Download - Breast cancer research
BREAST CANCER
RESEARCH
By Yana Puckett, MD
What is Breast Cancer?
Breast Cancer StatisticsPopulation affected: all women and men.
Chance of developing breast cancer in a lifetime: 1 in 8 women, 1 in 1000
men
● No. 1 cause of death in women and No.2 cancer overall in the United
States
● 2014: 235,000 new cases in the U.S 40,000 deaths
● 2.5 years = Median survival without treatment
● 25% decrease in mortality with screening
● Country with lowest incidence of breast cancer: Japan and Eastern Africa
Current Screening Recommendations
● Annual mammography starting at the age of
40
● Clinical breast examination every 2-3 years
starting at the age of 20
● Continue mammograms if woman is in good
health
Social Determinants of Breast
Cancer
● Breast cancer disparities exist
● Higher death rates 27/100 (B) vs 18/100 (W)(1)
● Inequalities in breast cancer screening, follow-up, and
treatment after diagnosis, leading to greater mortality
Who Has a Higher Risk of Getting
Breast Cancer?● Use of oral birth control pills
● Not breastfeeding
● Diet high in fat, alcohol consumption
● Obesity
● Nulliparity
● Early menarche or late menopause
● Family history of breast cancer, ovarian cancer
● Smoking
What is Health Disparity?
“A particular type of health difference that is closely linked
with social, economic, and/or environmental
disadvantage.” *
* U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for
2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and
recommendations.
Social Determinants Of Health and
Breast Cancer● Racial or Ethnic group
● Religion
● Socioeconomic status
● Gender
● Age
● Mental health
● Cognitive, sensory, or physical disability
● Sexual orientation or gender identity
● Geographic location
● Other characteristics historically linked to discrimination or
exclusion
Cause of Disparities
Is it just because of
poverty and illiteracy?
Cause of Disparities● Genetic - Hispanic vs AA Women
● Nutrition and Physical Activity
● Lack of access to care - rural areas
● Lack of knowledge about insurance
coverage
● Tobacco use
● Culture/religious beliefs
● Fear or anxiety about mammography
Cultural Beliefs?
● Several latest studies published a recent
trend noted in African American women that
refuse chemotherapy and radiation
treatment (11-13).
● Fatalistic beliefs - CANCER = inevitable
death!
Reason for Lack of Screening
● Lack of knowledge about breast cancer
● Lack of belief in the healthcare system
● Mistrust of doctors - Tuskegee Trial in 1930s
● Lack of healthcare coverage
American Cancer Society. Cancer Facts & Figures for African Americans 2007-2008. Atlanta: American Cancer Society: 2007 Retrieved November 12, 2009 from,
http://www.cancer.org/downloads/STT/CAFF2007AAacspdf2007
Affordable Care Act Data Collection
● Quality Improvement and Research
● Expected 32 million additional Americans will have
health coverage by 2019
● ACA is the first major step since the implementation of
Medicaid which aims to relieve the disparity among
minority populations regarding health care coverage
and preventative care awareness
Milestones in Breast Cancer Research
● 1913 - X-rays are used to study breast cancer → introduces idea of
mammography
● 1947 - First use of chemotherapy for treatment of cancer
● 1955 - Link discovered between estrogen and growth of breast cancer
● 1966 - First targeted breast cancer therapy, Tamoxifen, developed in UK
● 1970s - First use of CT scan to show tumors
● 1976 - American Cancer Society officially recommends use of
mammography for breast cancer screening
● 1976 - Discovery of oncogene followed by tumor suppressor gene in
1982
Milestones in Breast Cancer Research
Continued
● 1977 - Lumpectomy proven effective → 10 year study by Dr. Bernard
Fisher, first randomized clinical trial
● 1994 - Dr. Mary-Claire King discovers location of BRCA1 gene and role in
hereditary breast and ovarian cancer; 1995 → BRCA2
● 1998 - FDA approves Herceptin, first target therapy for breast cancer, used
to treat HER2+
● 2009 - NIH launches The Cancer Genome Atlas following success of
Human Genome Project in 2003
Research - Stakeholders● National Cancer Institute: Federal organization under the National
Institute of Health established in 1937 under National Cancer Institute Act
funds from Congress
- 2011: 625.1 million
- 2012: 602.7 million
- 2013: 559.1 million → overall budget was 4.79 billion
● Grantees are “judged on scientific merit, potential impact, and likelihood of
success” by scientific advisory board (7).
● NCI leadership then considers “public health significance,
scientific novelty and overall representation of research
topic (7).”
