Bonifacio, Ma. Kristine Ioannou, Kathrina F.

Lesson Plan: Breast Cancer and Environment

Activity #1: Introduction Warm Up* Objectives: To present an overview of what students can expect during the breast cancer lesson To establish interest in the topics of breast cancer, environment, and modifiable risk factors To assess what students think or know about breast cancer Materials/Preparation Breast Anatomy: Simple Drawing List the following key words on blackboard or butcher paper: Breast Cancer, Facts and Risk Factors, Risk Reduction, Environmental Factors, Healthy Choices Fact Sheet Factors and Health Tips, and Teen Brochure before facilitating this activity Q & A section: Students Talk About Breast Cancer Alternate Option: Show power point: Breast Cancer, Genes and the Environment Peer Leaders can distribute Lesson Vocabulary, Fact Sheet, and/or Teen Brochure immediately after this Warm Up Activity, if you are not using the video or slides Lesson Activity Time: 10 15 minutes Introduction Warm-Up Activity: What Should I Know About Breast Cancer? Introductions: Peer Educators Who We Are/What We Do Sample Script (5 minutes) Ground Rules (Confidentiality, Right to Pass, Attention to Speakers) Today we want to share some important information about breast cancer. We will present some facts on what is known and not known about breast cancer. Well also give you some suggestions for what you can do to stay healthy now and in the future. Feel free to ask questions during any part of the lesson. Agenda: Raise Awareness of Breast Cancer, Risk Factors and Preventive Health Present Some Basic Breast Cancer Facts and Statistics Do Activities to learn about specific risk factors that we can control Present examples of how we can apply this information to our lifestyle now Optional: Ask to Take a Brief Survey at the end Give some take home resources to share with a parent or a friend

Breast cancer
Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer:

Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type. Lobular carcinoma starts in the parts of the breast, called lobules, that produce milk.

In rare cases, breast cancer can start in other areas of the breast. Breast cancer may be invasive or noninvasive. Invasive means it has spread from the milk duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. Noninvasive breast cancer is called "in situ."

Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues. It may progress to invasive cancer if untreated. Lobular carcinoma in situ (LCIS) is a marker for an increased risk of invasive cancer in the same or both breasts.

Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer or ER-positive cancer. Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells (including cancer cells) have too many copies of this gene, they grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk that the disease will return (recur) than women who do not have this type. Causes, incidence, and risk factors Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer. Risk factors you cannot change include:

Age and gender -- Your risk of developing breast cancer increases as you get older. Most advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer than men. Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease. Genes -- Some people have genes that make them more likely to develop breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life. Menstrual cycle -- Women who got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

Other risk factors include:

Alcohol use -- Drinking more than 1 - 2 glasses of alcohol a day may increase your risk for breast cancer. Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer. DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s 1960s. Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy with estrogen for several years or more.Obesity -Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer. Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a much higher risk for developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk -- especially if the radiation was given during breast development.

Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides. Symptoms Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:

Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men can get breast cancer, too. Symptoms include breast lump and breast pain and tenderness. Symptoms of advanced breast cancer may include:

Bone pain Breast pain or discomfort Skin ulcers Swelling of one arm (next to the breast with cancer) Weight loss

Signs and tests The doctor will ask you about your symptoms and risk factors. Then the doctor will perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Tests used to diagnose and monitor patients with breast cancer may include:

Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram Breast ultrasound to show whether the lump is solid or fluid-filled Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open CT scan to see if the cancer has spread Mammography to screen for breast cancer or help identify the breast lump PET scan Sentinal lymph node biopsy to see if the cancer has spread

If your doctor learns that you do have breast cancer, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Breast cancer stages range from 0 to IV. The higher the staging number, the more advanced the cancer. Treatment Treatment is based on many factors, including:

Type and stage of the cancer Whether the cancer is sensitive to certain hormones Whether the cancer overproduces (overexpresses) a gene called HER2/neu

In general, cancer treatments may include:

Chemotherapy medicines to kill cancer cells Radiation therapy to destroy cancerous tissue Surgery to remove cancerous tissue -- a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

Hormonal therapy is prescribed to women with ER-positive breast cancer to block certain hormones that fuel cancer growth.

