Breast cancer: an update

Transcription

1 Breast cancer: an update Dr. Sanjeewa Seneviratne M.D, MRCS, Ph.D. Senior Lecturer and Honorary Consultant Surgeon Department of Surgery Faculty of Medicine, Colombo

2 Plan The problem Screening & early detection Risk assessment Cancer prevention Advances in treatment Surgical treatment Breast conservation Breast reconstruction Oncoplastic surgery Sentinel lymph node biopsy Adjuvant therapy

3 Breast cancer the problem Commonest cancer in Sri Lanka Biggest cancer killer among women Both incidence and mortality are increasing

4 Age standardized rate per 100,000 population Incidence trends in breast cancer

5 Age standardized rate per 100,000 population Mortality trends in breast cancer

6 Why our mortality is increasing????? Stage at diagnosis Delayed diagnosis in developing countries Poor access to healthcare services Poor health literacy Lack of population screening programmes Quality of breast cancer care Advances in therapy 6

7 Cancer outcomes & treatment Survival rate is improving At the same time Treatment becoming less radical More breasts are conserved More personalized care Greater emphasis on Cosmesis Quality of life (QOL)

8 Breast cancer screening Helps detect cancers early or before a potential lesion becomes an invasive cancer DCIS Is a major factor for the reduction in breast cancer mortality Knowledge and awareness associated with promotion of screening programmes is also beneficial Move towards population based screening to individual risk based screening

9 Breast cancer screening

10 Impact of mammographic screening Reduces risk of death from breast cancer by over 25%

11 Risk based screening Risk calculators

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14 Breast cancer screening No national screening programme in Sri Lanka Hence, for women needing screening, have to pay for it (approx. Rs /=) Despite that, we need to promote screening Increase awareness Helps in early detection For average risk women mammography every 2 years is adequate

15 Surgical treatment of breast cancer Radical mastectomy Total mastectomy Mastectomy with reconstruction

16 Breast conservation new motto!!! Majority of women with early breast cancers are candidates Contraindications Large size in relation to breast Multifocality Patient preference Contraindications for radiotherapy

17 Breast conserving surgery Smaller surgery less surgical morbidity Early recovery No difference in survival compared with mastectomy Excellent cosmetic outcomes Proper patient selection Proper surgery

18 Breast conservation - Wide local excision

19 Problems of breast conservation Long term poor cosmetic outcomes Larger resections Poor technique Radiotherapy effects

20 Oncoplastic surgery Further refinement to traditional wide excision Has revolutionized breast surgery Has allowed to preserve breast even for large cancers while maintaining good cosmesis Highly effective in experienced hands

21 Oncoplastic surgery

22 Oncoplastic surgery

23 Oncoplastic surgery

24 Breast reconstruction Traditional TRAM and Latissimus dorsi flap Problems abdominal weakness and donor site morbidity New trend Free flaps - anastomosed to axillary or internal mammary vessels Fat grafting advantage gets rid of abdominal fat Latissimus dorsi flap

25 Sentinel lymph node biopsy Avoids the need for axillary clearance in a majority Equal cancer outcome Less morbidity reduced risk of arm lymphoedema In local setup - >50% require SNB only, thus avoiding axillary node dissection

26 Adjuvant therapy Chemotherapy Highly effective Many new drugs Low threshold for neo-adjuvant therapy Facilitate better surgery with better cosmetic outcomes Better survival Radiotherapy Better targeting with newer effective machines Less surrounding organ damage

27 Genetic screening & Risk reducing surgery

28 How common are genetically inherited breast cancer? Incidence of BRCA-1/BRCA-2 <5% in Caucasians Lower in Asians about 3% Risk of cancer Breast 40-50% Ovary 20-30% Options More frequent screening Chemoprevention Endocrine therapy Prophylactic / Risk reducing mastectomy

29 Follow up after cancer treatment Endocrine therapy for 5-10 years Annual mammographic screening Minimum of 10 years Ideally life long Encounter many other issues Psychological Social Sexual Financial Provide counselling and refer accordingly

30 Summary Breast cancer - an emerging public health problem Survival has and is improving With early detection Better treatment Surgery is becoming less radical With better cosmesis Less surgical morbidity To reduce the burden and improve outcomes in SL Promote awareness Promote breast cancer screening

31 Take home messages Early detection Promote breast cancer screening Promote self breast examination Be aware of risk assessment Educate and empower women to seek medical advice For women with breast caner symptoms Refer early and motivate Discuss about what to expect Arrange basic investigations US scan/mammogram/fnac Follow up Maintain motivation Ensure continuing follow up Help address other issues psychological, social, sexual, etc

32 Breast Health Centre at the University Surgical Unit, NHSL First mammographic unit in SL 1999 Objective to provide breast cancer screening and diagnostic services at an affordable price

33 Breast Health Centre at the University Surgical Unit, NHSL What do we offer Mammographic screening Breast US scanning Image guided biopsy No professional charges One stop clinic clinical assessment, imaging and biopsy at the same time Minimizes delay Reduces cost Reduces patient anxiety

34 Thank you