Breast Cancer. Breast Cancer. Established breast cancer risk factors. Established breast cancer risk factors. Cancer incidence.
|
|
|
- Paul Goodman
- 6 years ago
- Views:
Transcription
1 Breast Cancer A buffet of breast cancer topics Wendy Y. Chen, MD MPH Dana-Farber Cancer Institute Brigham and Women s Hospital Disclosures: none Not related to anything presented in this lecture Wendy Y. Chen, MD MPH Dana-Farber Cancer Institute Brigham and Women s Hospital Epidemiology Prevention Breast Cancer Cancer incidence Cancer cases Screening Primary, non-metastatic, breast cancer Metastatic breast cancer Cancer deaths Siegel et al, CA Cancer J Clin 2012 Established breast cancer risk factors Age Overweight Alcohol use Physical activity Postmenopausal hormone use Late age at first birth (> 30 y.o.) Early age at menarche Late age at menopause BRCA1/2 and Family history Established breast cancer risk factors Age Overweight Alcohol use Physical activity Postmenopausal hormone use Late age at first birth (> 30 y.o.) Early age at menarche Late age at menopause BRCA1/2 and Family history
2 Menopausal hormone therapy Women s Health Initiative Federally funded study of dietary modification, calcium/vitamin D, and postmenopausal hormones for heart disease and cancer prevention 10,739 women without uterus mg conjugated equine estrogen vs placebo 16,608 women with uterus mg CEE mg medroxyprogesterone vs placebo 40% intervention group and 60% control Women s Health Initiative E+P Mean f/u 5.6 yrs 42% stopped study meds abnormal mammograms Risk drops quickly after stopping Women s Health Initiative CEE Stopped at 7.1 yrs mean f/u due to stroke and? Overall benefit HR 0.77 (95% CI ) with 11.8 yrs f/u Chlebowski, JAMA 2003;289:3243 Anderson Lancet Oncol 2012; 476 Alcohol Alcohol Intake and Breast Cancer Relative Risk Alcohol Intake (g/d)
3 Alcohol and estrogen levels Body mass index P for trend= P for trend= 0.03 Onland-Mouret 2006, J Clin Endocrinol Metab Body mass index Body mass index and sex steroid levels Postmenopausal breast cancer risk 20-30% higher with BMI > 30 No increase in premenopausal breast ca Main source of estrogen after menopause = fat tissue which converts androgens into estrogens Estradiol SHBG 10 0 < Body Mass Index Family History/Genetics Family History Risk for Patient is Greater if: Women affected are first degree relatives Women in family affected at younger age Women in family have bilateral breast cancer
4 BRCA 1 & 2 Prevention Germ-line genetic mutations risk of breast and ovarian cancer BRCA1 : 50-70% breast, 40-50% ovarian ca BRCA2 : 40-60% breast, 10-25% ovarian ca male breast cancer with BRCA2 Only explains 5-10% of all breast cancers Tamoxifen vs Raloxifene vs Aromatase Inhibitors Tamoxifen Raloxifene AI Hot Flashes yes yes yes Bone Effect positive positive negative Uterine stim yes no no Thrombotic yes yes no Premenop OK yes no no Randomized placebo controlled prevention trials Tamoxifen, raloxifene, AI 40-60% breast ca risk Only prevents ER+ breast cancer No survival benefit seen Why isn t breast cancer chemoprevention done more? Absolute risk of breast cancer low Side effects Screening available for breast cancer Screening mammography To screen or not to screen US Preventive Services Task Force controversy November 2009: Recommends against routine screening mammography in women aged years USPTF, Ann Intern Med 2009
5 US Preventive Services Task Force controversy November 2009: Recommends against routine screening mammography in women aged years December 2009: The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. USPTF, Ann Intern Med 2009 What we know about screening Women aged should get routine screening mammogram Randomized controlled trials and metaanalyses => 20-30% mortality Recommended screening interval 1-2 years When should we start screening? Arguments against screening women aged Large randomized trials (100,000+) =>15-25% mortality but not statistically significant Breast cancer less common before age 50 so absolute benefits smaller Although screening began in 40 s, benefits generally not seen until women in 50 s More false positives among younger women Armstrong, Ann Intern Med, 2007 When should we start screening? Arguments for screening women aged Although most individual trials not significant, metaanalyses => 7-23% significant mortality USPTF meta-analysis RR 0.85 (95% CI ) Relative benefits similar to women 50+ Many older negative studies used outdated techniques (e.g. single rather than double view) Intention to treat analyses, but some crossover between groups Armstrong, Ann Intern Med, 2007 False-positive mammograms provider perspective Definition varies: additional mammo to biopsy 20-50% estimated risk over 10 mammograms More common in women < age 50 Chances of Malignancy by Age and Type of Mammographic Finding Age Mass Lesion Calcifications < 40 19/225 (8%) 21/66 (32%) /449 (12%) 62/201 (31%) /254 (29%) 35/175 (20%) /149 (43%) 29/120 (24%) >69 70/125 (56%) 18/72 (25%) Total 279/1202 (23%) 165/634 (26%) Elmore, NEJM 2004 Meyer, JAMA, 1999;281:1638
