Breast CA Flashcards
Breast CA is the ___ most common CA in women and the ___ leading cause of CA death in women
2nd
2nd
___% of women dx with breast CA have no identifiable risk factors
70%
5-year survival is ___% for localized dz (Stage 0 or 1)
5-year survival only ___% once it has spread to other organs (Stage 4)
100%
20%
What are unalterable RF for developing breast CA? (FYI)
age FHx race DES (medication) Radiation Genetic Factors menstrual hx reproductive hx
What are controllable factors for breast CA (FYI)
obesity/diet exercise no breast feeding alcohol hormone replacement therapy BC reproductive hx
What is the “most important” RF for breast CA?
age
Gail-NCI Model is a risk calculator for what?
breast CA
__-___% of Breast CA related to inherited factors (BRCA1/2)
5-10%
What are RF associated w/ BRCA mutations?
multiple cases of early onset breast CA ovarian ca with FHx of breast CA Ovarian and breast CA in the same woman b/l breast CA Ashkenazi jewish jeritgae male breast ca
What is the risk of breast CA in women w/ BRCA-1?
50-85%
2nd primary breast CA (40-60%)
ovarian CA 15-45%
What other CA are associated w/ BRCA 1?
prostate
colon
What are examples of breast CA prevention?
Clinical Breast Examination
Screening mammography
Chemoprevention
Surgical prophylaxis
When should a woman perform her self breast exam if premenopausal?
7-8 days post menses
__% of breast masses found by pt! (most non-malignant)
90%
___ is a woman’s awareness of the normal appearance and feel of their breasts
Breast Self Awareness
When should clinical breast examinations begin?
Age 20-39 every 1-3 years
Age 40 and older annually
When is screening mammography recommended?
Annually >40 y/o
Or 10 years prior to youngest relative age at dx
Recommendations >75—studies inconclusive
If BCA positive
Monthly breast self-examinations should begin at ____ y/o
Semiannual clinical breast examination beginning at ____ y/o
Annual mammography and breast MRI beginning at ____ y/o or earlier depending on FHx
18 y/o
25 y/o
25 y/o
T/F: Mammograms do not save lives
F, duh.
T/F: Women w/ breast implants should not have a mammogram because the implant may pop
F (but MRI is usually gold standard)
What medications are used for chemo-prevention of breast CA? (x3)
tamoxifen
Raloxifene
Aromatase Inhibitors
Using tamoxifen can reduce invasive breast CA up to ___%
50%
What are the risks and side effects of using tamoxifen?
increased endometrial CA and DVT cataracts depression vasomotor symptoms vaginal dryness/discharge
What are the side effects of raloxifene?
less ute CA
TE events
cataracts
improved bone density
What is raloxifene FDA approved for?
prevention of osteoporosis
What are the side effects of Aromatase Inhibitors?
osteoporosis
vasomotor sx
joint pain
depression
What are surgical prophylaxis options of breast CA?
Prophylactic mastectomy
Prophylactic bilateral salpingo-oophorectomy (BSO)
**need Genetic testing of high risk women
___% presenting complaint in breast CA is painless breast lump
___% breast masses found by pt on SBE
___ is location of ~60% of breast CA
70%
90%
UOQ
What is included in the CLINICAL exam of breast CA?
inspection
palpation (breast and lymph noses)
What are s/s of breast CA?
- painless lump or thickening in breast
- d/c or bleeding
- change in size or contour of breast
- change in color or appearance of areola
- redness or pitting of skin over the breast
What is the most common s/s of breast CA?
Painless lump or thickening in breast
What imaging studies do you use in the work up of breast CA?
mammogram
US
(MRI)
____ is performed by compression aided radiographic study of the breast.
It is the most reliable means to detect breast CA before _______ is present
Mammography
palpable mass
Slow growing tumors can be identified __ or more years before palpable w/ a mammogram
2
T/F: A palpable mass needs biopsy regardless if it is seen on mammogram or not
T
What are the different types of mammography?
Digital mammography
Computer assisted detection (CAD)
3-D mammography (tomosynthesis)
What are characteristic findings of breast CA on mammography?
calcifications
masses
ill-defined
What does BI-RADS stand for? Why is it used?
Breast Imaging Reporting and Data System
Standard way to describe mammogram findings and results
Also describes breast density
What is the grading system of BI-RADS?
0-6 (inconclusive to obvious malignancy)
T/F: The probability of CA is not directly related to BI-RADS assessment
F: Probability of CA IS directly related to BI-RADS assessment
What characteristic of a breast tissue can make is more difficult to detect breast CA?
More glandular tissue, less fat
**CA can be hidden
What is the main purpose of using breast US?
differentiating cystic from solid mass
US guided aspiration of cyst
How do you evaluate the pathology of breast CA?
FNAC (fine needle aspiration cytology)
Biopsy: Excisional, Core Bx
What are examples of different breast CAs?
Ductal Carcinoma in situ (DCIS)
Invasive Ductal Carcinoma (IDC )
Invasive Lobular Carcinoma (ILC)
What are characteristics of invasive breast CA?
CA cells invade blood vessels
CA cells invade lymph duct
What is the TNM system used for? What does it stand for?
Breast CA staging
T=tumor
N=regional lymph nodes
M=distant metastases
Describe stage 0-4 breast CA (FYI?)
Stage 0 –carcinoma in situ
Stage I – tumor < 2 cm, no nodes
Stage II—tumor 2-5 cm, +/- nodes*
Stage III – locally advanced disease, fixed or matted lymph nodes and variable tumor size**
Stage IV – distant metastases (bone, liver, lung, brain)
What factors are considered when establishing a prognostic value for a woman w/ breast CA?
Age/menopause status Tumor sz histological grade histological tumor type axillary lymph node involvement Distant mets Steroid receptors status
What is the primary therapy for breast CA?
Surgical resection followed by adjuvant radiation and/or chemotherapy
Neoadjuvant therapy
- Chemo to shrink large tumors pre-op to allow lumpectomy instead of mastectomy
What are some after breast CA tx effects?
Risk for local/distant recurrence, new primary CA—need for close follow-up Lymphedema of upper extremity “Chemo-brain” Menopausal symptoms Osteoporosis, cardiovascular issues
Paget carcinoma occurs in ____%, in the ____(anatomical location)____
1%
nipple
What are sx of paget carcinoma?
itch/burn/superficial erosion of nipple
looks innocuous
Why is the dx of paget carcinoma difficult?
often missed or delayed treated for dermatitis or infection
____ occur is in <3% of breast CA and is the most malignant for of breast CA
Inflammatory Carcinoma
What are the sx of Inflammatory Carcinoma?
(RED, HOT BREAST)
rapidly growing painful breast
inflammatory changes
sometimes a mass
What is Inflammatory Carcinoma most commonly mistaken for?
mastitis
Breast CA during Pregnancy and Lactation dx is often delayed, but should you work up a breast mass even if the women is pregnant?
yes
1/3000 pregnancies
For women w/ an augmented breast, capsule contracture/scarring occurs in ___-___%
Implant rupture in __-__%
15-25%
5-10%
____ _____ is palpable enlargement of male breast, it may be asymmetric or unilateral and is occasionally tender
Benign Gynecomastia
What is the tx for Benign Gynecomastia?
tx underlying cause
Rx or surgical reduction if ongoing and symptomatic
What are RF for male breast CA?
age
prostate CA
hyperestrogenic
BRCA2 +
Is prognosis for male breast CA better or worse than women?
worse than women, dx late/mets
