Breast Flashcards
What is the epidemiology of breast cancer?
- Most common malignancy in women (1 in 8)
- Second most common cancer death after lung
- In top 20 for men
What are the risk factors for breast cancer?
THINK ABOUT OESTROGEN EXPOSURE
Female gender
Age
Family history
Personal history of breast cancer
Genetic predispositions (e.g. BRCA 1, BRCA 2)
Early menarche and late menopause
Nulliparity
Increased age of first pregnancy
Multiparity (risk increased in period after birth, then protective later in life)
Combined oral contraceptive
Hormone replacement therapy
White ethnicity
Exposure to radiation
Obesity
What type of HRT increases the risk of breast cancer?
Combined!!!!!
COCP also raises risk but risk back to normal after 10 years of stopping
What are the BRCA mutations and what do they increase the risk of?
BRCA 1: mutation on chromosome 17 that predisposes patients to breast cancer, risk of 65-80% (compared to a baseline of around 12%) whilst the risk of ovarian cancer is 40-45% (compared to a baseline of around 1.3%).
BRCA 2: mutation on chromosome 13 that predisposes patients to breast cancer, risk of breast cancer is approximately 45-70% whilst the risk of ovarian cancer is 11-25%.
Also known to increase the risk of peritoneal, endometrial, fallopian, pancreatic and prostate cancer.
What type of genes are BRCA1 and 2 and what are some other genes that predispose to breast cancer?
Tumour suppressor genes
TP53 and PTEN genes
What is special type vs non-special type breast cancer?
Non-special type = invasive ductal carcinoma
Special type = any lobular carcinomas, any ductal carcinoma in situ and others
What is Paget’s disease of the nipple?
Paget’s Disease of the Nipple:
- Looks like eczema of the nipple/areolar
- Erythematous, scaly rash
- Indicates breast cancer involving the nipple
- May represent DCIS or invasive breast cancer
- Requires biopsy, staging and treatment
What is inflammatory breast cancer?
Inflammatory Breast Cancer:
- 1-3% of breast cancers
- Cancer cells block lymphatic drainage so inflamed & swollen breast
- Presents similarly to a breast abscess or mastitis
- Swollen, warm, tender breast with pitting skin (peau d’orange)
- Does not respond to antibiotics
- Worse prognosis than other breast cancers
Who in England is invited for breast cancer screening?
Women and trans-men/women aged 47-73 every 3 years (50-70 in the past)
May be invited younger if family history
What are the pros and cons of breast cancer screening?
Pros:
- Early detection of cancers
- Approximately 20% reduction in relative risk of death from breast cancer
- Can provide peace-of-mind for some patients
Cons:
- Painful and undignified
- Not 100% sensitive (i.e. false negatives)
- Over treatment
- False positive results can be emotionally distressing for patients
- Exposure to radiation, with a very small risk of causing breast cancer
How may breast cancer present?
- Asymptomatic: picked up on screening
- Pain
- Axilla or breast lump
- Changes to skin on breast
- Changes to nipples: inversion, discharge
- Lymphadenopathy
- Metastatic complications: bone pain, headaches, seizures, SOB, jaundice etc
What patients are classed as being at ‘high-risk’ of breast cancer and need to be offered earlier screening?
- A first-degree relative with breast cancer under 40 years
- A first-degree male relative with breast cancer
- A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
- Two first-degree relatives with breast cancer
What is the referral criteria for a 2 week wait for breast cancer?
> 30 with unexplained breast lump with or without pain or
> 50 with any of the following symptoms in one nipple only:
Discharge
Retraction
Other changes of concern
With skin changes that suggest breast cancer
> 30 with an unexplained lump in the axilla
What is the criteria for a non-urgent referral for breast changes?
Under 30 with unexplained breast lump with or without pain
What are the main sites of metastases for breast cancer?
(LLBB)
Lung
Liver
Bone
Brain
