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WEEK 23:
Breast cancer epidemiology and risk factors:
| Question | Answer |
|---|---|
| incidence | rate of new cases of a disease occurring in a specific population over a particular period of time |
| formula for incidence | number of new cases during specified time period/ size of population at start of time period |
| prevalence | number of cases of a disease in a specific population at a particular time point over a specified period of time |
| formula for prevalence | number of cases in the population at one time/ total population at the same point in time |
| how is prevalence different to incidence | prevalence includes all cases (new and pre-existing) in the population at the specified time whereas incidence is limited to new cases only |
| incidence of invasive breast cancer | highest in people aged 90+ and lower in women from ethnically diverse backgrounds (south asian, black, chinese and mixed groups) when compared to white women according to calculated risk ratios |
| most common location for invasive breast cancer in UK | upper outer quadrant of breast |
| incidence rates for breast carcinoma in situ are highest in people aged | 65-69 |
| since early 1990s breast carcinoma in situ incidence rates have | tripled (200%) |
| DCIs | most common specific location for in situ breast carcinomas |
| over the last decrease breast carcinoma in situ incidence rates | increased by 31% |
| invasive breast cancer differences in income | disproportionately affects individuals in low and middle income countries, where breast cancer 5 year survival rates in high income countries exceed 90% compared with 66% India and 40% South Africa |
| risk factors for breast cancer | modifiable and non modifiable |
| non modifiable factors | female, older age, family history, genetic mutations, race/ethnicity, pregnancy and breastfeeding, menstrual period and menopause, density of breast tissue, previous history of BC, non cancerous breast diseases, and previous radiation therapy |
| modifiable factors | hormonal replacement therapy, overweight/ obesity, alcohol intake and smoking |
| major risk factor associated with increased risk of breast cancer | female sex due to enhanced hormonal stimulation (oestrogen, progesterone, and testosterone) |
| family history as a risk factor for BC | having a mother, sister, daughter diagnosed with BC (or ovarian) and the risk is higher when the relatives are closer and under the age of 50 |
| genetic factors can be explained as | high or moderate penetrance |
| high penetrance | BRCA1, BRCA2, TP53, CDH1, PTEN, and STK11. |
| moderate penetrance | DNA repair genes that can interact with BRCA genes including ATM, PALB2, and CHEK2 |
| HRT (hormone replacement therapy) as a risk factor | slightly increases risk of BC where combined HRT high risk than oestrogen only HRT (but benefits of HRT outweigh the risks) |
| breast density as a risk factor | breast tissue density correlates with greater breast cancer risk however you need to consider that this can also be seen in females of younger age, lower BMI, pregnant or during breastfeeding period, and those taking HRT |
| factors and conditions associated with a REDUCED risk of BC | first full term pregnancy at early age (especially early 20s), along with subsequently increasing number of births, longer duration of breastfeeding period |
| specific ages to do with menstruation and menopause increasing risk of BC | menarche before age of 12 and menopause after age 55 due to longer exposure to oestrogen |
| examples of other non cancerous alternations in breasts which increase risk of BC (3) | atypical hyperplasia, carcinoma in situ, and other proliferative or non proliferative lesions |
| lifestyle as a risk factor | overweight/ obese after menopause have a higher risk due to higher oestrogen production as well as drinking alcohol and smoking tobacco |
| environmental risk factors | ionizing radiation increases risk (medical radiological procedures eg Xrays and CT scans, and sources of gamma ray emissions eg nuclear power plant) |
| Tyrer cuzick model | explains range of risk factors eg age |
| symptoms and signs of BC | new lump/ thickened tissue in breast change in size or shape of breast discharge of fluid from nipple lump/ welling in armpit change in the look/feel of skin rash/crusting/scaly/itchy skin around nipple change in appearance of nipple pain-unlikely |
| awareness for breast cancer | NHS has a 5 point plan for being breast aware: know what's normal for you look at your breasts and feel them know what changes to look for report any changes to a GP without delay attend routine screening if aged 50 to 70 (women) |
| breast screening programme | mammography radiography to detect small changes in breast before other symptoms/ signs |
| when is a mammogram performed (xray) | every 3 years for women aged 47-73 |
| key features of screening | prevent earlier deaths/ improve quality of life by detecting condition so treatment can be given more effectively, reach everyone in target population, reduce chance of development/ complications, and provide information for people to make informed choice |
| benefits of screening programme | early detection and reduction in breast cancer mortality |
| harms of screening programme | Over-diagnosis = unnecessary treatment. False-positive mammograms =unnecessary further investigations + psychological distress/ anxiety False reassurance, due to missed cancer + incorrect diagnosis. Pain + discomfort |
Created by:
kablooey
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