Breast CancerAdriana Padilla, MD

Family Medicine

Douglas Wong, MDRadiation Oncology

Michael Moffitt, MDOncology

Rebecca Stickler, MDSurgery

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 CancerTake 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 CancerTake home goals:

Understand the difference between non-cancer and cancerous lumps

Breast CancerTake home goals: Understand the basic principals of treatment

options Local Treatments: Surgery, Radiation Systemic (Adjuvant) Therapy

Chemotherapy Hormone therapy Other options

Breast CancerTake 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 FactorRISK

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 8NCI SEER Program, 1995-1997

Risk FactorsControllable Alcohol drinking Being overweight Never having children 1st child >30yrs of age Hormone Replacement Birth control pills (very

slight)ACS Breast Cancer Facts 2001-02

Uncontrollable Getting older First degree relative

with breast cancer A previous breast

biopsy showing atypical changes

Risk Factors Controllable Being exposed to

large amounts of radiation

Uncontrollable Being young (<12) at the

time of menses 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 Women1. 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 Ignored1. 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 mammogramand is it enough to screenfor Breast Cancer?

When you discover a breast lumpWhat do you do?1. Don’t 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 lumpWhat 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 The Role of Surgery in Breast CancerCancer

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

Suspicion for breast cancer Suspicion for breast cancer based onbased on•• Physical examPhysical exam

•• Imaging studiesImaging studies–– MammogramMammogram

–– UltrasoundUltrasound

Diagnostic ProceduresDiagnostic Procedures

•• Closed surgical techniquesClosed surgical techniques

•• Open surgical techniquesOpen surgical techniques

Closed surgical techniquesClosed surgical techniques

•• FNA: Fine needle FNA: Fine needle aspiration cytologyaspiration cytology

•• Core needle biopsyCore needle biopsy

•• StereotacticStereotactic biopsybiopsy

Open surgical techniquesOpen surgical techniques

•• ExcisionalExcisional biopsybiopsy

•• IncisionalIncisional biopsybiopsy

•• Needle or wire localized Needle or wire localized excisionalexcisional biopsybiopsy

Types of cancerTypes of cancer

•• NonNon--invasiveinvasive

•• InvasiveInvasive

Surgical treatmentsSurgical treatments

•• Usually part of a combined treatment Usually part of a combined treatment approachapproach–– MultiMulti--modality treatmentmodality treatment

•• RadiationRadiation

•• ChemotherapyChemotherapy

•• Hormonal therapyHormonal therapy

Objective of surgical treatmentObjective of surgical treatment

•• Identify extent of tumorIdentify extent of tumor–– StagingStaging

•• Obtain local control of the Obtain local control of the cancercancer–– Sometimes in combination Sometimes in combination

with radiation treatmentswith radiation treatments

•• Assess whether the Assess whether the breast cancer is present breast cancer is present in the lymph nodesin the lymph nodes–– AxillaryAxillary lymph node lymph node

dissectiondissection–– Sentinel lymph node Sentinel lymph node

dissectiondissection

Surgical optionsSurgical options

•• MastectomyMastectomy–– With or without lymph With or without lymph

node dissectionnode dissection

–– With or without With or without immediate immediate reconstructionreconstruction

•• Partial mastectomyPartial mastectomy–– With or without lymph With or without lymph

node dissectionnode dissection

–– With or without With or without radiation treatmentsradiation treatments

Why surgery in breast cancerWhy surgery in breast cancer

•• Required to verify the diagnosisRequired to verify the diagnosis

•• Stages the tumor so that treatment can be Stages the tumor so that treatment can be appropriately directedappropriately directed

•• May be the definitive treatment in some May be the definitive treatment in some casescases

•• Needed to confirm a recurrence or disease Needed to confirm a recurrence or disease outside the breastoutside the breast

Radiation Treatment Conventional whole breast treatment:

mastectomy or radiation therapy Recent innovations

Revisit the concept of partial breast treatment onlySmaller volumesShorter 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 theMammoSite® 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 TeamCommunication is key Be prepared Write down your questions Explain your situation and concerns Give feedback to your health care team

Accessing Breast Health Care1. 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 DuringBreast 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