancer
C
hronic
low
erR
espiratry
B
reastC
ancer
Number
11
12. 15% decrease (42-
27/100,000)
Life time risk of 1:8
47,700 new cancers per
annum (2008)
< 50yrs 20%
50-70yrs 50% only 33% are Screen
>70yrs 30%
Rising Incidence over 25 years
Falling mortality
50% increase
(75-124/100,000)
over 550,000 ‘survivors’
8 out of 10
12
14. 12 Things you must know before you can plan
treatment for breast cancer
Age at Diagnosis
Tumour Size
(1)
Tumour Grade (2) Tumour Type
Lymph Node
Status (3)
Lympho-vascular
Invasion
(Nottingham
Prognostic Index)
Margins of clearance
Immunohistochemistry -3 (IHC-3) ER PgR Her2
Menopausal status Health performance
status
Presentation source Screening / Symptomatic
1,2,3 = Nottingham Prognostic Index (NPI) 14
17. Life events associated with
breast cancer
Age
Sex – Female
Race
Age at Menarche
Age at first live birth
Multiparity – Nulliparity
Breast Feeding
17
18. Life events associated with breast
cancer (Cont)
Contraceptive Pill
Diet – Exposure to Oestrogens
Alcohol
Lack of exercise
Age at Menopause
Hormone Replacement Therapy
18
30. Thousands of women die from breast cancer
caused by drinking: research
The risk of developing breast cancer from
drinking even small amounts of alcohol is
being ignored by women with thousands now
needlessly dying every year.
Thousands of women die from breast cancer
caused by drinking: research
Telegraph.co.uk
The risk of developing breast cancer from drinking even small amounts
of alcohol is being ignored by women with thousands now needlessly
dying every year.
30
35. Factors that might influence breast density -
nutrition, physical activity, BMI, alcohol, and tobacco
35
36. Your views are important!
Remember that you can ask questions
and send comments at any time.
36
37. Reproductive History
How many Children?
Age at first live birth ?
First Child before age 30
Breast feeding
12 months of total breast feeding in life
time
37
39. Life Style
Weight gain after menopause
Lack of exercise
High intake of animal fat
Lack of vegetables and grain in diet
Alcohol
Smoking ?
39
40. Educating health promoting behaviours
Weight reduction
Physical activity and exercise 30 minutes most days.
Having first child before the age of 30
Breast feeding for 12 months during reproductive life
Diet – Less saturated and animal fat - more Fruit & Veg
• Less processed and red meat - more fish
• Less refined flour and sugar - more fibre
Avoiding hormones in the ‘pill’ , HRT and IVF
Alcohol - Less than 1 drink a day
Stockphoto.comexercise and diet
40
43. The next e-ESO session
will take place next Thursday, July 18th, at the same time
News from St Gallen Early Breast Cancer Conference
2013
Dr. Fatima Cardoso,
Champalimaud Cancer Center, Lisbon, Portugal
44. For additional information, please visit www.e-eso.net
This activity is CME accredited.
Please close the webcast window to access the CME forms
Thank you!
for participating to this
e-grandround
Hinweis der Redaktion
Good Afternoon, Good Evening and Good Morning to all Participants in today’s e-grandround.I would like to thank European School of Oncology for allowing me to make this presentation.I would also like to thank Dr. Fatima Cardoso who is my Discussant for this session.And my greetings to FracescaMarangoni of the ESO. I will now start my presentation on Lifestyle Modification and prevention of Breast Cancer. (Slide 4 please)
In order to discuss Lifestyle modification and prevention of breast cancer and to identify the factors which may influence the development of Breast Cancer we will remind ourselves of the steps that are likely to lead to breast cancer.The cells in the breast ducts and Lobules undergo Cell Proliferation under the influence of oestrogen Hormone.When breast cells are maturing particularly rapidly between Menarche and First Live Birth, they are most likely to be affected by cancer causing agents. (Slide 5 Please).
After the first Live birth Breast cells have matured and are less sensitive to such stimuli.Breast feeding further reduces the breast cell sensitivity to mutations. (Slide 6 please)
Normal ductal cells are in single layerWhen these cells proliferate too much they can become abnormal. (Slide 7 please)
Proliferating breast cells can change shape and orientation and thus become Dysplastic. (Slide 8 please)
Ovarian Oestrogen and Prgesterone affects breast stimulating the oestrogen ReceptorsDietary oestrogen and body fat affects breast via peripheral conversion requiring the enzyme Aromatase. (Slide 9 please)
All these factors have made the breast cancer as the commonest cancer in women. (Slide 10 please)
…. Slide 11 please
Although breast cancer is the commonest cancer diagnosed in women it has good treatments available and Breast Cancer is not the commonest cause of death in females. (Slide 12 please)
The incidence of breast cancer has been rising for many years but its mortality is falling primarily because of The increasing use of chemotherapy in pre menopausal women, RT after breast conserving surgery, the use of Tamoxifen and more recently Herceptin.The results of these improvements are an Increased number of SURVIVORS. (Slide 13 please)
When we look at the age of patients who have had operative treatment for a potentially curable breast cancer we notice that there are very few patients under the age of 30 who are diagnosed with breast cancer. Does it mean that something at the age 0f 30 makes them develop breast cancer? It is more likely that the agents responsible for breast cancer have been working since the birth and have taken a number of years to produce breast cancer. Lifestyle modification therefore need to start right from the birth of a female child. (Slide 14 please)
When we look at this slide we will notice that there can been be many different types of breast cancer. (Slide 15 please)
Their radiological appearance s are different. (Slide 16 please)
Their clinical presentations are different (Slide 17 Please)
The life events that are associated with breast cancer are well recognized (Slide 18 Please)
It is more likely that in patients who develops breast cancer many of these are working in combination at different time in their life. (Slide 19 please)
Histologically we know that there are two main types of breast cancer, Ductal and Lobular (Slide 20 Please)
Slide 21 please
A 50 years old lady who is pre menopausal has a higher risk of breast cancer than a fifty years old who has achieved menopause.Reduction in body weight around menopause decreases the risk of breast cancer. (Slide 23 Please)
The three main lifestyle changes that can reduce the risk of breast cancer are Diet, Having children below the age of 30, Multiparity and reduction in the amount of alcohol consumtion. (Slide 25 please)
Footballers wife has a child at 23 where as a lady who has three degrees has her first child at 35. This is a modifiable lifestyle factor. (Slide 30 Please)
Practical approaches to dietary modification that include increasing fruit and vegetable consumption, eating a low fat diet, reducing meat consumption, and avoiding alcohol are likely to be of potential overall benefit in lowering the risk of breast cancer.Three types of my patients ask about Lifestyle modification for the prevention of breast cancer 1. those who have had treatment for breast cancer2. Patients who have had breast cancer and have survivors ask about their daughters. Third who have some form of breast cancer in the family.