Breast Cancer

Adriana Padilla, MD
Family Medicine
Douglas Wong, MD
Radiation Oncology
Michael Moffitt, MD
Oncology
Rebecca Stickler, MD
Surgery
By the time the Lord/Higher Power made woman, he was into his sixth day of working overtime.
An angel appeared and said, "Why are you spending so much time on this one?
And the Lord/Higher Power answered, "Have you seen the spec sheet on her? She has to be
completely washable, but not plastic, have over 200 movable parts, all replaceable, run on diet
coke and leftovers, have a lap that can hold four children at one time, have a kiss that can cure
anything from scraped knee to a broken heart and have two pairs of hands.
The angel was astounded at the requirements. "Two pairs of hands! No way! And that's just on
the standard model? That's too much work for one day. Wait until tomorrow to finish.
"But I can't," the Lord/Higher Power protested. "I am so close to finishing this creation that is so
close to my own heart. She already heals herself when she is sick AND can work 18 hour days.
The angel moved closer and touched the woman. "But you have made her so soft, Lord/Higher
Power."
"She is soft," the Lord/Higher Power agreed, "but I have also made her tough. You have no idea
what she can endure or accomplish."
"Will she be able to think?", asked the angel.
The Lord/Higher Power replied, "Not only will she be able to think, she will be able to reason and
negotiate.
The angel then noticed something, and reaching out, touched the woman's cheek. "Oops! It looks like
you have a leak in this model. I told you that you were trying to put too much into this one..
"That's not a leak," the Lord/Higher Power corrected, "that's a tear!"
"What's the tear for?" the angel asked.
The Lord/Higher Power said, "The tear is her way of expressing her joy, her sorrow, her pain, her
disappointment, her love, her loneliness, her grief and her pride.
The angel was impressed. "You are a genius, Lord/Higher Power. You thought of everything! Woman is
truly amazing.
And she is!......
Women have strengths that amaze men.
They bear hardships and they carry burdens,but they hold happiness, love and joy.
They smile when they want to scream.
They sing when they want to cry.
They cry when they are happy and laugh when they are nervous.
They fight for what they believe in.
They stand up to injustice.
They don't take "no" for an answer when they believe there is a better solution.
They go without so their family can have.
They go to the doctor with a frightened friend.
They love unconditionally.
They cry when their children excel and cheer when their friends get awards.
They are happy when they hear about a birth or a wedding.
Their hearts break when a friend dies.
They grieve at the loss of a family member, yet they are strong when they think there is no
strength left.
They know that a hug and a kiss can help to heal a broken heart.
Women come in all sizes, in all colors and shapes. They'll drive,fly, walk, run or e-mail you to
show how much they care about you. The heart of a woman is what makes the world keep
turning! They bring joy and hope.They have compassion and ideals.They give moral support to
their family and friends. Women have vital things to say and everything to give.
Pass this along to your women friends to remind them how amazing they are because if there's
one flaw in women, it is that they tend to forget about themselves.
Breast Cancer

Women Are Amazing!

Breast Cancer
Take home goals:
Understand Breast Cancer Risk Factors
Be comfortable with Breast Cancer
screening methods
What to do if you or your physician has
found a new breast lump
Breast Cancer
Take home goals:
Understand the difference between
non-cancer and cancerous lumps
Breast Cancer
Take home goals:
Understand the basic principals of treatment
options
Local Treatments: Surgery, Radiation
Systemic (Adjuvant) Therapy
Chemotherapy

Hormone therapy

Other options
Breast Cancer
Take home goals:
Coping with your diagnosis
Talking with your doctor
Accessing breast exams and mammogram
services
Breast Cancer Risk Factors
Risk Factors do not cause breast cancer but
are associated with an increased chance of
getting breast cancer
The number one risk factor for breast
cancer is being a women
Age is a risk; the chance of getting breast
cancer increases with age
Age as a Risk Factor
RISK
By age 30 1 out of 2,000
By age 40 1 out of 233
By age 50 1 out of 53
By age 60 1 out of 22
By age 70 1 out of 13
By age 80 1 out of 9
Lifetime risk 1 out of 8
NCI SEER Program, 1995-1997
Risk Factors
Controllable Uncontrollable
Alcohol drinking Getting older
Being overweight First degree relative
Never having children with breast cancer
1st child >30yrs of age A previous breast
Hormone Replacement biopsy showing
Birth control pills (very atypical changes
slight)
ACS Breast Cancer Facts 2001-02
Risk Factors
Controllable Uncontrollable
Being exposed to Being young (<12) at the
large amounts of time of menses
radiation Starting menopause after
age 55
Having an inherited
mutation in the breast
cancer genes (BRCA 1 or 2)
ACS Breast Cancer Facts 2001-02
 Radiation Exposure
Risk Vs benefit
Same decision making for surgery, chemotherapy, ERT: benefit > risk?
Woman choosing lumpectomy, XRT benefit >>>> risk
Uncontrolled vs controlled
Warfare, industrial, environmental: total body, mixed radiations, variable
distances and time maximum risks
Diagnostic, therapeutic: collimated, pure radiations, measured distances
and time minimum risks
Secondary malignancies in women surviving breast cancer
Occurs with or without use of radiation therapy
Observed to occur as frequently in women that received no XRT as in
women that received XRT
Breast Cancer Screening Methods
For Healthy Women
1. Breast Self Exam Status
Guiding principal Know your breasts they
are not land mines
2. Clinical Breast Exam
Age 20-39: every 3 years
Age after 40: every year
3. Mammography
Age after 40: every year
Trouble Signs That Should Not
Be Ignored
1. Finding a lump, hard knot or thickening
2. Unusual swelling, warmth, redness or darkening
3. Change in size or shape of your breast
4. Dimpling or puckering of the skin of your breast
5. Finding an itchy, scaly sore or rash on the nipple
6. Pulling in of the nipple or other parts of the breast
7. Nipple discharge that starts suddenly
8. Pain in one spot that does not vary with cycle
Breast Cancer Screening Methods
For Healthy Women
How do you do a Breast Self Exam?