6 False-positive mammograms patient perspective Ductal Carcinoma In-Situ (DCIS) Rare before screening mammography 57,650 cases in 2010 ~30% of all mammographically detected masses Uncertainty re: natural history of DCIS 14-40% estimated to recur if untreated Largest study had 80 women (Eusebi 1994) Cannot identify those that will recur so all treated equally Mastectomy or lumpectomy + RT +/-tamoxifen Is it really cancer? Confusing nomenclature Cancer cells similar to invasive disease, but no invasion of basement membrane Lobular Carcinoma in Situ (LCIS) Often incidental finding risk of invasive carcinoma bilaterally without predictable location - ~1%/yr Generally does not need surgical excision Management options observation tamoxifen prophylactic bilateral mastectomy Breast MRI More sensitive especially in young women May miss DCIS does not replace mammograms Many more false positives Current indications for MRI ACS Recommended for: BRCA1/2, Li-Fraumeni, Cowden s Radiation to chest between age 10 and 30 Lifetime risk of >20-25% Insufficient evidence for or against Personal history of breast cancer Dense breasts on mammography = >Never been shown to reduce mortality! Saslow CA J Clinic 2007 Breast Cancer Treatment Management of Primary Invasive Breast Cancer Disease confined to the breast +/- axillary lymph nodes Local tumor control Lumpectomy/Radiation vs Mastectomy Systemic disease prevention Adjuvant chemotherapy +/- hormonal therapy
7 Primary breast cancer local control Mastectomy vs lumpectomy + RT Primary Breast Cancer Systemic Rx Patients with disease confined to breast and axilla can often be cured by local therapy, but some at risk to develop metastatic disease Metastatic disease not generally curable Decision for adjuvant treatment based on: Likelihood of developing metastatic disease Overall life expectancy Jacobson, N Engl J Med 1995;332;907 Risk factors for development of metastatic breast cancer Tumor size and grade Axillary lymph node involvement Estrogen receptor status HER2/neu status Breast Cancer is More than 1 Disease 1. Estrogen receptor positive HER2 negative Sensitive to hormonal therapy 2. Estrogen receptor positive HER2 positive Sensitive to hormones and trastuzumab 3. Estrogen receptor negative - HER2 positive Sensitive to trastuzumab 4. Triple negative (basaloid) No targeted therapies Gene expression profiling of tumor OncotypeDX For ER positive tumors and mainly node negative Sorlie, PNAS, 2001 Paik NEJM 2004
8 Primary Breast Cancer Adjuvant Rx Chemotherapy +/- Trastuzumab Hormonal Therapy Tamoxifen Aromatase Inhibitors Ovarian suppression/ablation Chemotherapy Improves Cure Rate for Patients with Primary Breast Cancer Patients with node-positive breast cancer Modified Radical Mastectomy C cyclophosphamide, d1-14 M methotrexate days 1 & 8 F 5-FU days 1 & 8 No Post-op treatment Bonadonna, NEJM 1976;294:405 & 1995;332:901 Milan CMF Trial for Node + Disease Flavors of Adjuvant Chemotherapy CMF cyclophosphamide +methotrexate +5-FU CA cyclophosphamide + doxorubicin CA - T - Taxane (paclitaxel or docetaxel) TAC - docetaxel + AC TC doctaxel + cyclophosphamide CAF AC + 5-FU HER2/neu and Trastuzumab HER2/neu (c-erbb2) proto-oncogene kd transmembrane, glycoprotein growth factor receptor without known ligand HER2neu pathway Drugs include trastuzumab,lapatinib, pertuzumab Trastuzumab - Humanized monoclonal antip185 HER Can cause congestive heart failure No administered with or after an anthracycline 20-25% of breast cancers overexpress HER2 HER2+ tumors have worse prognosis, if not treated with trastuzumab Hudis, NEJM, 2007
9 Intergroup Adjuvant Trial N9831 Adjuvant AC-T With and Without Trastuzumab: Combined Analysis of NASBP B-31 and N9831 Cyclophosphamide/Doxorubicin x 4 q 3 wks 2700 pts Paclitaxel q wk x 12 Paclitaxel q wk x 12 Paclitaxel q wk x 12 Trastuzumab x 12 50% Reduction in Recurrence Trastuzumab x 52 Trastuzumab x 40 Perez, NEJM, 2005 Perez, NEJM, 2005 Adjuvant Hormonal therapy Metastatic Breast Cancer 1 st targeted therapy! breast cancer mortality by 1/3 Tamoxifen selective estrogen receptor modulator No data for raloxifene in adjuvant setting Aromatase inhibitors Only postmenopaual women Anastrozole, letrozole, exemestane Metastatic Breast Cancer Treatment Decision Tree Metastatic breast cancer Hormonal Rx ER +, HER2 - Hormonal Rx Chemotherapy ER +, HER2 + ER -, HER2 + Hormonal Rx + Trastuzumab Chemotherapy + Trastuzumab Chemotherapy + Trastuzumab ER -, HER2 - Chemotherapy +?novel agents 1 st line except for visceral crisis AI for postmenopausal Tamoxifen + ovarian suppression for premenopausal Aromatase inhibitor Anastrozole + letrozole non-steroidal reversible AI Exemstane steroidal irreversible AI Both equally effective Fulvestrant pure estrogen receptor antagonist High dose progesterone /estrogens rarely used
