SH0U!

Ü
ÎOOW

How se ioUs is it and a e we mal

ing any
p oç ess
 Cumulative No. of
completed
screening mammograms
 wome
n

.orç
/
 Femal
Breast e
Lung&bronchus 116,660
Co|on&rectum 69,980 89
Uterinecorpu o
sMelanomaoftheskin 43,830
h0h-h0Ëgkinljmphoma 11,930
ThyfOÏË
28,480

Leukemia 25,560
Allsites 927,910
 Feeal
Lun e 62,470
&bronchus 126
Brez3 43,6@ 3
CoLon&recum 24,460 %

Uterinecopus 4
Liver&intahepaûcbiledu %
ü
NOn-IJOdgFin IÿMpFOMü
Bain&othernenoussyste
m
Ho ladsr h Cronin EADorian AT Andridge Cancer Epîdezîo/ BimarkersPres 2018 Jun' 27(6).'619-
R. 626.
TabIe2,Age•specificTen-yearêobabiliçofereast
¢ancerbiag«osisar0eakforUS¥omen
biagnoad wió bying from
Currentag invasive beast beast can‹er
e cancer <0.16(J in
20 0.\8 (J in 1,479) 18,503)
30 0.50/ (I in 209) <0.18 (1 in
40 1.SB(1in65) 2,016)
50 2.46(1in42) 0.18(1.in@5)
@ 3.58(1 in28) 0.3°à(1in310)
70 0.58(\in193)
Lifetime risk 12.8 1in 8) 2.ã8 in 39) 0.86 (\ in 132)
t. B(t in 101)
Note: Probability is among those who have not been previously
diagnosed with cancer. Percentages and “1 in“ numbers ma/ not
be numerically equivalent due to rounding.
02019, Ameriun Cancer Society, Inc., Suneilance
Research
Figure 2.Age-specifi¢Female Breast Cancer
Incidence Rates by Rae/Ethnicity,US,2012-2016

Ag
e
 rea
Long-T
s erm Trends in SEERAge-Adjusted
Incidence Rates,1975-2018
By Sex, Delay-adjusted SEER Incidence Rate, All Races (includes
Hispanic), All

16
0
0 140

0
120
6 Overali, up over the iast yo
100
4
0
years
2 C Female
0197 198 198 \993 1998 200 200 201 201
5 3 8 Year of 3 8 3 8
Diagnosis
 Breast
Recent Trends in SEERAge-AdjustedIncidence
Rates,
2000-2018
By Sex, Delay-adjusted SEER Incidence Rate, All RaceS (includes
HiS§dnic),
All Ages, All Stages

0
Female
2 Overall, flat over the last 20
0
200
0
years
2003
2015
2006 2009 2012 201
8
Year of Diagnosis
 Breas
R
t ecent Trends in SEER Age-Adjusted Incidence
Rates
2000-2018
By Race/Ethnicity, Delay-adjusted SEER Incidence Rate, Female, All
Ages, All
Stages

0 160
0 12
0

80
60 ac‹ (includes H syanic (aty
40 g span races
g Black rates now about the same as
20
whites
2012
Year of Diagnosis
more common
in
Breas
tStage Distribution of SEERlncidence Cases,
2009-
2018
By Age, Female, All Races (includes Hispanic)

5.8
%
Localize Regiona Distan Unstage
d l t d
 0|fe ese ctfaSf0 Jwfe |eS|iO§WaSec0mmenJeJb Ølac
NCCN f

Datü älS0 SrşşeS 6lact aTe

i nTS z e 0 e c0ł0 TaJ!e w0 tiny
will ÿ 0ViJe S 0ï TJe
Sãte are LsT Only aL00T“› 0t U.S. 0ñ00l0§İSTS a e 6lart.
Fi•urc 8. TrendS 1 Fcma!r Breast Cancer Beath
Rates

NHbhck
Asian/Pacific
Islander

Note Rates are per I0D.b0D and age adjusted ‘o tLe 2b0D UJ starda d
population
Sourte: NCFS 2019 Fates 'o American Indian/Alaska Na!ive are b6sed 0ñ
tbe
PRCDA(ounDe andxe3 yea:mounga eagev
 Breas
tC»ncer Risk From Birth Over Time, 2016-
2018
By RÏSk Type, Female, ÂII RaceS (includes Hispanic)

