BREAST CANCER - RISK FACTOR & PATHOGENESIS.pdf

Breast ca

1. HOD & CHIEF MAM :
DR.R.BANUREKHA MS.,DGO
PRESENTOR: HARI KUMARAN T
FINAL YEAR
UNIT 1

2. q MOST COMMON MALIGNANCY AMONG
WOMEN GLOBALLY
q2.3 MILLION NEW CASES DIAGNOSED
WORLDWIDE IN 2020
q25% OF ALL NEWLY DIAGNOSED CANCERS
q14% CANCER RELATED DEATHS IN WOMEN

3. qBROADLY CATEGORISED INTO
1. MODIFIABLE RISK FACTORS
2. NON-MODIFIABLE RISK FACTORS
3. HISTOLOGICAL RISK FACTORS

4. ØOBESITY : BMI>30 INCREASED RISK IN
POSTMENOPAUSAL WOMEN
ØPARITY : NULLIPAROUS WOMEN OR 1
ST

PREGNANCY AFTER 35 YEARS OF AGE
ØBREAST FEEDING :PROTECTIVE WHEN
BREASTFED >12 MONTHS
ØUSE OF HORMONAL REPLACEMENT
THERAPY:USE FOR >10YRS INCREASED RISK

5. ØAGE AT 1
ST CHILD BIRTH:
LESS RISK<20YEARS
HIGH RISK>35YEARS
ØTOBACCO USE:SMOKING >25
CIGARETTES/DAY(RR:1.14) ;>20 YEARS(RR:1.07)
ØALCOHOL CONSUMPTION
ØRADIATION EXPOSURE (RR:6)

6. ØAGE:INCREASING AGE
ØSEX : FEMALES ARE AT HIGH RISK (0.5-1% RISK IN
MALES)
ØFAMILY HISTORY OF BREAST CANCER : 1
ST
DEGREE RELATIVES(MOTHER,SISTER,DAUGHTER)
ØGENETIC PREDISPOSITION : 70% DUE TO BRCA1 &
BRCA2 MUTATIONS

7. EARLY MENARCHE : <12 YEARS
LATE MENOPAUSE : >55 YEARS

8. HISTOLOGICAL TYPES RELATIVE RISK
PROLIFERATIVE DISEASES
v ATYPICAL DUCTAL
HYPERPLASIA
v ATYPICAL LOBULAR
HYPERPLASIA
3.7 - 4.2
PROLIFERATIVE DISEASES WITH
STRONG FAMILY HISTORY 4 - 9
LOBULAR CARCINOMA INSITU>7

9. q GAIL MODEL
FEATURES:
Ø AGE
Ø AGE AT MENARCHE
Ø AGE AT 1
ST LIVE BIRTH
Ø NUMBER OF PREVIOUS BREAST BIOPSIES
Ø NUMBER OF 1
ST DEGREE RELATIVES
WITH BREAST CANCER
vDOESNOT INCLUDE GENETIC FACTORS

10. qCLAUS MODEL
ØBASED ON PREVALENCE OF HIGH PENETRANCE
BREAST CANCER SUSCEPTIBITY GENES
qBRCAPRO MODEL(MANDELIAN MODEL)
ØRISK OF BRCA1 & BRCA2 MUTATIONS

11. qTYRER-CUZICK MODEL
FEATURES:
Ø AGE AT MENARCHE
Ø AGE AT MENOPAUSE
Ø PARITY
Ø AGE AT 1
ST LIVE BIRTH
Ø HISTORY OF ATYPICAL HYPERPLASIA
Ø HEIGHT&BMI

14. ØDEVELOPS FROM TDLU(TERMINAL DUCTAL
LOBULAR UNIT)
ØONLY IN FEMALES
ØNEIBOURING CALCIFICATION
ØINCIDENTAL FINDING
Ø25-35% DEVELOPS INTO INVASIVE CANCER

15. Ø65% SUBSEQUENT INVASIVE CANCERS ARE
DUCTAL NOT LOBULAR IN ORIGIN
ØMARKER OF INCREASED RISK FOR
INVASIVE BREAST CANCER NOT
ANATOMICAL PRECURSOR
qCOUNCELLING:
v OBSERVATION WITH SCREENING
v CHEMOPREVENTION
v BILATERAL MASTECTOMY

16. PREDOMINANTLY IN FEMALES (5% IN MALES )
PROLIFERATION OF DUCTAL EPITHELIUM
PAPILLARY GROWTHS(PAPILLARY GROWTH
PATERN)
COALASES & FILL THE DUCTAL
LUMINA(CRIBRIFORM PATTERN)

17. FREQUENT MITOSIS OBLITERATES LUMEN &
DISTEND DUCTS( SOLID GROWTH PATTERN)
NECROSIS(COMEDO GROWTH PATTERN)
CALCIUM DEPOSITION (CALCIFICATIONS)

18. LCIS DCIS
AGE (YRS ) 44-47 54-58
INCIDENCE 2-5% 5-10%
CLINICAL SIGNS NONE MASS,PAIN,NIPPLE
DISCHARGE
MAMMOGRAPHIC
SIGNS
NONE MICROCALCIFICATIO
N
MULTICENTRICITY60-90% 40-80%
SUBSEQUENT
CARCINOMAS:
LATERALITY BILATERALIPSILATERAL
HISTOLOGIC TYPEDUCTAL DUCTAL

19. CLASSIFICATION HORMONE
RECEPTOR(ER/PR)
HER2
LUMINAL A POSITIVE NEGATIVE
LUMINAL B POSITIVE NEGATIVE
TRIPLE NEGATIVE NEGATIVE NEGATIVE
HER2 ENRICHED NEGATIVE POSITIVE
NORMAL NEGATIVE NEGATIVE

20. SPORADIC BREAST CANCER 65-75%
FAMILIAL BREAST CANCER 20-30%
HEREDITARY BREAST CANCER 5-10%
BRCA1 45%
BRCA2 35%
P53(LI-FRAUMENI SYNDROME) 1%
STK11(PEUTZ-JEGHERS SYNDROME) <1%
PTEN(COWDEN SYNDROME) <1%
ATM(ATAXIA-TELANGIECTASIA) <1%
UNKNOWN 20%

21. qLOCAL SPREAD
Ø SKIN LEADS TO ULCERATION &
SATELLITE NODULES
ØPECTORALIS MAJOR , SERRATUS
ANTERIOR OR EVEN CHEST WALL

22. qAXILLARY LYMPH NODES
qINTERNAL MAMMARY NODES
qCONTRALATERAL NODES -MALIGNANCY

23. qSKELETAL SYSTEM
Ø LUMBAR VERTEBRAE
Ø NECK OF FEMUR
Ø THORACIC VERTEBRAE
Ø RIBS
Ø SKULL
qLUNGS,BRAIN,ADRENAL GLANDS,OVARIES
qIN LIMBS , DEPOSITS ABOVE ELBOW &ABOVE
KNEE

24. qDISCRETE LUMP – MOST COMMON
PRESENTATION
(COMMON IN
UPPER-OUTER
QUADRANT)
qNIPPLE
RETRACTION
(CIRCUMFERENTIAL)

25. qBLOODY
DISCHARGE
qSEROUS
DISCHARGE

26. qULCERATION
qPEAU’D ORANGE
APPEARANCE

29. qBAILEY AND LOVE’S SHORT PRACTICE OF
SURGERY 28
TH EDITION – VOL 2
qSCHWARTZ’S PRINCIPLES OF SURGERY
10
TH EDITION
qSABISTON TEXTBOOK OF SURGERY
21
ST EDITION