An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogensensitive breast cancer benefit from this drug. Another class of hormonal therapy medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer. Aromatase inhibitors blockestrogen from being made.

Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anticancer drugs that target certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). It may be used for women with HER2-positive breast cancer. Cancer treatment may be local or systemic.

Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment. Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning (curing). For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.

Stage 0 and DCIS -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS. Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is the standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery. Stage III -- Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and biologic therapy. Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of these treatments.

After treatment, some women will continue to take medications such as tamoxifen for a period of time. All women will continue to have blood tests, mammograms, and other tests after treatment. Women who have had a mastectomy may have reconstructive breast surgery, either at the same time as the mastectomy or later.

QUIZ 1. A lump in the breast is almost always cancer. (True or False)

Explanation:
A lump in the breast is not always cancer. When a lump turns out not to be cancer, what else might it be? It could be a cyst, an abnormal noncancerous growth, or a blood clot that causes lumpiness. It could also be a "pseudo lump," caused by hormonal changes that isn't a lump at all. Still, whatever the cause, it's important to get any lump evaluated.

2. How often do doctors recommend breast self-exams? A Once per day B Once per week C Once per month D Twice per year
Explanation:
It was once widely recommended that women check their own breasts once a month. The current thinking is that it's more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule.

3. Breast

cancer CAN BE inherited. True False

Explanation:
If you have a strong (positive) family history for breast cancer, ovarian cancer, or even prostate cancer, this information is relevant to your diagnosis. A strong family history in this case usually means that a mother, sibling, child, or father has had a related malignancy. Information about other family members (aunts, nieces, etc.) is also important.

4. Which

is NOT a term describing a normal part of the breast?

A Ducts B Lymph nodes C Fat D Mastalgia

Explanation:
Mastalgia is the medical term for breast pain. It does not describe a part of the breast.

5.

Abnormal cells that do not function like the body's normal cells are called... A Stem cells B Muscle cells C Cancerous cells D Mitochondrial cells

Explanation:
Cells in the body normally divide (reproduce) only when new cells are needed. If however, the cells that are growing out of control are abnormal and do not function like the body's normal cells, the tumor is called malignant (cancerous).

6. What

causes breast cancer?

A No one knows B Living near highly industrialized cities C Low levels of bodily

hormones D Vaccines

Explanation:
We do not know what causes breast cancer, although we do know that certain risk factors may put you at higher risk of developing it. A person's age, genetic factors, personal health history, and diet all contribute to breast cancer risk.

7. The medical term for the spread of cancer is called ________________. B Metastasis
Explanation:
The medical term for the spread of cancer is called metastasis. 8. Benign

tumors in the breast are capable of metastasis.

True False
Explanation:
Tumors in the breast can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors. Benign tumors: - are rarely a threat to life - can be removed and usually don't grow back - don't invade the tissues around them - don't spread (metastasize) to other parts of the body 9. What

are breast cancer risk factors for women? A Childbearing later in life B Having never had children C Being overweight after menopause D All of the above
Explanation:
Certain risk factors for breast cancer are: - Childbearing later in life - Having never had children - Being overweight after menopause Note: Having risk factors does not mean that a woman will get breast cancer. In fact, most women who have risk factors never develop breast cancer. 10. Bloody

discharge from the nipple can be a symptom of breast cancer. True False

The correct answer is: True

Explanation:
Early breast cancer usually doesn't cause symptoms. But as the tumor grows, it can change how the breast looks or feels. The common changes include the following: - A lump or thickening in or near the breast or in the underarm area - A change in the size or shape of the breast - Dimpling or puckering in the skin of the breast

- A nipple turned inward into the breast - Discharge (fluid) from the nipple, especially if it's bloody - Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin at the center of the breast). The skin may have ridges or pitting so that it looks like the skin of an orange.