BREAST CANCER

Oleh : Farida Citra (1102014094) M. Khalil Akbar (1102014169)

Olvie Astanaini Annisa (1102014205) Siti Zulfah (1102014255)
PREFACE
Breast cancer is the most frequent cancer among women,
impacting 2.1 million women each year, and also causes the
greatest number of cancer-related deaths among women.

In 2018, it is estimated that 627,000 women died

from breast cancer – that is approximately 15% of all
cancer deaths among women.

In order to improve breast cancer outcomes and

survival, early detection is critical. There are two
early detection strategies for breast cancer: early
diagnosis and screening.
INCIDENCE
Source : Cancer Statistic. 2019
Estimated of new
cases and deaths
due to cancer in
Dharmais
Hospital in 2010-
2013
Sumber :Globocan, 2019.
INCIDENCE & MORTALITY
 INCIDENCE
60.290 new case
About 1 in 8 (12%) ofcarcinoma in situ (CIS) will be
diagnosed.

Women in the US will develop

INVASIVE breast cancer in
their lifetime.
2015 ESTIMATES for
breast cancer in the US

40,290 women will 231,840 new case of

die from breast cancer invasive breast cancer will
be diagnosed in women
Source : American Cancer Society. 2015
 Early Detection
Breast self-examination is one that is conducted at the same time each month, uses the techniques appropriately and covers
the whole area of each breast, including the lymph nodes, underarms and upper chest, from the collarbone to below the
breasts and from the armpits to the breastbone.

Source : Indonesia Cancer Care Community, 2019

 SADARI
(Breast Self Exam)
SADARI is method to develop women
awareness of breast conditions. SADARI is
done between 7-10 days after the first day
of menstruation / menstruation has
finished.

(Source : Pusat Data dan Informasi. Kanker Payudara.

Kementerian Kesehatan Republik Indonesia. 2016.)

1 2 3
Detection of breast Feel breast changes Detection of breast changes
changes in front of the when lying down while bathing
mirror

(Source : Indonesia Cancer Care Community, 2019)

 HOW TO DO SADARI
STEP 6
STEP 1
In the lying position, place the pillow under the right
shoulder. Raise your arms up. Pay attention to the right Stand up straight. Look for changes in the
breast and do three patterns of movement as before. shape and surface of the breast skin,
Using the tips of your fingers, press all parts of the breast
around the armpit.
6 1 swelling and / or changes in the nipples

STEP 5
Pinch both nipples. Pay attention if there is fluid
coming out of the nipple. Consult a doctor if 5 2
that happens.
STEP 4
Raise your left arm up, and bend your elbows so that
your left hand holds the upper part of your back. By
using the tip of the right hand finger, touch and press the
4 3
area of the breast, and examine all parts of the left
breast to the armpit area. Perform up-down movements,
circular movements and straight movements from the
edge of the breast to the nipple, and vice versa. Repeat
the same movement on your right breast
STEP 2
Lift both arms up, bend your elbows and
position your hands behind your head. push the
elbow forward and look at the breast; and push
the elbows back and look at the shape and size
of the breast.
STEP 3
Position both hands at the waist, lean your
shoulders forward so that the breasts hang, and
push both elbows forward, then tighten (contract)
your chest muscles.

( Source : P2PTM KEMENKES, 2016)

 Visual examination

• Performed with mild, moderate and strong pressure. Examination position

• With the Wedge Section, Vertical Strip and Concentric Circle
methods (using 2 or 3 fingers)
• Can be done while lying down and when standing under the
shower
• Visual inspection is done by standing in front of the mirror and
the position of both arms are relaxed beside the body, hands
raised up and against waist
(Source : Guidelines for the early detection and screening of breast cancer, 2006)
How changes that indicate
abnormalities?

Changes in breast shape and size

Palpable lump

Pain

Thickening of the skin

There are skin hollows like dimples

0
How changes that indicate
abnormalities?

Shrinkage of breast skin

Fluid from the nipple comes out

Withdrawal of the nipple

Sores on the breast that do not heal

(Source: Pusat Data dan Informasi. Kanker Payudara.