Research - Stakeholders● Breast Cancer Research Foundation: nonprofit organization
founded in 1993
● Funds from donors → Estee Lauder Companies Inc, Play for PINK, Ann
Inc.
● Generated over half a billion in breast cancer research since its start
- 2013: 50 million
- 2012: 40 million
- Projected 2014-2015: 70.2 million
● Scientific Advisory Board seeks out researchers to fund 220 researchers
across 14 countries and 6 continents
Latest Research: Did you know?● Self-breast exams have not been proven
to be helpful and are now not recommended (14)
● New initiative on the rise to start screening
mammograms at the age of 50 instead of 40 or mammogram
every 2 years rather than 1. Controversial, more
studies needed (16)
● MRI instead of mammogram (15)
● Stopping screening at 70, 75, 80 (17)
Testing for Breast Cancer Genes
What is the breast cancer gene?
● BRCA1 and BRCA2 produce tumor
suppressor proteins
● Mutations = proteins not produced, cancer
sometimes ensues
● These mutations are inherited genetically
● Responsible for 5-10% of all breast
cancers
Testing for Breast Cancer Genes
What does it mean if you have a
mutation?
● Your risk for developing breast cancer is
greatly increased - 90% chance of
developing breast cancer overall.
● More likely to have another cancer such
as ovarian.
Testing for Breast Cancer Genes
What is the test?
● Blood test detects harmful mutations in
BRCA1 and BRCA2
Who should get tested?
● Family history of breast cancer on same
side of family
● Immediate family member diagnosed before
age 45
● Family history of bilateral breast cancer
● Ashkenazi Jewish heritage and family
history of breast cancer
Testing for Breast Cancer GenesWhat does it tell you?
Positive result: significantly at more risk, and treatment
options are available:
● Increase cancer screenings and surveillance
● Preventive surgery (prophylactic mastectomy)
● Preventive medications
Negative result: not genetically predisposed
Ambiguous result: detects mutations not necessarily linked
to cancer
Testing for Breast Cancer Genes
Benefits
● Knowledge of increased risk
● Increase in access to preventive measures
Challenges
● Cost of test
● Can be emotionally taxing
● Negative test results should not deter future screenings
Connecting Research, Social
Determinants, and Treatment
General Benefits of Breast Cancer Research
● A better understanding of risk factors can allow for earlier detection and
better prevention methods
● Increased ability for individualized treatment
● Identification of populations at risk allows for targeting screening and
prevention towards these populations
Challenges of Research Application
● Treatment of cancer happens at a very individualized level
Questions?
References1. Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual report to the nation on the status of cancer, 1975–2008, featuring cancers
associated with excess weight and lack of sufficient physical activity. Cancer 2012;118:2338–66.
2. Crawford, S. P., & Alder, R. P. (2014). Breast cancer. Magill’S Medical Guide (Online Edition),
3. BRCA1 and BRCA2: Cancer risk and genetic testing. (2014). National Cancer Institute a the National Institutes of Health.
4. Genetic Testing. (2014). Susan G. Komen Foundation.
5. Tests and procedures: BRCA gene test for breast cancer. (2014). The Mayo Clinic.
6. http://www.bcrfcure.org/sites/default/files/2013-06%20BCRF%20Financial%20Statements.pdf
7. http://www.cancer.gov/cancertopics/factsheet/NCI/research-funding
8. http://www.bcrfcure.org
9. http://ww5.komen.org/BreastCancer/1877GOKOMEN.html
10. http://www.cancer.org/research/acsresearchupdates/breast-cancer-research
11. Simon, C. E. (2006). "Breast cancer screening: cultural beliefs and diverse populations." Health Soc Work 31(1): 36-43.
12. Thompson, H. S., et al. (2004). "The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer
screening." Prev Med 38(2): 209-218.
13. Klassen, A. C., et al. (2008). "A healthy mistrust: how worldview relates to attitudes about breast cancer screening in a cross-sectional
survey of low-income women." Int J Equity Health 7: 5.
14. Grother, J. P. (2003). "Is breast self-exam efficacious?" J Midwifery Womens Health 48(4): 298.
15. (2014). "Breast cancer screening: options beyond the mammogram. The mammogram remains the foundation of breast cancer
screening, but variations on this test can improve detection for some women." Harv Womens Health Watch 21(11): 3.
16. Saeger, H. D. and M. Hampl (1999). "[Mammographic screening starting in the fifth or sixth decade of life]." Chirurg 70(4): 380-383.
17. Rich, J. S. and W. C. Black (2000). "When should we stop screening?" Eff Clin Pract 3(2): 78-84.