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What is Cancer?
Our own cells that grows without
control
Grow (faster or slower than normal cells)
Die (slower than normal cells)
Proteins and structures that are very similar to
normal cell
???
Basics of Cells
cancer
Non Modifiable
Inherited Factors
Family history
Benign breast disease
Hormones
Modifiable
Dietary Factors
Environmental factors
3.2
Postmenopausal
1.5
Premenopausal, b/l
8.8
Postmenopausal, b/l
4.0
( * RR = Relative Risk )
Mother
Sister
Estrogen Exposure
Early menarche (< 12 yo)
Late menopause (> 55 yo)
Having no pregnancy
Childbirth after 30 yo (RR: 4-5x)
Exogenous estrogen use
Obesity (post-menopausal)
Prior RT to breast
Mantle RT
Relative risk of breast ca depends on the age at
which she received RT
56% for women 19 yrs of age at RT
7% for women b/ 20-29 yrs of age at RT
1% for women 30 yrs of age at RT
Screening Mammography
HIP (Health Insurance plan of NY) Study
61,000 women, age 0-64 yrs
Randomization:
Screening mammo vs. routine medical care
Results:
Mortality rate was reduced by 33% in screened
women 50-59 yrs of age
Survival difference was higher by 7 to 10 yrs after
diagnosis in women who had screening mammography
Includes:
Current age
Number of 1st-degree
female relatives with a
history of breast cancer
History of atypical
hyperplasia
Race
Age at menarche
NSABP-P1(BCPT): Schema
Randomization
n = 13,388
Tamoxifen
5 Years
n = 6681
Fisher et al. J Natl Cancer Inst 1998;90:1371-1388.
Placebo
5 Years
n = 6707
Number of Events
Placebo
Tamoxifen
100
50
31
38
41
14
Negative
Positive
ER Status
10
Unknown
Rate/1000
40
Placebo
Tamoxifen
30
175
89
Placebo
P < 0.00001
49%
reduction
20
10
0
Tamoxifen
Years
Adapted from Fisher B, Constantion JP, Wickerham DL, et al. J Natl Cancer Inst. 1998;90:1371-1388.
Risk Ratio
(all ages)
Risk Ratio
(ages 50)
Endometrial
cancer
2.53
4.01
Stroke
1.59
1.75
Pulmonary
embolism
3.01
3.19
Deep vein
thrombosis
1.60
1.71
NewEnglJMed 2001;345:159-64
Conclusions
Many Non-Modifiable risk factors for breast
cancer
Early dectection
Thank You
Acknowledgement for materials in slides:
Dr. Arun Banu
Dr. Hemangini Shah