1
12.Ç/
0 0

2. 'ttps://seer.cancer.gov/explorer/
0

Risk Interval (Start Age - End

Age)
0 Bcinç DiaçrioseJ rith A Dyirig lrom
Cancer Cancer
Lung and prostate
Cancer Risk From Birth Over Time, 2016-
Bronchus Cancer Risk From Birth Over Time, 2016-
2018 2018
1
6.1 4
% 12.5
6.0
0
%
5.0
4.5
%
2. 4.
0 0
2.
0

Risk Interval (Start Age - End

Risk Interval (StaX Age - End
Age)
Age)
0 Being Diagnosed with Cancer A Dying fr0o
Cancer
hxps://seer.cancer.gov/explorer
SEER Median Age of Cancer Patients SİS Median Age of Cancer Patients at
Dİägn
ät
Death ,
2014-2018 2814-2018
By Primary Cancer Site Race and
Sex

AI 66 (M) 6 2 (M)
I (F) (F)

Colo 6 M) /o M) /ç
n oF (F)

Prostat 6/ 6ş 8i(W) 6
e B) B)
https://see .canoe .gov cs / g/§_2018 b 0Wse_cs .pŁp?sectionSEL=z&pageSEL-sect_o
_tabIe.zi
Based on the most recent data, relatlve surVlval rates
f0f
women dlagnosed Wlth breast cancer
are:
• 91P‹at5 years after Lose g people first j
diagnosis year
- 84'f after 10 Lose y people next j
years yea‹s
• 80% after IS Lose t people next j
years years
Based on the most recent data, relative survival rates Stage at
for diagnosis
Stage at diagnosis is one of the most important
women diagnosed with breast cancer are:
factors affecting prognosis. Five-year relative
• 9l$o at5 years after diagnosis survival rates for breast cancer are:
• 848c after 10
years - 99'$ for localized disease
80%ażerl5
ears - 86& for regional disease

BrertLsncerFxl &Fi ure ' 27'£ for patients diagnosed with metastatic
ż01%ż0ż0 disease”

BreastcancerSUbtype(HR/HER2)
Breast cancer survival also varies by tumor
subtype. Five-year relative survivalrates are:

- 92% for HR+/HERż-

- 898o for HR+/HERż+

- 83'S for HR-/HERż+

- 77iPo for HR-/HERż-

 Breast Cancer Prevention (PDğz^)-
Health Professional Version

Facto Compariso NUme iCa!

r n Ñsi È

1
Dense B den$e 0

east normal
1.2
1.0/Ż
Breast Feeding pe iz mos o pe
Lić 0.Ü
Exercise ronactive 0
o.şo
Teen P eçnancy nUllip olate X
preen
7able4. Facten That Increase the Relative Risk
for

Relative Fanor
risk Age(65+ versus <65 pars,»Ithovgh risk
>4.0 increases
aooss all ages until age 80)
Aqpicalhyperplaia
Lobularu«inoma
insiG
2.\- Pathogenicgeneticva
4.0 Jatiou(e.g. 8R¢éf,
gR@7, PALB2, TPS3)
Du‹tal carcinoma in
situ
Figh
endogenoushomonel
evels(ponmenogv»I)
High-doseradiation
to‹hen(e.g. Fodgfin
lymphoma
treatment)
Mammographiulydens
Alcohol
consumption
Excess body weight
Rebtiveris Facto
High endo9enouesstrogen or testosterone k r
levels (premenopausal)
Late age at fir5t full-term pregnancy(>30
year5) Late menopause (z55 years)
hever breastfed a
ch No full-term
pregnant
One first-de9‹eerelative wth breast
P
caenrsCoenraObesi
story ofmovari
ty(post an or )
enopausal
endometr cal inactvity
Proliferative breast disease without
atypia (usual dunal
hyperplasia, fibroadenoma)
Recent and long-term use of
menopausa

hormone
therapy c00taining estrogen and
progestin
Recent hormonal contracept
Weight ga n in adulthood
I height
Xow arc breast xxd ovarisacaaccr
èbcrited?
Mot(7&7J% breÆ ædoveiacxersæs/'OA4D/C - dwtoagcad
no>
.ox.
M«nple. Cxatdaoker wi1Iræstcæcer äagrosed atage 75.

