For Breast Cancer

A program of theA program of the

UAMS College of PharmacyUAMS College of Pharmacy

Funded through unrestricted educational grants by Susan G. Komen Breast Cancer Foundation

Arkansas Affiliate

Overview of Breast Cancer

Jan K. Hastings, Pharm.D.Jan K. Hastings, Pharm.D.

Breast Cancer The most common form The most common form

of cancer among womenof cancer among women The second most The second most

common cause of cancer common cause of cancer related mortalityrelated mortality

1 of 8 women (12.2%)1 of 8 women (12.2%) One third of women One third of women

with breast cancer die with breast cancer die from breast cancerfrom breast cancer

Risk Factors for Breast Cancer

Female (1% male)Female (1% male) AgingAging Relative (mother or Relative (mother or

sister)sister) Menstrual historyMenstrual history

early on setearly on set late menopauselate menopause

Child birthChild birth After the age of 30After the age of 30

Exogenous Estrogen Hormonal replacement Hormonal replacement

therapy(HRT)therapy(HRT) 30% increased risk with 30% increased risk with

long term use long term use Oral Contraceptives(OC)Oral Contraceptives(OC)

risk slightrisk slight risk returns to normal once risk returns to normal once

the use of OC’s has been the use of OC’s has been discontinueddiscontinued

Risk Factors for Breast Cancer Radiation exposureRadiation exposure Breast diseaseBreast disease

Atpyical HyperplasiaAtpyical Hyperplasia Intraductal carcinoma in situIntraductal carcinoma in situ Intralobular carcinoma in situIntralobular carcinoma in situ

ObesityObesity DietDiet

FatFat AlcohoAlcoholl

Genetics BRCA-1BRCA-1 BRCA-2BRCA-2 P53, Rb-1P53, Rb-1 Her-2/neu, c-erB2, Her-2/neu, c-erB2,

c-mycc-myc

Staging of Breast Cancer

The American Joint Committee on The American Joint Committee on Cancer (AJCC) has designated staging by Cancer (AJCC) has designated staging by TNMTNM

T= tumor sizeT= tumor size N = lymph node involvementN = lymph node involvement M = metastasisM = metastasis

Stage 1

Tumor Tumor << 2.0 cm in 2.0 cm in greatest dimensiongreatest dimension

No nodal No nodal involvement (N0)involvement (N0)

No metastases (M0)No metastases (M0)

Stage II

Tumor > 2.0 Tumor > 2.0 << 5 cm 5 cm

oror Ipsilateral axillary Ipsilateral axillary

lymph node (N1)lymph node (N1) No Metastasis (M0)No Metastasis (M0)

Stage III

Tumor > 5 cm (T3)Tumor > 5 cm (T3) or ipsilateral axillary lymph nodes fixed or ipsilateral axillary lymph nodes fixed

to each other or other structures (N2)to each other or other structures (N2) involvement of ipsilateral internal involvement of ipsilateral internal

mammary nodes (N3)mammary nodes (N3) Inflammatory carcinoma (T4d)Inflammatory carcinoma (T4d)

Stage IV (Metastatic breast cancer)

Any TAny T Any NAny N Metastasis (M1)Metastasis (M1)

Types of breast cancer

In situIn situ Intraductal (DCIS)Intraductal (DCIS) Intralobular (LCIS)Intralobular (LCIS)

InvasiveInvasive Infiltrating ductal carcinomaInfiltrating ductal carcinoma Tubular carcinomaTubular carcinoma Medullary carcinomaMedullary carcinoma Mucinous carcinomaMucinous carcinoma

Symptoms and ScreeningSymptoms and Screening

Normal breast physiology and anatomyNormal breast physiology and anatomy

Symmetry and balanceSymmetry and balance SizeSize

weightweight menstrual cyclemenstrual cycle pregnancy and lactationpregnancy and lactation

TextureTexture ShapeShape

ageage

Abnormal signs and symptomsAbnormal signs and symptoms

PuckeringPuckering DimplingDimpling RetractionRetraction Nipple dischargeNipple discharge Thickening of skin or lump or “knot”Thickening of skin or lump or “knot” Retracted nippleRetracted nipple

