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Risk Factors of Breast Cancer

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Risk Factors of Breast Cancer

  1. 1. Risk Factors of Breast Cancer Dr- Zainab A. Al-Dubisi
  2. 2. Contents <ul><li>Introduction. </li></ul><ul><li>Epidemiology. </li></ul><ul><li>Risk Factors. </li></ul><ul><li>Recommendations. </li></ul><ul><li>References. </li></ul>
  3. 3. Introduction <ul><li>Breast cancer is the commonest female cancer. </li></ul><ul><li>The 2 nd most common cancer death in women. </li></ul><ul><li>The main cause of death in women ages 45- 55. </li></ul><ul><li>1/2cases can be explained by known risk factors. </li></ul><ul><li>15% are associated with +ve family history. </li></ul>
  4. 4. Cont… <ul><li>Understanding the risk factors for breast cancer permits us to identify women at increased risk and intervene to modify risk, both individually and socially. </li></ul>Risk Factors
  5. 6. Epidemiology in KSA <ul><li>The recent data collected was in 2004 that by Saudi Cancer Registry (SCR) </li></ul><ul><li>“ Cancer Incidence Report in Saudi Arabia 2004” </li></ul><ul><li>It constitutes 11.5% of all cancers in Saudi. </li></ul><ul><li>Breast cancer in female accounts for 22.4% of all newly diagnosed cancer in female </li></ul><ul><li>The ASR was 15.4/100,000 for female population. </li></ul>
  6. 11. The five regions with the highest ASR <ul><li>Eastern region at 22.6/100,000. </li></ul><ul><li>Riyadh region at 19.4/100,000. </li></ul><ul><li>Makkah region at 19.1/100,000. </li></ul><ul><li>Jouf region at 17.5/100,000 </li></ul><ul><li>Qassim region at 12.6/100,000. </li></ul>
  7. 12. Epidemiology in U.S <ul><li>The incidence of breast cancer increased during the 1980s but leveled off in the 1990s and declined between 2001 and 2003. </li></ul><ul><li>The current incidence is estimated at around 120/100,000 women. </li></ul>
  8. 13. Cont… <ul><li>Annually: </li></ul><ul><li>approximately 182,460 American women are diagnosed with breast cancer. </li></ul><ul><li>40,480 die from the disease . </li></ul>
  9. 14. Cont… <ul><li>The incidence of breast cancer is highest in developed countries: </li></ul><ul><li>North America & Western Europe. </li></ul><ul><li>Lowest incidences seen in: </li></ul><ul><li>South America, Africa and parts of Asia . </li></ul>
  10. 15. Survival rate <ul><li>The 5-year breast cancer survival rate 98% for stage I cancer </li></ul><ul><li>16% for stage IV cancer </li></ul><ul><li>85% after 5 years </li></ul><ul><li>71% after 10 years </li></ul><ul><li>57% after 15 years </li></ul><ul><li>52% after 20 years </li></ul><ul><li>www.emedicine.com </li></ul>
  11. 16. Risk Factors of Breast Cancer...
  12. 17. Risk Factors of Breast Cancer <ul><li>Endogenous factors : </li></ul><ul><li>produced within or caused by the organism… </li></ul><ul><li>Exogenous factors: </li></ul><ul><li>Produced out side the body… </li></ul>
  13. 18. Endogenous factors <ul><li>Age and gender. </li></ul><ul><li>Family history and genetic factors . </li></ul><ul><li>Race and ethnicity. </li></ul><ul><li>Benign breast disease. </li></ul><ul><li>Personal history of breast cancer. </li></ul><ul><li>Hormonal & reproductive Factors. </li></ul><ul><li>Bone & breast Density </li></ul>
  14. 19. Age & Gender <ul><li>They are the strongest risk factors. </li></ul><ul><li>It is 100x > in female than male. </li></ul><ul><li>Annually, in U.S 182,460 women diagnosed with invasive breast cancers versus1900 in men. </li></ul>
  15. 20. Age <ul><li>Breast cancer is rare in women< 25 y. </li></ul><ul><li>Incidence increases with age, with a plateau in women aged 50-55 y. </li></ul><ul><li>At age 75-80, the incidence decreases. </li></ul>
  16. 22. Family History <ul><li>+ve family History is seen in 15-20 % of women with breast cancer. </li></ul><ul><li>The risk associated with having an affected 1 st or 2 nd degree maternal or paternal relative . </li></ul>
  17. 23. Cont… <ul><li>The lifetime risk is up to 4 times higher if a mother or sister are affected. </li></ul><ul><li>The risk increased if: </li></ul><ul><li>1 st degree relative affected by 1.80 fold. </li></ul><ul><li>2 affected 1 st degree relatives, the risk is increased 2.93 fold. </li></ul>
