PUBLIC HEALTH CAMPAIGN

PUBLIC HEALTH CAMPAIGN. PROGRAMME NAME: Masters in Public Health MODULE: Society and Human Health MODULE CODE: 7BH501 MODULE LEADER: Dr Jinit Masania STUDENT ID: 100674246.

BREAST CANCER AWARENESS IN DERBY. Knowledge Empowerment.

CONTENTS.

INTRODUCTION. Cancer is the leading cause of all deaths and premature deaths in Derbyshire. Breast cancer is the most common cancer among women in Derby and worldwide. Breast cancer can occur in men and women, but it is far more common in women. Approximately 0.5–1% of breast cancers occur in men. 1 in 7 women are diagnosed with breast cancer in the uk. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together..

Pink stethoscope and breast cancer awareness ribbon.

Breast cancer is a disease in which cells in the breast grow out of control. This can occur in one or two breast. Most breast cancers begin in the ducts or lobules. Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to be metastatic breast cancer, while when it is confined to the breast, it is said to be benign. It is important to note that not every breast lumps are cancerous, most are benign that do not spread outside the breast nor invade surrounding breast tissues..

Types of Breast Cancer. Breast cancer may be classified as invasive, non invasive, recurrent and metastatic. Non invasive are cancers that has not spread outside its original point of origin. Invasive breast cancers are those that has spread to surrounding healthy tissues. Recurrent breast cancers are those that returned after treatment while breast cancers that has spread to from its origin to other parts of the body are metastatic..

Most common breast cancers are invasive ductal carcinoma which makes up about 80% of diagnosed breast cancer, and invasive lobular carcinoma. This is the earliest form of breast cancer. In DCIS there are cancer cells in the ducts of the breast but these cells are contained (in situ). They have not spread into normal breast tissue. DCIS may show up on a mammogram and is commonly diagnosed when women have breast screening. Some women have abnormal cell changes in the lining of the lobules. This is called lobular carcinoma in situ (LCIS). LCIS is not a cancer. It means a woman has a slightly increased risk of developing breast cancer in later life..

Less common types of breast cancer includes; Angiosarcoma Paget disease of the breast Phyllodes tumour Inflammatory breast cancer Tripple negative breast cancer: The term triple-negative breast cancer refers to the fact that the cancer cells don’t have estrogen or progesterone receptors (ER or PR) and also don’t make any or too much of the protein called HER2. (The cells test "negative" on all 3 tests.) These cancers tend to be more common in women younger than age 40, who are Black, or who have a BRCA1 mutation..

Staging and Grading of breast cancer. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. It also determines long term survival rate. stage 0 – the cancer is where it started (in situ) and hasn't spread stage 1 – the cancer is small and hasn't spread anywhere else stage 2 – the cancer has grown, but hasn't spread stage 3 – the cancer is larger and may have spread to the surrounding tissues and/or the lymph nodes (or "glands", part of the immune system) stage 4 – the cancer has spread from where it started to at least 1 other body organ, also known as "secondary" or "metastatic" cancer.

grade 1 – cancer cells that resemble normal cells and aren't growing rapidly grade 2 – cancer cells that don't look like normal cells and are growing faster than normal cells grade 3 – cancer cells that look abnormal and may grow or spread more aggressively.

Causes and Risk Factors. Breast cancer develops due to DNA damage and genetic mutations that can be influenced by exposure to estrogen. This mutation causes the breast cells to divide and multiply to create tumours resulting in cancerous cells. The exact cause for this is not clear. However, there are risk factors that increases the chance of developing breast cancers such as; Older Age: The risk for breast cancer increases with age. Most breast cancers are diagnosed after age 50. Sex: women are at greater risk than men Dense breast Family history of breast cancer or ovarian cancers.

Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer. Up to 15% of women develop breast cancer because of this mutations. Previous history of breast cancer or certain non-cancerous breast diseases eg LCIS. Women who have had breast cancer are more likely to get breast cancer a second time. Smoking Alcohol Obesity/overweight especially after menopause Radiation exposure: If you’ve had prior radiation therapy — especially to your head, neck or chest — you’re more likely to develop breast cancer. Hormone replacement therapy: People who use hormone replacement therapy (HRT) have a higher risk of being diagnosed with the condition..

Signs and Symptoms. a lump, or swelling in your breast, chest or armpit. This is usually one of the earliest signs. a change in the skin of your breast, such as dimpling (may look like orange peel) or redness (may be harder to see on black or brown skin) a change in size or shape of 1 or both breasts nipple discharge (if you are not pregnant or breastfeeding), which may have blood in it a change in the shape or look of your nipple, such as it turning inwards (inverted nipple) or a rash on it (may look like eczema) pain in your breast or armpit which does not go away – breast pain that comes and goes is usually not a symptom of breast cancer.

