All things breasty Flashcards
What does TFF3 predict?
Independently predicts response to endocrine therapy regardless of ER positivity
NPI components?
LN status, tumour size, grade
Is being ER positive good?
Yes - it carries a good prognosis
Percentage of breast cancer caused by genetics?
25% familial; 5% is due to dominant, high risk mutations e.g. BRCA1/2, TP53.
Advantages of breast conserving surgery?
Better cosmesis, reduced psychiatric morbidity, good if single lesion and small tumour-to-breast ratio
When is BCS contraindicated?
When unable to have radiotherapy to the breast (pregnant, Li-Fraumeni) (see 1985 EBCTCG guidance) or when large-tumour-to-breast ratio. Also, if too diffuse then may need mastectomy. Serious connective tissue disease such as scleroderma is also contraindicated because of sensitivity to radiotherapy
BRCA and receptor expression?
BRCA1 associated with TNBC; BRCA2 is more likely to be ER positive.
Prevention of breast cancer in high risk patients?
- Chemoprevention using tamoxifen or raloxifene is a viable option, unless patients have a particularly high risk of VTE or endometrial cancer.
BRCA screening?
30-49 annual MRI; 40-69 annual mammography.
Surveillance for TP53 mutations?
Annual MRI from 20-49. Consider through to 69 but risk is lower. Do not offer mammography because of sensitvity to ionising radiation.
Risk reducing surgery?
Offered to BRCA patients. Predicted 90-95% RRR but no proven survival benefit. Bilateral salpingo-oopherectomy also offered once childbearing is complete!
Benefit and problems of neoadjuvant therapy?
May get more drugs, convert AxCL to SLNB, downstage, more BCS, good for trials! Problem is may progress and may increase LRR 2018 study.
Neoadjuvant chemotherapy?
Consider in younger, TNBC. Definitely better then neoadjuvant endocrine therapy in premenopausal. USe platinum based and an anthracycline
Margins in breast surgery?
If <1mm, then positive (after BCS); discuss re-excision or mastectomy
Who gets axilla radiotherapy?
1-4 nodes and high risk, or 4+ nodes.
