Lecture 18 Breast Cancer Hormones and Genes HPV Vaccines is a True Cancer Vaccine HPV Vaccines and Cancer 10 25 12 US Vaccine Advisory Board recommends Gardasil for boys Throat cancer then and now Until recently throat cancer was associated with age smoking and alcohol consumption Studies have now shown that throat cancers in younger 30 40 are often due to HPV infection 2 1974 2000 76 Currently no swab test for throat HPV Throat HPV smear Herd Immunity Immunization of boys would prevent protect individuals and would offer greater protection for all sexually active individuals Safety of HPV Vaccines Gardasil and Cervarix 4 567 represents the total numver of reactions reported in the UK between 14 April 2000 to 23 September 2009 In the US figures represent reactions between June 2006 and June 2009 Out of 1 4 million vaccinations Breast Cancer Statistics 1 in 8 women in the US 12 to 13 will develop invasive breast cancer over the course of her lifetime In 2015 231 840 new cases of invasive breast cancer will be diagnosed in women in the U S along with 60 290 new cases of non invasive in situ breast cancer About 2 350 new cases of invasive breast cancer will be diagnosed in men in 2015 Less than 1 of all new breast cancer cases occur in men 2 8 million survivors in US Anatomy of the Breast Lymph nodes Lymph vessels Lobe 20 different sections made up of lobules that make milk Lobules Ducts milk ducts that connect the lobes Nipple Areola Fat Majority is made up of a certain type of tissue Breast Cancer Types Tissue type lobular carcinoma Invasive Lobular Carcinoma ILC invasive or Lobular Carcinoma In Situ LCIS Non Invasive Tissue Type Ductal Carcinoma Invasive Ductal carcinoma IDC Invasive or Ductal Carcinoma In Situ DCIS Non Invasive Noninvasive Breast Cancer For patients with LCIS the risk for developing invasive cancer in the same breast is about 18 and 14 in the other breast after 20 years Invasive Ductal Carinoma IDC IDC This is invasive breast cancer that penetrates the wall of a duct It comprises between 70 80 of all breast cancer cases How Breast Cancer Metastasizes IDC in an invasive malignancy which has spread beyond the ducts It accounts for almost 80 of all invasive cancers The cancer cells grow in the milk duct until they break the membrane lining the duct and move into the surrounding tissue cancer cells enter the lymphatic vessels and travel to other areas of the body Invasive Lobular Carcinoma ILC ILC Accounts for 10 15 of all breast cancers Risk Factors Being a women 100X versus men Getting older Having an inherited mutation BRCA1 or BRCA2 A personal or family history of breast or ovarian cancer Having high breast density on a mammogram 4 6 folds increase High bone density Having had hyperplasia or LCIS Being exposed to large amounts of radiation at a young age Having more than one drink of alcohol per day Never having children or having first child 35 years High levels of blood androgens or estrogens Postmenopausal hormone use current or recent use of estrogen or estrogen plus progestin Starting menopause after age 55 Being younger than 12 at the time of your first period Current or recent use of birth control pills Age is a major factor Age 20 1 in 1 681 Age 30 1 in 232 Age 40 1 in 69 Age 50 1 in 42 Age 60 1 in 29 Age 70 1 in 27 Symptoms A persistent lump or thickening in the breast or armpit area A newly retracted inverted pulled in nipple Changed in the color or skin of the breast areola or nipple dimpling puckering or scaling Blood or discharge from the nipple A change in the size or shape of the breast Detecting Breast Cancer Manual inspection non invasive In mammography each breast is compressed horizontally then obliquely and an x ray is taken of each position non invasive Lumpectomy An open biopsy is surgical procedure in which all or part of a lump is removed and tested for malignancy Breast Density Why is breast density important Women with dense breasts have an increased risk of breast cancer Unfortunately we don t yet know why breast density is related to breast cancer Research is ongoing Dense breasts make it difficult to detect breast cancer on a mammogram Dense breast tissue can look white or light gray on a mammogram and cancer can also look white or light gray As a result mammograms may not be as effective in women with dense breasts Inflammatory Breast Cancer What is it Most aggressive form Rare Often no lump formation cancer is a sheet Affects younger women Metastasizes quickly Affects men too Symptoms Sudden increase in size temperature Redness itching Ridged skin Bruise swollen lymph nodes Breast Cancer Subtypes Hormone and HER2 HR HER2 73 of all breast cancer cases best prognosis HR HER2 13 of all breast cancer cases worst prognosis HR HER2 10 of all breast cancer cases HR HER2 5 of all breast cancer cases What are Hormones A hormone from Greek horman to set in motion is a chemical messenger from one cell or group of cells to another Function as a signal to the target cells Actions can include stimulation or inhibition of growth induction or suppression of apoptosis activation or inhibition of the immune system regulating metabolism and reparation for a new activity or phase of life Hormones are produced by and secreted from endocrine glands Estrogen and Cancer The main beneficial effects of estrogen include its roles in Programming the breast and uterus for sexual reproduction Safeguarding the heart by controlling cholesterol production in ways that limit the buildup of plaque in the coronary arteries Preserving bone strength by helping to maintain the proper balance between none buildup and breakdown Estrogen can also be harmful The most serious problem arises from its ability to promote proliferation of cells in the breast and uterus Estrogen Target Tissues Targets cells with estrogen receptor Too much can lead to a cancer causing situation It helps tell cells when to grow Human Epidermal Growth Factor Receptor 2 Normal situation HER2 proteins mediate normal cell growth and division HER2 Amplification and overexpression In HER2 positive breast cancer HER2 gene amplification results in 10 to 100 fold overexpression of the HER2 protein HER2 Over Expression Drives Tumor Growth Persistent HER2 overexpression leads to uncontrolled cell division and aggressive tumor growth HER2 over expression affects 25 to 30 of breast cancer patients HER2 amplification to predictive of a poor prognosis in breast cancer less HER 2 over expression is also observed
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