Breast Cancer

Question 1

Describe the demographic risk factors for breast cancer.

Answer 1

• Women > Men (only about 100 men/year)
• Age: Risk increases exponentially with age
  (Do NOT assume low risk due to age)

Question 2

Describe the risk factors for breast cancer related to physical traits and family history/genetic risk.

Answer 2

Physical traits:
- Obesity
- Dense breast tissue (screening via 3D tomosynthesis)

Family history/Genetic risk*:
- Ontario Family History Assessment Tool
- BRCA 1 & BRCA 2 genetic mutations

*NOTE: If positive, these patients should be REFERRED!!!

Question 3

Describe the risk factors for breast cancer related to reproductive history and estrogen exposure due to menstruation or medications.

Answer 3

Reproductive history:
- Inverse to risk
- Fewer pregnancies & less breastfeeding = Higher risk

Estrogen exposure:
- Early menarche (< 12 years) = Higher risk
- Late menopause (> 55 years) = Higher risk

Estrogen medications:
- Combo PO contraceptives = Very low risk
- Vaginal estrogen = No risk

Question 4

What are the most common types of breast masses?

Answer 4

• Fibroadenomas
• Cysts

Question 5

Discuss the differentiation of cancerous masses from benign conditions.

Answer 5

Cancerous masses can mimic benign conditions and vice versa

Question 6

When should ultrasound be performed for breast cancer screening?

Answer 6

• For patients < 30 years old with focal mass (lump)/symptom
• First line in pregnancy or < 30 years
• Follow-up of mass identified on mammography

Question 7

When should mammogram be performed for breast cancer screening?

Answer 7

For any woman/man > 30 years with a breast complaint

Question 8

When should 3D tomosynthesis be performed for breast cancer screening?

Answer 8

Follow-up if dense breasts on a mammogram

Question 9

What is 3D tomosynthesis?

Answer 9

3D tomosynthesis:

• Multiple views in an arc
• BEST diagnostic tool in detecting breast cancer

Question 10

What are the screening guidelines for mammogram use for patients of average risk?

Answer 10

USPSTF & ACS recommendations don’t agree

They vary by age groups and frequency of screening)

USPSTF:
United States Preventative Services Task Force
ACS: American Cancer Society

Question 11

What are the screening guidelines for clinical or self breast exam for patients of average risk?

Answer 11

• Not recommended by ACS (American Cancer Society)
• Consider performing & teaching self breast exams

Question 12

What are the breast cancer screening guidelines for patients with high risk ?

Answer 12

Who is high risk:
- Personal or family history of cancer:
- breast
- ovarian
- tubal
- Ontario Family History Assessment Tool:
- if +, refer for genetic testing

What tests to perform & when:
- MRI or clinical breast exam:
- consider annually
- Ultrasound if < 30 years

NOTE: ALWAYS REFER HIGH RISK WOMEN!