1. BY DR RUBY BAZEER a.k.a DR. RUBZ
Presented on Charity Dinner
Date: 29th March 2014
Venue: Paradox Art Cafe
BREAST
CANCER
Supported by

3.  Commonest cancer affecting
women (White American > African American, Chinese >Indian>Malay) 24:16:1
 1.5 million new cases diagnosed
every year
 1200 new patients/year
 14% of all cancer deaths annually

5. But there is hope……
……breast cancer is
CURABLE
when detected in EARLY stages!
! ! !

6. 1. Chest wall.
2. Pectoral muscles.
3. Lobules (glands that make milk).
4. Nipple surface.
5. Areola.
6. Lactiferous duct tube that carries
milk to the nipple
7. Fatty tissue.
8. Skin.
THE ANATOMY OF BREAST

8. THE LYMPHATIC SYSTEM
Lymphatic System which consists of vessels and
organs plays two vital roles in our lives:
1. The vessels essentially maintain interstitial fluid levels by carrying
excess fluids as well as any plasma proteins, back into the CVS.
2. The organs, house critical immune cells such as lymphocytes which
carry out our body defense against infection.

9. Most of the lymph vessels of the
breast drain into:
 Lymph nodes under the arm (auxiliary nodes).
 Lymph nodes around the collar bone (supraclavicular and
infraclavicular lymph nodes)
 Lymph nodes inside the chest near the breast bone (internal mammary
lymph nodes)

11. PHYSIOLOGY
 Estrogen
 - Development of the breast and
 lactiferous ducts
 Progesterone
 - Together with estrogen causes lobular and
 alveolar growth
 Prolactin
 - Synergizes the effect of estrogen and
 progesterone

12. WHAT IS CANCER ?
Cancer is the abnormal,
uncontrollable , continuous
replication of cells which will
inevitably lead to the formation
of a tumor.

13. • A tumor can be benign (not dangerous to health) or
malignant (has the potential to be dangerous.
• Malignant tumors are cancerous. Left unchecked,
malignant cells eventually can spread beyond the
original tumor to other parts of the body.
? ? ?

14. BENIGN TUMORS
• Not cancerous.
• Benign breast tumors are abnormal growths, but they do not spread
outside of the breast and they are not life threatening.
• Most lumps are caused by the combination of cysts and fibrosis
• Cysts are fluid-filled sacs.
• Fibrosis is the formation of scar - like tissue.
• These changes can cause breast swelling and pain.

16. WHAT IS BREAST CANCER ?
• The term “breast cancer” refers to a malignant
tumor that has developed from cells in the breast.
• It is found mostly in women, but men can get
breast cancer, too.

17. • Usually breast cancer either begins in the cells of the
lobules, which are the milk-producing glands, or the
ducts, the passages that drain milk from the lobules to
the nipple. Less commonly, breast cancer can begin in
the stromal tissues, which include the fatty and fibrous
connective tissues of the breast.
• Over time, cancer cells can invade nearby healthy breast
tissue and make their way into the underarm lymph
nodes,(lymph nodes are : small organs that filter out
foreign substances in the body).
• If cancer cells get into the lymph nodes, they then have
a pathway into other parts of the body.

18. RISK FACTORS OF BREAST CANCER
(WHAT INCREASES THE RISK OF HAVING BREAST CANCER ? )
• Sex (female > male) 1 in every 150 cases (male).
• Age (Over 80% of all female breast cancers occur among women aged 50+ years)
• Personal History (Previous cancer history or benign breast lump)
• Family History (Breast cancer risk is higher among women whose close blood relatives have this
disease.)
• The Breast Cancer Genes (Women who carry the BRCA1 and BRCA2 genes has 40- 85% risk )
• Early menarche ( <12 years old)
• Late menopause (> 55 years old)
• Having no children

19. • Having a first full term pregnancy after age 25
• Not breast feeding
• Certain kind of birth control (Progesteron only)
• Use of Hormone Replacement Therapy
• Increased daily fat intake (especially saturated or hydrogenated fats)
• Obese
• Breast radiation early in life: (Women who have had radiation treatment to the
chest area as a child or young adult have a greatly risk)
• Tobacco smoke

20. • studies show that eating a lot of red and/or processed
meats is associated with a higher risk of breast cancer.
A low-fat diet rich in fruits and vegetables is generally
recommended.
• Being overweight is associated with increased risk of
breast cancer, especially for women after menopause.
Fat tissue is the body’s main source of estrogen after
menopause, when the ovaries stop producing the
hormone. Having more fat tissue means having higher
estrogen levels, which can increase breast cancer risk.
RISK FACTORS YOU CAN CONTROL
Weight
Diet.