10 Active Chemotherapeutic Agents in Metastatic Breast Cancer Doxorubicin Paclitaxel Docetaxel Cyclophosphamide Methotrexate Eribulin 5-fluorouracil Capecitabine Vinorelbine Gemcitabine Liposomal doxorubicin Ixabepilone Principles of chemotherapy for metastatic breast cancer Different chemotherapy regimens have shown only modest improvements in overall survival Main goal of treatment is symptom prevention/palliation Single agent chemotherapy less toxic than doublet chemotherapy with similar effectiveness Trastuzumab and Chemotherapy Trastuzumab and Chemotherapy Metastatic Breast Cancer Chemotherapy Alone Chemotherapy + Trastuzumab Progression Chemotherapy + T Slamon, NEJM 2001;344:783 Slamon, NEJM 2001;344:783 Bisphopshonates for bone metastases 70-75% of women with metastatic breast cancer have bone mets Complications of poorly controlled bone metastases Pain Hypercalcemia Pathologic fracture Cord/nerve compression => Routine bisphosphonate use for bone metastases has significantly improved quality of life for metastatic pts Breast Cancer Summary Epidemiology E+P HT, overweight, and alcohol use increase breast ca risk Prevention Tamoxifen, raloxifene, and AI reduce breast ca risk, but no effect on mortality Screening Mammography remains a mainstay for early diagnosis of breast ca small benefit does exist for women in 40 s Primary, non-metastatic, breast cancer Biologic subtypes of breast cancer drive appropriate therapy Metastatic breast cancer New biologic agents offer hope for better survival
11 Question 1 Which of these statements are true about mammography? 1. Mammograms do not reduce mortality for women years of age 2. MRI reduce breast cancer mortality more than mammograms do 3. 45% of abnormalities found on screening mammography turn out to be cancer 4. Mammographically detected lesions can be safely evaluated by core needle biopsy Question 2 The following is true about metastatic breast cancer 1. Many women with metastatic breast cancer are cured of their disease 2. Hormone therapy is not effective for patients with liver metastases 3. Therapy for patients with metastatic breast cancer is determined by the biologic characteristics of their cancer 4. Chemotherapy has substantially extended life for patients with metastatic breast cancer References 1. Women s Health Initiative Writing Group. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 2002; 288: Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006; 295: Romond E, Perez E, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005; 353: American Cancer Society. Breast Cancer Facts and Figures Atlanta: American Cancer Society, Inc. documents/document/acspc pdf
12
Breast Cancer. Dr. Andres Wiernik 2017
Breast Cancer Dr. Andres Wiernik 2017 Agenda: The Facts! (Epidemiology/Risk Factors) Biological Classification/Phenotypes of Breast Cancer Treatment approach Local Systemic Agenda: The Facts! (Epidemiology/Risk
It is a malignancy originating from breast tissue
59 Breast cancer 1 It is a malignancy originating from breast tissue including both early stages which are potentially curable, and metastatic breast cancer (MBC) which is usually incurable. Most breast
Adjuvant Systemic Therapy in Early Stage Breast Cancer
Adjuvant Systemic Therapy in Early Stage Breast Cancer Julie R. Gralow, M.D. Director, Breast Medical Oncology Jill Bennett Endowed Professor of Breast Cancer Professor, Global Health University of Washington
Breast Cancer: Selected Topics for the Primary Care Clinician
Breast Cancer: Selected Topics for the Primary Care Clinician Leah Karliner, MD MAS October 2009 Primary Care Medicine: Principles and Practice OUTLINE Incidence and Mortality Risk Factors and Risk Reduction/Prevention
Breast Cancer. Most common cancer among women in the US. 2nd leading cause of death in women. Mortality rates though have declined
Breast Cancer Most common cancer among women in the US 2nd leading cause of death in women Mortality rates though have declined 1 in 8 women will develop breast cancer Breast Cancer Breast cancer increases
4/13/2010. Silverman, Buchanan Breast, 2003
Tailoring Breast Cancer Treatment: Has Personalized Medicine Arrived? Judith Luce, M.D. San Francisco General Hospital Avon Comprehensive Breast Care Center Outline First, treatment of DCIS Sorting risk
Breast Cancer. Saima Saeed MD
Breast Cancer Saima Saeed MD Breast Cancer Most common cancer among women in the US 2nd leading cause of death in women 1 in 8 women will develop breast cancer Incidence/mortality rates have declined Breast
Case 1. BREAST CANCER From Diagnosis to Treatment: The Role of Primary Care
BREAST CANCER From Diagnosis to Treatment: The Role of Primary Care Leah Karliner, MD MAS University of California San Francisco Primary Care Medicine Update 2009 April 2009 Case 1 AR, a 60 year old African
Treatment Options for Breast Cancer in Low- and Middle-Income Countries: Adjuvant and Metastatic Systemic Therapy
Women s Empowerment Cancer Advocacy Network (WE CAN) Conference Bucharest, Romania October 2015 Treatment Options for Breast Cancer in Low- and Middle-Income Countries: Adjuvant and Metastatic Systemic
COME HOME Innovative Oncology Business Solutions, Inc.