What is a mammogram
and is it enough to screen
for Breast Cancer?
When you discover a breast lump
What do you do?
1. Dont Panic most breast lumps are not
cancer (Benign Breast Changes - Cysts and
Fibroadenomas)
2. See your primary health care provider for a
full assessment and recommendations
3. You may need a fine needle aspiration
procedure and or a diagnostic mammogram
or ultrasound
When you discover a breast lump
What do you do?
4. If the breast lump turns out to be solid,
what happens then?
5. If after a biopsy, the tissue is found to be
cancerous, what happens then?
6. If after a biopsy the tissue is found to not
be cancerous, but not entirely normal, what
happens then?
When the Diagnosis is Cancer
What then?
Types of Breast Cancer?
Types of Treatment: Local and Systemic
Local
Surgery
Radiation Therapy
Systemic
Chemotherapy
Hormone Therapy
Biological Therapy
The Role of Surgery in Breast
Cancer

Rebecca Stickler, M.D., F.A.C.S.

Suspicion for breast cancer
based on
Physical exam
Imaging studies
Mammogram
Ultrasound
Diagnostic Procedures

Closed surgical techniques

Open surgical techniques
Closed surgical techniques
FNA: Fine needle
aspiration cytology
Core needle biopsy
Stereotactic biopsy
Open surgical techniques

Excisional biopsy
Incisional biopsy
Needle or wire localized excisional biopsy
Types of cancer
Non-invasive
Invasive
Surgical treatments

Usually part of a combined treatment

approach
Multi-modality treatment
Radiation
Chemotherapy
Hormonal therapy
Objective of surgical treatment
Identify extent of tumor
Staging
Obtain local control of the
cancer
Sometimes in combination
with radiation treatments
Assess whether the
breast cancer is present
in the lymph nodes
Axillary lymph node
dissection
Sentinel lymph node
dissection
Surgical options
Mastectomy
With or without lymph
node dissection
With or without
immediate
reconstruction
Partial mastectomy
With or without lymph
node dissection
With or without
radiation treatments
Why surgery in breast cancer

Required to verify the diagnosis

Stages the tumor so that treatment can be
appropriately directed
May be the definitive treatment in some
cases
Needed to confirm a recurrence or disease
outside the breast
Radiation Treatment
Conventional whole breast treatment:
mastectomy or radiation therapy
Recent innovations
Revisit the concept of partial breast treatment
only
Smaller volumes
Shorter treatment course

Balloon catheter / multi-catheters / IORT / IMRT

Balloon and lumpectomy
A dose of 34 Gy was delivered at a depth of 1 cm over the
course of 5 days. CT scans were used to assess the
conformance of the resection cavity tissue to the
MammoSite RTS balloon.

Balloon on CT
When the Diagnosis is Cancer
What then?
With the help of your family, friends and your
medical team, you can:
1. Understand your diagnosis and prognosis
2. Make treatment decisions from the best and latest
research and clinical trials
3. Become comfortable with your treating team
(primary health care provider, surgeon, oncologist,
radiation oncologist and others)
4. Know what to expect
Coping with your Diagnosis
Express your emotions
Develop a fighting spirit
Build a strong support group
Trust your health care team
Working with your Health
Care Team
Communication is key
Be prepared
Write down your questions
Explain your situation and concerns
Give feedback to your health care team
Accessing Breast Health Care
1. HMO, PPO, Medi-Cal, Medicare covers
services
2. Breast Cancer Early Detection Programs:
Free services to individuals who do not
have nor qualify for health care. You must
qualify on an intake assessment
Women
Are Amazing!

Remember Yourself During

Breast Cancer Awareness
Month!
Important Information Sites
www.komen.org
www.cancer.gov for the National Institute
of Health
www.cancer.org for the American Cancer
Society
www.ahcpr.gov for the US Preventive
Health Task Force recommendations