  18. 24. Cont… <ul><li>The risk ratios were highest for women with young affected relatives. </li></ul><ul><li>Risk increased </li></ul><ul><li>2.9 fold for a woman whose relative was diagnosed before age 30. </li></ul><ul><li>1.5 fold increased if the affected relative was diagnosed after age 60. </li></ul>Medline ® Abstracts for References 188 of 'Epidemiology and risk factors for breast cancer
  19. 25. Genetics… <ul><li>BRCA1, BRCA2,p53, ATM, and PTEN mutations are associated with higher risk. </li></ul><ul><li>Ataxia telangiectasia heterozygotes are at 4-times increased risk </li></ul>Medline ® Abstracts for References.19, 189 of 'Epidemiology and risk factors for breast cancer
  20. 26. Race and ethnicity <ul><li>Compared with US women: </li></ul><ul><li>Individuals of Ashkenazi Jewish descent have a 2x greater risk. </li></ul><ul><li>Japanese and Taiwanese woman have 1/5 the risk. </li></ul>
  21. 27. Cont… <ul><li>The highest rates occur in whites; that is </li></ul><ul><li>133 /100,000 </li></ul><ul><li>The rate in blacks is 118/ 100,000 </li></ul><ul><li>Asian Americans / Pacific Islanders is </li></ul><ul><li>89/100,000 </li></ul><ul><li>American Indians / Alaska natives is 70/ 100,000 Medline ® Abstracts for References of 'Epidemiology and risk factors for breast cancer </li></ul>
  22. 28. Cont...
  23. 29. Benign breast disease <ul><li>Proliferative lesion: </li></ul><ul><li>1-without atypia (complex fibroadenoma, moderate or florid hyperplasia, sclerosing adenosis, intraductal papillomas) relative risk 1.3 to 2) . </li></ul><ul><li>2-with atypia (atypical lobular hyperplasia, atypical ductal hyperplasia) (relative risk 4 to 6) </li></ul>
  24. 30. Cont… <ul><li>Nonproliferative lesions: </li></ul><ul><li>1-Single ( fibrocystic change, solitary papilloma, simple fibroadenoma ) are not associated with an increased risk for breast cancer. </li></ul><ul><li>2-Muliple may increase the risk for breast cancer modestly (1.8% at 10y-one cohort study). </li></ul><ul><li>Medline ® Abstract for Reference 25 of 'Epidemiology and risk factors for breast cancer' </li></ul>
  25. 31. PERSONAL HISTORY OF BREAST CANCER   <ul><li>In Pt with personal Hx of: </li></ul><ul><li>I nvasive breast cancer the risk of developing invasive breast cancer in the contralateral breast is 1.5% yearly. </li></ul><ul><li>I n situ lesions the 10-year risk of developing a contralateral invasive breast cancer is 5% Medline ® Abstract for Reference 27 of 'Epidemiology and risk factors for breast cancer' </li></ul>
  26. 32. Other Pathology <ul><li>Risk is increased with Hx of ovarian cancer, endometrial cancer, </li></ul><ul><li>Risk is decreased with cervical cancer. </li></ul>
  27. 33. Hormonal/Reproductive Factors <ul><li>Factors increasing the number of menstrual cycles increase the risk, probably due to increased endogenous estrogen exposure.. </li></ul><ul><li>(1) Menarche < 13 years. </li></ul><ul><li>(1) Nulliparity </li></ul><ul><li>(2) 1 st pregnancy > 30 years. </li></ul><ul><li>(4) No breastfeeding. </li></ul><ul><li>(5) Menopause > 50 years. </li></ul>
  28. 34. Breastfeeding
  29. 35. Breast feeding… <ul><li>protective effect has been shown in multiple case - control and cohort studies. </li></ul><ul><li>The magnitude of which is dependent on the duration of breastfeeding, and on the confounding factor of parity . </li></ul>Medline ® Abstracts for References 69 of 'Epidemiology and risk factors for breast cancer
  30. 36. Bone & Breast density   <ul><li>Bone density : In multiple studies, women with higher bone density had a higher breast cancer risk. </li></ul><ul><li>Breast density : dense breast tissue is independently associated with an increased risk of breast cancer . </li></ul>Medline ® Abstracts for References of 'Epidemiology and risk factors for breast cancer
  31. 37. Exogenous factors <ul><li>Exogenous hormones . </li></ul><ul><li>Weight. </li></ul><ul><li>Socioeconomic Status. </li></ul><ul><li>Exposure to ionizing radiation. </li></ul><ul><li>Environment factors . </li></ul>
  32. 38. Hormonal Therapy <ul><li>Long - term use of HT is associated with the highest risk . In contrast, short - term HT appears not to increase the risk of breast cancer significantly </li></ul><ul><li>The use of combined estrogen plus progesterone is associated with an increased relative risk of breast cancer </li></ul>
