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Breast Cancer

  1. 1. Haneen Hassan Shaker. Baghdad university/Alkindy college of Medicine. hassanhaneen13@gmail.com
  2. 2. • Introduction • Risk factors • Symptoms and presentation • History
  3. 3. Introduction • Globally, breast cancer is the most frequent cancer among women; comprising about 23 % of all female cancers. • It is also the leading cause of cancer-related deaths. • Breast cancer survival rates vary greatly worldwide, ranging from over 80% in North America, Sweden and Japan to around 60% in middle- income countries and below 40% in low income regions of the world . • The low survival rates in less developed countries are mainly attributed to the lack of awareness programs, resulting in a high proportion of women presenting in late-stages.
  4. 4. Breast Cancer among Iraqi Individuals ∞ Breast cancer is the most common type of malignancy among the Iraqi population in general. ∞ responsible for about one third of the registered female cancers and almost one quarter of female deaths from the disease ∞ Within the last two decades, there has been an obvious increase in the incidence rates of breast cancer, which became one of the major threats to Iraqi female health. ∞ It has a tendency to affect middle aged women ∞ In 2010, it has been reported that out of 721 women, who presented with palpable breast masses in a screening center for early detection of breast cancer in Iraq, 143 were diagnosed with breast cancer ∞ Although 90.6% of those patients detected the lumps initially by themselves, only 32% sought medical advice within the first month while 16. % visited the doctor one year later.
  5. 5. Risk Factors Modifiable factors Non modifiable factors
  6. 6. ☻Gender: more prevalent in women. One (MALE) in every 150 cases (female). ☻Age: The chance of getting breast cancer goes up as a woman gets older. Over 80% of all female breast cancers occur among women aged 50+ years
  7. 7. ☻Genetic risk factor: • Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast cancer. • Those have cancer early in life usually before the age of 40 .
  8. 8.  Race/Ethnic background: Overall, white women are slightly more likely to get breast cancer than African-American women.  African-American women, though, are more likely to die of breast cancer. Asian and Native-American women have a lower risk of getting and dying from breast cancer.
  9. 9. HISTORY • Age Carcinoma of the breast is extremely rare in teenagers and unusual in the twenties. From the thirties onwards, there is a progressively increasing incidence, which peaks in the late fifties. The condition remains common into old age. • Ask about all the modifiable and non modifiable risk factors.
  10. 10. Symptoms & presentation 1-Classically, the patient notices a painless lump • the size of which does not correlate with the length of the history. • Occasionally, a prickling sensation in the breast draws attention to the swelling. • The first symptom may be an axillary lump, with the primary lesion in the breast being less obvious or even impalpable.
  11. 11. 2-The patient may notice skin dimpling caused by tethering, skin ulceration, change in the breast size and shape, eczema (paget’s dis) 3-The nipple may become retracted & destroyed ; Ask about. Unilateral or bilateral New or old retraction Spontaneous or manually returned back Associated with underlying lump If there is any discharge Symptoms & presentation
  12. 12. 4- nipple discharge: Ask about:
  13. 13. Characteristics of nipple discharge
  14. 14. 5- breast pain ; ask about:
  15. 15. 6-Backache due to bony metastases is a common symptom of advanced disseminated disease, but an uncommon mode of presentation. 7- Occasionally, a pathological fracture may be the first sign of the disease, as may symptoms from cerebral, lung or abdominal deposits. 8-systemic symptoms commonly associated with cancer, such as malaise and weight loss in the late stages. Symptoms & presentation
  16. 16. Past medical history ; • Hx of benign breast disease • Hx of previous cancer (breast , ovaries, lungs , colon) • Hx of previous radiation exposure. Past surgical history : • Breast biopsy • Lumpectomy • Mastectomy • Oophorectomy • Hysterectomy
  17. 17. Family history:  Breast cancer risk is higher among women whose close blood relatives have this disease.  Risk increased 5times in women with two or more first degree relatives, Especially if the disease occurred in early age bellow the age of 50.  Family history of ovarian ,lung and colonic ca. Drug history : Hx of estrogen therapy for along periods. Using hormone therapy(HRT) after menopause.
  18. 18. Social history ;  Alcohol consumption.  Being overweight or obese.  Tobacco smoke: Smoking may increase the risk of breast cancer. Gynecological history : • Nulliparous or multiparous • Age of getting her first child. • Number of children • Lactating or not. • Exclusive breast feeding and for how long , or using bottle feeding
  19. 19. Menstrual history : • Age of the menarche • age of the menopause • Regularity , duration and the amount of blood loss. Women with early menarche (before age 12) or late menopause after the age of 55 have a slightly increased risk of breast cancer.

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