Breast Flashcards
Van Nuys prognostic index
Scoring system for recommended post-operative treatment of breast cancer
- Takes into account tumour size, tumour free margins, pathological classification (grad eand presence of necrosis) and age. Each has a score of 1-3
- Low score 4-6: excision alone sufficient
- Middle score 7-9: excision + radiotherapy
- High score 10-12: Reccomend mastectomy
Risk of malignancy in benign breast lesions
Non-proliferative (fibrocystic changes) - No increased risk of cancer
- Duct ectasia
- Cysts
- Mild hyperplasia
- Adenosis
- Fibroadenoma without complex features
Proliferative disease without atypia - 5% risk
- Papilloma
- Radial Scar
- moderate or florid hyperplasia
- Sclerosing adenosis
- Fibroadenoma with complex features
Proliferative disease with atypia 25-30% risk
- ADH / low grade DCIS
- Lobular neoplasia
- Low grade DCIS
Familial breast cancer syndromes
BRCA1 - chromosome 17 75%
BRCA2 - crhomosome 13 65%
Li-Fraumeni (p53) 85%
CDH1 40%
Cowden disease (PTEN) 30%
Peutz Jegher (STK11) 30%
PALB2 45%
Indications for breast cancer genetics referral
Known high risk mutation (BRCA, Li-Fraumeni, PALB2, CDH1, Cowden, Peutz Jegher)
High risk family history: 2 on same side of family as well as one or more of:
- hx of breast or ovarian Ca
- Breast cancer < 40 years
- bilateral breast CA
- Male breast Ca
- Ashkenazi Jewish ancestry
BRCA mutations
Tumour suppressor genes
Autosomal dominant condition
BRCA1 - chromosome 17
- 75% breast Ca (70% TN)
- 50% ovarian Ca
Recommend mastectomy <40 yrs + BSO by age 35-40
BRCA2 - crhomosome 13
- 70% breast Ca (75% ER +ve)
- 11% Breast Ca in males
- 20% ovarian Ca
- 30% prostate Ca
Recommend mastectomy < 40 yrs + BSO by age 40-45. Can give tamoxifen.
High risk breast cancer
2 first or second degree members on the same side of the family + one of:
- Breast Ca < 40
- Bilateral breast ca
- Breast and ovarian cancer
- Male breast cancer
- Ashkenazi Jewish ancestry
