Breast Flashcards
What is included in breast triple assessment
Clinical assessment
Imaging
Biopsy
How is each aspect of the breast triple assessment scored
1 - normal 2 - benign 3 - intermediate/probably benign 4 - suspicious 5 - malignant
What is the main risk factor for breast cancer other than being female
Age
What is the lifetime risk for developing breast cancer
1 in 8
Factors that lower the risk of developing breast cancer
Increasing parity
Earlier age at first birth
Longer duration of breastfeeding
Factors that increase the risk of breast cancer
Early menarche HRT use Smoking Alcohol Nulliparity Obesity Radiation FH Dense breasts
Letters used in assessment for breast cancer
P - palpation M - mammogram U - USS B - biopsy (core biopsy) C - cytology (FNAC)
What is Pagets disease of the nipple
Eczema like changes that begin in the nipple then spread out to the areola. Red, itchy, scaly, burning.
It is a signs of breast cancer in the tissue behind the nipple
What are the two views taken in mammography
MLO - mediolateral oblique
CC - craniocaudal
What is the age where you would use USS rather than mammography and why
<40 because breasts are more dense (fibroglandular > fat)
What is the name of the ligaments you can see on mammograms
Coopers ligaments
What are the two ways you can obtain a breast biopsy
FNAC
Core biopsy
What are the subtype of breast cancer B5
5a - non-invasive
5b - invasive
What information can core biopsy of the breast provide than FNAC can’t
Whether it is invasive or not
Receptor status
Anatomical margins of the breast
2nd - 6th rib
Lateral edge of sternum
Mid-axillary line
Axillary tail extends up into the axilla
What are the 3 levels of axillary lymph nodes
Level 1 - nodes inferior to pect minor
Level 2 - nodes behind pec minor
Level 3 - nodes above pec minor
Skin tethering Vs skin fixation
Skin tethering means that the lump is attached to the skin, but can be moved in an arc without moving the skin. If the lump is pulled outside the arc, the skin indents. Skin fixation is where the lump cannot be moved without moving the skin.
Most breast cancers occur in which part of the breast
Upper outer quadrant
When would you perform sentinal node biopsy rather than axillary node clearance
If imaging and FNAC/Biopsy of the node is normal then do SNB, whereas if either were abnormal then you do clearance
ER positive breast cancers should be treated with which agent
Tamoxifen (anti-estrogen)
HER2 positive breast cancers should be treated with which agent
Herceptin (Trastuzumab - anti-HER2)
What are the two most common types of breast cancer
Invasive ductal carinoma
Invasive lobular carcinoma
What is the goal of adjuvant chemotherapy in breast cancer
To eradicate micrometastatic disease
Triple negative breast cancer is negative for which receptors
ER
PR
HER2
What tool can be used to estimate breast cancer survival and estimate the benefits of hormone therapy/chemotherapy
PREDICT tool
What drug is Herceptin
Trastuzumab
What are the two main classifications of breast pain
Cyclical
Non-cyclical
What antibiotic is used to treat infectious lactational mastitis or breast abscess
Flucloxacillin
If a woman presents with mastitis or breast abscess who isn’t breast feeding what should you think of
Inflammatory breast cancer
If you can feel what you think is a fibroadenoma what P score would that be
P2
What age group with suspected fibroadenomas will need biopsy as well to complete the triple assessment
Age >25
What does popcorn calcification on mammography represent
Multiple calcified fibroadenomas in post menopausal women
Most common benign breast lump in a woman >50
Cyst
Microcalcifications on mammogram can indicate what
Ductal carcinoma in situ
Previous trauma/surgery
Can be seen in association with cysts/fibroadenomas
Follow up for women after DCIS breast cancer treatment
Annual clinic appointments
Annual mammogram for 5 years
FH referral criteria for breast cancer
- one first-degree female relative diagnosed with breast cancer at younger than age 40 years or
- one first-degree male relative diagnosed with breast cancer at any age or
- one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years or
- two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age or
- one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative) or
- three first-degree or second-degree relatives diagnosed with breast cancer at any age
What are the two genes most commonly mutated in cases of familial breast cancer
BRCA1 and BRCA2
What are diagnostic and predictive testing in relation to genetic breast cancer screening
Diagnostic testing is where somebody affected has genetic testing to pin point a cause
Predictive testing is where relative then have their genes tested for the defect found
Siblings of a BRCA1 carrier have what % chance of also being a carrier
50%
When is breast cancer screening offered
Age 50 - 71 every 3 years
In extension areas age 47-73