Innovative Oncology Business Solutions, Inc. Breast Cancer Diagnostic/Therapeutic Pathway V11, April 2015 Required Structured Data Fields: ICD9 Code Stage Staging Components Performance Status Treatment
Increased Risk of Breast Cancer: Screening and Prevention. Elizabeth Pritchard, MD 4/5/2017
Increased Risk of Breast Cancer: Screening and Prevention Elizabeth Pritchard, MD 4/5/2017 No disclosures Defining Risk Risk Factors Modifiable Lifestyle obesity physical activity alcohol consumption breast
Breast Cancer Basics. Clinical Oncology for Public Health Professionals. Ben Ho Park, MD, PhD
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
Breast Cancer Risk Assessment and Prevention
Breast Cancer Risk Assessment and Prevention Katherine B. Lee, MD, FACP October 4, 2017 STATISTICS More than 252,000 cases of breast cancer will be diagnosed this year alone. About 40,000 women will die
Breast Cancer Earlier Disease. Stefan Aebi Luzerner Kantonsspital
Breast Cancer Earlier Disease Stefan Aebi Luzerner Kantonsspital stefan.aebi@onkologie.ch Switzerland Breast Cancer Earlier Disease Diagnosis and Prognosis Local Therapy Surgery Radiation therapy Adjuvant
Evolving Practices in Breast Cancer Management
Evolving Practices in Breast Cancer Management The Georgia Tumor Registrars Association 2016 Priscilla R. Strom, MD, FACS Objectives 1. understand newer indications for neoadjuvant treatment 2. understand
Breast Cancer Breast Managed Clinical Network
Initial Evaluation Clinical Stage Pre-Treatment Evaluation Treatment and pathological stage Less than 4 positive lymph nodes Adjuvant Treatment ER Positive HER2 Negative (see page 2 & 3 ) HER2 Positive
Index. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, for early-stage triple-negative breast cancer, 740 742 in older early-stage breast cancer patients, 790 795 anti-her2-directed
Diseases of the breast (2 of 2) Breast cancer
Diseases of the breast (2 of 2) Breast cancer Epidemiology & etiology The most common type of cancer & the 2 nd most common cause of cancer death in women 1 of 8 women in USA Affects 7% of women Peak at
Breast Cancer Prevention Studies. Key Points. Breast cancer prevention studies are clinical trials (research studies conducted with
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Breast Cancer Prevention
BREAST CANCER BREAST CANCER
BREAST CANCER George Raptis, M.D., M.B.A Division of Medical Oncology & Hematology College of Physicians & Surgeons Columbia University BREAST CANCER Epidemiology - Commonest cancer in women - About 235,000
Breast Cancer? Breast cancer is the most common. What s New in. Janet s Case
Focus on CME at The University of Calgary What s New in Breast Cancer? Theresa Trotter, MD, FRCPC Breast cancer is the most common malignancy affecting women in Canada, accounting for almost a third of
Update from the 29th Annual San Antonio Breast Cancer Symposium
Update from the 29th Annual San Antonio Breast Cancer Symposium The San Antonio Breast Cancer Symposium is one of the most important breast cancer conferences. Approximately 8,000 physicians, oncologists,
So, Who are the appropriate individuals that should consider genetic counseling and genetic testing?
Hello, I m Banu Arun, Professor of Breast Medical Oncology and Co-Director of Clinical Cancer Genetics at the University of Texas MD Anderson Cancer Center. Today I will be discussing with you Hereditary
Breast Cancer. Excess Estrogen Exposure. Alcohol use + Pytoestrogens? Abortion. Infertility treatment?
Breast Cancer Breast Cancer Excess Estrogen Exposure Nulliparity or late pregnancy + Early menarche + Late menopause + Cystic ovarian disease + External estrogens exposure + Breast Cancer Excess Estrogen
BREAST CANCER. Dawn Hershman, MD MS. Medicine and Epidemiology Co-Director, Breast Program HICCC Columbia University Medical Center.
BREAST CANCER Dawn Hershman, MD MS Florence Irving Assistant Professor of Medicine and Epidemiology Co-Director, Breast Program HICCC Columbia University Medical Center Background Breast cancer is the
Metastatic Breast Cancer What is new? Subtypes and variation?
Metastatic Breast Cancer What is new? Subtypes and variation? Anne Blaes, MD, MS University of Minnesota, Division of Hematology/Oncology Director, Adult Cancer Survivor Program Current estimates for metastatic
Clinical Management Guideline for Breast Cancer
Initial Evaluation Clinical Stage Pre-Treatment Evaluation Treatment and pathological stage Adjuvant Treatment Less than 4 positive lymph nodes ER Positive HER2 Negative (see page 2 & 3 ) Primary Diagnosis:
Breast Cancer: Current Approaches to Diagnosis and Treatment
Breast Cancer: Current Approaches to Diagnosis and Treatment Barbara L. Smith, MD, Ph.D. Massachusetts General Hospital Division of Surgical Oncology No Disclosures Incidence of Breast Cancer USA 2018
Department of Endocrine & Breast Surgery Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Department of Endocrine & Breast Surgery Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Evidence-Based Pragmatic SGPGI Breast Cancer Management Protocols (Summary) Background:
My Personalized Breast Cancer Worksheet
My Personalized Breast Cancer Worksheet KNOW For Early-Stage Breast Cancer. No Questions. Only Results. No two tumors are alike. What are the characteristics of your breast cancer and how will that effect
Ductal Carcinoma-in-Situ: New Concepts and Controversies
Ductal Carcinoma-in-Situ: New Concepts and Controversies James J. Stark, MD, FACP Medical Director, Cancer Program and Palliative Care Maryview Medical Center Professor of Medicine, EVMS Case Presentation
Breast cancer remains the most common malignancy and the second leading. cause of cancer mortality in women in the United States.
