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Transcript of For Breast Cancer A program of the UAMS College of Pharmacy UAMS College of Pharmacy Funded through...
For Breast Cancer
A program of theA program of the
UAMS College of PharmacyUAMS College of Pharmacy
Funded through unrestricted educational grants by Susan G. Komen Breast Cancer Foundation
Arkansas Affiliate
Overview of Breast Cancer
Jan K. Hastings, Pharm.D.Jan K. Hastings, Pharm.D.
Breast Cancer The most common form The most common form
of cancer among womenof cancer among women The second most The second most
common cause of cancer common cause of cancer related mortalityrelated mortality
1 of 8 women (12.2%)1 of 8 women (12.2%) One third of women One third of women
with breast cancer die with breast cancer die from breast cancerfrom breast cancer
Risk Factors for Breast Cancer
Female (1% male)Female (1% male) AgingAging Relative (mother or Relative (mother or
sister)sister) Menstrual historyMenstrual history
early on setearly on set late menopauselate menopause
Child birthChild birth After the age of 30After the age of 30
Exogenous Estrogen Hormonal replacement Hormonal replacement
therapy(HRT)therapy(HRT) 30% increased risk with 30% increased risk with
long term use long term use Oral Contraceptives(OC)Oral Contraceptives(OC)
risk slightrisk slight risk returns to normal once risk returns to normal once
the use of OC’s has been the use of OC’s has been discontinueddiscontinued
Risk Factors for Breast Cancer Radiation exposureRadiation exposure Breast diseaseBreast disease
Atpyical HyperplasiaAtpyical Hyperplasia Intraductal carcinoma in situIntraductal carcinoma in situ Intralobular carcinoma in situIntralobular carcinoma in situ
ObesityObesity DietDiet
FatFat AlcohoAlcoholl
Genetics BRCA-1BRCA-1 BRCA-2BRCA-2 P53, Rb-1P53, Rb-1 Her-2/neu, c-erB2, Her-2/neu, c-erB2,
c-mycc-myc
Staging of Breast Cancer
The American Joint Committee on The American Joint Committee on Cancer (AJCC) has designated staging by Cancer (AJCC) has designated staging by TNMTNM
T= tumor sizeT= tumor size N = lymph node involvementN = lymph node involvement M = metastasisM = metastasis
Stage 1
Tumor Tumor << 2.0 cm in 2.0 cm in greatest dimensiongreatest dimension
No nodal No nodal involvement (N0)involvement (N0)
No metastases (M0)No metastases (M0)
Stage II
Tumor > 2.0 Tumor > 2.0 << 5 cm 5 cm
oror Ipsilateral axillary Ipsilateral axillary
lymph node (N1)lymph node (N1) No Metastasis (M0)No Metastasis (M0)
Stage III
Tumor > 5 cm (T3)Tumor > 5 cm (T3) or ipsilateral axillary lymph nodes fixed or ipsilateral axillary lymph nodes fixed
to each other or other structures (N2)to each other or other structures (N2) involvement of ipsilateral internal involvement of ipsilateral internal
mammary nodes (N3)mammary nodes (N3) Inflammatory carcinoma (T4d)Inflammatory carcinoma (T4d)
Stage IV (Metastatic breast cancer)
Any TAny T Any NAny N Metastasis (M1)Metastasis (M1)
Types of breast cancer
In situIn situ Intraductal (DCIS)Intraductal (DCIS) Intralobular (LCIS)Intralobular (LCIS)
InvasiveInvasive Infiltrating ductal carcinomaInfiltrating ductal carcinoma Tubular carcinomaTubular carcinoma Medullary carcinomaMedullary carcinoma Mucinous carcinomaMucinous carcinoma
Symptoms and ScreeningSymptoms and Screening
Normal breast physiology and anatomyNormal breast physiology and anatomy
Symmetry and balanceSymmetry and balance SizeSize
weightweight menstrual cyclemenstrual cycle pregnancy and lactationpregnancy and lactation
TextureTexture ShapeShape
ageage
Abnormal signs and symptomsAbnormal signs and symptoms
PuckeringPuckering DimplingDimpling RetractionRetraction Nipple dischargeNipple discharge Thickening of skin or lump or “knot”Thickening of skin or lump or “knot” Retracted nippleRetracted nipple
Abnormal signs and symptomsAbnormal signs and symptoms
Change in breast sizeChange in breast size Pain or tendernessPain or tenderness RednessRedness Change in nipple positionChange in nipple position Scaling around nipplesScaling around nipples Sore on breast that does not healSore on breast that does not heal
Methods of DetectionMethods of Detection
