Breast Cancer

Question 1

What is the “gold standard” for breast cancer screening

Answer 1

Bilateral mammogram

Question 2

At what age does the current Canadian guidelines recommend that screening mammography should start

Answer 2

50

Question 3

How often should screening mammography occur in average risk women aged 50-74

Answer 3

Every 2 years

Question 4

What does High Risk Ontario Breast Screening Program (HR-OBSP) offer to patients

Answer 4

Annual mammography and breast MRI

Question 5

According to 2015 Canadian Statistics, how many women will be diagnosed with breast cancer in their lifetime?

Answer 5

1 in 8

Question 6

What are the common signs of breast cancer?

Answer 6

1. breast or axilla mass
2. Inverted nipple, ulcerated nipple and/or nipple discharge
3. Change in breast size or shape

Question 7

What are the 4 concerning features
of nipple discharge?

Answer 7

Uniductal, unilateral, bloody, spontaneous

Question 8

Attributes of concerning breast lump

Answer 8

constantly present and does not come and go
with menstrual cycle
– may feel like it is attached to the skin
– may feel hard and irregular
– may be tender but not painful

Question 9

Attributes of concerning axilla lump

Answer 9

– enlarged lymph node
* usually means that the lymphatic system is fighting an
infection in that area
* sometimes means that breast cancer has spread to the
lymph nodes

Question 10

What is the most common type of breast cancer?

Answer 10

Invasive ductal (IDC)

Question 11

What are the types of breast cancer?

Answer 11

Invasive (70%)
– Ductal
– Lobular
In-situ (30%)
– Ductal (DCIS)
– Lobular (LCIS)
Other:
Inflammatory
Paget’s, mucinous,
medullary, tubular,
Pregnancy associated

Question 12

What are the 2 most common breast cancer gene mutations

Answer 12

BRCA 1 & 2

Question 13

What is the likelihood of developing breast cancer in women who have BRCA 1 & 2

Answer 13

40-85%

Question 14

What is the genetic risk component of breast cancer

Answer 14

• <5% of all breast cancers are attributable
  to a hereditary predisposition.
• The most commonly identified germ-line
  mutation is in BRCA1 and BRCA2 tumour
  suppressor genes.
• BRCA1 and BRCA2 carriers have a 40-
  85% lifetime risk of breast cancer.
• Mutation can have a paternal or maternal
  lineage
• Pedigree for several generations is
  advised

Question 15

What are prognostic indicators of breast cancer?

Answer 15

• Lymph node involvement
• Tumor size
• Extent of involvement with skin, muscle and
  other tissues/organs
• Lymphovascular invasion (LVI)
• Histological type (ductal vs. lobular)
• Histological /Nuclear grade (1-3)
• Hormone receptor status (ER/PR)
• HER-2

Question 16

Treatment Pathway and Team

Answer 16

Diagnosis (md or RDC)
* Surgical consult class
surgery
* Post-op appoint.
– radiation and medical
consult
* Start chemo
– f/u with med onc
* Start Radiation
– F/u with rad onc
* RDC Nurse practitioners
* Breast surgeon
* CNS
– Breast surgical
– Reconstruction/plastic
* Medical oncologists
* Radiation oncologist
* Clinic nurses
* Social workers
* Genetic counselors
* AYA (fertility etc)
* Nurse Navigator (high and
average risk)