Kementerian Kesehatan Republik Indonesia. 2016.)
SADANIS (Periksa Payudara Klinis)

Women who have entered the age of 40 years - above must do SADANIS
(perikSA payuDAra kliNIS) once every year. SADANIS is a breast examination
by a doctor or health professional. SADANIS can be done in a clinic,
polyclinic, or gynecology clinic. In the SADANIS process, the doctor will
examine your breasts. If the doctor discovers something suspicious, you will
be referred for further testing (such as mammography, ultrasound, or
biopsy).

(Indonesian Cancer Care Community, 2019)

 SCREENING

USG MAMMOGRAPHY

02 03

Screening
Modalities

01
BSE and CBE
04
MRI and CT-SCAN

(Komite Penanggulangan Kanker Nasional, 2015)

 Ages 20-30 years do clinical doctor's
Women> 55 and older conduct breast examination every 3 years
mammograms every 2 years and
periodically.

Source : American
Cancer Society

Ages 40 to 44 begin clinical examinations

Ages 45 to 54 conduct regular every 1 year and begin mammography
mammography checks every year. examinations

In women <40 years of age with a family history of breast cancer and high risk factors, screening can begin early. For those
with high risk, mammography and MRI are carried out every year
 BREAST USG Taller and wider

Has the advantage to detecting

cystic mass.

Hyperechoic edge appearance

Uneven surface
Ultrasound
appearance on a
lump suspected
malignant, including:

Echo interna
Vascularization heterogen
(Komite Penanggulangan Kanker Nasional, 2015) increases
 MAMMOGRAPHY

Mammography is imaging using X-rays on compressed breast

tissue. Mamogram is an image of a mammography.
Mammography can aim at breast cancer screening, diagnosis of
breast cancer.

(American Cancer Society, 2017)

Mammography Examination should be done on days 7-10 from

the first day of menstruation; at this time will reduce the
discomfort in women when compressed and will give optimal
results.

(Komite Penanggulangan Kanker Nasional, 2015)

MRI and CT-SCAN

Although in some cases MRI is better than mammography,

it is generally not used as a screening test because it is
expensive and requires a long examination time. However
MRI can be considered in young women with dense breasts
or in breast implants, considered by patients at high risk for
breast cancer

(American Cancer Society, 2017)

(Komite Penanggulangan Kanker Nasional, 2015)

 PREVENTION
Get rid of cigarette Calorie balanced Manage stress
smoke and healthy diet

C E R D I K

Check health regularly Do physical Adequate rest

activity

Kementerian Kesehatan RI, 2016

 REFERENCE
• American Cancer Society. 2015. Breast and Cancer Facts & Figures 2015-2016. Atlanta : American Cancer Society.
• American Cancer Society. 2017. Recommendations for the Early Detection of Breast Cancer. Available at:
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-
the-early-detection-of-breast-cancer.html/. (Accessed 22 August 2019)
• Indonesia Cancer Care Community. 2019. Deteksi Dini Kanker Payudara. Available at: https://iccc.id/deteksi-dini/. (Accessed 22 August
2019)
• Kementerian Kesehatan RI. 2016. Enam Langkah SADARI untuk Deteksi Dini Kanker Payudara. Available at:
http://www.p2ptm.kemkes.go.id/artikel-sehat/enam-langkah-sadari-untuk-deteksi-dini-kanker-payudara. (Accessed 22 August 2019)
• Kementerian Kesehatan RI. 2016. Pusat Data dan Informasi Kanker Payudara (INFODATIN). Kementerian Kesehatan Republik
Indonesia.
• Komite Nasional Penanggulangan Kanker (KPKN). 2015. Panduan Nasional Penanganan Kanker Payudara. Kementrian Kesehatan
Republik Indonesia
• Oussama M.N. Khatib. 2006. Guidelines For The Early Detection And Screening Of Breast Cancer. World Health Organization : EMRO
Technical Publications Series 30.
• The Global Cancer Observatory. 2019. Breast. Pada https://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf.
(Accessed 24 August 2019)
• WHO. 2019. Breast Cancer. Available at: https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/. (Accessed
22 August 2019)