2.
Founda(onal
Science
–
Breast
Anatomy
UOQ contains a greater volume of tissue than any other quadrant
3.
Incidence
of
Breast
Cancer
in
India
(ICMR)
Number(#),
Rela/ve
Propor/on(%)
&
Rank(R)
of
leading
sites
of
cancer
4. • Iden2fy
those
who
are
going
to
develop/early
breast
cancer
• Low
false
posi2ve
rate
• Low
false
nega2ve
rate
• Inexpensive,
reproducible
• RCT
should
reveal
reduc2on
in
mortality
• Available
to
masses
• Average
Risk
• High
Risk
4
Cancer
Control
Screening
5.
Modali(es
Available
• BSE
• CBE
• Mammography
• MRI
• Tomography
• USG
• Thermal
detec2on
Monitors
• Proteomics
Controversies
• No
SINGLE
TEST
(Combina2on)
(Opinion
Vary)
• BSE
?
BREAST
AWARENESS
• MAMMOGRAPHY
?
AGE
Breast
Cancer
Screening
6. Breast self-exam (BSE) first introduced
American Cancer society (ACS)
initiated campaign Cancer’s Danger
Signals “Look for a lump or
Thickening in the Breast”
First studies evaluating BSE
presented. Women confused about
proper technique and relied on clinical
breast exam
Russian
study
found
BSE
did
not
decrease
Breast
Cancer
mortality
China study found no decrease of
Breast Cancer deaths after giving
women BSE instructions
Malaysia
&
other
countries
where
Mammography
is
scarce,
declared
women
should
conduct
monthly
BSE
US Preventive Service Task Force
(USPSTF) recommended against
teaching BSE.
ACS recommended against BSE.
Several new studies directly refute the
China & Russia studies:
DUKE
Found
46.6%
of
the
cancers
diagnosed
were
first
found
during
the
BSE
&
limita2on
of
Mammography
HARVARD
71%
of
cancers
detected
were
first
detected
by
BSE
in
women
under
40
MAYO
CLINIC
Found
that
women
under
50
were
more
likely
to
find
cancer
by
BSE
than
detected
by
Mammography
Still mixed messages
Susan G. Komen no longer recommends monthly
BSE, but encourages women to become familiar with
the way their breast normally look and feel
(but, isn’t t hat a breast self-exam?)
7. USPSTF
ACS
ACOG
Recommends
against
clinicians
teaching
women
how
to
perform
Breast
self-‐
examina2on
Recommends
against
clinicians
teaching
women
how
to
perform
Breast
self
examina2on
Consider
Breast
self
examina(on
instruc(on
for
high-‐risk
pa2ents.
Breast
self-‐awareness
should
be
encouraged
and
can
include
Breast
self-‐examina2on
Recommenda(ons
for
Breast
Cancer
Screening
8. • Breast
Awareness
empowers
women
to
fight
BC/disease
not
in
terms
of
sta2s2cs
used
for
mortality
but
on
the
qualita2ve
effects
of
reduc2ons
in
morbidity
• BSE
in
Conjunc2on
with
Mammography
provide
with
added
layer
of
protec2on
Controversy
con(nues
14. USPTSF
• Biennial
screening
mammography
beginning
at
age
50.(B
Recommend)
• Evidence
is
insufficient
for
assessing
the
addi2onal
benefits
of
screening
mammography
in
women
past
age
74
• Annual
screening
mammography
beginning
at
age
45
with
an
op2on
to
begin
at
age
40.
Transi2on
to
biennial
screening
at
age
55
with
op2on
to
con2nue
annual
screening
• Con2nue
biennial
screening
mammography
for
as
long
as
a
woman
is
in
good
health
and
a
life
expectancy
of
has
at
least
10
years
• Annual
Screening
Mammography
beginning
at
age
40
• Women
aged
75
years
and
older
should
consult
with
their
physicians
to
decide
whether
or
not
to
con2nue
screening
mammography
Controversies
in
Mammography
ACS
ACOG
15. • Mammography
Screening
Increased
detec2on
of
precancerous
lesions
/
In-‐situ
• 25%
of
newly
diagnosed
BC
cases
in
screening
is
DCIS.(FEA,
ADH)
• Biological
Significance
and
prac2cal
M/M
Big
challenge
and
s2ll
unclear
• Trials/Individual
studies
No
reduc2on
to
30-‐45%
modest
decrease
in
BC
when
screened
every
1-‐2
years
Controversies
in
Mammography
16.
17. • Despite
Rising
incidence
of
cancer
breast
• Decrease
in
Absolute
Number
of
deaths
•
Not
afributed
to
mammography
screening
• Risk
stra2fied
screening
is
gaining
momentum
Mammography
debate
/
controversy
18. • The
most
well
known
and
extensively
used
breast
cancer
risk
assessment
model
• Well
validated,
modified
and
improved
ager
original
development
• Some
limita2ons
• Provides
es2mated
5-‐year
and
life2me
breast
cancer
risk
based
on:
– Current
age
(>35
and
<85)
– Age
at
menarche
– Age
at
1st
live
birth
– Number
of
1st
degree
rela?ves
with
breast
cancer
(0,1,
>1)
– Number
of
previous
breast
biopsies
(1,
>1)
– History
of
atypical
hyperplasia
on
prior
breast
biopsy
– Race
ACOG,
2011;
NCCN,
2013;
NCI,
2013;
Amir,
2010
Gail
Model
(NCI-‐GAIL
MODEL)
19.
20. • Breast
cancer
risk
and
BRCA
muta?on
probability
model
• Developed
using
data
derived
from
the
Interna2onal
Breast
Interven2on
Study
and
other
epidemiologic
data
• Only
model
to
incorporate
extensive
family
history,
reproduc2ve/hormonal
factors,
gene2c
factors,
AJ
ancestry,
and
benign
breast
disease
in
one
comprehensive
model
• Some
limita2ons
TYRER-‐CUZICK
(IBIS)
MODEL
21. IBIS
MODEL
• Provides
es2mated
10-‐year
and
life2me
breast
cancer
risk
and
probability
of
a
BRCA1
or
BRCA2
muta?on
based
on:
• Current
age
• Age
at
menarche/age
at
menopause
• Age
at
1st
birth
• Use
of
HRT
• BMI
• Abnormal
breast
biopsy
findings
• History
of
ovarian
cancer
• Family
history
of
ovarian
cancer,
breast
cancer
(including
• affected
1st
degree
male
rela2ves)
• AJ
ancestry
• Also
accounts
for
half-‐siblings,
and
affected
cousins/nieces,
• Gene2c
test
results
of
pa2ent
and
family
members
• Cuzick,
2013
13/12/18 21
22. • Should
be
used
and
start
at
the
age
of
50
years
• Majority
of
BC
is
preventable
• Chemopreven2on
is
real
possibility
Risk
based
stra(fica(on
Screening
for
Breast
Cancer