Abnormal signs and symptomsAbnormal signs and symptoms

Change in breast sizeChange in breast size Pain or tendernessPain or tenderness RednessRedness Change in nipple positionChange in nipple position Scaling around nipplesScaling around nipples Sore on breast that does not healSore on breast that does not heal

Methods of DetectionMethods of Detection

Clinical exam by MD or nurseClinical exam by MD or nurse MammographyMammography Monthly breast self-exam Monthly breast self-exam

(BSE)(BSE)

Clinical examinationClinical examination Performed by doctor or Performed by doctor or

trained nurse practitionertrained nurse practitioner Annually for women over 40Annually for women over 40 At least every 3 years for At least every 3 years for

women between 20 and 40women between 20 and 40 More frequent examination More frequent examination

for high risk patientsfor high risk patients

MammographyMammography X-ray of the breastX-ray of the breast Has been shown to save Has been shown to save

lives in patients 50-69lives in patients 50-69 Data mixed on Data mixed on

usefulness for patients usefulness for patients 40-4940-49

Normal mammogram Normal mammogram does not rule out does not rule out possibility of cancer possibility of cancer completelycompletely

MammographyMammography

American Cancer Society recommends:American Cancer Society recommends:

Women (asymptomatic) 40 years Women (asymptomatic) 40 years of age and older should have a of age and older should have a mammogram every yearmammogram every year..

Mammography-more guidelinesMammography-more guidelines Mammogram facility guidelinesMammogram facility guidelines Avoid mammogram week before periodAvoid mammogram week before period Don’t wear deodorant powder or creamDon’t wear deodorant powder or cream Bring a list of the places and dates of other Bring a list of the places and dates of other

mammograms,biopsies you’ve had beforemammograms,biopsies you’ve had before If you don’t hear from the MD within 10 If you don’t hear from the MD within 10

days, call the facilitydays, call the facility

Free MammogramsFree Mammograms

MedicareMedicare Arkansas Breast Cancer Control Arkansas Breast Cancer Control

ProgramProgram Breast and Cervical Cancer Control Breast and Cervical Cancer Control

Program of the Arkansas Program of the Arkansas Department of HealthDepartment of Health

MedicareMedicare

Women over 65Women over 65

Arkansas Breast Cancer Control ProgramArkansas Breast Cancer Control Program

Started in 1999Started in 1999 EligibilityEligibility

Women 40 or olderWomen 40 or older No insuranceNo insurance Income at or below 2 times the poverty levelIncome at or below 2 times the poverty level Call county or state heath departmentCall county or state heath department

1-800-482-54001-800-482-5400

Eligibility for ABCCCP MammogramEligibility for ABCCCP Mammogram 50 years or older and50 years or older and At or below 200 percent povertyAt or below 200 percent poverty

OROR Between 40 and 49 andBetween 40 and 49 and A breast cancer survivor or have a mother, A breast cancer survivor or have a mother,

daughter, or sister who has breast cancer anddaughter, or sister who has breast cancer and At or below 200 percent povertyAt or below 200 percent poverty

Breast Self ExaminationBreast Self Examination Opportunity for woman to Opportunity for woman to

become familiar with her become familiar with her breastsbreasts

Monthly exam of the Monthly exam of the breasts and underarm areabreasts and underarm area

May discover any changes May discover any changes earlyearly

Begin at age 20, continue Begin at age 20, continue monthlymonthly

When to do BSEWhen to do BSE Menstruating women- 5 to 7 days after Menstruating women- 5 to 7 days after

the beginning of the beginning of their periodtheir period Menopausal women - Menopausal women - same date each monthsame date each month Pregnant women – Pregnant women – same date each monthsame date each month Takes about 20 minutesTakes about 20 minutes Perform BSE at least Perform BSE at least once a monthonce a month Examine all breast tissueExamine all breast tissue

Why don’t more women practice BSE?Why don’t more women practice BSE? FearFear EmbarrassmentEmbarrassment YouthYouth Lack of knowledgeLack of knowledge Too busy, Too busy,

forgetfulnessforgetfulness

ConclusionConclusion

Pharmacists have a Pharmacists have a responsibility as responsibility as patient advocates patient advocates for breast cancer for breast cancer

awarenessawareness