Jackie Osland, MD, FACS October 9, 2012 * Breast Cancer Management in 2012
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Jackie Osland, MD, FACS
October 9, 2012
*Breast Cancer Management in 2012
* Cancer Death Rates* Among Women, US,1930-2005
*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.
0
20
40
60
80
10019
30
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Lung & bronchus
Colon & rectum
Uterus
Stomach
Breast
Ovary
Pancreas
Rate Per 100,000
*Risk
*Early Detection
*Advances in Therapy
*Breast Cancer Statistics
*Most common cancer in women
*Nearly 300,000 women diagnosed per year in the US
*One in 3 women in the US will get cancer
*One in 8 women in the US will get breast cancer
*Survival rates have increased over the past decade
*Hereditary Breast Cancer
*Most women who get breast cancer don’t have a family history of breast cancer
*5-10% of breast cancer is related to a genetic syndrome
*Most common genetic syndromes are related to a BRCA 1 or BRCA 2 mutation
*Lifetime risk of breast cancer with a genetic syndrome is 60-85%
*Am I at risk for having the breast
cancer gene?
*BRCA mutations
*Risk factors
*Early onset breast cancer < 50 years of age
*Multiple family members with breast cancer
*Ovarian cancer
*NCCN guidelines
*Risk Factors for Breast Cancer
*Age
*Family History
*Not deodorant, under-wire bras or mammograms
*Obesity
*Obesity Increases Breast Cancer
Risk
*By 2030, obesity may replace smoking as the leading causative agent of cancer
*“Should I get a mammogram?”
*US Preventive Services Task Force November 2009
*Screening 1,339 women in their 50’s to save one life makes screening worthwhile
*Screening 1904 women in their 40’s to save one life is not worthwhile
*Screening women in their 40’s would reduce their risk of death by 15%
*American Cancer Society
*Acknowledges the limitations of mammography
*False alarms, missed cancers, unnecessary biopsies
*Effectiveness of mammography does increase with age
*In fact, the technology used today is better that the technology used in the studies for this review
*ACS continues to recommend annual screening beginning at age 40
“We have learned nothing, we are where the Greeks were. “
Francis Wood Carter 1914
*Digital Mammograms
*Less Invasive Tissue Biopsy
*Less Morbid Surgery
*Sentinel Node Biopsy
*Drastically reduces risk of lymphedema for the node negative patient
*Many women are now saved a full axillary node dissection
*Human Genome Project
*Completed in 2003
*13 year project
*Coordinated by the US Department of Energy and the NIH with international contributors
*Analysis of the data will continue for many years
*Cracking the Genetic Code of
Cancer
*Exponential growth in information for treatment
*Increase in molecular alterations associated with disease
*Scientific Explosion
*Cancer Gene Analysis: HER 2
Neu
*Cancer Gene Analysis:Oncotyp
e
* Cancer Death Rates* Among Women, US,1930-2005
*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.
0
20
40
60
80
10019
30
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Lung & bronchus
Colon & rectum
Uterus
Stomach
Breast
Ovary
Pancreas
Rate Per 100,000
*Reconstruction Advances
*While breast conservation provides excellent cancer control, there are some cases that require mastectomy
*BRCA mutations
*Extensive disease through the breast
*Prior radiation treatment
*Dr. Vanessa Voge –Plastic Surgical Specialists
*The Emperor of All Maladies
*Pulitzer Prize 2010 for General Nonfiction
*Described by TIME as one of the 100 most influential books of the last 100 years
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