Republic of the PhilippinesProvince of Negros Oriental

CITY of TANJAYCity Health Unit 1

ANATOMYANATOMY

• Mammary gland.• Present in both

sexes.• Rudimentary in

male.• Well developed in

female after puberty

- In the superficial fascia of the pectoral region.

Vertically: 2nd to 6th ribs. Horizontally: lateral border of sternum to mid-axillary line.

• Above: Clavicle • Below: 7th to 8th ribs • Medially: Midline • Posteriorly : to the edge of latissimus dorsi

Skin

2nd rib

6th rib

Pectoralis major

Fat

Internal thoracic artery

Axillary artery

Lateral thoracicartery

Superior thoracicartery

Acromiothoracicartery

Posterior intercostalarteries

o Veins follow the arteries.o First converge around the nipple to form an

anastomotic venous circle & then form 02 sets of veins.• Superficial veins: drain into Internal thoracic

vein & superficial veins of the lower part of the neck

• Deep veins: drain into Internal thoracic , Axillary & Posterior intercostal veins

Internal thoracic vein Internal thoracic vein

Axillary veinAxillary vein

Anastomotic venous circle Anastomotic venous circle

Axillary (85%) (Sentinel Lymph Node)• Anterior• Central• Apical• Lateral• Posterior• Interpectoral

Internal mammary / Parasternal (10%)• Others (5%)

• Supraclavicular• Cephalic / Deltopectoral• Posterior intercostal• Subdiaphragmatic • Subperitoneal

Axillary lymph nodes

Anterior

Central

Apical

Lateral

Posterior

Interpectoral

Internal mammary

lymph nodes

Devoid of valves.•Superficial lymphatics skin over breast except nipple & areola•Deep lymphatics parenchyma as well as nipple & areola

•Subareolar plexus Subareolar plexus (of Sappy)(of Sappy)

Subareolar plexus of Sappy

PHYSIOLOGYPHYSIOLOGY

- Important accessory organ of the female reproductive system.

- Provides nutrition to the new born in the form of milk.

What is Breast cancer ?

• The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast.

• Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

• Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes,(lymph nodes are : small organs that filter out foreign substances in the body).

• If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body.

Breast Cancer Facts

2 nd leading cause of death2 nd most common cancerIncidence increases with ageAll women are at risk

Risk factors of breast cancer(what increases the risk of having breast

cancer ? )

• A “risk factor” is anything that increases your risk of developing breast cancer. Many of the most important risk factors for breast cancer are beyond your control, such as age, family history, and medical history. However, there are some risk factors you can control, such as weight, physical activity, and alcohol consumption.

Risk factors you can control

• WeightBeing overweight is associated with increased risk of breast cancer,

especially for women after menopause. Fat tissue is the body’s main source of estrogen after menopause, when the ovaries stop producing the hormone. Having more fat tissue means having higher estrogen levels, which can increase breast cancer risk.

• Diet.studies show that eating a lot of red and/or processed meats is

associated with a higher risk of breast cancer. A low-fat diet rich in fruits and vegetables is generally recommended.

• ExerciseEvidence is growing that exercise can reduce breast cancer risk. The

American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.

Alcohol consumption

Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk

Risk factors you can’t control

• Gender. Being a woman is the most significant risk factor for developing breast cancer. Although men can get breast cancer, too, women’s breast cells are constantly changing and growing, mainly due to the activity of the female hormones estrogen and progesterone. This activity puts them at much greater risk for breast cancer.

• Age. Simply growing older is the second biggest risk factor for breast cancer. From age 30 to 39, the risk is 1 in 233, or .43%. That jumps to 1 in 27, or almost 4%, by the time you are in your 60s.

• Race. White women are slightly more likely to develop breast cancer than are African American women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.

• Pregnancy and breastfeeding. Pregnancy and breastfeeding reduce the overall number of menstrual cycles in a woman’s lifetime, and this appears to reduce future breast cancer risk

• Family history of breast cancer. If you have a first-degree relative (mother, daughter, sister) who has had breast cancer, or you have multiple relatives affected by breast or ovarian

• Radiation therapy to the chest. Having radiation therapy to the chest area as a child or young adult as treatment for another cancer significantly increases breast cancer risk. The increase in risk seems to be highest if the radiation was given while the breasts were still developing (during the teen years).

What causes Breast cancer

• Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

How is the Breast DesignedThe breasts sit on the chest

muscles that cover the ribs. Each breast is made of 15 to 20

lobes. Lobes contain many smaller

lobules. Lobules contain groups of tiny

glands that can produce milk. Milk flows from the lobules

through thin tubes called ducts to the nipple.

The nipple is in the center of a dark area of skin called the areola.

Fat fills the spaces between the lobules and ducts.

Signs & Symptoms:

Early breast cancer may not have symptoms.

Stages of Breast cancer

• Stage 0:Cancer cells

remain inside the breast duct, without invasion into normal adjacent breast tissue.

Stage IB : There is no tumor in the breast; instead, small groups of cancer cells -- larger than 0.2 millimeter but not larger than 2 millimeters – are found in the lymph nodes OR there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – in the lymph nodes.

