Breast

Question 1

List 6 common breast complaints and their risks of malignancy

Answer 1

1. Pain- 5%
2. Inflammation- <1%
3. Nipple discharge- 7% (less than 60 yrs) and 30% (over 60 yrs)
4. Lumpiness- 1%
5. Palpable Masses- 10% (less than 40 yrs) and 60% (over 50 yrs)
6. Gynecomastia- in men, low risk

Question 2

What are densities on mammographic screening?

Answer 2

1. Normal breast adipose tissue replaced with breast lesions.
2. Rounded= benign
3. Irregular= invasive carcinoma

Question 3

What are calcifications on mammographic screening?

Answer 3

Form on secretions, necrotic debris, or hyalinized stroma.

1. Often associated with benign lesions.
2. Malignant= small, irregular, numerous, clustered.

Question 4

What are characteristics of non-proliferative epithelial breast lesions?

Answer 4

1. Not associated with increased risk of breast cancer.
2. Cysts, fibrosis and adenosis (increased number of acini per lobule).
3. Lumpy on palpation

Question 5

What are characteristics of proliferative disease without-atypia breast lesions?

Answer 5

1. Slightly increased risk of breast cancer.
2. Epithelial hyperplasia.
3. Sclerosing adenosis.
4. Papilloma.

Question 6

What are characteristics of proliferative disease with-atypia breast lesions?

Answer 6

1. Modest increase in risk of breast cancer.
2. Atypical ductal hyperplasia.
3. Atypical lobular hyperplasia.

Question 7

What lesions are associated with the lobules and terminal ducts of the breast?

Answer 7

1. Cysts
2. Sclerosing adenosis
3. Small duct papilloma
4. Hyperplasia
5. Atypical hyperplasia
6. Carcinoma

Question 8

What lesions are associated with the large ducts of the breast?

Answer 8

1. Duct ectasia
2. Squamous metaplasia of lactiferous ducts.
3. Large duct papilloma.
4. Paget disease.

Question 9

What lesions are associated with intralobular stroma of the breast?

Answer 9

1. Fibroadenoma

2. Phyllodes tumor

Question 10

What lesions are associated with interlobular stroma of the breast?

Answer 10

1. Fat necrosis
2. Lipoma
3. Fibromatosis
4. Sarcoma

Question 11

What is gynecomastia?

Answer 11

Breast swelling in boys or men. Increase in stroma and epithelial cells of breast tissue. Stimulated by imbalance of estrogens and androgens.

Question 12

What are the age and gender risk factors for breast cancer?

Answer 12

1. Risk increases after age 30.
2. 75% of women with breast cancer are over 50 yrs old.
3. Incidence of breast cancer in men is 1% that of women.

Question 13

What are the family history risk factors for breast cancer?

Answer 13

1. Greatest risk with multiple affected first-degree relatives with early-onset breast cancer.
2. 5-10% of breast cancers occur in persons with tumor suppressor gene mutations (e.g. BRCA 1). For these people, lifetime risk greater than 90%

Question 14

What are the race and ethnicity risk factors for breast cancer?

Answer 14

1. Highest rate in women of European descent, with higher incidence of ER+ cancers.
2. Hispanic and African american women develop cancer at younger age and more likely to be aggressive

Question 15

What are the reproductive history risk factors for breast cancers?

Answer 15

1. Early age of menarche.
2. Nulliparity.
3. Absence of breastfeeding.
4. Older age at first pregnancy.

Question 16

What are the three categories of breast cancer by hormone receptors?

Answer 16

1. Estrogen receptor (ER)- most common
2. Progesterone receptor (PR)
3. Human epidermal growth factor 2 (HER2 aka ERBB2)

Question 17

What is the most common location for breast malignancies?

Answer 17

95% of breast malignancies are adenocarcinomas that first arise in the duct/lobular system.

Question 18

Describe ER positive breast cancers.

Answer 18

1. Frequency: 40-55%
2. Older age
3. Metastasis: bone (70%), visceral (25%), brain (<10%)
4. Relapse pattern: late, >10 yrs, survival with metastasis is possible

Question 19

Describe HER2 negative breast cancers.

Answer 19

1. Frequency: 10%
2. BRCA 2 mutation carriers.
3. Metastasis: bone (80%), visceral (45%), brain (10%)
4. Relapse pattern: intermediate.

Question 20

Describe HER2 positive (ER positive or negative) breast cancers.

Answer 20

1. Frequency: 20%
2. Young, non-white women, TP53 mutation carriers
3. Metastasis: Bone (70%), visceral (45%), brain (30%)
4. Relapse pattern: short <10 years, survival with mets is rare

Question 21

Describe ER negative, HER2 negative breast cancers.

Answer 21

1. Frequency: 15%
2. young women, BRCA 1 mutation, African american and hispanic women.
3. Metastasis: Bone (40%), visceral (35%), brain (25%).
4. Relapse pattern: short <5 years, survival with mets is rare

Question 22

What is Lobular carcinoma in situ (LCIS)?

Answer 22

1. Clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion.
2. Not associated with calcifications or mammographic densities.

Question 23

What is ductal carcinoma in situ (DCIS)?

Answer 23

1. Malignant clonal proliferation of epithelial cells limited to ducts and lobules by basement membrane.
2. Associated with calcifications and mammographic densities.

Question 24

What is a fibroadenoma?

Answer 24

Benign tumor containing a mixture of proliferating ductal elements (adenoma) embedded in loose fibrous tissue (fibroma).
Most common benign tumor of female breast.