Dr. Andrew Seidman s Commentary I. Breast Cancer Overview Breast cancer remains the most common malignancy and the second leading cause of cancer mortality in women in the United States. The following
Advances in Neoadjuvant and Adjuvant Therapy for Breast Cancer
Advances in Neo and Adjuvant Therapy for Breast Cancer Nicole Kounalakis, MD, and Christina Finlayson, MD OVERVIEW Systemic therapy for breast cancer is evolving rapidly. The medical treatment of cancer
SOFTly: The Long Natural History of [Trials for] [premenopausal] ER+ Breast Cancer
![SOFTly: The Long Natural History of [Trials for] [premenopausal] ER+ Breast Cancer](/thumbs/95/125806264.jpg "SOFTly: The Long Natural History of [Trials for] [premenopausal] ER+ Breast Cancer")
SOFTly: The Long Natural History of [Trials for] [premenopausal] ER+ Breast Cancer Charles Moertel Lecture May 12, 2017 Gini Fleming Charles Moertel Founder of NCCTG Dedication to high quality clinical
BREAST SURGERY PROGRESS TEST Name:
General Surgery Residency Program Excellent surgeons BREAST SURGERY PROGRESS TEST Name: Choose the BEST answer for the following questions. 1. All of the following factors are associated with an increased
OBJECTIVES CASE 1. Breast Cancer Risk Factors, Genetics, Screening, Diagnosis AGE. Risks of developing breast cancer
Breast Cancer Risk Factors, Genetics, Screening, Diagnosis Bhuvaneswari Ramaswamy, MD, MRCP Assistant Professor of Internal Medicine Breast Cancer Fellowship Program Director Medical Director of Clinical
Mdi Medical Management of Breast Cancer Morbidity and Mortality Aug 13, 2009 Irina Kovatch, PGY3 Introduction Metastatic disease is the principal cause of death from breast cancer Metastatic events often
Appendix 2. Adjuvant Regimens. AC doxorubin 60 mg/m 2 every 3 weeks x 4 cycles Cyclophosphamide 600 mg/m 2
Appendix 2 Adjuvant Regimens AC doxorubin 60 mg/m 2 every 3 weeks x 4 cycles Cyclophosphamide 600 mg/m 2 CMF IV cyclophosphamide 600 mg/m 2 days 1 & 8 every 4 weeks methotrexate 40 mg/m 2 for 6 cycles
Chemo-endocrine prevention of breast cancer
Chemo-endocrine prevention of breast cancer Andrea DeCensi, MD Division of Medical Oncology Ospedali Galliera, Genova; Division of Cancer Prevention and Genetics, European Institute of Oncology, Milano;
Considerations in Adjuvant Chemotherapy. Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology
Considerations in Adjuvant Chemotherapy Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology 80 70 60 50 40 30 20 10 0 EBCTCG 2005/6 Overview Control Arms with No Systemic Treatment
Advances in the Management. of Breast Cancer
reviews therapy Advances in the Management of Breast Cancer by Rowan T. Chlebowski, MD, PhD, Professor of Medicine, University of California, Los Angeles School of Medicine; Chief, Division of Medical
Intro to Cancer Therapeutics
An Intro to Cancer Therapeutics Christopher R. Chitambar, MD Professor of Medicine Division of Hematology & Oncology Froedtert and Medical College of Wisconsin Clinical Cancer Center cchitamb@mcw.edu Intro
Systemic Treatment of Breast Cancer. Hormone Therapy and Chemotherapy, Curative and Palliative
Systemic Treatment of Breast Cancer Hormone Therapy and Chemotherapy, Curative and Palliative Systemic Therapy Invasive breast cancers Two forms Curative Palliative Curative Systemic Therapy Adjuvant Therapy
Does HER2/neu overexpression in breast cancer influence adjuvant chemotherapy and hormonal therapy choices by Ontario physicians? A physician survey
MYERS et al. ORIGINAL ARTICLE Does HER2/neu overexpression in breast cancer influence adjuvant chemotherapy and hormonal therapy choices by Ontario physicians? A physician survey J.A. Myers MD FRCPC, G.