• Stage IA :The tumor measures up to 2 cm AND the cancer has not spread

outside the breast; no lymph nodes are involved.

• Stage IIA: No tumor can be found

in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm)OR the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes OR the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

• Stage IIB: The tumor is larger

than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodesOR the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes

• Stage IIIA: No tumor is found in the breast. Cancer is found in axillary lymph

nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone

ORthe tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or

cancer may be found in lymph nodes near the breastbone.

• Stage IIIB: The tumor may be any size

and has spread to the chest wall and/or skin of the breastANDmay have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.

• Stage IIIC: There may either be no sign of cancer in the breast or a tumor may

be any size and may have spread to the chest wall and/or the skin of the breast

AND the cancer has spread to lymph nodes either above or below the collarbone AND the cancer may have spread to axillary lymph

nodes or to lymph nodes near the breastbone.

• Stage IV: The cancer has spread — or metastasized — to other parts of the

body.

Screening For Breast Cancer

A Good Breast Health Plan

• Self Awareness (Monthly Self Exams) (BSE)

• Clinical Breast Examination (CBE)

• Mammograms

Screening Average-size lump found by woman practicing occasional breast self-exam (BSE)

Average-size lump found by woman practicing regular breast self-exam (BSE)

Average-size lump found by first mammogram

Average-size lump found by getting regular mammograms

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Breast Self Examination (BSE)

• Opportunity for woman to become familiar with her breasts

• Monthly exam of the breasts and underarm area

• May discover any changes early

• Begin at age 20, continue monthly

When to do BSE

• Menstruating women- 5 to 7 days after the beginning of

their period• Menopausal women - same date each month• Pregnant women – same date each month• Takes about 10 minutes• Perform BSE at least once a month• Examine all breast tissue

Why don’t more women practice BSE

• Fear

• Embarrassment

• Youth

• Lack of knowledge

• Too busy, forgetfulness

Clinical Breast Examination

• Performed by doctor or trained nurse practitioner

• Annually for women over 40yrs

• At least every 3 years for women between 20 and 40 yrs

• More frequent examination for high risk patients

MammographyX-ray of the breast

Has been shown to save lives in patients 50-69

Data mixed on usefulness for patients 40-49

Normal mammogram does not rule out possibility of cancer completely

Women (asymptomatic) 40 years of age and older should have a

MAMMOGRAM every year.

Treatment for Breast Cancer

• Surgery• Radiation Therapy• Chemotherapy• Hormonal Therapy

SurgerySurgery

•Lumpectomy

•Modified Radical Mastectomy

•Radical Mastectomy (rare)Reconstruction

Breast ReconstructionBreast Reconstruction

Pre and Post Expander and ImplantPre and Post Expander and Implant

Pre and Post Tissue and Implants CombinedPre and Post Tissue and Implants Combined

•Radiation Therapy•Chemotherapy•Hormonal Therapy

As a adjunct to surgery depending on stage of cancer

Prognosis after Breast Cancer

5-Year Survival (%)

10-Year Survival (%)

Stage 0 95 90

Stage I 85 70

Stage II 70 50

Stage III 55 30

Stage IV 5 2

Facts About Breast Cancer

• Fact # 1 All women are at risk. Approximately 70% of breast cancers occur in women with none of the known risk factors.

Fact # 2 Only about 5% of breast cancers are inherited. About 80% of women diagnosed with breast cancer will be the first to be victims in their families.

Fact # 3 Early detection does NOT prevent breast cancer. Avoiding and elimating known causes will prevent breast cancer!

• Fact # 4 Mammography fails to detect as much as 20% of all breast cancer and as much as 40% in women under the age of 50.

Fact # 5 One out of four who are diagnosed with breast cancer die within the first five years. No less than 40% die within ten years.

Fact # 6 Risk factors are not necessarily causes of breast cancer. Enough evidence exist linking environmental pollution and contamination to cause breast cancer.

Fact # 7 The global incidence of breast cancer has tremendously risen by 256% the past 30 years with Southeast Asia increasing by 479%! And the supposed authorities and experts that should know, don't know why.

• Fact # 8 Breast cancer is the leading killer of women ages 35 to 54 worldwide. More than a million women develop breast cancer without knowing it and almost 500,000 die from it every year.

Fact # 9 1 out of 13 Filipno women will develop breast cancer in her lifetime. The province of Pampanga has the highest incidence rate in the entire country.

Fact # 10 The Philippines has the highest incidence rate of breast cancer in Asia and registered the highest increase of 589% among 187 countries over a 30 year period from 1980 to 2010.

Myths & Facts•Touching the breasts too often will lead to cancer

•Talking about cancer causes cancer

•Using illegal drugs causes cancer

•Herbs cure breast cancer(uña de gato/cat’s claw)

•A bruise on the breast will lead to breast cancer.

•If an incision is made during breast cancer surgery,the cancer will spread.

•Getting too many mammograms leads tobreast cancer.

•Mammograms are only used to evaluatebreast lumps.

Myths & Facts

• Breast cancer only affects older women

• If you have a risk factor for breast cancer, you're likely to get the disease

• Using antiperspirants causes breast cancer.

