Hi, welcome to an introduction to breast cancer. I'm Dr. Anees Chagpar. I am so glad that you joined us today. I hope that this is going to be a really fun and interactive journey through learning everything there is to know about breast cancer or at least an introduction. I look forward to interacting with you on the discussion boards and on social media. So let's get started. To begin with, what's cancer, anyways? Well, when I looked it up in the dictionary, cancer was defined as the disease caused by an uncontrolled division of abnormal cells in a part of the body. The two key words, of course are uncontrolled and abnormal. We all have division of cells going on in our body all the time, it's how we grow, it's how we differentiate and it's important for our livelihood. But what if those cells run amok? What if they become abnormal? And what if their division is completely uncontrolled? Kind of like an accelerator with no brake pedal and no traffic lights. This is Calvin and Hobbs in their little red wagon going down the hill at 90 miles an hour with no brakes in sight. What happens? Disaster, that's cancer. When cells that become abnormal divide and proliferate without any control and without any regulation, we end up with cancer. And that's problematic, but the other definition in the dictionary was this. It's a practice or phenomenon perceived to be evil or destructive and hard to contain or eradicate. We often talk about cancers in an organization or in a department, people or things that we just don't want to deal with, because they invoke fear and trepidation. And for a lot of women, that's what cancer is like, for a lot of men too. And so I hope what we'll do during the time we have together is really unpack what is cancer, learn a little bit more about it, so that we really can kind of control it. Know more about it, so that we're less fearful. But more than cancer, we're going to look at breast cancer and breast cancer happens to be my personal area of expertise and my favorite cancer. I hope that all of you have an interest in breast cancer, as well. It may be for a variety of reasons. Maybe you treat patients who have breast cancer like I do or am a researcher who starts looking at why people develop breast cancer. Maybe you're an epidemiologist who's trying to figure out how you can rid the world of breast cancer, looking at population trends and risk factors. Maybe you're a patient who has had breast cancer or know somebody who has, a family member, a friend. It said that cancer affects one in two American men and one in three American women. And so for many of you, this may hit pretty close to home. Maybe you're a health economist who's wondering about how cancer costs are really are skyrocketing and what it's doing to the economy? Or maybe you're an administrator whose trying to figure out how to make health systems work more efficiently, particularly in the cancer space. There are many, many reason to look at cancer and breast cancer in particular and I hope you will enjoy this journey with us. Breast cancer, in particular is one that's of key relevance. It tends to be the most common cancer affecting women in the United States and the second leading cause of cancer related deaths, but it's not just the United States. Breast cancer is a disease that affects women all over the world. Here's a map of the globe and I'm sure that you can find your country of origin. Is there anything that surprises you? Remember that the dark blue are higher incidence, places where more breast cancer is diagnosed and the lighter colors are where less breast cancer is diagnosed. One thing that struck me was that the majority of breast cancers are found in places that are more industrialized, places like Canada, the United States, Western Europe, Australia. Does that surprise you? Some people may argue that this may be related to Western diet, lack of exercise, higher body mass index or maybe lifestyle factors like alcohol. And while that may be the case, another set of statistics also from Globocan, whose website. I'd encourage you to check out, as there are plenty of interactive graphs and maps and charts that can really give you a sense of cancer incidents all over the world is this one. This bar chart shows you that with the blue bars indicating incidents, how many cancers are diagnosed? And the red bars showing you mortality, how many people actually die from breast cancer? We see some very interesting trends. So the places that are more developed tend to have the higher incidence just like we saw on the map, but they also tend to have a relatively lower mortality. So why could that be? There's a few possibilities. The first is that maybe these are areas where people are getting screened, where there's widespread mammography. So people are finding these cancers at really early stages where they're the most treatable, when they're very tiny. The other possibility is that these are places where healthcare is far more available and so better treatments are available. And therefore, the mortality from this disease is much lower. Interesting epidemiologic trends, but nobody wants to be diagnosed with breast cancer to begin with. So, what are the risks for developing breast cancer? I group these into two main factors. Those that we can do something about, the modifiable ones and those that are really out of our control, what I call non-modifiable. Truthfully, when we look at all of the risk factors for developing breast cancer, the two main risk factors are being a woman and getting older. What are you going to do about that? There are other non-modifiable risk factors, as well. Our genetic makeup, our family history. Some of us may carry mutations, mistakes in genes that were designed to protect us from getting cancer. And so when we have a mutation or a mistake in those genes, that's kind of like a chink in our armor. It increases our risk of developing breast cancer. Some of us have intrinsically benign breast disorders, things like atypia. Atypia are funny looking cells. There not cancer or precancer in and of themselves, but they increase our risk of developing cancer and then there are hormones that we make. Our ovaries produce hormones when we're premenopausal and our adrenal glands which sit on top of our kidney also make hormones. These hormones, which are converted to estrogen in peripheral fat also increase our risk of developing breast cancer. We'll talk a little bit more next time about how we can reduce this circulating estrogen. But in general, there's little that we can do about non-modifiable risk factors. What are the things that we can do something about? Well, we don't have to take hormones. Many women take hormones to reduce menopausal side effects. Hot flashes, vaginal dryness. Taking these hormones does increase your risk of developing breast cancer and so not taking them or taking them in the lowest dose for the shortest amount of time possible decreases your risk of developing breast cancer. We know that breastfeeding also decreases your risk. Alcohol taken in excess increases your risk. So reducing your alcohol intake to make it mild to moderate say, one to two glasses a week will reduce your risk of developing breast cancer. And of course, healthy lifestyle. So eating right, exercise, maintaining a normal body weight, reduced obesity also reduces your risk of developing breast cancer. Now, there are some modifiable risk factors that really we can't do very much about. We know, for example, that high dose radiation, people who were exposed to Hiroshima or Nagasaki or the Chernobyl nuclear disaster were at higher incidence of developing breast cancer. They didn't choose to be at high-risk by having exposures to nuclear disasters, but it still is a modifiable risk factor. So, do you wonder what your personal risk is? Well, the news flash is you can find out. Here's a calculator that I encourage you to check out. It's for free and it's on the National Cancer Institute's website. When you go to this website, it'll ask you all kinds of factors that increase your risk of developing breast cancer. Your age, any atypia that you may have had in the past due to breast biopsies. Factors that are associated with endogenous hormone production. The age at which you started having periods. The age at which you stopped having periods. How many children you had? When you had your first pregnancy? What your family history is? And we'll put all of that information together to give you your personal five-year and lifetime risk. It'll be cool to check out, particularly when we start thinking about how we reduce our risk of developing breast cancer next time. I hope you'll join me then. Until next time, this is Dr. Anees Chagpar. Thanks for joining us.
