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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
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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
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Dysplasia: Cells proliferate too much and look abnormal in
shape and orientation.
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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
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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
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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
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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
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250
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186203
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Age Range 692 Operated Breast Cancer patients
University Hospital of North Staffordshire 2008-0913
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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)
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Life events associated with breast cancer
AgeSex – Female
RaceAge at Menarche
Age at first live birthMultiparity – Nulliparity
Breast Feeding
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Life events associated with breast cancer (Cont)
Contraceptive Pill
Diet – Exposure to Oestrogens
Alcohol
Lack of exercise
Age at Menopause
Hormone Replacement Therapy
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Ductal Cancer (Ductal Carcinoma of
no special Type)
Lobular Cancer
80 %
10 %
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Breast cancer risk factors that are difficult to modify
Age
Race
Age at menarche
Age at menopause
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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
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Before After
Reduce intake of Animal sourced fat
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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.
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Phytoestrogens
Wheat germ, rice , Oats, Barley, Beans, Lentils, Mung beans,
Apples, Carrots, Pomegranates
soybeans and soy products,
linseed (flax),
sesame seeds,
coffee, mint.32
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Factors that might influence breast density -
nutrition, physical activity, BMI, alcohol, and tobacco
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Your views are important!Remember that you can ask questions and send comments at
any time.
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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
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Hormonal History
Oral Contraceptive pill
HRT (Combined)
Intrauterine Contraceptive Coil
Hormonal treatment for conception
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Life Style
Weight gain after menopause
Lack of exercise
High intake of animal fat
Lack of vegetables and grain in diet
Alcohol
Smoking ?
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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
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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
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