Breast Flashcards

Question

Who gets population breast cancer screening in Australia?

Answer 1

- Biennial screening age 50-74yo - 40-49yrs at request - asymptomatic Mammo sensitivity 80%, specificity 90%

Answer 2

CONDITION - important health problem - natural history understood - recognisable latent/early symptomatic phase TEST - suitable test with: -high sensitivity and specificity -validated -safe TREATMENT - accepted treatment for pts with disease - treatment effective, available and accessible SCREENING PROGRAMME - agreed policy on who to treat - facilities for diagnosis and treatment - economically balanced in relation to health budget expenditure - case findings should be a continuous process POPULATION SCREENING - test offered systematically to all individuals in the defined target group within a framework of agreed policy, protocols, quality management, monitoring and evaluation

Answer 3

**4 RR** - Female sex >50years - carrier of known genetic mutation associated with BC - history of previous breast cancer or DCIS Other risk factors: **2-4 RR** - FHx BC/ovarian - Hx other proliferative breast pathology **1.25-2 RR** - lifetime oestrogen exposure (early menarche, late menopause, nulliparity; OCP or HRT) - body size and lifestyle (post-menopausal obesity, ETOH >3 drinks/day) -Other medical history (other ca including ovary, thyroid, endometrium, colon; high dose radiation esp <20yrs, in utero diethylstilbestrol exposure)

Answer 4

**BRCA 1 and 2** - TSG - Autosomal dominant - Breast, ovarian, prostate, pancreas Breast - BRCA1 55-70% BRCA2 45-70% Ovarian BRCA1 40% BRCA2 15% Prostate BRCA1 20% BRCA2 40% Pancreatic BRCA1 2-4% BRCA2 5% BRCA1 - younger, 'medullary-like", high-grade, ER/PR-ve **Li Fraumeni** - TP53 - Breast, bone/soft tissue sarcoma, CNS tumour, adrenal cortex - 50% lifetime risk - high rate HER2+ve Risk ++ with radiation **Cowden Dx** - PTEN - multiple hamartomas, breast, thyroid, endometrial - 50% risk **Peutz-jeghers** -STK11 - CRC, gastric, SB, pancreatic, biliary, GB, oesophagus, ovaries, cervix, Sertoli cell - CRC 40% - gastric 30% - SB 10% - pancreatic 10-25% **Hereditart diffuse gastric cancer syndrome** - CDH1 - loss of e-cadherin - 50-60% risk **LOBULAR** BC **PALB2** - 45% risk BC **CHECK2** - Li Fraumeni variant - 30% risk **ATM** - 30% risk

Answer 5

Early breast cancer - T1/2, N0/N1, no Mets Locally-advanced - T3/4 or N2/3, M0 Advanced - metastatic disease

Answer 6

**T** Tis- carcinoma in situ Tis (DCIS) Tis (Pagets) T1 - <2cm T2 - 2-5cm T3 - >5cm T4 - involving chest wall/skin (ulceration/nodules) T4a chest wall T4b ulceration, peau d’orange, ipislateral nodules T4c both T4a and b T4d inflammatory (dermal lymphatic invasion) **N - clinical** N1 - mobile level 1/2 N2 - matted/fixed level 1/2 or IM LN N3 - supraclavicular/infraclavicular **N -pathological** N1 - micromets or 1-3 axillary LN N2 - 4-9 LN N3 - >10 LN **M** Cervical or contralateral axillary LN Distant Mets

Answer 7

Lesion taller than wide Irregular/poorly defined margin Invasion of tissue planes Hypoechoic Microlobulation Internal calcification Posterior acoustic shadowing Internal vascularity LN suspicious features: Thickened cortex Eccentric rounded node Loss of cortico-medullary differentiation

Answer 8

For locally advanced CT chest and abdo CT brain Bone scan FDG-PET LA = T3/4 or N2/3 T3 >5cm T4 chest wall/skin/inflammatory