Breast Cancer and Family History KSA 2018
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Transcript of Breast Cancer and Family History KSA 2018
FAMILY HISTORY
&
BREAST CANCER
DR. MOHAMAD AL-GAILANI FRCS
CONSULTANT BREAST SURGEON
MEDICAL EDUCATION & TRAINING HEAD
OCTOBER BREAST CANCER AWARENESS MONTH2017
Riyadh, KSA
OUTLINE:
FAMILY HISTORY & BREAST CANCER (BC)
A QUESTION & ANSWER SESSION
• Q1: How can I reduce my risk of developing BC?
• Q2: Are all breast cancers familial?
• Q3: How can I determine if my family history of BC is significant?
• Q4: Having a significant family history of BC, can I do something
about it?
• Q5: Does the Oral Contraceptive Pill (OCP) increase BC Risk?
• Q6: Does Hormone Replacement Therapy (HRT) increase BC Risk?
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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BREAST CANCER
• Breast cancer (BC) is the most common cancer among
women
•Accounting for about 22% of all female cancers.
• It is expected to affect 1:8 (12%) of women during
their lifetime.
• In KSA, it affects a younger age group, on average a
decade younger than in the West.
• In KSA, 16% Breast Screening Uptake (MOH 2016)
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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THE REALITY OF INCURABLE BREAST CANCER
RISK FACTORS
• REPRODUCTIVE RISK FACTORS
• Early Menarche <12
• Late Menopause >55
• Nullipara
• Age first birth >30
• None Breast Feeding
• NON REPRODUCTIVE RISK
FACTORS
• Age
• Family History
• Obesity
• Alcohol
• HRT >10 years
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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Q1: HOW CAN I REDUCE MY RISK OF
DEVELOPING BC?
• There are lifestyle choices that can reduce the risk of breast
cancer:
1. Early First Child <30, Breast Feed >1 year, Multiparity
2. Maintain ideal body weight (obesity is a risk factor)
2. Exercise regularly
3. Avoid alcohol
4. Eat nutritious food
5. Avoid smoking OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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Q2: ARE ALL BREAST CANCERS
FAMILIAL?
• NO
• Nearly 90% of BC are incidental, (bad luck!)
• However10% could be familial.
• The risk of BC increases, the higher the number of relatives
who have been diagnosed with breast cancer.
• Especially if they are first degree relatives (Mother, Sister,
Daughter)
• Diagnosed at a younger age <40 years.OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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BRCA1 & BRCA2 GENE MUTATION
• Inherited Breast Cancer genes BRACA1 & BRACA2
• 80% BC Lifetime Risk
• 50% Ovarian Cancer Lifetime Risk.
• Significantly High Family History of Breast and Ovarian
Cancers.
•Genetic blood tests Diagnostic.OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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Q3: HOW CAN I DETERMINE IF MY FAMILY
HISTORY OF BC IS SIGNIFICANT?
• Through Breast Cancer Family History Assessment
• Low: (Population Average) Lifetime Risk 12%
•Moderate: Lifetime Risk 17-30%
•High: Lifetime Risk >30%
• BRCA Probability >30%
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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CASE 1
• AGE 30• 2 RELATIVES BC:1. M. GM 602. P. AUNT 65
• BREAST CANCER RISK ASSESSMENT:
• 10 YEAR RISK 1.2%• LIFETIME RISK 28.5%• PROB. BRCA 0.14-
0.16%• RESULT:
• MODERATE
• ADVICE:
• Annual
Mammograpy Age
40-50
BREAST CANCER FAMILY HISTORY RISK ASSESSMENT
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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CASE 2
• AGE 40• 4 RELATIVES: 1. SISTER 39 2. SISTER (Ov) 35 3. MOTHER 35 4. M. GM 55
• BREAST CANCER RISK ASSESSMENT:
• 10 YEAR RISK 58%• LEFETIME RISK 91.3• PROB. BRCA1 GENE 41.1%• RESULT:
• HIGH
• ADVICE:
• Gene Testing To
Exclude BRCA Gene
Mutation
BREAST CANCER FAMILY HISTORY RISK ASSESSMENT
Q4: HAVING A SIGNIFICANT FAMILY
HISTORY OF BC, CAN I DO SOMETHING
ABOUT IT?
Yes
1.Breast Surveillance: Breast screening, Breast Self Exam (BSE) & Clinical Breast Exam (CBE)
2.Chemoprevention
3.Risk Reducing Mastectomy with Immediate Reconstruction
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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BREAST SURVEILLANCE
• Breast Screening plan tailored to the risk.
1. BSE: Monthly
2. CBE: Annual
3. Mammography: Annual from age 40
4. Magnetic Resonance Imaging (MRI) BRCA carriers:
Annual from Age 30
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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THE BREAST CANCER SCREENING PROGRAMME
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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CHEMOPREVENTION
• Women diagnosed with BRCA gene or with a significant high
family history benefit from Chemoprevention.
• 40% Risk Reduction.
• SERMS (Selective Oestrogen Receptor Modulator):
• Tamoxifen (Nolvadix)
• Raloxifene (Evista)
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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TAMOXIFEN * RALOXEFINE
• Given for 5 years only
• Any age group Pre and Post Menopausal
• Precautions:
• Deep Vein Thrombosis (DVT) X
• History of Endometrial Cancer X
• Pregnancy X
* * NICE Clinical Guideline, March 2017
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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RISK REDUCING MASTECTOMY (RRM) & IMMEDIATE BREAST RECONSTRUCTION
• Risk reduction up to 90%
• Much higher than any Chemoprevention (40%)
• Recommended for women with BRCA1 or BRCA2 carriers
or with significant family history
• Prophylactic Laparoscopic Oophorectomy up to 50% lifetime
risk of Ovarian Cancer (BRCA gene carriers)
• Requires psychological counsellingOCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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Q5: DOES THE ORAL CONTRACEPTIVE PILL
(OCP) INCREASE BC RISK?
•Under the age of 35: No significant risk
•Over the age of 35: there is a risk that taking
OCP might increase their risk of BC
•Alternative methods of contraception are advised
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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Q6: DOES HORMONE REPLACEMENT
THERAPY (HRT) INCREASE BC RISK?
• There is a risk involved in taking HRT
• The benefits should be weighed against the risk
•Oestrogen-Only HRT is recommended
• Shortest duration of time: usually 5 years
• Risk becomes significant on usage beyond 10 years.
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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WHAT IS BEST FOR ME?
• Every woman’s BC risk is different from others.
• Based on her assessed risk, the appropriate measures could be
advised.
• It is important to remember that any action, not even removing
both breasts completely eliminates the risk.
• Continued close monitoring remains necessary, even after Risk
Reducing Mastectomy.
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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CONCLUSION
•Only 10% of BC are Familial
• Risk reduction options are tailored towards the
individual’s risk
• Breast Screening, Breast Self Exam and Annual Breast
Clinical Exam help with Earlier Diagnosis, but do not
reduce Risk!
• Risk Reducing Chemoprevention: up to 40% Risk
Reduction
• Risk Reducing Mastectomy: 90% Risk Reduction
OCTOBER BREAST CANCER AWARENESS MONTH 2017 DR. MOHAMAD AL-GAILANI RIYADH, KSA
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