Breast Cancer Flashcards
What mutation increases the incidence of breast and ovarian cancers?
BRCA1
What mutation increases the risk of ovarian cancer in both male and female breast cancer?
BRCA2
What genetic mutations have a part in causing breast cancer?
- p53 mutation
- BRCA1
- BRCA2
What are risk factors for breast cancer?
- female
- age
- genetic mutations
- family history
- endogenous estrogen exposure
- benign breast disease
- obesity
- low physical activity
- alcohol cosumption
Is early menarche <14 years a risk/protective factor?
risk
Is late menopause > 55y/o a risk/protective factor?
risk
is having your first child younger than 30 y/o a risk or protective factor?
protective
How do oral contraceptives effect breast cancer risk?
benefits usually outweigh risk
How do HRT effect breast cancer risk?
not clear; little benefit
What factors lower the risk of breast cancer?
- breastfeeding
- moderate/ vigorous physical activity
- maintaining healthy body weight
When should screening start for women of average risk?
talk to your doctor at age 40 to decide if annual or every other year mammography is appropriate
What is used to prevent breast cancer?
- prophylactic mastectomy
- bilateral oophorectomies
- Tamoxifen/Raloxifene
When should patients receive breast cancer prevention?
high risk only
What are the most common symptoms?
- painless lump
- stabbing/aching pain
What are less common symptoms?
- nipple tenderness
- change in size/shape of breast
- erythema, scaling, eczema, swelling
- peau d’orange
What are the sites of metastasis?
Bone
Liver
Lung
Brain
Skin
When is endocrine therapy used in breast cancer?
ER+ and/ or PR+
When can trastuzumab be used in breast cancer?
HER2neu +
What does Ki-67 proliferation index indicate?
cancer is spreading fast; need chemo
What is the most common type of breast cancer?
invasive ductal carcinoma
What must patients get if they chose to have a lumpectomy?
XRT
When is neoadjuvant chemo considered in stage 1,2A, and 2B?
if the tumor is too large for a lumpectomy
What type of surgery is possible in stage 1,2A, and 2B?
mastectomy
lumpectomy
When is XRT done in stage 1,2A, and 2B?
lumpectomy
lymph node involvement
What situations in stage 1,2A, and 2B do patients get adjuvant chemo?
ANY of the following:
1. ER and PR negative
2. HER2neu positive
3. lymph node involvement
What test can be done in stage 1,2A, and 2B to determine the benefits of chemo?
Oncotype Dx test
AC
anthracycline + alkylating agent
TC
docetaxel + cyclophosphamide
TAC
docetaxel, doxorubicin, and cyclophosphamide
How long does someone get adjuvant chemo in stage 1,2A, and 2B?
6 months
What should not be given in combination with trastuzumab?
anthracycline
What are side effects with trastuzumab?
- cardiac concerns (CHF, MI, decreased LVEF)
What is the MOA of Tamoxifen?
SERM (selective estrogen receptor modulator); competes with estradiol binding to estrogen receptors
What are side effects with Tamoxifen?
- hot flashes
- vaginal dryness/discharge
- irregular menses
- endometrial thickening
- THROMBOEMBOLISM
- ENDOMETRIAL/UTERINE CANCER
What beneficial effects does tamoxifen have?
- may prevent bone loss
- lowers total cholesterol
What 2 psych meds lower Tamoxifen effects?
Fluoxetine
Paroxetine
What is the MOA of aromatase inhibitors?
inhibits aromatase the enzyme which catalyzes the conversion of androgens to estrogens
What are side effects with aromatase inhibitors?
- Osteoporosis
- Musculoskeletal pain, arthralgias
When is adjuvant chemo not needed?
ER+/PR+ AND
Her2neu - AND
no lymph involvement
