Breast cancer Flashcards
What is the number one cause of cancer in women
breast cancer
What is the median age of diagnosis for breast cancer
63
What are some risk factors for developing breast cancer
increased lifetime exposure to estrogen
early menarche
late menopause
advanced maternal age
What are some protective factors of breast cancer
lack of ovaries
no prior HRT
Early menopause
longer duration of breast feeding
early age of first pregnancy
low dose ASA
Where on the breast is breast cancer most common
outer, upper quadrant
How is breast cancer classified
histologic type
What are the histological types of breast cancer
non-invasive
invasive
Paget carcinoma
inflammatory carcinoma
what is the most common type of breast cancer
infiltrative ductal carcinoma
Which types of breast cancer have a better prognosis
ER/PR positive tumors
What control hormone responsiveness in breast cancer
HER2/neu (+/-)
Estrogen ER (+/-)
Progesterone PR(+/-)
Which type of breast cancer has the worst prognosis
triple negative tumors
Who are triple negative tumors most common in
<40
Black
BRCA1+
Which BRCA gene is more likely to cause breast cancer
BRCA 1
(typically triple negative)
Who are BRCA driven breast cancer most common in
Ashkenazi jewish
What are the indications for BRCA screening
Breast cancer in 2+ first degree relatives
+FH prior to age 50
+FH ovarian cancer
+FH male breast cancer
1st degree w/ bilateral breast CA
breast + ovarian CA in 1 individual
Ashkenazi Jew ancestry
What are the common signs and symptoms for breast cancer
painless, palpable lump that is firm and has ill defined margins
What are the symptoms for Paget carcinoma
Starts as nipple itching/burning
often misdiagnosed as dermatitis/bacterial infection
Often no discrete breast mass
What are the symptoms of inflammatory carcinoma
Rapidly growing, large, painful mass
breast enlargement
often misdiagnosed as infection (then wont respond to abx)
Does the USPSTF recommend teaching self breast exams?
no
*just wants them aware of what is normal so they can report any changes
What is the gold standard for screening for breast cancer
mammography
What age range should have screenings for breast cancer and how often
women 40-74, every 2 years
How are mammography results reported
via BIRADS SCORE
What are the most commonly identified abnormalities seen on breast exams
calcifications
What abnormality on breast imaging is most likely malignant
<.5mm
various sizes / shapes
clustered in 1 area
What is US useful in differentiating between in regards to
cystic vs solid masses
which patients will get an MRI for their breast imaging
negative mammo but still suspicious
more info needed
breast implants
adjunct to mamma if high risk
What type of biopsy is is preferred when working up a breast cancer
core needle because it is less prone to sampling error
*able to test for HER2/neu, ER, PR
What are the following steps if there is a concern for advanced disease
CXR to eval for lung mets
Abdominal CT for liver mets
+/- PET scan
+/- DEXA
What are the common metastatic locations with breast cancer
Liver
lung
bone
brain
Which form of breast cancer is most likely to lead to brain mets
Triple negative
HER2/neu
If clustered pleomorphic micro calcifications are seen on a mammogram, what are you concerned for
Breast cancer
What are the stages of breast cancer
0 - abnormal cells
1- early stage
2- localized
3- regional spread
4 - distant spread
What are the primary treatment strategies for breast cancer
Surgical resection + axillary lymph node dissection or sentinel node biopsy
radiation
What is the first line treatment for stage 1 and 2 breast cancer
breast conserving lumpectomy
What are the contraindications for breast conserving lumpectomy
> 4cm
multifocal
fixation to chest wall
skin involvement
What is a mastectomy
Removal of entire breast, overlying skin, nipple/areola, and pectorals fascia
What is the major advantage for a mastectomy
may not need radiation
When is Chemo useful with breast cancer
Reduces recurrence and mortality for all stages EXCEPT stage 4
Which age group is most benefited by chemo for breast cancer
patients < 50
How long is a chemo treatment with breast cancer
3-6 months
What are common side effects to chemo
N/V
Infertility
Premature ovarian failure
What are less common but important side effects of chemo
Neutropenia
Cardiomyopathy
peripheral neuropathy
leukemia
cognitive dysfunction
What are some anti-HER2 treatments
Mab drugs (pertuzumab)
Kinase inhibitors (Neratinib)
What are some hormonal treatments with breast cancer
tamoxifen (SERM)
aromatase inhibitor (letrozole)
Bisphosphonates (early stages)
Which age group are more susceptible to aggressive breast cancer / worse prognosis
Younger patients
How often to women who have had breast cancer need to be evaluated
q6 months for 2 years, then annual exams
What is the average age for breast cancer in men
70
What symptoms will men present with with breast cancer
gynecomastia
nipple discharge
What is the most common cause of breast cancer in men
ER positive (tomoxifen is used)