Breast Cancer Screening. Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. Although breast cancer screening cannot prevent breast cancer, its benefit is that it can help find breast cancer early, when it is easier to treat. Screening for breast cancer includes; Self breast examination Clinical breast examination Screening Mammogram: A mammogram is an X-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women of screening age. MRI screening; shows more details than a mammogram and can pick up certain breast cancer that mammogram may miss..

American cancer society screening recommendation.

Women who are at high risk for breast cancer based on certain factors should get a breast MRI and a mammogram every year, typically starting at age 30. This includes women who: Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (see below) Have a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing) Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves Had radiation therapy to the chest before they were 30 years old Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes The American Cancer Society recommends against MRI screening for women whose lifetime risk of breast cancer is less than 15%. personal history of pre-cancerous lesions and/or breast cancer; the family history of breast cancer; the known genetic predisposition of breast cancer; the history of mantle or chest radiation therapy; and dense breasts..

Breast cancer diagnosis. Breast cancer diagnosis usually needs triple assessment which includes; Clinical evaluation Use of imagine such as diagnostic mammogram, breast ultrasound and breast MRI Tissue biopsy Mammography is a more detailed X-ray of the breast, and it is the most commonly used modality for the diagnosis of breast cancer. However, mammography becomes less sensitive in younger women for whom breast ultrasonography can be used. Ultrasonography is useful in assessing the consistency and size of breast lumps. It has a great role in guided needle biopsy. Breast magnetic resonance imaging (MRI). This reveals more details than a mammogram. It is indicated if there are occult lesions, or suspicion of multifocal or bilateral malignancy. Breast tissue biopsy: This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy)..

Treatment. Breast cancer treatment depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment. The 2 basic principles of treatment are to reduce the chance of local recurrence and the risk of metastatic spread. Surgery with or without radiotherapy achieves local control of cancer. When there is a risk for metastatic relapse, systemic therapy is indicated in the form of hormonal therapy, chemotherapy, targeted therapy, or any combination of these. treatments includes; Surgery Radiation therapy Chemotherapy Hormonal therapy Targeted therapy.

Surgery: Surgery is usually the main treatment for breast cancer and is mostly done when the cancer cells has not metastasized to other part of the body. Common types includes; Lumpectomy/quadrantectomy: this removes the cancer/tumor cells and small portion of health cells tissues around it. Quadrantectomy is removal of one or more quadrant of the breast containing the tumour. Simple mastectomy: removing the entire affected breast with the removing the lymph nodes Modified radical mastectomy: removing the entire breast and lymph nodes in the armpit Prophylactic mastectomy: removing one or both breast to reduce the risk of developing breast cancer as seen in women with Mutated BRCA1 and BRCA2 gene. Mastectomy with breast reconstruction: this is removal of the affected breast then reconstructing new breast at the same time. However, the reconstruction can be done at another time. Sentinel lymph node biopsy: This is to check if the lymph nodes contains cancer cells Axillary lymph node dissection: this is the removal of affected lymph node in the armpit region.

Chemotherapy: this is a systemic treatment of breast cancer. It is the use of drugs given Intravenously or as a pill to destroy cancer cells. It is usually done before or after surgery or to control metastatic cancer. Types include Neoadjuvant chemotherapy: this is given before surgery to shrink the tumor Adjuvant chemotherapy: given after surgery to kill the remaining cancer cells Palliative chemotherapy: to control metastatic breast cancer which have no cure..

Radiation therapy: this uses radiation energy to kill cancer cells typically provided after surgery and/or chemotherapy. It is performed to ensure that all of the cancerous cells remain destroyed, minimizing the possibility of breast cancer recurrence. Further, radiation therapy is favorable in the case of metastatic or unresectable breast cancer. Irritation and darkening of the skin exposed to radiation, fatigue, and lymphoedema are one of the most common side effects of radiation therapy. Nonetheless, radiation therapy is significantly associated with the improvement of the overall survival rates of patients and lowered risk of recurrence..

Hormonal therapy: this is the use of hormones to treat breast cancer. It is given if the tumor cell is positive for estrogen and/or progesterone hormones. it is effective in cases of breast cancer recurrence or metastasis. This can be used with chemotherapy and/or surgery. Targeted therapy: uses drugs to help target and kill cancer cells without affecting healthy non cancer cells. This can be provided at every stage of breast therapy– before surgery as neoadjuvant therapy or after surgery as adjuvant therapy. target therapy is quite common in HER2-positive breast cancer patients; major drugs include trastuzumab. This is often given along side chemotherapy..