Breast Flashcards
What is the appropriate initial follow-up evaluation of a 47-year-old female with underwent surgical excision for LCIS?
A) Annual screening mammogram
B) Annual diagnostic mammogram
C) Bi-annual screening mammogram
D) Bi-annual diagnostic mammogram
A) Annual screening mammogram
NCCN recommend women with a history of LCIS under annual screening mammograms beginning at diagnosis of LCIS, but not prior to age 30, in addition to clinical encounters and breast awareness.
in the EORTC 10981-22023 AMAROS trial, what were the 5-year-rates of clinical signs of lymphedema with axillary dissection vs. axillary RT?
A) 5% vs. 3%
B) 23% vs. 11%
C) 13% vs. 22%
D) 14% vs. 11%
B) 23% vs 11%
Clinical lymphedema was noted significantly more often after ALND than after axillary RT at 1, 3 and 5 years.
Per the SSO-ASTRO-ASCO consensus guidelines, what is the recommend surgical margin for patients with DCIS treated with breast-conserving surgery and whole-breast RT.
A) No ink on DCIS
B) 2 mm
C) 3 mm
D) 5 mm
B) 2 mm
Minimized the risk of IBTR compared with smaller negative margins, and more widely clear margins do not significantly decrease IBTR compared with 2 mm margins
What is the rate of supraclavicular recurrence in women with N1 breast cancer treated without nodal RT?
A) <3%
B) 4-6%
C) 7-8%
D) 9-10%
A) <3%
Both EORTC 22922 and NCIC MA 20 demonstrated low rates of failure in the supraclavicular region in patient not receiving nodal radiation 2% and <1% respectively
A 45-year-old woman undergoes wide local excision for a 3 cm, grade 3, invasive lobular carcinoma. On final pathology, the sentinel node is negative, and a single margin is close at < 1 mm. Which is the MOST appropriate next step in local management?
A) Re-excision of the close margin prior to RT
B) Accelerated partial breast RT
C) Whole breast RT using conventional fractionation
D) Hypo-fractionated whole breast RT with a boost
D) Hypo-fractionated whole breast RT with a boost
Hypofrac whole breast radiation therapy is SOC for women undergoing RT to the breast, and boost is indicated based on age, grade, and narrow margin. No tumor on ink, resection not indicated. Age, lobular histology, size, and margin status are not suitable for accelerated partial breast radiation.
What is the lifetime risk of tubo-ovarian cancer in a woman who carries a pathogenic BRCA1 mutation?
A) < 10%
B) 11-30%
C) 31-70%
D) >70%
C) 31-70%
BRCA1 carriers have a higher cumulative risk of ovarian cancer than BRCA2 carriers. BRCA1 lifetime risk is best represented by the 31-70% category, though there is some variation with published series.
Following breast-conserving surgery, the use of the 21 gene recurrence score assay to guide decision making about adjuvant chemotherapy is validated in which of the following scenarios?
A. T2N0 ER+ PR+ HER2+
B. T1bN2 ER+ PR+ HER2-
C. T2N0 ER+ PR+ HER2-
D. T1cN0 ER- PR- HER2-
C) T2N0 ER+ PR+ HER2-
The 21 gene recurrence score is validated for hormone receptor positive, HER2 negative, node negative breast cancer. These patients derive significant benefit from chemo if score is high. For RxPonder trial early results indicated chemo can safely be omitted for post-menopausal women with N1a disease and 21 gene RS = 25.
A patient with a 2.5 cm cN0 breast cancer is determined to have a 2 mm deposit of tumor in a sentinel lymph node biopsy performed at breast conserving surgery. What outcome(s) is/are associated with completion axillary LND?
A. Increases the risk of lymphedema without reducing axillary recurrence
B. Reduces axillary recurrence, but does not improve OS
C. Increases the risk of lymphedema and reduces axillary recurrence
D. Would detect additional positive nodes in < 5% of women
A. Increases the risk of lymphedema without reducing axillary recurrence
Both IBSCG 23-01 and ACOSOG Z-11 trial demonstrate increased risk of lymphedema with no difference in ax recurrence for women with clinically node negative breast cancer with 1-2 positive node of SLNB. 13-27% had additional positive nodes at time of ALND. More ax symptoms including lymphedema were noted in both trials in ALND groups.
A 50 year-old patient presents with breast cancer involving axillary and infraclavicular lymph nodes and exhibits a pCR at mastectomy and sentinel node biopsy following neo-adjuvant chemotherapy. What is the current standard of care for adjuvant RT?
