the live session will start at 18:15 hours C.E.T.

Welcome!you are part of a growing community of people interested in our

educational programmes online.

As of the 11th of July 2013 this is the 285th e-session that is offered to 5,xxx registered users who have viewed 24,xxx e-sessions

since January 2008

Please note that this activity is CME accredited.

At the end of the presentation, by closing the webcast window, you will be directed to the CME evaluation and multiple-choice test.

Expert: Dr. Abdul Basit,

University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom

Discussant: Dr. Fatima Cardoso,

Champalimaud Cancer Center, Lisbon, Portugal

e-grandround

Lifestyle modification and prevention of breast cancer

Lifestyle modification and prevention of breast cancer

Abdul BasitUniversity Hospital of North Staffordshire

Stoke-on-Trent

United Kingdom

3

4

How Does Breast Cancer Develop ?

A multistep process taking many years in most cases

Cell Proliferation

Oestrogen Hormone breast cell division

Cancer causing agents bind more strongly to maturing cells of girls and young women.

From the Cornell University Program on Breast Cancerand Environmental Risk Factors in New York State 1997

How Does Breast Cancer Develop ?

Puberty – First pregnancy

After first full term pregnancy, breast cells are mature and are less sensitive to DNA

damage.

Breast feeding further reduces the

breast cells’ sensitivity to mutations

5

6

Dysplasia: Cells proliferate too much and look abnormal in

shape and orientation.

7

How does the breast cancer develop ?Prof. Michael Baum University College , London

ERAromatase 8

OtherMesothelioma

Cervix Liver

Multiple myeloma Brain with CNS

Oral Ovary

Leukaemias Uterus

Pancreas Stomach

Oesophagus Kidney

Bladder

Malignant melanoma

N-H-LProstate

Colorectal Lung

Breast

0 10,000 20,000 30,000 40,000 50,000

Male Female

Number of new cases

Figure 1.1: The 20 most commonly diagnosed cancers (excluding non-melanoma skin cancer), UK, 2007

The largest group of survivors are those of breast cancer9

10

Your views are important!Remember that you can ask questions and send comments at

any time.

Breast cancer is not the number one killerCause of Death in Females 2009

0

5000

10000

15000

20000

25000

30000

35000

IHD

CVA

Denen

tia

Influ

enza

Lung C

ance

r

Chronic

lower

Res

piratry

Breas

t Can

cer

Nu

mb

er

11

12

15% decrease (42-27/100,000)

Life time risk of 1:8

47,700 new cancers per annum (2008) < 50yrs 20% 50-70yrs 50% only 33% are Screen

>70yrs 30%

Rising Incidence over 25 years

Falling mortality

50% increase (75-124/100,000)

over 550,000 ‘survivors’8 out of 10

<30 30-39 40-49 50-59 60-69 70-79 ≥800

50

100

150

200

250

3

26

99

186203

123

52

Age Range 692 Operated Breast Cancer patients

University Hospital of North Staffordshire 2008-0913

14

12 Things you must know before you can plan treatment for breast cancer

Age at DiagnosisTumour Size

(1)Tumour Grade (2) Tumour Type

Lymph Node Status (3)

Lympho-vascular Invasion

(Nottingham Prognostic Index)

Margins of clearanceImmunohistochemistry -3 (IHC-3) ER PgR Her2

Menopausal status Health performance status

Presentation source Screening / Symptomatic

1,2,3 = Nottingham Prognostic Index (NPI)

15

16

Life events associated with breast cancer

AgeSex – Female

RaceAge at Menarche

Age at first live birthMultiparity – Nulliparity

Breast Feeding

17

Life events associated with breast cancer (Cont)

Contraceptive Pill

Diet – Exposure to Oestrogens

Alcohol

Lack of exercise

Age at Menopause

Hormone Replacement Therapy

18

Ductal Cancer (Ductal Carcinoma of

no special Type)

Lobular Cancer

80 %

10 %

19

Breast cancer risk factors that are difficult to modify

Age

Race

Age at menarche

Age at menopause

20

21

22

23

Your views are important!Remember that you can ask questions and send comments at

any time.

Recommended lifestyle modifications

Diet

Having first child under 30

Alcohol

24

25

26

27

28

Before After

Reduce intake of Animal sourced fat

29

30

Thousands of women die from breast cancer caused by drinking: researchThe risk of developing breast cancer from drinking even small amounts of alcohol is being ignored by women with thousands now needlessly dying every year.

Thousands of women die from breast cancer caused by drinking: research

Telegraph.co.uk

The risk of developing breast cancer from drinking even small amounts of alcohol is being ignored by women with thousands now needlessly dying every year.

31

Phytoestrogens

Wheat germ, rice , Oats, Barley, Beans, Lentils, Mung beans,

Apples, Carrots, Pomegranates

soybeans and soy products,

linseed (flax),

sesame seeds,

coffee, mint.32

33

34

35

Factors that might influence breast density -

nutrition, physical activity, BMI, alcohol, and tobacco

36

Your views are important!Remember that you can ask questions and send comments at

any time.

37

Reproductive History

How many Children?

Age at first live birth ?

First Child before age 30

Breast feeding

12 months of total breast feeding in life time

38

Hormonal History

Oral Contraceptive pill

HRT (Combined)

Intrauterine Contraceptive Coil

Hormonal treatment for conception

39

Life Style

Weight gain after menopause

Lack of exercise

High intake of animal fat

Lack of vegetables and grain in diet

Alcohol

Smoking ?

40

Educating health promoting behaviours

Weight reductionPhysical activity and exercise 30 minutes most days.

Having first child before the age of 30Breast feeding for 12 months during reproductive life

Diet – Less saturated and animal fat - more Fruit & Veg• Less processed and red meat - more fish• Less refined flour and sugar - more fibre

Avoiding hormones in the ‘pill’ , HRT and IVFAlcohol - Less than 1 drink a day

Stockphoto.comexercise and diet

41

Thank You for your attention

e-grandround

Question & Answer Session

The next e-ESO session

will take place next Thursday, July 18th, at the same time

News from St Gallen Early Breast Cancer Conference 2013

Dr. Fatima Cardoso,Champalimaud Cancer Center, Lisbon, Portugal

For additional information, please visit www.e-eso.net

This activity is CME accredited. Please close the webcast window to access the CME forms

Thank you!

for participating to thise-grandround