This document discusses breast cancer trends, risks, screening recommendations, and advances in treatment. It notes that breast cancer is the most common cancer in women, with nearly 300,000 new cases per year in the US. Screening and early detection have increased survival rates over the past decade. While mammography screening is effective, some guidelines recommend beginning annual screening at age 50 rather than 40 due to the higher number of women needed to be screened to save one life at younger ages. The sequencing of the human genome project in 2003 and exponential growth of scientific knowledge have led to increases in targeted therapy options. While breast conservation is often possible, mastectomy is still required in some cases such as with BRCA mutations or extensive disease.

1. *
Jackie Osland, MD, FACS
October 9, 2012

3. *
100
Rate Per 100,000
80
60
Lung & bronchus
40 Uterus
Breast
Colon & rectum
20 Stomach
Ovary
Pancreas
0
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
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.

4. *Risk
*Early Detection
*Advances in Therapy

5. * 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
*

6. Age-specific Risk of Developing
Invasive Cancer in Next 10 Years
Current Age Women (general population)
20 years…………………..1 in 2,000
30 years………………….. 1 in 256
40 years………………….. 1 in 67
50 years………………….. 1 in 39
60 years………………….. 1 in 29
85 years………………….. 1 in 8

7. * 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%
*

8. *BRCA mutations
*Risk factors
*Early onset breast cancer < 50 years of age
*Multiple family members with breast cancer
*Ovarian cancer
*NCCN guidelines
*

9. *Age
*Family History
*Not deodorant, under-wire bras or
mammograms
*Obesity
*

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

12. * 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%
*

13. * 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
*

14. “We have learned nothing, we are
where the Greeks were. “
Francis Wood Carter 1914

15. *

16. *

17. * Sentinel Node Biopsy
* Drastically reduces risk of
lymphedema for the node
negative patient
* Many women are now saved
a full axillary node dissection
*

19. 2000
1990
1970 1980
1950 1960
Tumor Human
DNA Sequencing Suppressor Genome
PCR
Genes Project

20. * 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
*

21. * Exponential growth in
information for
treatment
* Increase in molecular
alterations associated
with disease
* Scientific Explosion
*

22. *

23. *

24. *
100
Rate Per 100,000
80
60
Lung & bronchus
40 Uterus
Breast
Colon & rectum
20 Stomach
Ovary
Pancreas
0
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
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.

25. * 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
*

26. *Pulitzer Prize 2010
for General
Nonfiction
*Described by TIME
as one of the 100
most influential
books of the last
100 years
*