Breast cancer

Question 1

What is the routine age for breast screening?

Answer 1

50-70 years

Question 2

Sensitivity of breast screening for breast cancer?

Answer 2

85%

Question 3

What is the recall for normal breast screening?

Answer 3

3 yearly

Question 4

What proportion of women have an abnormal initial screen?

Answer 4

5%

Question 5

Alternative screening programmes: TP53

Answer 5

Annual MRI 20-49; consider if 50-69

Question 6

Alternative screening programmes: BRCA1/2

Answer 6

Annual MRI 30-49

Annual mammography 40-69 if not having MRI

Three- yearly mammography >70

Question 7

Lifestyle risk factors for breast cancer? (4)

Answer 7

Obesity post-menopause
Physical inactivity
High-fat diet
Alcohol

Question 8

Protective factors?

Answer 8

Pregnancy and breastfeeding

Question 9

How do combined hormonal HRT and COCP affect risk?

Answer 9

combined HRT- small risk if >51 (1 extra case in 1000 on HRT) which disappears on stopping

COCP- slight risk, excess risk disappears 10yrs after stopping

Question 10

Trials are undergoing for which drug as chemoprophylaxis? What are the adverse effects currently limiting this?

Answer 10

Tamoxifen

VTE and endometrial cancer

Question 11

Paget’s disease of the breast?

Answer 11

Eczema of the nipple suggesting intra-epidermal, intra-ductal cancer

Question 12

Adjuvant therapy for breast cancer? (3)

Answer 12

Tamoxifen
Aromatase inhibitors- superior efficacy to tamoxifen for post-menopausal women
Trastuzumab (Herceptin) for HER2 positive cancers

Question 13

How should benign-feeling lumps of acute onset in the luteal phase be managed?

Answer 13

Re-examine in follicular phase as lump may have regressed