A&ut U-2@/‹ fbræst adovøiæcæex øe FÆlLfAt - wlerc mdtiØe

minor
kte/act wtl!ietivir0i:i«tetitt0 iticreæ risk.0»nefic iesiin$ is w/iL'/y
la& helpfnlfor/hi‹$je offanil)'.
Manpl».’Moùer bext cancer à ô5 and siaer wi1beæ caxer g
48.
Ca»cer&sk. Some«hathi@ertlwi g#«eèI popul#iort bxmos/
«omex
roximatelv J-IP/• fbread aid oveia can¢en æ H£ÆDITÆ¥-
d«to
enbnce o amvtaæ(misbke) in a single major can¢er sus¢eptibilip gene
such

Ceneùc lesiingfor mÆhonz in BRC1I/2 imzj'& helpfiJ lo

iÆùidsals
Swd on in death from breast cancer for women who consumed a
y
Focu balanced, low-fat diet as well as daily potions of fruits, vegetables
s and gra ns
TrialType Randomized tûal ofa dietay
intervention
Patient
48,835 postmenopausai women age
on Trial 50-79
Treatmen A low-fatdietwiththe goal of20& or fewer caloriœ fromfat
t alongwîh increased consumption offruib, vegetables, andgrains
T«ted
21B lower risk of death from breast cancer in women on a
Primar
balanced, low-fat diet compared with women whose diet comprised
y
326 or more calories
Finding
tome
Secoedary
15& lower risk of death from ary cause atera breast cancer
Findings)
diagnosis in women on a Glanced, low-fat dia compared
r/ithromen whose diet comprised 326 or more calories from fat
 U.S. beventieSavic« I **e«antIa Ta6Fome

BRCA-Related ¢an‹er: Risk Assessment, Genetic Counseling, and Genetic Testing -- Women with a personal or family history of
breast, ovarian, tubal, or peritoneal cancer or an ancestry associated with 6RCA1/2 gene mutation
RECOMMENDATION

Breast Cancer: Medication Use to Reduce Risk -Women at increased risk for breast cancer aged JJ years or older
RECOMMENDATION

Breast tancer: Screening -- Women aged 60 to 74 years

RECOMMENDATION

BRCA-Related ¢an‹er: Risk Assessment, Genetic Counseling, and Genetic Women whose personal or family history or ancestry
Testing associated with potential harmful BkCA1/2 gene mutations is not

RECOMMENDATION

Breast Cancer: Medication Use to Reduce Risk - Women not at increased risk for breast cancer aged JJ
years or older
RECOMMENDATION
NÊCk CliI1i¢dl bfd4iCe ÊUidelineS in OnCOlOgÿ (NCCN
ÉUid9lifl8S*}

reas
ancer
Version 1.2021 March
24s2021

NCCN.07g
 Elementsthat inceass
•ûsk!
FamiÇ history
• Inceasing age
• EthniciÇ/ace’
• É!@8ÇI6 &Z0r6
›Inceas@ body mass index(BMI)
›AIcohoI consumpáon
› Current or prior estrogen and proguteone homone tleapy
• Reprodu4ive history
›Youngerage at menamhe
› NullipsriÇ/Lower parity
› Older age at first live binh
› Older age at menopauce
• Qher
›History oflobularcaæinoma in s•itu(LCIS);AÇpicaI hypeplasia(ducbl and lobular)
›Flatepikelial aÇpia(FŒ)'
› humberofpûor beast biopsies
ô Proc@ua doæ ÜD De inänt to diagnose cancer; niuäple biopsies(needlaexcùion)
ofthe same
lesion aæ scoed as one biopsy.
› Mammogaphic beastdensity(heterogenæusly anôor extremeÇ @næ Æasb)
› Pûorthoacic adiaûon Aerapy(RÇ 60 y ôage
 0.04