• A breast cancer diagnosis is an automatic death sentence.

• Breast cancer is preventable

Youngest known survivor of breast Youngest known survivor of breast cancercancer

Diagnosed at age ofDiagnosed at age of

22 years years

““You are never too You are never too young for young for breast cancer”breast cancer”

Total MastectomyTotal Mastectomy

Juvenile Secretory Juvenile Secretory Breast CarcinomaBreast Carcinoma

• Katie Adams . A T,A in university of Ottawa • What was your diagnosis? Stage 2 Breast Cancer • How did you find out you were sick? What led to your

diagnosis? • I found a lump and told my doctor about it. From there, there was a

lot of imaging done but because of my age, it was assumed that I did not have cancer. Two months before my diagnosis, I was told, “You don't have cancer” by a surgeon. Finally, seven months after telling my doctor about my lump, a biopsy was done and it came back positive.

“Cancer can take my breast and rob me of a summer but it can't take my spirit. I 've learned that no matter how bad life gets, I am the only one who can control my attitude and I will not let cancer take that away from me.”

• What was the toughest part of your challenge?

Chemo was pretty tough but I think the transition between treatment and finding your “new normal” has been the hardest for me. I think a lot of time people assume that when you're done treatment, you're done cancer and if you've ever had cancer, you know that is not the case. I'm trying to get back to the life I knew but trying to incorporate cancer into that life.

• What really motivated you to keep going while you were sick?

I knew that other women needed to be helped so I knew if I was strong, it would give other women strength. I also had such a fantastic support system that picked me up when I was down and it made it easier to be strong when so many people believed in me.

• What are your thoughts and feelings about your illness now? How have they changed since before your diagnosis?

I realize now that having cancer isn't a death sentence and as I mentioned before, you become an expert about (in my case) breast cancer. I knew virtually nothing compared to what I know now. Now, when I hear “breast cancer” I have a physical reaction to it. Rather than just hearing the words, I feel the pain.

• What year was it? What was your age at the time? 2011/26• What were your first thoughts when diagnosed? • Disbelief, I thought they had the wrong file. I was obviously numb

for a few days, too.• What did your treatment consist of? • I had two surgeries (a mastectomy and nine months later, I had the

second part of my reconstruction) and six rounds of chemo. Now I am on a hormone inhibitor for the next five years that will slow the growth of cancer if there were any cells that survived surgery and chemo.

‘I was losing my hair because of the chemo and that affected me greatly. One day I decided that I was going to take control and I totally shaved my head. It’s a difficult thing to explain, but it felt like I was taking control for once.

Andrew Hartling• How did you find out you were sick? What led to the

diagnosis? • I noticed a small bump under my right nipple. Being a typical man, I

ignored it for a while but ended up seeing my family doctor in December 2010. I was told it was probably nothing but I should have some tests done to make sure. I was sent for an ultrasound and a mammogram. Being a man and being sent for a mammogram is quite an experience. The results came back and I was told they still weren’t quite sure so I was scheduled for a biopsy. It was about a week later the doctor called me and told me my diagnosis was Invasive Ductal Carcinoma. I was very confused about what I was being told and I had to ask him to confirm if that meant I had cancer. He was very sympatric as he explained to me I had breast cancer. I was at a loss for words and simply thanked the doctor and hung up on him.

• What were your first thoughts when diagnosed? • I was very scared and confused. My first instinct was that I needed

information and I researched the Internet. There really wasn’t a lot of information on men’s breast cancer, but I did find an inspirational story of a gentleman from England who fought breast cancer and completely recovered. I have read his story at least 100 times.

• What is your current medical status?• I am currently cancer-free but undergoing chemo and radiation treatments as

a precaution to prevent reoccurrence.• What is the toughest part of your challenge?• The toughest part is putting my life on hold for so long. There are so many

things that have changed in the last months and it is overwhelming sometimes.

• What are your thoughts and feelings about your illness now? How have they changed since before your diagnosis?

• It’s hard to explain but I was so secretive and private about my diagnosis for the first months. I didn’t tell anyone I had cancer, much less breast cancer. People around me knew I something was going on but only my closest circle of friends knew the truth. It’s been five months now since my first diagnosis and my attitude has changed. I want to talk about what is happening to me and ask for help when I need it.It took me quite a while to figure out that I couldn’t fight cancer by myself.

Common misconception • Common Misconception• Eating fatty foods causes breast cancer. • Reality Check!• Research studies have not been able to prove that there is clearly a direct correlation

between the fat content in food and the dangerous factors that lead to all forms of Breast Cancer, however it has been proven to be a risk factor increasing the chances of Breast Cancer in post-menopausal women.

• Common Misconception• Breast cancer is a fatal disease that kills all patients.• Reality Check!• There has been a noticeable increase in the number of women diagnosed with Breast

Cancer each year, but the mortality rate is significantly decreasing. Some reasons for this phenomenon comprise the enhanced availability and nature of resources for treatment and early detection of tumors through both Breast Self-examination and various technologies including X-Ray Mammography.

THANK YOU