New Insights into Breast Cancer Risk Reduction
New Insights into Breast Cancer Risk Reduction November 10, 2013 Rowan T. Chlebowski Professor of Medicine David Geffen School of Medicine at UCLA Chief, Division of Medical Oncology and Hematology Harbor-UCLA
Triple Negative Breast Cancer: Part 2 A Medical Update
Triple Negative Breast Cancer: Part 2 A Medical Update April 29, 2015 Tiffany A. Traina, MD Breast Medicine Service Memorial Sloan Kettering Cancer Center Weill Cornell Medical College Overview What is
SYSTEMIC THERAPY OPTIONS FOR BREAST CANCER IN 2014
SYSTEMIC THERAPY OPTIONS FOR BREAST Oncology Day 2014 CANCER IN 2014 Dr. Katherine Enright, M.D., M.P.H., F.R.C.P.(C) Katherine.enright@Trilliumhealthpartners.ca OBJECTIVES 1. Outline an approach to the
8/8/2011. PONDERing the Need to TAILOR Adjuvant Chemotherapy in ER+ Node Positive Breast Cancer. Overview
Overview PONDERing the Need to TAILOR Adjuvant in ER+ Node Positive Breast Cancer Jennifer K. Litton, M.D. Assistant Professor The University of Texas M. D. Anderson Cancer Center Using multigene assay
Best of San Antonio 2008
Best of San Antonio 2008 Ellie Guardino, MD/PhD Assistant Professor Stanford University BIG 1 98: a randomized double blind phase III study evaluating letrozole and tamoxifen given in sequence as adjuvant
Key Words. Adjuvant therapy Breast cancer Taxanes Anthracyclines
The Oncologist Mayo Clinic Hematology/Oncology Reviews Adjuvant Therapy for Breast Cancer: Recommendations for Management Based on Consensus Review and Recent Clinical Trials BETTY A. MINCEY, a,b FRANCES
Current Strategies in the Detection of Breast Cancer. Karla Kerlikowske, M.D. Professor of Medicine & Epidemiology and Biostatistics, UCSF
Current Strategies in the Detection of Breast Cancer Karla Kerlikowske, M.D. Professor of Medicine & Epidemiology and Biostatistics, UCSF Outline ν Screening Film Mammography ν Film ν Digital ν Screening
Prophylactic Mastectomy
Prophylactic Mastectomy Policy Number: Original Effective Date: MM.06.010 01/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO 08/24/2012 Section: Surgery Place(s) of Service: Inpatient I.
Case Scenario 1: This case has been slightly modified from the case presented during the live session to add clarity.
Case Scenario 1: This case has been slightly modified from the case presented during the live session to add clarity. Background: 46 year old married premenopausal female with dense breasts has noticed
HEALTH CARE DISPARITIES. Bhuvana Ramaswamy MD MRCP The Ohio State University Comprehensive Cancer Center
HEALTH CARE DISPARITIES Bhuvana Ramaswamy MD MRCP The Ohio State University Comprehensive Cancer Center Goals Understand the epidemiology of breast cancer Understand the broad management of breast cancer
Follow-up Care of Breast Cancer Patients
Follow-up Care of Breast Cancer Patients Dr. Simon D. Baxter, MD, FRCPC Medical Oncologist BC Cancer Kelowna Clinical Instructor, Dept of Medicine University of British Columbia 24 November 2018 Disclosures
Evolving Insights into Adjuvant Chemotherapy. Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology
Evolving Insights into Adjuvant Chemotherapy Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology 80 70 60 50 40 30 20 10 0 EBCTCG 2005/6 Overview Control Arms with No Systemic
Case Scenario 1: This case has been slightly modified from the case presented during the live session to add clarity.
Case Scenario 1: This case has been slightly modified from the case presented during the live session to add clarity. Background: 46 year old married premenopausal female with dense breasts has noticed
LOBULAR CARCINOMA IN SITU: WHAT DOES IT MEAN? THE SURGEON'S PERSPECTIVE
: WHAT DOES IT MEAN? THE SURGEON'S PERSPECTIVE Benjamin O. Anderson, M.D. Director, Breast Health Clinic Professor of Surgery and Global Health, University of Washington Joint Member, Fred Hutchinson Cancer
Breast Cancer Statistics
1 in 8 Breast Cancer Statistics Incidence Mortality Prevalence 2 Breast Cancer Incidence Breast Cancer Mortality Breast Cancer Prevalence ~$100,000 Female Breast Anatomy Breasts consist mainly of fatty
Follow-up Care of Breast Cancer Patients
Follow-up Care of Breast Cancer Patients Dr. Simon D. Baxter, MD, FRCPC Medical Oncologist BC Cancer Kelowna Clinical Instructor, Dept of Medicine University of British Columbia 19 April 2018 Disclosures
Disclosures. Objectives. Novel Agents in the Systemic Management of Breast Cancer (Breast Cancer Update 2012) Peter Kabos, MD
Mountain States Cancer Conference 2012 Novel Agents in the Systemic Management of Breast Cancer (Breast Cancer Update 2012) Peter Kabos, MD University of Colorado Denver Disclosures No relevant disclosures
Beyond the Guidelines: Clinical Investigators Provide Their Perspectives on Current Strategies and Ongoing Research in the Management of Breast Cancer
Beyond the Guidelines: Clinical Investigators Provide Their Perspectives on Current Strategies and Ongoing Research in the Management of Breast Cancer Wednesday, December 11, 2013 7:30 PM 9:30 PM San Antonio,
Extended Hormonal Therapy
Extended Hormonal Therapy Dr. Caroline Lohrisch, Medical Oncologist, BC Cancer Agency Vancouver Centre November 1, 2014 www.fpon.ca Optimal Endocrine Therapy for Women with Hormone Receptor Positive Early
Non-Anthracycline Adjuvant Therapy: When to Use?
