Breast Cancer Flashcards
What are risk factors for breast cancer?
Nulliparity, first childbirth after age 30, early menarche, late menopause, older age, postmenopausal obesity, alcohol use, lack of physical activity, and family history, exposure to ionizing radiation, atypical ductal hyperplasia, lobular carcinoma in situ, and ductal carcinoma in situ.
Who should get BRCA testing?
Ashkenazi Jewish women with one first degree relative or two second degree relatives with BC. Otherwise, two first degree relatives, one under age 50 with BC, 3 or more relatives with BC, combination breast/ovarian CA in the family, 1st degree relative with bilateral BC, two+ relatives with ovarian CA, or a male relative with BC.
How would you manage a patient positive for BRCA mutation?
Mammogram and breast MRI yearly, though many will opt for prophylactic bilateral mastectomy and salpingo-oophorectomy.
What tool is used to screen patients for risk of breast cancer and what prophylactic medication is available?
The Gail Model calculator to risk stratify. Both tamoxifen and raloxifene are approved for breast cancer prevention with evidence of efficacy, though mortality benefit unknown. They can also be used to prevent post-menopausal osteoporosis.
How does tamoxifen compare to raloxifene?
Tamoxifen is better at preventing noninvasive breast cancer, however, raloxifene has lower incidence of endometrial cancer, vaginal side effects, cataracts, and thrombotic effects.
How is Ductal Carcinoma in Situ (DCIS) managed?
Lumbectomy + radiation or mastectomy followed by five years of tamoxifen. No data for AIs, or role for chemotherapy.
Who should have mastectomy vs. lumpectomy with radiation for invasive breast cancer?
Those with tumors >5cm, involving the nipple and areola, and multi centric tumors, those with scleroderma or SLE, and those with previous ionizing radiation to the area.
When is regional lymph node dissection performed in breast cancer?
Only if the sentinel node is positive.
Who will need radiation even after mastectomy?
If the margins were not clear despite mastectomy, inflammatory cancer, large >5cm tumors, or 4+ positive LNs.
What tool can be used to calculate a patient risk of breast cancer recurrence?
The surveillance, epidemiology, and end results (SEER) database of the National Cancer Institute.
What are favorable prognostic factors in breast cancer?
ER or PR+, small tumor size, low grade.
What are poor prognostic factors in breast cancer?
Large tumor size, lymph node involvement, and over expression of HER2/neu.
Who should get adjuvant systemic therapy in early stage breast cancer?
Only when treatment with such outweighs the risks of the treatment. Generally used if there are poor prognostic factors, or if the patient is younger/healthier.
Who should get tamoxifen versus aromatase inhibitors?
Any premenopausal woman should get tamoxifen x 5 years. AIs are only used in postmenopausal women for at least 5 years.
Why can’t AIs be used in premenopausal women?
The ovaries produce estogren that won’t be blocked by aromatase inhibitors.
