Jackie Osland, MD, FACS

October 9, 2012

*Breast Cancer Management in 2012

* Cancer Death Rates* Among Women, US,1930-2005

*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

0

20

40

60

80

10019

30

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

Lung & bronchus

Colon & rectum

Uterus

Stomach

Breast

Ovary

Pancreas

Rate Per 100,000

*Risk

*Early Detection

*Advances in Therapy

*Breast Cancer Statistics

*Most common cancer in women

*Nearly 300,000 women diagnosed per year in the US

*One in 3 women in the US will get cancer

*One in 8 women in the US will get breast cancer

*Survival rates have increased over the past decade

*Hereditary Breast Cancer

*Most women who get breast cancer don’t have a family history of breast cancer

*5-10% of breast cancer is related to a genetic syndrome

*Most common genetic syndromes are related to a BRCA 1 or BRCA 2 mutation

*Lifetime risk of breast cancer with a genetic syndrome is 60-85%

*Am I at risk for having the breast

cancer gene?

*BRCA mutations

*Risk factors

*Early onset breast cancer < 50 years of age

*Multiple family members with breast cancer

*Ovarian cancer

*NCCN guidelines

*Risk Factors for Breast Cancer

*Age

*Family History

*Not deodorant, under-wire bras or mammograms

*Obesity

*Obesity Increases Breast Cancer

Risk

*By 2030, obesity may replace smoking as the leading causative agent of cancer

*“Should I get a mammogram?”

*US Preventive Services Task Force November 2009

*Screening 1,339 women in their 50’s to save one life makes screening worthwhile

*Screening 1904 women in their 40’s to save one life is not worthwhile

*Screening women in their 40’s would reduce their risk of death by 15%

*American Cancer Society

*Acknowledges the limitations of mammography

*False alarms, missed cancers, unnecessary biopsies

*Effectiveness of mammography does increase with age

*In fact, the technology used today is better that the technology used in the studies for this review

*ACS continues to recommend annual screening beginning at age 40

“We have learned nothing, we are where the Greeks were. “

Francis Wood Carter 1914

*Digital Mammograms

*Less Invasive Tissue Biopsy

*Less Morbid Surgery

*Sentinel Node Biopsy

*Drastically reduces risk of lymphedema for the node negative patient

*Many women are now saved a full axillary node dissection

*Human Genome Project

*Completed in 2003

*13 year project

*Coordinated by the US Department of Energy and the NIH with international contributors

*Analysis of the data will continue for many years

*Cracking the Genetic Code of

Cancer

*Exponential growth in information for treatment

*Increase in molecular alterations associated with disease

*Scientific Explosion

*Cancer Gene Analysis: HER 2

Neu

*Cancer Gene Analysis:Oncotyp

e

* Cancer Death Rates* Among Women, US,1930-2005

*Age-adjusted to the 2000 US standard population.Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

0

20

40

60

80

10019

30

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

Lung & bronchus

Colon & rectum

Uterus

Stomach

Breast

Ovary

Pancreas

Rate Per 100,000

*Reconstruction Advances

*While breast conservation provides excellent cancer control, there are some cases that require mastectomy

*BRCA mutations

*Extensive disease through the breast

*Prior radiation treatment

*Dr. Vanessa Voge –Plastic Surgical Specialists

*The Emperor of All Maladies

*Pulitzer Prize 2010 for General Nonfiction

*Described by TIME as one of the 100 most influential books of the last 100 years