Prevention of Breast
Cancer
Breast Diseases Fourth Edition, chapter 6
screening
• reduce mortality but not the incidence
• cost effective only among women for whom breast cancer is common (2-
...
Management options for women at significantly
increased risk of breast cancer
• Take no action
• Try to reduce risks:
◦ Pl...
Tamoxifen:
 the agent of choice for preventive therapy, especially in:
 premenopausal high-risk women
 atypical hyperpl...
Raloxifen:
 a marked decrease in breast cancer incidence
 a greater benefit than tamoxifen
 direct comparison with tamo...
 particularly in BRCA1/2 carriers about 40 years of age
 reduce subsequent breast cancer risk by approximately 50%
 Ear...
Aromatase inhibitors (AI)
 overall reduction of 50%compared to tamoxifen
 suggesting a potential 75% reduction overall.
Other agents
 Bisphosphonates
 30% lower breast cancer incidence.
 may have a greater effect in ER-negative breast canc...
Regular screening
 Annual mammographic breast screening will identify over 60% of
cancers in young women, but interval ca...
MRI scanning for women at high risk.
Three studies (from the United Kingdom, the Netherlands and Canada)
have shown MRI to...
Prophylactic surgery
 reduces the risk of breast cancer in BRCA mutation carriers
by 90%
 psychosocial and emotional iss...
Patient who underwent bilateral subcutaneous mastectomies and
immediate breast reconstruction because she was considered t...
Ovarian cancer
 Transvaginal ultrasound
 CA125
 Annual Pelvic examination
in general the sensitivityis only found to be...
Men with BRCA1 and BRCA2
mutations
 BRCA2 mutation carriers lifetime risk of breast cancer, 6–8%
compared with 0.1% for m...
Thanks for your attention…
Prevention of breast cancer
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Prevention of breast cancer

breast cancer prevention abc of breast disease, chapter 6 4th edition
Published on: Mar 4, 2016
Published in: Education      
Source: www.slideshare.net


Transcripts - Prevention of breast cancer

  • 1. Prevention of Breast Cancer Breast Diseases Fourth Edition, chapter 6
  • 2. screening • reduce mortality but not the incidence • cost effective only among women for whom breast cancer is common (2- 3/1000 per year) Hormonal and cytotoxic treatment • significant survival benefits Life style • as well as surgical and medical therapeutic interventions
  • 3. Management options for women at significantly increased risk of breast cancer • Take no action • Try to reduce risks: ◦ Plan family early ◦ Avoid OCP and HRT use ◦ Good diet and regular exercise ◦ Delaying menarche ◦ Artificial early menopause (oophorectomy or treatment with goserelin) ◦ Anti-oestrogen therapy (tamoxifen)
  • 4. Tamoxifen:  the agent of choice for preventive therapy, especially in:  premenopausal high-risk women  atypical hyperplasia  lobular carcinoma in situ (LCIS)  Overview of four large trials: 1. 43% reduction in ER-positive invasive cancer 2. no impact on ER-negative disease 3. a reduced incidence in the period after active treatment was completed, with an additional 38% reduction in years 6–10. 4. As side effects were minimal in the post-treatment period, the risk–benefit ratio has improved with longer follow-up Selective estrogen receptor modulators (SERMs)
  • 5. Raloxifen:  a marked decrease in breast cancer incidence  a greater benefit than tamoxifen  direct comparison with tamoxifen in the STAR trial at 81 months indicated that the risk ratio of raloxifene:tamoxifen was 1.24 for invasive cancer and 1.22 for non-invasive disease  Adverse events were less common: endometrial cancer, endometrial hyperplasia and thromboembolic events.  a significant decrease in ER-positive breast cancers lasofoxifene and arzoxifene None of the SERMs has demonstrated any impact on oestrogen receptor-negative tumors.
  • 6.  particularly in BRCA1/2 carriers about 40 years of age  reduce subsequent breast cancer risk by approximately 50%  Early menopause and Long HRT salpingo-oophorectomy 2842 women with mutation 247: prophylactic mastectomy, no breast cancer to date 1372: no prophylactic mastectomy 98 (7.1%) diagnosed with breast cancer Salpingo-oophorectomy reduced breast cancer risk in 1372 women with intact breasts in: BRCA1 carriers from 20 →14% BRCA2 carriers from 23 →7% Ovarian cancer mortality fell with oophorectomy from 3–0.4% HR 0.21 (95% CI 0.06–0.80) Role of prophylactic mastectomy and salpingo-oophorectomy in BRCA mutation carriers.
  • 7. Aromatase inhibitors (AI)  overall reduction of 50%compared to tamoxifen  suggesting a potential 75% reduction overall.
  • 8. Other agents  Bisphosphonates  30% lower breast cancer incidence.  may have a greater effect in ER-negative breast cancer  Metformin:  in women with type 2 diabetes have shown a reduced risk of breast cancer  Aspirin:  a chemopreventive effect of aspirin for a number of cancers  about 10% reduction of breast cancer risk for aspirin and a possibly a little more for Ibuprofen.  Other NSAIDs  COX-2 inhibitors  statins
  • 9. Regular screening  Annual mammographic breast screening will identify over 60% of cancers in young women, but interval cancers do occur.  economic grounds in young age group  MRI is limited to very high-risk women:  BRCA1/2 and TP53 mutation carriers aged 30–49  very high-risk individuals without mutations
  • 10. MRI scanning for women at high risk. Three studies (from the United Kingdom, the Netherlands and Canada) have shown MRI to be a better screening tool than mammography. The UK study∗ used 949 women aged 35–49 years with a strong family history or proven genetic mutation. Thirty-five cancers were found by annual screening • 77% detected by MRI • 40% detected by mammography • 94% detected by either MRI or mammography • Mammography was more specific (93%) than MRI (81%)
  • 11. Prophylactic surgery  reduces the risk of breast cancer in BRCA mutation carriers by 90%  psychosocial and emotional issues  Nipple-sparing mastectomy with reconstruction  skin and nipple-areola sparing mastectomy and areola sparing mastectomy
  • 12. Patient who underwent bilateral subcutaneous mastectomies and immediate breast reconstruction because she was considered to be at high risk of developing breast cancer; and patient who underwent bilateral skin- sparing mastectomies and immediate free transverse rectus abdominus myocutaneous (TRAM) flap reconstructions with subsequent nipple reconstructions.
  • 13. Ovarian cancer  Transvaginal ultrasound  CA125  Annual Pelvic examination in general the sensitivityis only found to be 60% with no reduction in mortality. Women who carry a BRCA1/2 mutation should be advised to undertake bilateral salpingo-oophorectomy once their family is complete.
  • 14. Men with BRCA1 and BRCA2 mutations  BRCA2 mutation carriers lifetime risk of breast cancer, 6–8% compared with 0.1% for men who are not carriers.  risk of prostate cancer is increased to 4.7 times higher  breast screening  annual prostate screening from age 40 (blood PSA level) BRCA1 carriers are probably not at any increased risk of cancer overall.
  • 15. Thanks for your attention…