Breast cancer preventionBreast cancer prevention

By Julian Kunz

What is Breast cancer?What is Breast cancer?

Also known as mammacarcinomaA malign tumor spreading from the lobar

epithelium (lobar carcinoma) or the lactiferous ducts (ductal carcinoma)

EtiologyEtiology

Most common malign tumor in the female population (~ 25%)

In women between 30 and 60 it is the most common cause of death in the western world

In germany 17000 women die of it every year Even though it is very rare men can be affeceted

too

Cause of death Cause of death „mammacarcinoma“„mammacarcinoma“

Age 2003 2004 2005 2006

0 – 30 0.4 0.5 0.5 0.4

30 – 40 10 11 10 11

40 – 50 13 14 14 13

50 – 60 14 14 13 14

60 – 70 9 10 10 10

70 – 80 4 5 4 5

80 > 2 2 2 2

Risks and CausesRisks and Causes Genetic factors: play a big rule in the type of

breast cancer affecting young women Breast cancer virus: Since the 1930s researchers

have been looking for a virus analogous to the mamma-tumor-virus causing benign cancer in mice

Birth control pills: The adverse effect of these drugs hasn‘t been completely discovered; however there is a moderate risk increase if the medication has been taken for longer than 5 years

Risks and CausesRisks and Causes

Hormone therapy: to reduce symptoms menopause

Pregnancy: an early first pregnancy reduces the risk of breast cancer

Osteoporosis prevention: calcium and vitamin D therapy also decrease the risk of breast cancer markedly

Prevention and ScreeningPrevention and Screening

80 – 90% of all changes are discovered by women themselves even though only 20% examine themselves

The examination should be done on a monthly basis 5-7 days after menorrhoea

In case of a palpated anomaly women should consult their physician for a more detailed examination

„„Discovering Hands“Discovering Hands“

Blind people have a highly developed sense of touch

This special ability might be put to use in North Rhine-Westfalia (NRW)

In case of success it would create a new profession for blind women

Training programs will begin in 2008

MammographyMammography

Is an x-ray examination with a special apparatus

The breast is comprimed between two plates of plexiglass to keep the breast in position (might result in bruises)

The applied x-rays are rather soft (26-30 keV) to increase the contrast small neoplasmatic tissue formations can be seen

SonographySonography

Ultrasound-based technique done after palpation of an anomaly to rule out possible cysts and to estimate the size of the tumor

Only in addition to mammography as neither microcalcium nor tumors smaller than 5mm can be detected

MRIMRI

An important imaging technique to find out if the breast has been affected by more than one tumor

Multifocality: more than one tumor in the same quadrant

Multicentrality: other tumors in other quadrants

Computer Assisted Detection Computer Assisted Detection (CAD)(CAD)

CAD systems help searching digital images for typical structures and also to point out possibly diseased regions

It is a relatively young interdisciplinary technology combining elements of artificial intelligence and digital image processing

It serves mostly as a second opinion to the report of the responsible physician

Mammography-Screening-Mammography-Screening-CentersCenters

Currently a network of quality assured screening centers is being build up in Germany

Woman between the age 50 and 70 are invited once a year to get a mammography

In case of a report of an anomaly in the scan they are send for a biopsy of the suspicious tissue formation

Punching BiopsyPunching Biopsy

A needle is shot at high velocity into the neoplasmatic tissue

Done in locally sedated state

(At least 3 samples are taken to avoid mistakes

Needle BiopsyNeedle Biopsy

With a syringe and a special needle tissues are drawn from a palpable tissue formation

As painful as venipunctureIn case of a malign tumor the result is sure

wheras it is only 90% sure for a benign tumor

Advanced Breast Biopsy Advanced Breast Biopsy Instrumentation (ABBI)Instrumentation (ABBI)

Biopsy with relatively large probe (6-20 mm)

Done with x-ray to ensure localisation of target

Mostly used for analysis of microcalcification

Has only been in use for a few years many unexperienced physicians