A. No adjuvant RT is indicated for a pathologic complete response
B. Adjuvant RT to the chest wall and regional nodes
C. Adjuvant RT directed only to the undissected level 3 node
D. Adjuvant RT directed only to the chest wall
B. Adjuvant RT to the chest wall and regional nodes
With initial level 1 and 3 LN involvement, cN3b and anatomic stage group is III. In this group, even in the setting of pCR, there is an overall advantage to radiation therapy. Women with cN1 and pN0 may be candidates for clinical trial NASBP B-51 for de-escalation of RT. Standard PMRT fields would include the regional lymphatics as well as the chest wall.
In the setting of an in-breast recurrence, a second lumpectomy and partial breast RT results in which of the following at 5-years based on RTOG 1014?
A. < 10% rate of local recurrence
B. 25% rate of late grade 3 breast shrinkage and pain
C. Increased regional recurrence compared to mastectomy
D. Decreased OS compared to mastectomy
A. < 10% rate of local recurrence
RTOG 1014 was a single-arm prospective trial and the rate of late grade 3 adverse events was only 7%. The rate of local recurrence was low at exactly 5% at 5 years. There was no comparison to mastectomy in this trial.
Which shorter breast RT regimen is supported by a RCT showing equivalence or non-inferiority in local control to the comparative standard arm with at least 5 years of follow-up?
A. 26 Gy in 5 Fx whole breast RT every day
B. 38.5 Gy in 5 Fx whole breast RT once a week
C. 35 Gy in 5 Fx partial breast RT every other day
D. 38.5 Gy in 10 Fx partial breast RT twice a day
A. 26 Gy in 5 Fx whole breast RT every day
UK FAST-Forward trial, 26 Gy in 5 fx to whole breast daily. Equivalent breast control. UK FAST trial 28.5 Gy in 5 fx to whole breast once per week. Florence trial 30 Gy in 5 fx partial breast RT every other day. NSABP B-39 38.5 Gy in 10 fx BID but did not reach equivalence in local control. Shorter regimens have been found to be both safe and effective on large randomized trial with at least 5 years of follow-up.
Which patient would gain the greatest benefit in local control from RT?
A. 0.9 cm grade 3 DCIS s/p lumpectomy with negative margin
B. 1.8 cm grade 2 DCIS s/p lumpectomy with negative margin
C. 7 cm DCIS s/p mastectomy with negative margins
D. 4.5 cm DCIS s/p mastectomy with a positive margin
A. 0.9 cm grade 3 DCIS s/p lumpectomy with negative margin
ECOG E5194 demonstrated grade 3 DCIS has local recurrence rate as high as 25%, even for small tumors. PMRT for DCIS is not recommended due to < 10% recurrence benefit, even for close or positive margins.
What were the 5-year local control results for the 1-week regimens of the FAST-Forward phase III RCT as compared to 3-week hypofractionated breast RT?
A. Increased ipsilateral breast tumor relapse
B. Increased locoregional relapse
C. Non-inferior ipsilateral breast tumor relapse
D. Non-inferior ipsilateral breast tumor relapse but increased locoregional relapse
C. Non-inferior ipsilateral breast tumor relapse
UK FAST-Forward trial compared 40 Gy in 15 fx to 27 Gy in 5 fx and 26 in 5 fx over 1 week. Non-inferior IBTR was demonstrated in the 1 weeks course. 27 Gy had more normal tissue effects than the 26 Gy course.
Which clinical finding is characteristic of locally advanced breast cancer?
A. Bloody nipple discharge
B. Mobile axillary lymph nodes
C. Nipple retraction
D. Palpable supraclavicular node
D. Palpable supraclavicular node
Typically LABC refers to patients with stage III unresectable breast cancer at presentation. Presence of supraclavicular adenopathy is cN3 disease, anatomic stage IIIC. Presence of bloody nipple discharge, mobile axillary lymph nodes (cN1), and nipple retraction can be seen in early stage breast cancer and do not necessarily preclude upfront resection.
Which is considered a high-penetrance breast cancer susceptibility gene?
A. APC
B. MSH2
C. PALB2
D. RET
C. PALB2
High-penetrance breast and/or ovarian cancer susceptibility genes include: BRCA1, BRCA2, CDH1, PALB2, PTEN, and TP53.
APC is associated with familial adenomatous polyposis; MSH2 is associated with Lynch syndrome, RET is associated with multiple endocrine neoplasia type 2(MEN2).
