BREAST CANCER RESEARCH By Yana Puckett MD What

BREAST CANCER RESEARCH By Yana Puckett, MD

What is Breast Cancer?

Breast Cancer Statistics Population 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

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 1930 s 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/CAFF 2007 AAacspdf 2007

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 ● 1970 s - 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 BRCA 1 gene and role in hereditary breast and ovarian cancer; 1995 → BRCA 2 ● 1998 - FDA approves Herceptin, first target therapy for breast cancer, used to treat HER 2+ ● 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 at the age of 50 instead of 40 or rather than 1. Controversial, more ● MRI instead of mammogram (15) ● Stopping screening at 70, 75, 80 (17) mammograms mammogram every 2 years studies needed (16)

Testing for Breast Cancer Genes What is the breast cancer gene? ● BRCA 1 and BRCA 2 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 BRCA 1 and BRCA 2 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 Genes What 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?

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