Presents

PLWC Slide Deck Series:

Understanding Breast Cancer
2006

What is Cancer?

A group of 100 different diseases

The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body

What is Breast Cancer?

The most common type of cancer in women in the United
States (excluding cancers of the skin) and the second most
frequent cause of death from cancer in women
A disease in which normal cells in the breast begin to
change, grow without control, and no longer die
Cancer that has not spread is called in situ, meaning in
place
Cancer that has spread is called invasive or infiltrating

What is the Structure of the Breast?

The breast is composed mainly of fatty
tissue, which contains a network of
lobes made up of tiny, tube-like
structures called lobules that contain
milk glands
Tiny ducts connect the glands, lobules,
and lobes, and carry the milk from the
lobes to the nipple
Blood and lymph vessels run
throughout the breast
About 90% of all breast cancers
originate in the ducts or lobes of the
breast

What Are the Risk Factors

for Breast Cancer?
Age
Race
Individual or family history of breast cancer
A history of ovarian cancer
A genetic predisposition (mutations to the BRCA1 or BRCA2
genes cause 2% to 3% of all breast cancers)
Estrogen exposure
Atypical hyperplasia of the breast
Lobular carcinoma in situ (LCIS)
Lifestyle factors (obesity, lack of exercise, alcohol use)
Radiation

Hereditary Breast Cancer

About 15% of breast cancers are inherited
Approximately 80% of hereditary breast cancer is caused by
mutations in the BRCA1 or BRCA2 genes
Women who inherit a BRCA mutation have a 50% to 85% chance
of developing breast cancer in their lifetime
Women with especially strong family history may consider
preventive surgery to remove breast tissue and/or
chemoprevention
Several other genetic syndromes can increase breast cancer risk
Genetic counseling and testing is available for most syndromes
For more information, www.plwc.org/genetics

Breast Cancer and Early Detection

Early diagnosis means a better chance of successful
treatment
Mammography is the best tool doctors have to screen for
breast cancer
Many organizations recommend that women obtain a
mammogram each year, starting at the age of 40
Regular clinical breast examinations and breast selfexaminations are also recommended
Women are encouraged to discuss the frequency of
screening with their doctors

What Are the Symptoms of Breast Cancer?

New lumps or a thickening in the breast or under the arm
Nipple tenderness, discharge, or physical changes
Skin irritation or changes, such as puckers, dimples, scaliness, or
new creases
Warm, red, swollen breasts with a rash resembling the skin of an
orange
Pain in the breast (usually not a symptom of breast cancer, but
should be reported to a doctor)
No visible or obvious symptoms (asymptomatic)

How is Breast Cancer Evaluated?

Screening and/or diagnostic mammography
Ultrasound
Magnetic Resonance imaging (MRI) scan
Biopsy is necessary to confirm a diagnosis
Blood tests are often used to determine if the cancer has spread
outside the breast
Additional tests may be used to determine stage

Breast Cancer Staging

Staging is a way of describing a cancer, such as the depth
of the tumor and where it has spread
Staging is the most important tool doctors have to
determine a patients prognosis
Staging is described by the TNM system: the size of the
Tumor, whether cancer has spread to nearby lymph
Nodes, and whether the cancer has Metastasized (spread
to organs such as the liver or lungs)
The type of treatment a person receives depends on the
stage of the cancer

Stage 0 Breast Cancer

Known as cancer in situ, meaning the cancer has not
spread past the ducts or lobules of the breast (the natural
boundaries)
Also called noninvasive cancer
Ductal carcinoma in situ (DCIS) is the most common in
situ breast cancer

Stage I Breast Cancer

The tumor is small and

has not spread to the
lymph nodes

Stage IIa Breast Cancer

Stage IIa breast cancer
describes a smaller tumor
that has spread to the
axillary lymph nodes
(lymph nodes under the
arm), or a medium-sized
tumor that has not spread
to the axillary lymph nodes
Stage IIa may also describe
cancer in the axillary lymph
nodes with no evidence of a
tumor in the breast

Stage IIb Breast Cancer

Stage IIb breast cancer
describes a medium-sized
tumor that has spread to
the axillary lymph nodes
Stage IIb may also
describe a larger tumor
that has not spread to the
axillary lymph nodes

Stage IIIa Breast Cancer

Stage IIIa breast cancer

describes any size
tumor that has spread
to the lymph nodes

Stage IIIb Breast Cancer

Stage IIIb breast cancer

has spread to the chest
wall, or caused swelling or
ulceration of the breast, or
is diagnosed as
inflammatory breast
cancer

Stage IIIc Breast Cancer

Stage IIIc breast cancer
has spread to distant
lymph nodes but has
not spread to distant
parts of the body

Stage IV Breast Cancer

Stage IV breast cancer can be any size and has
spread to distant sites in the body, usually the
bones, lungs or liver, or chest wall

How is Breast Cancer Treated?

