Breast Cancer

Question 1

What are some established risk factors of developing breast cancer?

Answer 1

Age
Early onset of menstruation
Late menopause
Family history of breast cancer
Use of oral contraceptives
HRT
Obesity
Alcohol consumption

Question 2

What is invasive breast cancer (ductal carcinoma in situ)?

Answer 2

Where the cancer remains localised in the ducts

Question 3

What does adjuvant drug therapy aim to do in breast cancer?

Answer 3

Reduce the risk of disease recurrence and the risk of developing invasive disease

Question 4

What is neoadjuvant drug therapy?

Answer 4

It is drug treatment before surgery, and it aims to reduce the size of the tumour to allow breast-conserving surgery to be possible.

Question 5

Advanced breast cancer (Stage IV) is still curable.
True or false?

Answer 5

False
It is not curable, so treatment aims to prolong survival, relieve symptoms and improve quality of life

Question 6

What do surgery and radiotherapy aim to do when it comes to breast cancer?

Answer 6

They aim to remove the tumour mass

Question 7

Management of Breast Cancer

-Surgery, radiotherapy, drug therapy, or a combination.

Question 8

Management of Early and Locally Advanced Breast Cancer

-Surgery to the breast and to the axillary lymph nodes, with or without radiotherapy.
-Often followed by adjuvant drug therapy to reduce likelihood of relapses
-Radiotherapy is recommended for women with invasive breast cancer

Answer 8

.

Question 9

Adjuvant Drug Therapy

May involve the use of chemotherapy, endocrine therapy, biological therapy or bisphosphonate therapy.

Answer 9

.

Question 10

What may adjuvant therapy involve the use of?

Answer 10

Chemotherapy
Endocrine therapy
Biological thersapy
Bisphosphonate therapy

Question 11

Which chemotherapy is recommended in patients with invasive breast cancer who are at sufficient risk of disease recurrence?

Answer 11

Adjuvant anthracycline-taxane combination chemotherapy

Question 12

Biological therapy

-Trastuzumab should be offered to patients with tumour size T1c and above HER2-positive invasive breast cancer, in combination with surgery, chemotherapy or radiotherapy.

Answer 12

.

Question 13

What is the main biological therapy drug?

Answer 13

Trastuzumab

Question 14

Endocrine Therapy

-Tamoxifen should be initial adjuvant endocrine therapy in men and pre-menopausal women with oestrogen-receptor positive invasive breast cancer.

-Ovarian function suppression with a gonadotropin-releasing hormone (GnRH) should be considered in premenopausal women- aims to stop the production of circulating oestrogen, which can stimulate breast cancer progression.

-In postmenopausal women at a risk of recurrence, an _ inhibitor should be given as first-line therapy. Tamoxifen should be given if an aromatase inhibitor is not tolerated.

Answer 14

Aromatase

Question 15

Which endocrine therapy should be used for postmenopausal women with oestrogen-receptor positive invasive breast cancer at a risk of recurrence?

Answer 15

Aromatase inhibitor

Question 16

Which adjuvant endocrine therapy should be used first-line in premenopausal women with oestrogen-receptor positive invasive breat cancer?

Answer 16

Tamoxifen

Question 17

Extended Endocrine Therapy

-Extended endocrine therapy (total duration longer than 5 years) with an aromatase inhibitor should be offered to postmenopausal women with oestrogen-receptor-positive invasive breast cancer at medium or high-risk of disease recurrence who have been taking tamoxifen for 2 to 5 years. Extended therapy should also be considered in postmenopausal women at low risk of disease recurrence.

Extended tamoxifen therapy for longer than 5 years can also be considered in both premenopausal and postmenopausal women with oestrogen-receptor-positive invasive breast cancer.

Answer 17

.

Question 18

When should extended endocrine therapy (total duration of greater than 5 years) with an aromatase inhibiter be offered?

Answer 18

Offer to postmenopausal women with oestrogen-receptor positive invasive breast cancer at medium or high risk of disease recurrence who have been taking tamoxifen for 2-5 years

Question 19

Bisphosphonate Therapy

-Zoledronic acid and Sodium clodronate- they improve disease-free survival for postmenopausal women. Insufficient evidence to recommend their use in premenopausal women.

Answer 19

.

Question 20

Chemoprevention

-Should be offered to all women who are at high-risk of developing breast cancer.
-Do NOT offer chemoprevention to people who opt for a bilateral mastectomy.

Options include:
-Tamoxifen- premenopausal women who do have no history or increase risk of thromboembolic disease or endometrial cancer
-Anastrozole- postmenopausal women who do not have severe osteoporosis.

Answer 20

..

Question 21

If diagnosed with breast cancer, women should discontinue HRT.
True or false?

Answer 21

True