21. • Alcohol can limit your liver’s ability to control blood
levels of the hormone estrogen, which in turn can
increase risk
• Evidence is growing that exercise can reduce breast
cancer risk. The American Cancer Society recommends
engaging in 45-60 minutes of physical exercise 5 or more
days a week.
RISK FACTORS YOU CAN CONTROL
Exercise
Alcohol
consumption

22. RISK FACTORS YOU CAN’T CONTROL
• Gender. Being a woman is the most significant risk factor for
developing breast cancer. Although men can get breast cancer,
too, women’s breast cells are constantly changing and growing,
mainly due to the activity of the female hormones estrogen and
progesterone. This activity puts them at much greater risk for
breast cancer.
• Age. Simply growing older is the second biggest risk factor for
breast cancer. From age 30 to 39, the risk is 1 in 233, or .43%. That
jumps to 1 in 27, or almost 4%, by the time you are in your 60s.

23. FACTORS NOT LINKED TO BREAST
CANCER
• Antiperspirant
• Bras
• Induced Abortion
• Breast implants

24. RISK FACTORS FOR MEN
• High levels of estrogen (due to cirrhosis of the
liver, for example) or estrogen-related drugs
(such as for prostate cancer)
• Exposure to radiation
• Over age 60
• High alcohol consumption
• Obesity
• Inherited gene mutations
• Family history of breast cancer

25. SIGN AND SYMPTOMS
• Painless lump or swelling
• Pitting or redness of the skin of the
breast; like the skin of an orange.
• An area of thickening of skin
• Nipple retraction (pulled inward)
• Nipple discharge
• Swelling/ pain in the armpit or breast
• (not related to menstrual cycle)

26. EARLY DETECTION/ SCREENING
• Self examination
• Clinical breast examination
• Ultrasound
• Mammography

27. • BREAST SELF EXAMINATION (90% of the
breast lump are found by patients themselves. Encourage female
have regular self breast examination.)
What am I looking for when I do a breast
self-exam?
You are looking for a lump or change that
stands out as different from the rest of
your breast tissue. If you discover a lump
or other change in your breast, either
during breast self examination or by
chance, you should examine the other
breast. If both breasts feel the same, the
lumpiness is probably normal.

28. What
should
you look
for?

32. . How often should I do a self-exam?
A breast self-exam is recommended every month a few days after your
period ends. During this time, your breasts are less tender or swollen. It
is important to do your breast self-exam at the same time during your
menstrual cycle.
All women >20 years
Breast Self Examination every month
Clinical Breast Examination every 2 to 3
years
All women > 40 years
Clinical Breast Examination yearly
Mammography yearly

33. MAMMOGRAM
What is a mammogramph and why should I have one?
the process of using low-energy-X-rays to examine the human
breast and is used as a diagnostic and a screening tool. The goal
of mammography is the early detection of breast cancer typically
through detection of characteristic masses and/or
microcalcifications.
You simply stand in front of an x-ray machine. Your breast is
placed between two plastic plates to flatten it. This helps in
getting a more clear picture and subsequently a more accurate
diagnosis. A mammogram takes only a few seconds.

34. INVESTIGATION AND STAGING
• When a patient detects a lump in the breast, a specialist opinion should
be sought to confirm if the lump is cancerous or not. The doctor will
perform a through physical examination before requesting for
mammography and ultra sound scan of the breast.
• A tissue sample in the form of needle suction or biopsy may be
obtained. Upon confirmation of the cancer, the patient will be staged
with x-rays or scans of the lungs and liver. A bone or brain scan may be
ordered to evaluate any spread (metastasis) to the bones or the brain.

35. STAGES OF BREAST
CANCER

36. • Stage 0 - Cancer in Situ(non invasive)
• Stage I - Cancer is less than 2 cm.
• Stage II - Cancer is between 2 to 5 cm with or
without involvement of the glands in the armpit
• Stage III - Cancer is larger than 5 cm or there is
extensive involvement of the glands in the armpit
• Stage IV - Cancer has spread outside the breast and
involves other organs in the body
• Stage I & II are considered early and curable (80 per
cent and above)
• Stage III ( percentage of cure is much lower than Stage I and II)
• Stage IV disease is not curable.(aim of the treatment is
palliative (control of symptoms).