Northwestern University Feinberg School of Medicine Non-Anthracycline Adjuvant Therapy: When to Use? William J. Gradishar MD Betsy Bramsen Professor of Breast Oncology Director, Maggie Daley Center for
Maram Abdaljaleel, MD Dermatopathologist and Neuropathologist University of Jordan, School of Medicine
Maram Abdaljaleel, MD Dermatopathologist and Neuropathologist University of Jordan, School of Medicine The most common non-skin malignancy of women 2 nd most common cause of cancer deaths in women, following
Jose A Torres, MD 1/12/2017
Jose A Torres, MD 1/12/2017 Background Globally leading cause of cancer related death in women ~249,000 Americans diagnosed with invasive breast cancer ~40,890 will die of their disease Breast cancer risk
A Slow Starvation: Adjuvant Endocrine Therapy of Breast Cancer
A Slow Starvation: Adjuvant Endocrine Therapy of Breast Cancer Dr. Susan Ellard Surgical Oncology Update October 24, 2009 Disclosure slide Participant in various meetings or advisory boards sponsored by
Nadia Harbeck Breast Center University of Cologne, Germany
Evidence in Favor of Taxane Based Combinations and No Anthracycline in Adjuvant and Metastatic Settings Nadia Harbeck Breast Center University of Cologne, Germany Evidence in Favor of Taxane Based Combinations
Risk Assessment, Genetics, and Prevention
Risk Assessment, Genetics, and Prevention Katherine D. Crew, MD MS Director, Clinical Breast Cancer Prevention Program Columbia University Medical Center 1 Outline Breast cancer risk factors Hereditary
Early Stage Disease. Hope S. Rugo, MD Professor of Medicine Director Breast Oncology and Clinical Trials Education UCSF Comprehensive Cancer Center
SABCS 2014: Early Stage Disease Hope S. Rugo, MD Professor of Medicine Director Breast Oncology and Clinical Trials Education UCSF Comprehensive Cancer Center Topics for Discussion Chemotherapy plus 10
Prophylactic Mastectomy
Prophylactic Mastectomy Policy Number: Original Effective Date: MM.06.010 01/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO 07/22/2011 Section: Surgery Place(s) of Service: Inpatient I.
NSABP Pivotal Breast Cancer Clinical Trials: Historical Perspective, Recent Results and Future Directions
1 1 NSABP Pivotal Breast Cancer Clinical Trials: Historical Perspective, Recent Results and Future Directions Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health
RALOXIFENE Generic Brand HICL GCN Exception/Other RALOXIFENE EVISTA Is the request for the prevention (risk reduction) of breast cancer?
Generic Brand HICL GCN Exception/Other RALOXIFENE EVISTA 16917 GUIDELINES FOR USE 1. Is the request for the prevention (risk reduction) of breast cancer? If yes, continue to #2. If no, approve by HICL
Breast Cancer and Bone Loss. One in seven women will develop breast cancer during a lifetime
Breast Cancer and Bone Loss One in seven women will develop breast cancer during a lifetime Causes of Bone Loss in Breast Cancer Patients Aromatase inhibitors Bil Oophorectomy Hypogonadism Steroids Chemotherapy
Screening Mammography: The Controversy, Risk Assessment and Individualized Screening recommendations. Jonathan T. Sims MD, MBA
Screening Mammography: The Controversy, Risk Assessment and Individualized Screening recommendations. Jonathan T. Sims MD, MBA I have no relevant Financial Disclosures Agenda Discuss the recent studies
Spectrum of Care Options for Women at High Risk for Breast and Ovarian Cancer
Spectrum of Care Options for Women at High Risk for Breast and Ovarian Cancer Sheryl G.A. Gabram, MD, MBA, FACS Professor of Surgery, Emory University Director, High Risk Assessment Program Winship Cancer
Case Scenario 1. 2/15/2011 The patient received IMRT 45 Gy at 1.8 Gy per fraction for 25 fractions.
Case Scenario 1 1/3/11 A 57 year old white female presents for her annual mammogram and is found to have a suspicious area of calcification, spread out over at least 4 centimeters. She is scheduled to
Basement membrane in lobule.
Bahram Memar, MD Basement membrane in lobule. Normal lobule-luteal phase Normal lobule-follicular phase Lactating breast Greater than 95% are adenocarcinomas in situ carcinomas and invasive carcinomas.