Treatment depends on stage of cancer
More than one treatment may be used
Surgery
Radiation therapy
Chemotherapy
Hormone therapy
Targeted therapy

Factors Considered in Treatment Decisions

The stage and grade of the tumor
The tumors hormone receptor status (ER, PR)
Factors that may signify an aggressive tumor, such as HER-2/neu
amplifications
The presence of known mutations to breast cancer genes
The patients menopausal status
The patients age and general health

Cancer Treatment: Surgery

Generally, surgery to remove the tumor with or without
radiation therapy is initial treatment
For invasive cancer, lymph nodes are removed and
evaluated
More invasive surgery (such as mastectomy) is not
always better; discuss with your doctor
Breast reconstruction is an option after mastectomy

Cancer Treatment: Adjuvant Therapy

Treatment given in addition to surgery to reduce the risk
of recurrence
May include radiation therapy, chemotherapy, biologic
therapy, and hormone therapy

Cancer Treatment: Radiation Therapy

The use of high-energy x-rays or other particles to destroy cancer
cells
Usually used to treat breast cancer after surgery
Different methods of delivery
External-beam: outside the body
Internal: uses implants inside the body
Side effects may include fatigue, swelling, and skin changes

Cancer Treatment: Chemotherapy

Drugs used to kill cancer cells
May be given before surgery to shrink a large tumor
(neoadjuvant chemotherapy) or after surgery to reduce
the risk of recurrence (adjuvant chemotherapy)
A combination of medications is often used

Cancer Treatment: Hormone Therapy

Used to manage tumors that test positive for either estrogen or
progesterone receptors
May be used alone or together with chemotherapy
Tamoxifen (Nolvadex) is a common hormone therapy and is
effective in many premenopausal and postmenopausal women
Aromatase inhibitors are also used alone or following
tamoxifen use as treatment for postmenopausal women,
including anastrozole (Arimidex), letrozole (Femara), and
exemestane (Aromasin)

New Therapies: Targeted Therapy

Treatment designed to target cancer cells while minimizing
damage to healthy cells
Used to stop the action of abnormal proteins that cause cells to
grow and divide out of control
Trastuzumab (Herceptin) for women with a HER-2/neupositive breast cancer either with or after adjuvant
chemotherapy
Bevacizumab (Avastin) blocks angiogenesis (the formation of
new blood vessels) and is under evaluation in clinical trials

The Role of Clinical Trials for the

Treatment of Breast Cancer
Clinical trials are research studies involving people
They test new treatment and prevention methods to
determine whether they are safe, effective, and better
than the best known treatment
The purpose of a clinical trial is to answer a specific
medical question in a highly structured, controlled
process
Clinical trials can evaluate methods of cancer prevention,
screening, diagnosis, treatment, and/or quality of life

Clinical Trials: Patient Safety

Informed consent: Participants should understand why
they are being offered entry into a clinical trial and the
potential benefits and risks
Informed consent is an ongoing process; participants are
constantly updated as new information becomes
available
Participation is always voluntary, and patients can leave
the trial at any time

Clinical Trials: Phases

Phase I trials determine safety and dose of a new
treatment in a small group of people
Phase II trials provide more detail about the safety of the
new treatment and determine how well it works for
treating a given form of cancer
Phase III trials take a new treatment that has shown
promising results when used to treat a small number of
patients with cancer and compare it with the current,
standard treatment for that disease; phase III trials
involve a large number of patients

Clinical Trials Resources

Coalition of Cancer Cooperative Groups
(www.CancerTrialsHelp.org)
CenterWatch (www.centerwatch.com)
National Cancer Institute
(www.cancer.gov/clinical_trials)

Coping With the Side Effects of Cancer

and its Treatment
Side effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain relievers are available
Antiemetic drugs can reduce or prevent nausea and vomiting
Lymphedema following breast cancer surgery can often be managed
with help from your doctor
For more information, visit www.plwc.org/sideeffects

Follow-Up Care
Important to detect possible recurrence at the earliest stage
Monthly breast self-examinations
Physical examinations
Mammograms
Pelvic examinations
More information can be found in the ASCO Patient Guide: FollowUp Care for Breast Cancer

Where to Find More Information:

PLWC Guide to Breast Cancer
(www.plwc.org/breast)
Overview
Medical Illustrations
Risk Factors
Prevention
Symptoms
Diagnosis
Staging With Illustrations
Treatment

Side Effects of Cancer and

Cancer Treatment
Questions to Ask the
Doctor
Current Research
Patient Information
Resources
Clinical Trials Resources

People Living With Cancer (www.plwc.org)

PLWC is the cornerstone of ASCOs patient resources program
Visitors to PLWC will find:

PLWC Guides to more than 90 types of cancer

Coping resources
Ask the ASCO Expert Series, including chats, Q&A forums,
and event transcripts
Cancer information in Spanish
The latest cancer news
For patient information resources, please call 888-651-3038