breast cancer

Question 1

Thelarche is

Answer 1

Sustained period of mammary gland growth in adolescence

Question 2

Breast parenchyma is composed of

Answer 2

Ducts and lobules

Question 3

Breast lymphatic drainage to

Answer 3

Axillary
internal mammary lymph nodes
supraclavicular

Question 4

2 types of breast stroma

Answer 4

1 - intralobular - supports lobules

2 - Fibroadipose - interlobular

Question 5

In young woman breast tissue is

Answer 5

very fibrous - more radiolucent with age - more adiopse

Question 6

Breast examination between what structures

Answer 6

clavicle
sternum
inframammary ridge
axilla

Question 7

Paget’s disease

Answer 7

In situ Brca

Question 8

Non -cancerous Breast lumps can be

Answer 8

fibroadenomas

fibrocytic chances in prolfierative disease

Question 9

triple test for breast cancer diag

Answer 9

1- breast exam
2- imaging
3- biopsy

Question 10

Fat and dairy have
red meat
vitamin D

Answer 10

no significant impact on brca
slight impact of red meat and alcohol
vitamin D reduces risk, soy not recommended

Question 11

Linear relationship between

Answer 11

Alcohol and breast cancer
3-5 drinks a day - 1.5x increased risk
advise 1 drink a day
folate reduces risk

Question 12

Can dietary changes reduce risk for Brca?

Answer 12

NO evidence - except for slight benefit of VitD

Question 13

Available agents to reduce risk

Answer 13

Tamoxifen -reduce opposite breast risk after brca in one breast
Raloxifene - for post menopausal

Question 14

Tamoxifen given as a chemopreventative can

Answer 14

Increase risk of endometrial hyperplasia after 5 years

better for women under 50

Question 15

Now 2011 guidelines recommend

Answer 15

against mammography and CBE (40-49)

Question 16

How are most brca detected in women <45

Answer 16

Most often self-detected - encourage opportunistic breast examinations

Question 17

In 50-69 age group
in 40s age group
In 70s

Answer 17

there is 20-35% reduction in mortality
15% reduction in mortality
55% reduction

Question 18

For 50-74 yr old women recommend mammography

Answer 18

Every 2 years - not 3

Question 19

NEJM article states that

Answer 19

30% overdiagnosis of brca

Question 20

recommendations of NEJM articles

Answer 20

Most people recommend routine mammography -

Question 21

Screening recommendations of the canadian task force are for
for clinicians

Answer 21

Average risk women with NO breast symptoms

discuss screening for all above 40

Question 22

50 yr old woman - screening recommendations

Answer 22

mammogram q2 years, annual if high risk
consider OBSP
discuss BA
Opportunistic BE

Question 23

40 yr old woman

Answer 23

consider mammogram q1-2 yrs depending on patient risk and preference
discuss bA
OBE

Question 24

70 yr old woman

Answer 24

mammography until life expectancy <10 years

Question 25

Younger women present with what type of tumor | Cysts common

Answer 25

Fibroadenoma - not always - wider than it is taller | pre and peri-menopausal women

Question 26

Mediolateral view of the breast is

Answer 26

Most important - covers most tissue

Question 27

Biopsy should be consideredin BI-RADS when

Answer 27

4 | 0- means needs more info

Question 28

What 4 things do you look for on screening

Answer 28

1- asymmetries 2- distortion 3- masses 4- calcifications

Question 29

Breast cancer attributable to inheritance of a known mutated gene constitutes

Answer 29

<10% of total cases | BRCA1/2 - 50-80% lifetime risk

Question 30

If you have pre-invasive disease -

Answer 30

at 10x increased risk for Brca (dcis, lcis)

Question 31

atypical hyperplasia

Answer 31

proiferative disease with nuclear atypia

Question 32

what percent of women will have fibrocystic breast changes

Answer 32

33% | thought to be estrogen driven

Question 33

Proliferative breast changes without atypia include

Answer 33

``` florid ductal hyperplasia sclerosing adenosis papillomas preserved basal cell layer!! 1.5-2x increased risk ```

Question 34

Proliferative breast changes WITH atypia include

Answer 34

ductal or lobular hyperplasias resemble cancer preserved basal cell layer! 5x risk! for both breasts!!

Question 35

DCIS

Answer 35

no invasion intact myoepithelial layer can get skin/nipple changes (paget's disease)

Question 36

paget's disease

Answer 36

extenstion of an insitu process

Question 37

No special type invasive ductal carcinoma

Answer 37

NO myoep cel layer

Question 38

Lobular carcinoma

Answer 38

lost E cadherin | indivdual cells

Question 39

Amplification of her2/neu seen

Answer 39

10-30% of breast and ova cancer and poorer prognosis

Question 40

Stage 3 and 4 tumors 5-yr survival

Answer 40

72% and 22%

Question 41

which type of brca do you do a full work up - metastatic work up on

Answer 41

Invasive ductal carcinoma | 12% will have distant mets

Question 42

lumpectomy - must get

Answer 42

radiation - 3-5 weeks - decrease local recurrence 40% recurrence just with lumpectomy 5% with radiation

Question 43

lumpectomy with radiation compared with mastectomy

Answer 43

same overall survival

Question 44

with an axillary dissection you remove

Answer 44

10 lymph nodes - 15% lymphedema

Question 45

sentinal node biopsy

Answer 45

2-3 nodes

Question 46

whether you have sentinal node positive and complete dissection

Answer 46

same recurrence!

Question 47

30% of people with stage 1 disease develop 50% with stage 2 70% with 3 or higher

Answer 47

mets

Question 48

what % of patients with her2+

Answer 48

20% of patients

Question 49

hormones and traztuzumab have | chemotherapy

Answer 49

50% efficacy | 15-40%

Question 50

luminal A tumors have

Answer 50

good prognosis c/w luminal b | high ER low prolif

Question 51

in positive and negative node early brca - with oncotype Dx

Answer 51

High risk groups benefit greatly from adding chemo+hormone therapy

Question 52

Chemo 1st gen, 2nd gen, 3rd gen

Answer 52

CMF

Question 53

Tamoxifen is used

Answer 53

eR antagonist - used in any age group

Question 54

aromatase inhibitors work

Answer 54

In the periphery, prevent androgen to estrogen conversion

Question 55

In post-menopausal women what is the standard of care

Answer 55

aromatase inhibitors

Question 56

aromatase inhibitors vs tamoxifen

Answer 56

no signficaint survival benefits!!

Question 57

Tamoxifen and AI both

Answer 57

reduce contralateral breast cancer risk

Question 58

Special Sideeffects of tamoxifen

Answer 58

increased risk of thromboembolic events | stroke and endometrial cancers

Question 59

Side effects of AIs

Answer 59

increases osteoporosis risk and CVD

Question 60

10 and 15 years after diagnosis there is a reduced risk

Answer 60

with taking tamoxifen continuation to 10 years