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Breast cancer screening and survivorship PowerPoint Presentation

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Description : This medical presentation on cancer titled "Breast cancer screening and survivorship" talks about breast cancer risk factors, breast cancer screening guidelines and controversies, breast cancer screening and management of patients at high risk, adjuvant systemic therapy, and breast cancer survivorship.

Tags : Breast cancer screening, survivorship, risk factors, breast cancer screening guidelines, controversies, management, adjuvant systemic therapy, breast cancer survivorship, Hereditary

Published on : Apr 28, 2021 | Views : 2347 | Downloads : 5

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Slide 1-

Breast cancer screening and survivorship Rachna Raman MD MS Hematology and Medical Oncology Bon Secours Cancer Institute at St. Mary’s Hospital
Slide 2-

Objectives Risk factors Screening guidelines and controversies Screening and management of patients at high risk for breast cancer Updates on adjuvant systemic therapy Survivorship
Slide 3-

Average risk of breast cancer Age- specific probabilities of developing invasive breast cancer Breast cancer facts and figures 2011-2012
Slide 4-

Relative risk of breast cancer Breast cancer risk factors
Slide 5-

Breast cancer risk with breast lesions Arpino G et al. Ann of Int Med 2005
Slide 6-

1 extra breast cancer for every 7690 women using hormonal contraception for 1 year 1.8 million women 15-49 y/o who used hormonal contraception followed for 10.9 years RR for breast cancer with 10 years of use 1.38 RR for progestin IUD 1.21 Risk remained high after stopping if > 5 years of use NEJM 2017
Slide 7-

Relative risk of breast cancer Breast cancer risk factors
Slide 8-

Screening Screening average risk (Life time risk < 15%) Controversies Increased risk populations (Life time risk > 20%) Hereditary breast cancer and genetic testing Screening in increased risk Breast MRI Risk reduction in increased risk populations
Slide 9-

Screening for average risk
Slide 10-

Screening: Why the controversy? Is 40 too early? Modest benefits of screening in the 40s Does not significantly decrease breast cancer mortality (RR 0.92, 95% CI 0.75-1.02) Does not reduce risk of advanced breast cancer (RR 0.98, 95% CI 0.74-1.37) False positives, biopsies, costs and psychological stress BUT: Some of these studies were done when treatments not that good-magnitude of benefit may be under estimated
Slide 11-

Screening- Controversy Why over 50? Studies show a significant RR for breast cancer mortality 50 to 59 years (RR 0.86, 95% CI 0.68-0.97 60 to 69 years (RR 0.67, 95% CI 0.54-0.83) Reduced risk of advanced breast cancer in > 50 (RR 0.62, 95% CI 0.46-0.83 Annual vs Biennial? 10-year cumulative false-positive mammography rates Annual 61% Biennial 42%
Slide 12-

Increased risk populations Lifetime risk of > 20% (models such as Tyrer-Cuzick, BRCAPRO) Prior h/o breast cancer H/O Thoracic RT under the age of 30 y 5 year risk of Invasive disease > = 1.66% in women >= 35 (Gail model) https://www.cancer.gov/bcrisktool/ Diagnosis of atypical hyperplasia, LCIS (DCIS)
Slide 13-

How common is Hereditary breast cancer?
Slide 14-

Who should have genetic testing? BRCA testing Individuals from families with known BRCA Personal history of breast cancer with multiple family members with breast and/or ovarian cancer Ashkenazi Jewish descent Young age at diagnosis (<= 45 y or <= 50 with other factors*) Triple negative cancer age <60 Personal history of ovarian cancer At any age if FH of ovarian cancer or male breast cancer Multigene/ Panel testing There are other cancer types in the family One or more rare syndromes in the differential, and/or The results would influence medical management. * >= 1 relative (first, second, third on the same side of the family) at any age with breast cancer, pancreatic cancer or prostate cancer. Also if has an additional breast primary
Slide 15-

Screening in increased risk populations Clinical encounter at least annually Annual screening Mammogram- 10 ys prior to youngest affected family member but at > 25y. Some may need screening breast MRIs
Slide 16-

