Breast Cancer

Question 1

How are pre and post-menopausal women treated differently with hormone therapies in breast cancer?

Answer 1

Pre-menopausal: Tamoxifen

Post-menopausal: Aromatase inhibitors

Question 2

When to begin BRCA1/BRCA2 screening and what to also include?

Answer 2

• Should begin at 25 or five years before youngest relative diagnosed
• Should include MRI and mammogram alternating

Question 3

A patient with early breast cancer is found to have a tumor larger than 1cm that is triple negative, what treatment should be considered in addition to surgery and radiation?

Answer 3

All triple negative breast cancer with tumor >1cm should consider chemotherapy

Question 4

Early breast cancer treatment

Answer 4

Surgery + radiation
or
Radical mastectomy if patient fears recurrence

Question 5

Adjuvant hormone therapy used in breast cancer that prevents conversion of testosterone to estrogen

Answer 5

Aromatase inhibitors

(anastrozole, letrozole, exemestane)

Question 6

True or false. In stage three breast cancer a modified radical mastectomy is never a necessity

Answer 6

True

Question 7

Two side effects of tamoxifen

Answer 7

• Thromboembolic disease
• Endometrial cancer

(mostly in women over 50)

Question 8

How are estrogen positive and estrogen negative metastatic breast cancers treated differently?

Answer 8

Estrogen positive: Hormone therapy

Estrogen negative: Chemo/immunotherapy

Question 9

Lifestyle changes to prevent breast cancer

Answer 9

• Minimize post-menopausal obesity
• Regular exercise
• Abstinence from alcohol

Question 10

Name for pre-breast cancer

Answer 10

In situ carcinoma

(most are ductal = DCIS)

Question 11

Estrogen positive and estrogen negative/HER2 positive breast cancers tend to metastasize to different locations. Where are they?

Answer 11

Estrogen positive: bone metastasis

Estrogen negative/HER2 positive: visceral metastasis

Question 12

Is the presence of estrogen/progesterone receptors on a breast cancer tumor a good or bad prognostic factor?

Answer 12

Good
- Estrogen/progesterone causes these tumors to grow.
- Hormone therapy can block estrogen and progesterone to stop these tumors from growing.

Question 13

Methods for diagnosis and staging of breast cancer

Answer 13

Dx: Fine needle aspiration/core-needle biopsy

Staging: MRI both breasts, evaluate lymph nodes, if lymph nodes suspicious then PET scan

Question 14

Risk factors for breast cancer (many)

Answer 14

• Advancing age, female gender, white
• Post-menopausal obesity
• Reproductive factors: early menarche, late first pregnancy, late menopause, nulliparity
• Environmental: Prolonged use of HRT, consumption of alcohol
• Family history
• Germline mutations (BRCA1 and BRCA2, p53, PTEN)

Question 15

Tamoxifen alternative with less risk of endometrial cancer

Answer 15

Raloxifene

Question 16

Treatments for stage three breast cancer

Answer 16

• Surgery, if resectable
• All get chemotherapy
• All get radiation
• Hormone therapy if tumor expresses estrogen/progesterone

Question 17

Medication used in breast cancer prophylaxis which prevents estrogen from reaching breast tissue

Answer 17

Tamoxifen

Question 18

Is the presence of HER2 proteins on a breast cancer tumor a good or bad prognostic factor?

Answer 18

Bad
- HER2 = human epidermal growth factor receptor 2
- These tumors are more likely to grow faster, spread to other parts of the body, and come back after treatment

(but better than triple negative, since HER2 can be targeted with treatments)