Breast Cancer

Question 1

What cells do breast cancer arise from?

Answer 1

epithelial cells of the milk ducts and lobules

Question 2

What (approx) percentage of ppl with Breast cancer have a familial genetic mutation?

Answer 2

~ 5%

Question 3

Which of the BRCA mutations is associated with prostate cancer (in men)

Answer 3

BRCA 2

Question 4

What does the BRCA1 protein do?

Answer 4

It’s a tumour suppressor

DNA repair (double stranded break repair)

Question 5

What are PARP inhibitors?

Answer 5

poly-ADP-ribose polymerase (PARP) inhibitors

causes double-stranded DNA breaks to occur
- normally this would be repaired by BRCA, but when it’s deficient the cell just dies instead (for example breast cancer cells where there is a second BRCA mutation)

Question 6

What age are women in Australia screened for breast cancer?

Answer 6

50-74: invited for beast mammogram 2 yearly in Australia

40-49 and > 74 : not invited, but have access to free screening

Question 7

Definition of breast cancer in-situ?

Answer 7

hasn’t breached the basement membrane

Question 8

Clinical factors associated with BRCA mutations?

Answer 8

• Invasive breast cancer ≤ 30 years

• Triple-negative breast cancer < 60 years

• Male invasive breast cancer of any age

• Ovarian or primary peritoneal cancer

• Ashkenazi Jewish heritage

Question 9

Cancer prevention interventions if BRCA positive?

Answer 9

• Risk-reducing bilateral mastectomy (offer at least)

• Risk-reducing salpingo-oophorectomy once childbearing is complete (before 40 years of age if possible)

• Increased surveillance – consider from 30 years of age including breast MRI

• Chemoprevention with tamoxifen, anastrazole or exemestane

Question 10

Investigations for breast cancer

Answer 10

Imaging
- including size, invasion, axillary lymph node status, look for mets

Histology
- grade
- Ki-67 (marker of proliferation)
- ER/ PR/ HER2 receptor status
- molecular profiling

Question 11

Which stage Breast Cancers are potentially curable?

Answer 11

I to III

exceptions:
- HER2-positive stage IV (achieve long term control at least)
- sometimes oligometastatic disease pretty well controlled

Question 12

Three broad categories of Breast Cancer (receptor based)

Answer 12

1. Hormone receptor-positive
2. HER 2 positive
3. Triple-negative

Question 13

What kind of breast cancers tend to have recurrences even at a late stage?

Answer 13

Hormone positive breast cancers

Question 14

Most common kind of breast cancer (out of hormone receptor positive, HER 2 positive and triple-neg)

Answer 14

Hormone receptor-positive (65%)

HER 2 positive (20%)

Question 15

Main deciding factor in suitability of chemo in Breast Cancer?

Answer 15

lymph node-positive

(or if stage IV)

Question 16

Choose of ostroegen receptor medication, based on menopausal status

Answer 16

Pre-menopause: tamoxifen

Post-menopause: aromatase inhibitor (or if they have ovarian function suppressed)

Question 17

Adverse effects of endocrine therapies in breast cancer?

Answer 17

Common toxicities:
- hot flushes,
- arthralgia/ myalgia
- vaginal atrophy

Tamoxifen specific:
- VTEs
- endometrial cancers

Aromatase inhibitors
- accelerated bone loss

Question 18

Management of early stage breast cancer?

Answer 18

Wide Local Exicision + Local Radiotherapy

+/- chemo (neoadjuvant)
+/- hormone therapy
+/- anti-oestrogen agents

Question 19

HER 2 inhibitors?

Answer 19

trastuzumab (herceptin)
pertuzumab

Question 20

Anti-oestrogen agents (in breast cancer) by class

Answer 20

oestrogen receptor antagonists: tamoxifen, raloxifene, fulvestrant (causes receptor to degrade also)

aromatase inhibitors: letrozole, anastrazole

Question 21

Treatment of widespread breast cancer

Answer 21

generally chemo - probably delay death
+/- endocrine therapy
+/- HER2 therapy