Who should get a screening MRI
Slide 17-

Risk reduction in high risk patients Risk reduction surgeries: In patients with a genetic mutation Endocrine therapy : Tamoxifen, raloxifene, or aromatase inhibitor for 5 years. Prevents HR+ breast cancer by 50%, does not prevent HR- cancer Most notable benefit is seen in Atypical hyperplasia No known survival benefit. Absolute benefit is small Consider sending these patients to an oncologist for further evaluation and management.
Slide 18-

Breast cancer treatment overview Management Patient factors: Age, comorbidities, patient preferences Tumor factors: Stage, receptors, biology Early/ Locally advanced: Stages I-III Surgery Chemotherapy Radiation Endocrine therapy
Slide 19-

Localized breast cancer- Adjuvant chemotherapy EBCTCG Lancet 2012
Slide 20-

Localized breast cancer: Adjuvant targeted therapy HER2 positive disease BMC cancer 2007 Traztuzumab given for a full year
Slide 21-

Adjuvant therapy- HER2+ updates Adjuvant Pertuzumab Minckwitz et al NEJM 2017; Martin et al. Lancet Oncol 2017 Neratinib: Extended adjuvant therapy significantly reduced breast cancer relapses
Slide 22-

Localized disease: Adjuvant endocrine therapy 10 years of AI or Tamoxifen followed by AI Davies et al. Lancet 2013
Slide 23-

Adjuvant endocrine therapy: Ovarian ablation (OFS)in high risk breast cancer Women < 35 of age (94% received chemotherapy) Role of ovarian function suppression – SOFT and TEXT
Slide 24-

Breast cancer – Long term care and survivorship
Slide 25-

Estimated Numbers of US Cancer Survivors by Site
Slide 26-

Why is survivorship important? Annual mortality rates are decreasing- 4/10 cancer survivors had breast cancer 61% have localized disease- 99% 5 year Relative Survival 43% older than 65 Must be managed with age associated comorbidities Studies show that Generalist follow up more cost effective and no less effective than specialist follow ups
Slide 27-

Aspects of Long term care & survivorship Surveillance for breast cancer recurrence Screening for second primary Assessment and management of physical and psychosocial long term effects of treatment Health promotion
Slide 28-

Surveillance for breast cancer recurrence- Local recurrences In breast Chest wall Nodal
Slide 29-

Surveillance for breast cancer recurrence- Distant recurrences Pan H et al. NEJM 2017
Slide 30-

Surveillance for recurrence: ACS and NCCN guidelines Detailed H and P 1-4 times a year x 5 years, annually thereafter Bilateral annual mammogram
Slide 31-

Screening for second primary cancers Second primary breast cancer Risk of a second breast cancer is between 0.5 and 1.0 percent per year Gynecologic cancers on SERM Extended tamoxifen doubles the risk of and mortality from endometrial cancer 3.1 versus 1.6 percent 0.4 versus 0.2 percent respectively Annual gynecologic exams
Slide 32-

Other second primaries Genetic susceptibilities Shared exposures Treatment adverse effects Radiation: Sarcomas of the breast, shoulder, lung cancer Surgery: Silicone Implant -anaplastic large cell lymphoma Chemotherapy: MDS, Leukemia Awareness for these is a shared responsibility of the Oncologist and PCP
Slide 33-

Long term adverse effects Cardiotoxicity Vasomotor symptoms Bone health Neuropathy Infertility Fatigue Cognition Sexual health
Slide 34-

Cardiac disease following breast cancer Risk The absolute risk of dying from CVD 1.6-10.4% older age, Left sided, AA Why? Coexisting CV risk factors more prevalent XRT Anthracycline Anti HER2 therapy What could we do? Identify patients at risk Aggressive management of cardiac risk factors Consider ECHO 1 year after Anthracyclines if additional CV risk factors Gernaat et al. Breast cancer Res Treat 2017
Slide 35-

Health Promotion Achieve and maintain a healthy body weight Healthy diet with vegetables, grains, fruits, low sugars Minimize alcohol- no more than 1 drink per day Vitamin D
Slide 36-

The American Cancer Society Website cancer.org/treatment/survivorshipduringandaftertreatment/index 36
Slide 37-

Community Resources 31st Annual National Cancer Survivors Day Sunday June 3, 2018 https://ha.healthawareservices.com/ra/survey/2860 Helping you find the Power to Overcome... so You Can! Live Well, Virginia!
Slide 38-

Thank you Thank you