Clinical exam by MD or nurseClinical exam by MD or nurse MammographyMammography Monthly breast self-exam Monthly breast self-exam
(BSE)(BSE)
Clinical examinationClinical examination Performed by doctor or Performed by doctor or
trained nurse practitionertrained nurse practitioner Annually for women over 40Annually for women over 40 At least every 3 years for At least every 3 years for
women between 20 and 40women between 20 and 40 More frequent examination More frequent examination
for high risk patientsfor high risk patients
MammographyMammography X-ray of the breastX-ray of the breast Has been shown to save Has been shown to save
lives in patients 50-69lives in patients 50-69 Data mixed on Data mixed on
usefulness for patients usefulness for patients 40-4940-49
Normal mammogram Normal mammogram does not rule out does not rule out possibility of cancer possibility of cancer completelycompletely
MammographyMammography
American Cancer Society recommends:American Cancer Society recommends:
Women (asymptomatic) 40 years Women (asymptomatic) 40 years of age and older should have a of age and older should have a mammogram every yearmammogram every year..
Mammography-more guidelinesMammography-more guidelines Mammogram facility guidelinesMammogram facility guidelines Avoid mammogram week before periodAvoid mammogram week before period Don’t wear deodorant powder or creamDon’t wear deodorant powder or cream Bring a list of the places and dates of other Bring a list of the places and dates of other
mammograms,biopsies you’ve had beforemammograms,biopsies you’ve had before If you don’t hear from the MD within 10 If you don’t hear from the MD within 10
days, call the facilitydays, call the facility
Free MammogramsFree Mammograms
MedicareMedicare Arkansas Breast Cancer Control Arkansas Breast Cancer Control
ProgramProgram Breast and Cervical Cancer Control Breast and Cervical Cancer Control
Program of the Arkansas Program of the Arkansas Department of HealthDepartment of Health
MedicareMedicare
Women over 65Women over 65
Arkansas Breast Cancer Control ProgramArkansas Breast Cancer Control Program
Started in 1999Started in 1999 EligibilityEligibility
Women 40 or olderWomen 40 or older No insuranceNo insurance Income at or below 2 times the poverty levelIncome at or below 2 times the poverty level Call county or state heath departmentCall county or state heath department
1-800-482-54001-800-482-5400
Eligibility for ABCCCP MammogramEligibility for ABCCCP Mammogram 50 years or older and50 years or older and At or below 200 percent povertyAt or below 200 percent poverty
OROR Between 40 and 49 andBetween 40 and 49 and A breast cancer survivor or have a mother, A breast cancer survivor or have a mother,
daughter, or sister who has breast cancer anddaughter, or sister who has breast cancer and At or below 200 percent povertyAt or below 200 percent poverty
Breast Self ExaminationBreast Self Examination Opportunity for woman to Opportunity for woman to
become familiar with her become familiar with her breastsbreasts
Monthly exam of the Monthly exam of the breasts and underarm areabreasts and underarm area
May discover any changes May discover any changes earlyearly
Begin at age 20, continue Begin at age 20, continue monthlymonthly
When to do BSEWhen to do BSE Menstruating women- 5 to 7 days after Menstruating women- 5 to 7 days after
the beginning of the beginning of their periodtheir period Menopausal women - Menopausal women - same date each monthsame date each month Pregnant women – Pregnant women – same date each monthsame date each month Takes about 20 minutesTakes about 20 minutes Perform BSE at least Perform BSE at least once a monthonce a month Examine all breast tissueExamine all breast tissue
Why don’t more women practice BSE?Why don’t more women practice BSE? FearFear EmbarrassmentEmbarrassment YouthYouth Lack of knowledgeLack of knowledge Too busy, Too busy,
forgetfulnessforgetfulness
ConclusionConclusion
Pharmacists have a Pharmacists have a responsibility as responsibility as patient advocates patient advocates for breast cancer for breast cancer
awarenessawareness