Estrogen-progeuin repIa‹zment
tberapy

Placeba

0.0
3

0.0
"

0.0
1

0.0
0

Time (yean)

No. at risk
Estiogen t 85D B39 83D 130
progestin 6 6 3 54Z 269 2
Placebo 81D BDD 789 0 6
2 * 5
Breast cancer risk and hormone replacement
therapy

Duration <t 0.99

tea‹ (0.085)

Duration 5-9
years
Duration t0-tc 304/63 1.24
years J (0.t08)
155(0.128
)

Duration zI0
years
• Healthy lifesgle
› Consider breast cancer risks associated with combinedestrogenl
progesterone therapy 1%5 year's duration of use.
› Alcoholic drinks increase the risk for breast cancer and arabest
avoided; patients who chooseto drink alcohol should limit their
consumptionto no more than one drink equivalent per day.
› Exercise'
d Be active daily; avoid being sedentary. Take part in 150••300
minutes of modsrate-intensig,physical activig per week;
exceeding thaupper limit is optimal.
r Weight control
0 Evidence suggests that maintaining a healthy body weight(2&25
BUI)
helps reduce breastcancer risk.
httDS //www.dance .gov/news-events/cancer-Arr ents-b!og/z020/b east-cance -su v‹val-exe
rise

set the minimum pLÿSlCal activity guidelinet both before diagnosis and at
the 2-year follow-up (afte t eatcent) had a reduced chance of their
cancer etvrning and a reduced rLarre of death I o+ ar cavte (not just
breatt

did not meet the guidelines before diagnosis but set them at the 2-year
follow-
up the chance of recurrence or death was reduced by ’. and -
espectively
Breast Cancer Risk Assessment
Tool
ABOUT THE
CALCULATOR
 2.7
ä

Lifetime Risk of Developing Breast

Cancer

27.9/
rigue 3.1: Breostcancerscreeningreommendationsforwomenat average
risk
hotionalComprehensiv U.S.PreventiveSewices
AmericanCancerSociet
e Task
y
CancerNetwork Force
Mammography

Every yeor (if a woman

chooses to do so) oges
40- 44
Informed decision-
Every yeor ages 45- Every yeor storting ot oge moking with o heolth
54 40, for os long os o core provider ages 40-
Every 2yeors (or every womon is in good health 49
yeor if o womon chooses
to do so) starting ot oge .. . .‘s ages 50-74
55, for as long as o
woman is in good heolth
 ?1 False-positive

6150 6150

OO
O
Development
of breast cancer
79 76 80
0 0 0 /27
22
0

40 50 60 40 S0 60 40 50
60

Years of age at beginning of tke 10 year period

 Diagnosis
45 43
0 Survival after
2

Effect of sci-
eening

Effect of treatment
regal dless of
screening

t50

100

Oveid Overti by screening

agnosis* eatmer
2\

40 50 40 50 40 50
60 60 60

Years of age at beginning of the 10-year period

NCCN Clinical Practice Guidelines in Oncology (NCCh
Guidelines°)

reas
creenic an
ancer
Version 1.2021

May 6, 2021
äğ9 ş0 ‘/th no Urpe age
lin+‹.
 Ø Top 25th
Percentile 5Oth
Percentile
| | Lowest 25th
Percentile
Year
s

1.
1.
9
0. 2
0
Increased risk:
• Lifetime risk ñ20% as defined by modeis that are iargeiy
dependent
h
on family history*' "
• Thoracic RT between the ages of 10 and 30 y

• 5-year risk of invasive breast cancer ñ1.7% in individuais

ñ35 y' (per Gail Model)
• Lobuiar neopiasia (LCiSlALh) orADh and ñ20% lifetime risk

• Pedigree suggestive of/or known genetic predisposition j

h

› Refer to a genetic counselor or other heaith professional

with
expertise and experience in cancer genetics
 Different Advice for High-Risl
W om e n
• Clinical encounter ’ "' ’ every &12 mo
bC e k

