Haneen Hassan Shaker.
Baghdad university/Alkindy college
• Risk factors
• Symptoms and presentation
• 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.
Breast Cancer among Iraqi Individuals
∞ Breast cancer is the most common type of malignancy among the Iraqi population in
∞ 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
☻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
☻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 .
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.
Carcinoma of the breast is extremely
rare in teenagers and unusual in the
From the thirties onwards, there is a
progressively increasing incidence,
which peaks in the late fifties. The
condition remains common into old
• Ask about all the modifiable
and non modifiable risk factors.
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 first symptom may be an axillary lump, with the primary lesion in
the breast being less obvious or even impalpable.
2-The patient may notice skin dimpling caused by tethering, skin
ulceration, change in the breast size and shape, eczema (paget’s
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
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
8-systemic symptoms commonly associated with cancer,
such as malaise and weight loss in the late stages.
Symptoms & presentation
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
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.
Social history ;
Being overweight or obese.
Tobacco smoke: Smoking may increase the risk of
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
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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