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Breast Cancer: Epidemiology & Risk Factors

by Carlo Raj, MD
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    00:01 Epidemiology: One of eight women, incidence.

    00:04 Rarely before age of 25.

    00:06 Average age, postmenopausal 64.

    00:09 Most common cause of breast mass in postmenopausal women.

    00:13 Look for postmenopausal.

    00:14 Frequently where do you find this once again? Upper outer quadrant because of all this increased tissue.

    00:21 Keep in mind, when I was walking through your risk factors for postmenopausal, you must be thinking about a patient most likely with that increase in estrogen, how does that increase estrogen possible postmenopausal if she’s not having a menstrual cycle.

    00:36 She’s probably obese.

    00:40 So therefore adipocytes with the increased aromatization.

    00:43 I brought up that point before.

    00:44 Do not forget this again.

    00:47 Epidemiology: Well, the genetics, BRCA1, BRCA2 is involved and Li–Fraumeni.

    00:53 What does that mean to you? This would then mean the p53 has been suppressed.

    00:58 And so therefore if p53 has been knocked out understand that your patient, not only does she have a primary breast cancer, she might have a primary lung cancer, probably a pancreatic cancer, primary GI cancer.

    01:11 These are not metastases.

    01:12 Primary, primary, primary, primary.

    01:14 Multiple malignancies, welcome to Li–Fraumeni and p53 might be often involved with suppression.

    01:22 Breast cancer here in clinical findings, I’ve mentioned a few times that I would tell you where you’d find your tumors in general on the breast.

    01:30 Let me set up this picture for you.

    01:33 On the right, you’ll see the overall picture of a female's sagittal view with the nipple being on the left and then breast being underlying.

    01:44 What I’ve done is taken the breast and then enlarged it on the left picture.

    01:48 So now here’s your patient, looking at you anteriorly.

    01:52 So now, you’re looking at your patient.

    01:55 As you look at your patient and as you continue doing your palpation and breast examination, you’ll begin at the nipple and move and move and move outwardly.

    02:05 And as you do so, you’re being firm on your touch because you want to make sure that you don’t miss anything.

    02:11 And don’t be shy, right? Because you’re trying to save your patient.

    02:15 And then here in the outer quadrant, you’ll notice here that majority or greatest percentage of your tumors let it be fibroadenoma, let it be breast cancers and such, all these for the most part will be located in the upper outer quadrant.

    02:30 Risk factors for breast cancer: Family history being positive changes your investigation completely.

    02:37 Much earlier in terms of mammography.

    02:41 First-degree female relative.

    02:44 The next risk factors all deal with increased estrogen exposure.

    02:49 Obesity, we talked about obese women with aromatization.

    02:55 If there is association of contralateral breast or perhaps endometrium.

    03:00 Early menarche, late menopause.

    03:02 Nulliparous women.

    03:03 Non-breastfeeding has shown statistically to increase risk of breast cancer.

    03:08 Age older than 30 and those who have had their first child.

    03:13 And then, true, statistically, there’s a lot of controversy as to whether or not exogenous estrogen is a possible risk factor for breast cancer.

    03:26 You should know it as yes.

    03:28 For example, hormone replacement therapy specifically.

    03:31 That’s what I’d like for you to focus upon with risk factor.

    03:35 Postmenopausal, if you’re a female, wishes to then opt for hormone replacement therapy and all the pros and cons had been weighed out.

    03:43 She’s at risk for breast cancer or perhaps endometrial cancer.

    03:48 So I do wish to point that out to you.

    03:50 There’s an awful lot of research on whether or not estrogen itself is going to be a risk factor.

    03:56 But as far as you’re concerned, yes, especially for hormone replacement therapy.


    About the Lecture

    The lecture Breast Cancer: Epidemiology & Risk Factors by Carlo Raj, MD is from the course Breast Disease. It contains the following chapters:

    • Epidemiology of Breast Carcinoma
    • Risk Factors of Breast Carcinoma

    Included Quiz Questions

    1. Familial adenomatous polyposis
    2. BRCA1
    3. P53
    4. Li-Fraumeni
    5. BRCA2
    1. Exogenous estrogens
    2. Polycystic ovarian disease
    3. Age greater than 30 of first live birth
    4. Nulliparity
    5. Obesity
    1. Aromatization of androstenedione in adipose tissue.
    2. Increased mass of breast tissue in obesity.
    3. Decreased ability to produce tumor suppressor proteins.
    4. Unknown mechanism
    5. Obesity is associated with decreased estrogen levels of estrogen

    Author of lecture Breast Cancer: Epidemiology & Risk Factors

     Carlo Raj, MD

    Carlo Raj, MD


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