Background information

Question 1

Screening

Answer 1

Recommended for all women 40+ with annual mammogram

Consider BRCA1/2 testing if strong family history

Question 2

Risk Factors

Answer 2

Personal hx of breast CA or DCIS
BRCA1/2
TP53
Family hx
Older age at 1st live birth
Nulliparity
Early menarche
Age
Female
BMI
Race
Hormonal therapy
Alcohol
Smoking
Physical inactivity

Question 3

Consider risk reduction if:

Answer 3

History of LCIS
5 yr Gail Risk >/= 1.7%
>20% Lifetime risk 
Genetic predisposition
Known gene mutation
Hx of thoracic XRT <30 yo
Life expectancy 10+ years

Question 4

Risk reduction strategies

Answer 4

Prophylactic mastectomies
Bilateral oophorectomy
Start screening at age 25
Premenopausal: tamoxifen
Postmenopausal: aromatase inhibitors or tamoxifen
Drugs effective only for preventing ER+ breast cancer.
Tamoxifen ineffective for BRCA mutation.

Question 5

Incidence and mortality

Answer 5

Most common cancer in women

Second leading cause of cancer-related death in women

Question 6

Pathology

Answer 6

80% adenocarcinoma

Question 7

Common metastatic sites

Answer 7

Skin
Brain
Bone
Liver 
Lung
Lymph nodes

Question 8

Adjuvant therapy candidates

Answer 8

Tumor >1 cm, yes

Tumor 0.6-1 cm, consider if high risk

Question 9

Neoadjuvant therapy candidates

Answer 9

Patients who meet all criteria except their tumor is too big

Question 10

Oncotype DX

Answer 10

<18 low risk hormone therapy
18-30 moderate risk
31+ high risk chemo +hormone therapy
Used to predict risk of recurrence or death in ER/PR+ invasive breast cancer (N-, HER2-)

Question 11

Diagnosis

Answer 11

H & P 
Mammogram +/- ultrasound
Biopsy (Fine-needle most common)
CBC, CMP
ER//PR status (older, slower growing)
HER2 status (younger, faster growing)