› To begin when identified as bein at increased risk, but not prior to age 21 y
› C0nSider referral to a enetic counselor r other health professional with experise and
experience in cancer genetics, if not already done
› Consider referral to a breast specialist as a o i t
• Annual screening mammogram,” conside to os nth sis
› To begin 10 years prior to when the youngest family member was diagnosed with breast
cancer, not
prior to age 30 y or age 40 whichever comes first)
• Recomme st MRI
› To begin 10 years prior to w en the youngest family member was diagnosed with breast
cancer, not
prior to age y or age 40 y (whichever comes first)
› Consider contrast-enhanced mammographybor whole breast ultrasoundbfor those who qualig
for
but cannot undergo MRI
• Consider risk reduction strategies (See hCCN Guidelines for Breast Cancer Risk Reduction)
• Breast awareness!
Table 5. Mammography (%), ¥/omen 45 and
Older,
US, 2018
Within the
Up to date’ past2
years (ñ 45 years) (50-
74yean)

45-
54
55-
64
50-
64
Race/Ethnicity
65-
Non-Hispanic White 6
74
Ñ0I1-Üif§üI1iC glüCÉ 4 7
Non-Hispanic Asian 4
American
Table 5. hammography(0/0)W, omen 45
and
US,20Older,
18
Within the
Upto date* past2
yean
(ñ 45 years) (50-24
Education
years)
/9S5 t##FI !1l§# SC#00I 6
high school diploma or 3
GED home 6 6
4 9
college/associates degree 8
College graduate 1
Health insurance status(age
sfé years) 6
4
 I NV lT/\
E
Invitae Cancer Invitae Cardio lnvitoe Genetic Health
Screen Screen Screen
t25O t250 5350
loofs ol ó genes o›socioteb with looks ót cp to 147 genes, inctvdirg old
I comnor the
corce s. ‹r¢luáing b o•otion r the Co nccr ond Co dio Sc cen›—
east aS
prottolc corcer.
 tancer \i\Without
Chemofherapy: A
* Totally OiPerent World

The L east cancer treaT+ert guidelines issued

bt the NCI J0 tears ago: che+0ïLerapy fo
aLout 95 pe rert oł pałierłs with breast cancer.
w0nen 60 to 0r older US pe bed of older women received
che+othe apy in 2012. That number fell ło 9 ne her by
łLe end of
The e are n0w at 4 g pe ed L eas carce ü
+a
SeasSet - łLree were approved just
p$ was 0n thelast tear -wi
t h cczers more
in
clirical trials arä urc c4s in initial äevel0pmenł.
 no
t

j0S /p0s
E
HER 2ITIaIfun‹tions in aboUt 2ş% of breast cancer
cases
Normal HER2- 05İtİVe CanCer
Cell cell

Normal amounts of Results in normal Too much Causes cells to grow

HčR2 tell growth and HER2 and divide too
division rapidly
HER2
Humanepidemal grovth factor receptor 2
(HED) is a protein found on the sulace There are 2tests for
of breast cells. ¥fhen amounk are high, it HER:
causes cells to grow and divide. Nomal
› Immunohlstochemlstry(IH¢)
breast cells have Uo opies of the gene measures receptors. If the IHC score
that makes HER. They also have is 3+, the cancer is HER+.
anomal number of HER on the cell
› In sltuhybrldlutlon (I6H) counts
sulace.
the number of copies of the ñ£9t
In ontrast to nomal cells, some
breast canurs have too many hER gene.
genes or receptor. Too many
HER2s is alled HER2-positive
(HER2›).
 hER2-Tarqeted
Therapies
FER2 Antib0di9\ HER2 lrhibitors HER2
Corjuqates
Herceptin LapütÏhÏb T-DMi
Perjeta Neratinib Enhefi
Tucatinib u
HER-targeted therapies
include:
» Pertuzumab (Perjeta^)
» Trastuzumab (Herceptin^)
› Trastuzumab substitutes such as
Kanjinti”, Ogivri°, Henuma°,
0ntruzan8, and Trazimera”
» Ado-trastuzumab emtansine(T-DU1)
(gig t;ye)
» Fam-trastuzumab deuXecan-
nxki (Enhertu*)
› Lapatinib(Tjkerb^)
› Neratinib (Nerlyné’)
, HED antibodies prevent growth
signals from HER from outside the
cell. They also increase the atack of
immune cells on cancer cells. These
drugs include trastuzumab (Herceptin°)
and pertuzumab (Pejeta°).
hER inhibitors stop groMh signals
from HER from rithin the cell.
Lapatinib (Tykerb°) and neratinib
(Ne#ynx*) are examples of these
drugs.
HED conjugates deliver cell-specific
chemotherapy. They atach to
HERsthen enter the cell. Once inside,
chemotherapy is
released.Adotrastuzumab emtansine
(Kadcyla^) and fam-trastuzumab
deuxtecan-nxki (Enhertu^) are included
in this class.
Combining Herceptin and Perjeta in canoe s is
HRER2 even
¥/hat is @DCf@and how is it di#erent?

