273 - Breast Cancer

Question 1

In which age group do mammograms show the greatest reduction for breast cancer?

What is the recommended age to start screening?

Answer 1

Most impact in 60-69 age group

Start screening at age 40

Less consensus when to stop screening

Question 2

List the aytpical hyperplastic breast lesions (2)

What is their risk for transformation to breast cancer?

What is the treatment?

Answer 2

• Atypical ductal hyperplasia
• Atypical lobular hyperplasia

3.7-5.5x increased risk to transform to breast cancer

Excise the mass if associated with concerning calcifications

Consider chemoprevention (anti-estrogen pill) for treatment

Question 3

What are the indications for genetic testing for breast cancer?

Answer 3

In general, cancer diagnosed in a young person (<50) with extensive family hx of breast cancer (especially if family also had young age at dx) should be genetic tested

Question 4

How does hormone receptor status inform treatment of breast cancer?

Answer 4

• ER+, PR+
  
  • Treat with estrogen blocker (Tamoxifen, raloxifene)
  • Does not require chemotherapy after lumpectomy
• HER-2
  
  • Treat with HER-2 targeted therapy (Trastusumab) in addition to chemotherapy (after lumpectomy)
• Triple negative
  
  • Treat with chemotherapy after lumpectomy

Question 5

In which populations would we consider risk reducing strategies for breast cancer?

Answer 5

• Genetic predisposition
• Proliferative breast lesions
• In-situ lesions

Question 6

Who is an breast MRI for breast cancer screening recommended for?

Answer 6

Women with higher than average (>20%) lifetime risk

Question 7

What are the 2 most common biological subtypes of breast cancer?

Answer 7

Ductal

Lobular

Question 8

Answer 8

D

Lumpectomy + radiation is usually just as good as full mastectomy, and avoids complications

Question 9

List the proliferative without atypia breast lesions (4)

What is their risk for transformation to breast cancer?

Answer 9

• Usual ductal hyperplasia
• Intraductal papilloma
• Radial scar
• Simple fibroadenoma

1.5-2x increased risk to transform to breast cancer

Excision not recommended

Question 10

What is the general approach to surgery for breast cancer?

Answer 10

• Lumpectomy > radical mastectomy
  
  • Same outcomes for cancer, fewer complications
• Sentinal LN biopsy
  
  • Avoids morbidity of full axillary dissection
  • Equivalent outcomes
  • Only do axillary if the nodes are actually involved

Question 11

What is the treament approach for breast cancer?

• Early:
• Metastatic:

Answer 11

• Early: Surgery = cornerstone
  
  • ​Systemic or radiation therapy can increase chance of cure, decrease risk of recurrence
• Metastatic: Systemic therapy = cornerstone
  
  • ​Surgery or radiation can be used for palliation

Question 12

List the nonproliferative breast lesions (2)

What is their risk for transformation to breast cancer?

Answer 12

1. Simple cysts
2. Fibrocystic changes

No increased risk of breast cancer

Question 13

How does the management of ductal vs. lobular carcinoma in situ differ?

Answer 13

• Ductal
  
  • Considered premalignant
  • Requires lumpectomy +/- radiation
  • Consider chemoprevention
• Lobular
  
  • Not considered premalignant
  • Marker of increased risk
  • Consider chemoprevention