Breast Cancer Flashcards
Breast screening
involves testing healthy people for early signs of cancer using a mammogram (involves taking an x-ray of the breast tissue)
Allows for potential earlier treatment and improves quality of life
How often is there a positive result for a cancer screen in women
9 out of 1000
Who has breast screening
• all women age 50 to 70 registered with a GP are screened every 3 years
• If you’re older than 70, can still be screened but won’t automatically be invited
• If younger than 50 there is a low cancer risk and mammograms are harder to read due to denser breast tissue, so aren’t eligible
• Breast screening is also available to trans men and non-binary people assigned female at birth who have not had a bilateral mastectomy as well as trans women and non-binary people assigned male at birth who have taken feminising hormones
Between which ages are mammograms conducted
50 to 70
How does a mammogram work
- Take off clothes from waist upwards and put a gown on
- Radiographer positions one breast at a time between 2 flat plates on the machine
- The plates press your breast firmly between them for a few moments
- There are 2 x-rays of each breast: one from the top and one from the side
- It usually lasts around 1 minute
Results of a mammogram
If the results are clear, the patient will receive a letter
If the results aren’t clear or show any abnormal areas, they will be called back again for a magnified mammogram which can show up particular areas of the breast more clearly and can show borders of any lumps or thickened are as well as areas of calcium (calcification). An ultrasound or biopsy may also be performed. MRI scans can also be performed
When were the Wilson and junger principles formed
1968
What are the Wilson and Junger principles for
Outline principles of a good screening program
What are the Wilson and Junger principles
- Important health problem
- Natural history well understood
- Recognisable at early stage
- Treatment better at early stage
- Suitable test exists
- Acceptable test exists
- Adequate facilities to cope with abnormal results
- Screening at interval for insidious onset
- Chance of harm is less than chance of benefit
- Cost balanced against benefit
Number of Wilson and Junger principles
10
Risk factors for breast cancer
• age– the risk increases as you get older
• a family history of breast cancer
• a previous diagnosis ofbreast cancer
• a previous non-cancerous (benign) breast lump
• being tall, overweight or obese
• drinking alcohol
Genetic risk factor for breast cancer
People without a personal history of breast cancer can be managed in primary care if they have only one first-degree relative (mother, father, daughter, son, sister, or brother) or second-degree relative (grandparents, grandchildren, aunt, uncle, niece, nephew, half-sister, or half-brother)diagnosed with breast cancer when over 40 years of age, provided that none of the following are present in the family history:
◦ Bilateral breast cancer.
◦ Male breast cancer.
◦ Ovarian cancer.
◦ Jewish ancestry.
◦ Sarcoma in a relative younger than 45 years of age.
◦ Glioma or childhood adrenal cortical carcinomas.
◦ Complicated patterns of multiple cancers at a young age.
◦ Two or more relatives with breast cancer on the father’s side of the family.
Secondary care referral is indicated for people without a personal history of breast cancer who have any of the following:
• One first-degree female relative diagnosed with breast cancer under the age of 40 years.
• One first-degree male relative diagnosed with breast cancer at any age.
• One first-degree relative with bilateral breast cancer where the first primary was diagnosed under the age of 50 years.
• Two first-degree relatives, or one first-degreeandone second-degree relative, diagnosed with breast cancer at any age.
• One first-degree or second-degree relative diagnosed with breast cancer at any ageandone first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative).
• Three first-degree or second-degree relatives diagnosed with breast cancer at any age
Specific gene mutations for breast cancer
They are far less common than BRCA1 or BRCA2, and they do not increase the risk of breast cancer as much. Some of these genes and syndromes are:
• Lynch syndrome, linked with the MLH1, MSH2, MSH6, and PMS2 genes
• Cowden syndrome (CS), linked with the PTEN gene
• Li-Fraumeni syndrome (LFS), linked with the TP53 gene
• Peutz-Jeghers syndrome (PJS), linked with the STK11 gene
• Ataxia telangiectasia (A-T), linked with the ATM gene
• Hereditary diffuse gastric cancer, linked with the CDH1 gene
• PALB2 gene
• CHEK2 gene
• TP53 gene
When should specialist advice be sought for a patient with breast cancer
Any of the following are present in the family history in addition to breast cancers in relatives not fulfilling the above criteria: bilateral breast cancer, male breast cancer, ovarian cancer, Jewish ancestry, sarcoma in a relative younger than 45 years of age, glioma or childhood adrenal cortical carcinomas, complicated patterns of multiple cancers at a young age, and two or more relatives with breast cancer on the father’s side of the family.
If a faulty gene (for example BRCA1 orBRCA2, PALB2) has been identified in the family, direct referral to a specialist genetics service should be offered.
Most common gene mutations for breast cancer
BRCA1
BRCA2