ItADPLA I5the first HER2-targeted treatment of its kind. It l5made up

of two cancer-fighting agents in one drug:

• The monoclonal antibodytrastuzvmab(the same antibody in

Herceptin°)
• Achemotherapy

\Yhen you take ltADCYLA,you are getting both a HER2-targeted

treatment and a
chemotherapy, zt the same time.

• KADC/LA is thought to bring chemotherapy inside hER2+ tells and kill them
• KADCYLA is designed to cause less harm to normal cells, although it can still affect them.KADCYLA can
cause serious side
Too +ar/ g ecepto s 0n be su Carv
ow *aCe of the b east carce cell ir e
HERE
The excessive number of growth recepto s on the SUrface combine and start eleasing g owth
signalling
—n . τή- ι
-

:: .- . ι

.. '.Ψ, "

ΠΑ
Ιζ"?
Ι;Π
ί 'ι

Φ cell proliferation
Φ cell survival - ι ι γ -

η ν .| . .

Φ metastasis
 Tue tinib a HER2
Inhibitor

TrLysa words or the HER2 g 0t9in I om irs‹de UE While TFüStUZUmab words on the extraceliula
CCI part
NARGENZA is a monoclonal antibody (mAb) made up of 2 functional
regions.12

HER
The anti-HER2 fragment antigen-binding (Fab) region
2 of the antibody binds to the HER2 receptor on tumor
cells. This interaction is the source of NARGENZAs'
Feb
Region antiproliferative

The engineered fragment crystal!izabte (Ft) region of

NARtENZA h»s been distinctly engineered in 5
locations. This mediates immune effects by recruiting
the innate immune cells (natural killer [NK] cetk and
macrophages) in order to cause antibody-dependent
cellular cytotoxicity (ADCC) of the tumor cells.
Ğßrqčf\Eß . h0\•/ ič M0rl‹S

HEk2 m0!CCu!
CS ÏhC
on Łkc
0t Cal\CCr tumors
surface
C0tt5
up

for
ktlp

Cancer cells
do

or call n
out

UCIR.or
d
VJCCFO '’ åO0 Oå| OÔÛ' OTTNBCS§ Od ce
åjOSíËO';› -' ’ OJ T0 OOmUźaIaÚJDJWiJ.
MOVED- Vaccine Information for People with
1 Cancer
 Brain Cancer -
Gliomas
Guidelines for Patients Version: 202t
Translations Breast Cancer - DCIS Breast Cancer
on: 2020
Free Printed Copies
Available in the Breast
Online Cancer -
Invasive
wt/ Webinars for Patients
Breast
Cancer
Mt• Animations for on:202
0
Patients Printable

Materials Support for

Breast
Cancer -
Patients & Metastati
Caregivers c Breast
Cancer
Version:
2020

Central
Metastatic Breast
Cancer
HER2+ Metaflatic Breast Targeted Theapiesfor
¢ancer HER2+
 Know What Your Doctors

Metastatic
Know:

Breast
Cancer
ber 12, 2020
u ET

Click the play button above to view the Know What Your Doctors Know: Metastatic
Breast Cancer videos playlist or select an individual video within the playlist menu in
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