37. TREATMENT OF BREAST CANCER
• Treatment plans for breast cancer
are developed based on a several
factors.
1. 1- The type and stage of the
cancer,
2. 2-the sensitivity of the cancer to
certain hormones
3. 3-the medical history of the patient

38. • The World Health Organisation [WHO] related that
two components of early detection have been shown
to improve cancer mortality:
1. 1- Education, which in turn helps people recognize early signs of
cancer and seek prompt medical attention for symptoms.
2. 2-Screening programs, which are a great tool in helping identify early
cancer or pre-cancer before signs are recognizable, including
mammography for breast cancer.

39. TREATMENT OF BREAST CANCER
• Surgery can be conservative (removing the lump or a segment of
the breast only) or may be in the form of a mastectomy (removing
the whole breast). In both cases, the glands in the armpit need
to be removed and checked for the presence of cancer cells.
• Radiotherapy uses high doses of radiation to kill cancer cells. It
is a localised form of treatment and is mandatory after
conservative surgical treatment. It is only given after a
mastectomy if the breast tumour is locally extensive.
Radiotherapy reduces the risk of local recurrence rate.
Radiotherapy is sometimes used as a palliative treatment to
control bone pain, bleeding or pressure symptoms.
• Chemotherapy involves the use of drugs given by injection or,
occasionally, orally. It treats the cancer by penetrating the
tissues and organ via the bloodstream. These drugs are toxic to
the cancer cells but they may also cause some side effects to
the normal tissues.

40. TREATMENT OF BREAST CANCER
• For early stage diseases, chemotherapy is used as an added
treatment to improve the outcome and cure rates. It is used to
"mop-up" the potential micro spread of cells that may have escaped
from the breast to the other parts of the body.
• For late stage disease, chemotherapy is used to "control" the rate
of growth of the tumour and to downsize the bulk of the disease.
The use of chemotherapy may also help to control symptoms,
prolong survival and improve the quality of life.
• Hormone or anti-hormone treatment is only given to patients whose
cancer cells are positive to oestrogen or progesterone receptors. By
blocking these receptors the growth of the cancer cells can be
curtailed. Drugs such as Tamoxifen and the new generation of
aromatase inhibitors may help to control the cancer for many years
after primary treatment.

41. FACTS ABOUT BREAST CANCER
• One in eight women will be diagnosed with breast cancer in their
lifetime.
• Breast cancer is the most commonly diagnosed cancer in women.
• Breast cancer is the second leading cause of death among women.
• Each year it is estimated that over 220,000 women in the United
States will be diagnosed with breast cancer and more than 40,000
will die.
• Although breast cancer in man is rare, an estimated 2,150 men will
be diagnosed with breast cancer and approximately 410 will die
each year.

42. COMMON MISCONCEPTION
• Common Misconception
• Breast cancer is a fatal disease that kills all patients.
• Reality Check!
• There has been a noticeable increase in the number of women diagnosed
with Breast Cancer each year, but the mortality rate is significantly
decreasing. Some reasons for this phenomenon comprise the enhanced
availability and nature of resources for treatment and early detection of
tumors through both Breast Self-examination and various technologies
including X-Ray Mammography.
• Common Misconception
• Breast Cancer is a contagious disease since it can occur in families with
many members affected over time or many women can be diagnosed in
single communities at the same time.
• Reality Check!
• Breast Cancer is not passed from person to person like an infectious
disease. Contagiousness has nothing to do with genetic mutations or
inheritance patterns of disease

43. • Common Misconception
• Finding an unnatural lump on the breasts means that a woman has Breast
Cancer.
• Reality Check!
• While you are undergoing a Breast-Self-examination if unnatural lumps,
infections, or any irregularities are detected, you should immediately
consult a specialist doctor. It is possible that detected irregularities are
not cancerous, however it is only a specialist doctor that can identify and
determine its nature..
• Common Misconception
• Breast cancer is a disease that is only found in women and not in men.
• Reality Check!
• Statistics in the United States of America have proven that women are
only more susceptible to the disease than men, where for every 135 cases
of Breast Cancer in women, one man is diagnosed. Men should also take a
proactive approach to their Breast health to encourage early detection
and curability if irregularities are present

44. GO HOME
AND
EXAMINE
YOUR
BREASTS!