Breast Cancer: Key Issues for the Non-Oncologist
Breast Cancer: Key Issues for the Non-Oncologist I have no financial disclosures I developed and validated one of the models that will be discussed. I hold no patents and derive no financial benefit from
Breast Cancer Screening: Changing Philosophies in Educating Women and Teens
Breast Cancer Screening: Changing Philosophies in Educating Women and Teens Courtney Benedict CNM MSN Disclosures Merck Nexplanon trainer Session Objectives Explain the rationale for initiation and frequency
Disease Update: Metastatic Breast Cancer
Disease Update: Metastatic Breast Cancer Aimee Faso, PharmD, BCOP, CPP Oncology Clinical Specialist, GI/Breast UNC Hospitals and Clinics August 2015 Objectives Identify treatment choices of metastatic
Endocrine Therapy in Premenopausal Breast Cancer. Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology, PA US Oncology
Endocrine Therapy in Premenopausal Breast Cancer Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology, PA US Oncology Ovarian Ablation or Suppression vs. Not in ER + or ER UK Breast Cancer
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Herceptin) Reference Number: ERX.SPA.42 Effective Date: 07.01.16 Last Review Date: 05/17 Line of Business: Commercial [Prescription Drug Plan] Revision Log See Important Reminder at the
General Information Key Points
The content of this booklet was adapted from content originally published by the National Cancer Institute. Male Breast Cancer Treatment (PDQ ) Patient Version. Updated September 29,2017. https://www.cancer.gov/types/breast/patient/male-breast-treatment-pdq
Breast Cancer Risk Factors 8/3/2014
Breast Cancer Screening: Changing Philosophies in Educating Women and Teens Courtney Benedict CNM MSN Session Objectives Explain the rationale for initiation and frequency of clinical breast exams to clients
Screening Mammography: Who, what, where, when, why and how?
Screening Mammography: Who, what, where, when, why and how? Jillian Lloyd, MD, MPH Breast Surgical Oncologist University Surgical Oncology Department of Surgery University of Tennessee Medical Center Disclosures
Breast Cancer Update 2018 The Latest in Diagnosis and Treatment SARATH K, PALAKODETI, DO, FAACS GENERAL, BREAST, AND COSMETIC SURGEON TOLEDO CLINIC
Breast Cancer Update 2018 The Latest in Diagnosis and Treatment SARATH K, PALAKODETI, DO, FAACS GENERAL, BREAST, AND COSMETIC SURGEON TOLEDO CLINIC Objectives Identify breast lesions and masses, and know
NHOLUA. September 20, 2016 Lincoln, NE
NHOLUA September 20, 2016 Lincoln, NE UNDERWRITING BREAST CANCER, A NEW APPROACH Dr Robert Lund Basics in Determination of Breast Cancer Prognosis Age at Diagnosis Tumor Size Lymph Node Status Title of
A breast lump or thickening that feels different from the surrounding tissue
Breast Cancer Breast cancer is caused by abnormal cells that form in the breast tissue. Breast cancer is the most common cancer affecting South African women 1 in 35 women in South Africa will be diagnosed
Systemic Management of Breast Cancer
Systemic Management of Breast Cancer Why Who When What How long Etc. Vernon Harvey Rotorua, June 2014 Systemic Management of Breast Cancer Metastatic Disease Adjuvant Therapy Aims of therapy Quality of
Breast cancer (screening) in older individuals: the oncologist s viewpoint for the geriatrician
Breast cancer (screening) in older individuals: the oncologist s viewpoint for the geriatrician Hans Wildiers Medical oncologist, Leuven, Belgium Past chairman of the EORTC elderly task force President-elect
Breast MRI: Friend or Foe?
Breast MRI: Friend or Foe? UCSF Postgraduate Course May 18, 2013 Cheryl Ewing, MD Clinical Professor of Surgery UCSF Department of Surgery APPLEGATE HAS DOUBLE MASTECTOMY IN CANCER SCARE DIAGNOSED WITH
Prophylactic Mastectomy State of the Art
Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 6 th Brazilian Breast Cancer Conference Sao Paulo, Brazil 9 March 2012 Prophylactic Mastectomy State of the Art Monica Morrow
Patient Education. Breast Cancer Prevention. Cancer Center
Patient Education Breast cancer affects one in nine women in the US by the time they reach their 80 s. It is the result of several mutations or alterations in the genes found in the DNA of normal breast
Diagnosis and Treatment of Breast Cancer in the Elderly
CA Cancer J Clin 2003;53:227 244 Diagnosis and Treatment of Breast Cancer in the Elderly Chris E. Holmes MD, PhD; Hyman B. Muss, MD ABSTRACT As the population of the United States ages, women over the
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Everolimus in combination with exemestane for the treatment of advanced or metastatic HER2 negative, oestrogen
Beyond the Break. After Breast Cancer: Osteoporosis in Survivorship. Dr Alexandra Ginty CCFP(EM) FCFP Regional Primary Care Lead CCO
Beyond the Break After Breast Cancer: Osteoporosis in Survivorship Dr Alexandra Ginty CCFP(EM) FCFP Regional Primary Care Lead CCO Disclosures No disclosures Osteoporosis in Breast Cancer Survivorship
Breast Cancer Diagnosis, Treatment and Follow-up
Breast Cancer Diagnosis, Treatment and Follow-up What is breast cancer? Each of the body s organs, including the breast, is made up of many types of cells. Normally, healthy cells grow and divide to produce
A case of a BRCA2-mutated ER+/HER2 breast cancer during pregnancy
ESMO Preceptorship Programme Breast Cancer Lisbon 16,17 September 2016 Emanuela Risi Sandro Pitigliani Medical Oncology Department Hospital of Prato, Istituto Toscano Tumori, Prato, Italy A case of a BRCA2-mutated
Effective Health Care Program
Comparative Effectiveness Review Number 17 Effective Health Care Program Comparative Effectiveness of Medications To Reduce Risk of Primary Breast Cancer in Women Executive Summary Background Breast cancer