Breast cancer

Question 1

What is involved in standard breast cancer screening?

Answer 1

Women aged 50-74, mammogram every 2 years

Question 2

What risk factors place women in a ‘moderate risk’ category for breast cancer screening?

Answer 2

One FDR or 2 SDR <50

Indication to start screening at 40yo

Question 3

What is the most common form of breast cancer to be missed on mammogram?

Answer 3

Lobular - loss of ecadherin, spreads in sheet like fashion rather than mass

Question 4

What is first line treatment of low risk early stage ER+ Her2- breast cancer?

Answer 4

Endocrine therapy for 5 years (i.e. AI, tamoxifen)

Question 5

What is first line treatment of high risk early stage ER+ Her2- breast cancer?

Answer 5

Chemo + endocrine therapy (AI or tamoxifen)

Question 6

What is first line therapy for early stage Her2+ breast cancer?

Answer 6

Neoadjuvant trastuzumab + chemotherapy, followed by endocrine therapy if ER+

Question 7

What is trastuzumab?

Answer 7

mAb directed against Her2, used in Her2 positive breast cancer

Question 8

What is the main side effect to be aware of with trastuzumab?

Answer 8

Cardiac dysfunction (due to myocyte stunning - reversible cf anthracyclines)

Question 9

What is first line endocrine therapy for women with ER+ early breast cancer?

Answer 9

Premenopausal - goserelin + AI (alternative - tamoxifen for low risk tumours)
Postmenopausal - AI alone (alternative - tamoxifen if CI/intolerant)

Question 10

What phase of the cell cycle do the taxanes (e.g. docetaxel) act on?

Answer 10

M phase - microtubule inhibitors

Question 11

What is the main specific side effect that occurs with taxane chemotherapy?

Answer 11

Peripheral neuropathy

Question 12

What is the main specific side effect that can occur with anthracycline chemotherapy?

Answer 12

Cardiotoxicity

Question 13

Tamoxifen and aromatase inhibitors are both used as endocrine therapy for ER+ breast cancer. Which causes increased VTE risk?

Answer 13

Tamoxifen

Question 14

Tamoxifen and aromatase inhibitors are both used as endocrine therapy for ER+ breast cancer. Which causes accelerated BMD loss?

Answer 14

Aromatase inhibitors

Tamoxifen is pro oestrogen in the bones

Question 15

Tamoxifen and aromatase inhibitors are both used as endocrine therapy for ER+ breast cancer. Which is associated with an increased risk of uterine cancer?

Answer 15

Tamoxifen - pro-oestrogenic in uterus

Question 16

A postmenopausal woman is being treated for early stage ER+ breast cancer. She complains of worsening early morning stiffness and pain affecting her hands. Which drug is likely to be causing this?

Answer 16

Aromatase inhibitors - cause a musculoskeletal syndrome

Question 17

Which is the most important prognostic factor in breast cancer?

A. Tumour grade
B. Tumour size
C. Lymph node involvement
D. ER positivity
E. Her2 amplification

Answer 17

Answer: C lymph node involvement

Question 18

A woman with a history of breast cancer presents with recurrence 12 years later with metastatic disease. What is the most likely receptor status of the cancer?

Answer 18

Her2+ and TNBC vast majority recur within 3 years

Therefore this most likely to be ER + - more likely to present later on

Question 19

Ribociclib belongs to a class of drugs known as CDK4/6 inhibitors. How do these work, and when are they used?

Answer 19

Inhibits CDK4/6-cyclin D1 complex, stopping progression from G1 > S phase.
Used in ER+, Her2- cancers

Question 20

What is first line therapy for metastatic ER+ breast cancer?

Answer 20

Endocrine therapy - aromatase inhibitor +/- CDK4/6 inhibitor

Question 21

What is first line treatment for Her2 amplified metastatic breast cancer?

Answer 21

Her2 Mabs x 2 (trastuzumab/pertuzumab) + taxane chemotherapy +/- aromatase inhibitor if ER+

Question 22

What is the most common receptor status seen in breast cancer?

Answer 22

ER+ (80%)