Globally, breast cancer is the most diagnosed cancer and the leading cause of cancer death among females. representing 23% of the total cancer cases and 14% of the cancer deaths. Breast cancer is now also the leading cause of death among women from all cancers in developing countries . Additionally, breast cancer mortality rates in African women are higher in comparison to women living in Western countries .

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3. Facts and figures
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY-NC-ND

6. Epidemiology
Facts and figures
Globally, breast cancer is the most diagnosed cancer and the leading cause of cancer
death among females.
representing 23% of the total cancer cases and 14% of the cancer deaths.
Breast cancer is now also the leading cause of death among women from all cancers
in developing countries .
Additionally, breast cancer mortality rates in African women are higher in
comparison to women living in Western countries .

7. Facts and figures

8. Facts and figures

9. Diagnosis and presentation

11. Risk factors
shift toward Western lifestyles in developing countries
These styles consequently result in dietary, reproductive, and hormonal changes
which are risk factors for the dramatic increase in cancer rates.
Although, the incidence rates of breast cancer are higher in developed countries,
mortality is much greater in developing countries, due to difficulty in early detection
of the disease and lack of access to treatment as well .

12. • BRCA 1/2 Mt: 56–84% lifetime risk of breast CA
o Other familial/hereditary breast CA: TP53, PTEN,
ATMgene Mt
Genetics

13. Staging •
1- History and physical examination
2-lab investigation
CBC liver and kidney function test
3-Biopsy
4-Son mammography
5-CT chest and pelvis- abdomen
6-PET-CT

14. Treatment
Surgery breast conservative surgery
(BCS) or modified radical mastectomy
MRM
Chemotherapy
Adjuvant and neoadjuvant
targeted therapy
Radiation therapy
hormonal treatment
Immunotherapy

15. • Invasive: Ductal (IDC) – most common of
invasive carcinomas.
invasive lobular (ILC) • Molecular & Receptor
classification.
Pathology

16. sagittal view of mammographic findings
the technique of mammography
: T1

18. • Tamoxifen:
Risk-benefit: 43% 7-y risk reductionof invasive breast CA but ↑
DVT/PE, ↑ endometrial CA
• Raloxifene:
76% as effective as tamoxifen for risk reductionalso ↓ vertebral
fractures,↑ risk of stroke, DVT/PE, cataracts but < tamoxifen
•Prophylactic bilateral mastectomy:
90% risk reductionfor women at high risk.
• Prophylactic bilateral salpingo-oophorectomy:
↓ risk of ovarian & breast CA
Prevention

19. PET CT Rt sided breast cancer

20. Patient related assessment
(KPS,ECOG
disease-related assessment
labs (CBC, CMP, consider tumor markers: CEA, CA15–3,
imaging (CT CAP & BS or PET/CT), consider additional imaging (x-ray, brain
MRI)if specific concern suchas fracture, brain met Strongly consider for the first
site of met/recurrence to document met
ER/PR/ HER2 status.
Workup H&P

21. Local Management •
Breast conservative surgery (BCS)
Modified Radical mastectomy
Management

22. When to Use SystemicChemotherapy •
high risk – biologically (HER2 +, triple negative)or histologically (node-
positive) for “most” pts to eradicateoccult micro metastatic disease •
Adjuvant Management:

23. HormoneTherapy for ER/PR Positive Disease
• Premenopausal: ↓ breast CA mortality (Tamoxifen) –
• Postmenopausal: AI either upfront or sequentially w/tamoxifen.
AIs: (1) Nonsteroidal: Anas (anastrozole), let (letrozole);
steroidal:Exe (exemestane)
Adjuvant Management cont. :

24. Giveto down-size (for inoperable Stage III or large tumors;
tumors requiring mastectomy but BCSdesired)
• Same DFS & OS as adjuvant,but ↑ BCS w/neoadj
Neoadjuvant Management: Chemotherapy •

25. Epidemiology Estimated survival at 5-y OS 24%:
Risk assessment
Prognostic Factors PS, site of disease (worse w/viscera or CNS),
no. of sitesof disease, subtypes
(worse HR− & HER2+), disease-free interval (>2 vs. <2), priortx exposure
Metastatic Breast cancer

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