  33. 39. Weight <ul><li>Obesity: Increased risk is probably due to adipose conversion of androgens to estrogens. </li></ul>
  34. 40. Cont.. <ul><li>Women> 80 kg have 25 % higher risk compared to those weighing< 60 kg , after adjusting for height . </li></ul><ul><li>BMI >33 kg / m2 has a 27% increased breast cancer risk compared to those with a BMI <21 kg / m2 . </li></ul>
  35. 41. Dose the height considerer factor for breast cancer ? <ul><li>Yes, it dose </li></ul>
  36. 42. Cont… <ul><li>Increased height has been associated with a higher risk. </li></ul><ul><li>Women > 175 cm tall were 20% more likely to develop breast cancer than those < 160 cm. </li></ul><ul><li>Medline ® Abstracts for References 33,34,45 of 'Epidemiology and risk factors for breast cancer </li></ul><ul><li>Seven prospective cohort studies 2000-sep-15 </li></ul>
  37. 43. Socioeconomic class <ul><li>Women of higher socioeconomic status are at greater risk for breast cancer. </li></ul><ul><li>It is independent factors that may reflect differing reproductive patterns </li></ul>Medline ® Abstract for Reference 28 of 'Epidemiology and risk factors for breast cancer '
  38. 44.    lifestyle <ul><li>Physical Activity </li></ul><ul><li>Regular physical exercise appears to provide modest protection against breast cancer particularly in premenopausal women </li></ul>Medline ® Abstracts for References 46-48 'Epidemiology and risk of breast cancer
  39. 45. Cont… <ul><li>Dietary </li></ul><ul><li>Red meat   An association between intake of (>5 servings per week) and premenopausal breast cancer . </li></ul>
  40. 46. Cont… <ul><li>Fat intake has significant impact on breast cancer risk that was suggested in a meta-analysis of studies of both premenopausal and postmenopausal women </li></ul>
  41. 47. Cont… <ul><li>Alcohol intake </li></ul><ul><li>It is associated with an increased risk of hormone receptor - positive breast. </li></ul>Medline ® Abstracts for References 'Epidemiology and risk of breast cancer
  42. 48. Antioxidants <ul><li>There is no strong evidence for an effect of intake of vitamin E , C or beta - carotene on breast cancer risk </li></ul><ul><li>The data are conflicting on vitamin A and breast cancer . </li></ul>Medline ® Abstracts for References 203,204f 'Epidemiology and risk factors for breast cancer
  43. 49. Environmental Factors <ul><li>Organochlorines include polychlorinated biphenyls ( PCB's ) , dioxins, and organochlorine pesticides such as DDT are persisting in body tissues for years </li></ul>Medline ® Abstracts for References 203,204f 'Epidemiology and risk factors for breast cancer
  44. 50. Ionizing radiation <ul><li>Ionizing radiation on the chest at a young age.10-14 yrs </li></ul><ul><li>Risk is seen up to 45 years & no risk after that. </li></ul>Medline ® Abstracts for References 203,204f 'Epidemiology and risk factors for breast cancer
  45. 51. Recommendations Primary cancer prevention evidence <ul><li>1-Maintain a healthy weight throughout life </li></ul><ul><li>A - Consistent ( Level 1 ) evidence that overweight and obesity are significant risk factors for cancers of the breast </li></ul>
  46. 52. Contd. <ul><li>2-Adopt a physically active lifestyle </li></ul><ul><li>A - Consistent (Level 1) evidence indicates that physical activity offers significant protection for cancers of the breast </li></ul>
  47. 53. <ul><li>3-Consume a healthy diet, with an emphasis on plant source </li></ul><ul><li>B-Limited-quality evidence suggests that plant-based diets that have high amounts of fruits, vegetables and whole grains are protective for some cancers </li></ul>
  48. 54. <ul><li>4-Limit consumption of alcohol </li></ul><ul><li>A - Consistent ( Level 1 ) evidence exists that high alcohol intake is associated with significantly and linearly increased risk of breast cancer . </li></ul>
  49. 55. References <ul><li>www.emedicine.com </li></ul><ul><li>ww.medline.com </li></ul><ul><li>www.cochrane.com </li></ul><ul><li>www.pubmed.com </li></ul><ul><li>www.uptodate.com </li></ul><ul><li>www.AAFP.com. </li></ul><ul><li>Swanson’s Family Medicine Textbook. </li></ul>
  50. 56. Thank You