Breast Cancer Professor Arnold Hill Wed 26th October 2011.

Breast Cancer

Professor Arnold Hill

Wed 26th October 2011

Breast Cancer

• Breast Cancer in Ireland

• If you find a lump…

• Treatments for breast cancer

• Latest breast cancer treatments

• Reorganisation of breast cancer services

Breast Cancer in Ireland

• Each year over 2,300 women & 25 men

diagnosed with breast cancer in Ireland

• Each year nearly 700 people die from

breast cancer in Ireland

• Lifetime risk: 1 in 10 women

New symptoms to seek medical opinion on…

• Breast lump

• Nipple discharge

• Nipple inversion

• Breast skin changes

• Strong family history

– Mother, sister, grandmother, aunt

Risk Factors

• Increasing age• Exposure to estrogens• Environmental/lifestyle• Family History• Genetic abnormality (5-10%)

– BRCA1/2

• Sister Study– National Institute of Environmental Health Sciences– 50,000 women followed for 10 years

Screening

• 50-64 years

• Every 2 years

Imaging

• >35 years of age

• < 35 years of age

Breast Cancer






What to do if you feel a lump?

• Check the other breast

• Don’t panic!– 9 out of 10 lumps are not cancerous

• Attend GP as soon as possible for review

• Referral to triple assessment specialist breast unit

Triple Assessment Breast Unit

Clinical exam

Radiological assessment

Pathological biopsy

TABC Accuracy

• Gold standard of breast cancer diagnosis

• > 95% of symptomatic breast cancers diagnosed using TABC¹,²,³

1) Merion Thomas J et al. Br Med J 1978; ii:1139 – 1141

2) Dixon JM et al. Br J Surg 1984; 71:593 – 596

3) Hermansen C et al. Cancer 1987; 60:1866 – 1871

Breast Cancer






Treatments for breast cancer

• Surgery

• Chemotherapy

• Radiotherapy

• Hormonal therapy

• Biological therapy

NeoadjuvantVersus

Adjuvant

Surgery

• Mastectomy

• Breast conservation

• Axillary lymph node clearance

• Sentinel Lymph node biopsy

• Breast Reconstruction

–DIEP, TRAM, LD

Reconstructive Surgery

http://en.wikipedia.org/wiki/File:MentorTRAM1.gif



Sentinel lymph node

Breast Cancer Cell

ER

HER2

Tumour growth

• ER positive breast cancer– 75% of Breast Cancers are ER positive– 150,000 EU women are on “hormonal

therapy”

– Tamoxifen, Arimidex, Femara, Aromasin

Hormonal therapy

Biological therapy

• HER2 positive breast cancer– 25% breast cancers overexpress HER2

– Herceptin, Tykerb (lapatinib)

• Clinical Trials– International– Institutional– Establishing ‘best treatment’– Novel oncological drugs

• Molecular Research

• Audit & database review

Beaumont Breast Cancer Research

Breast Cancer






New diagnostic resources

• Gene expression studies– Oncotype DX– MammaPrint

New surgical techniques

• Skin sparing mastectomy– Only used when immediate reconstruction

performed

• Oncoplastic Breast Reconstruction– Immediate versus delayed

New radiotherapy techniques

• Hypofractionated radiation– Larger doses over fewer days

• Accelerated partial breast irradiation– Intraoperative radiation therapy– Intracavitary brachytherapy

New Biological Treatments

• Targeting HER2– Neratinib– Tovok– Pertuzumab

• Anti-angiogenesis– Bevacizumab

• Targeting EGFR– Gefitinib– Erlotinib– Cetuximab

• Other– Vitamin D– Bisphosphonates

The price tag of progress…

• Herceptin– € 2,000 / month

• Lapatinib– € 2,000 / month

• Bevacizumab– € 3,000 / month

• Cetuximab– € 3,400 / month

Breast Cancer






Managed Cancer Control Networks& Cancer Centres

Network Cancer Centres

HSE Dublin – North East Beaumont Hospital

Mater Misericordiae Hospital

Dublin – Mid Leinster St. James’s Hospital

St. Vincent’s University Hospital

HSE South Cork University Hospital

Waterford Regional Hospital

HSE West UCH Galway

Limerick Regional Hospital Letterkenny General Hospital

Breast Cancer update

Network Cancer Centres

HSE Dublin – North East

Drogheda

James Connolly

Mullingar

Beaumont

Mater Misericordiae

Dublin – Mid LeinsterPortlaoise

AMNCH

St. James’s

St. Vincent’s University

HSE South

Tralee

South Infirmary Cork

Clonmel

St Luke’s, Kilkenny

Wexford

Cork University

Waterford Regional

HSE West

Portiuncula

Castlebar

Sligo

UCH Galway

Limerick Regional

Cancer Strategy

Hospitals providing initial diagnosis + surgery for

breast cancer

June 2007 33

Sept 2007 20

June 2008 16

Dec 2008 12

Spring 2009 8

Summary

• Lifetime risk of breast cancer 1 in 10 women

• Surgery & chemoradiotherapy the mainstay of treatment

• Hormonal and biological therapies increasing in efficacy, but costly

• Irish NCCP – 8 designated breast cancer centres

Thank you

Breast Cancer Professor Arnold Hill Wed 26th October 2011.

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