Breast cancer Flashcards
Incidence of breast cancer
1 in 9 women will develop breast cancer during their lifetime
Risk factors for breast cancer x10
Gender Increasing age Nulliparity- late age at first baby Early menarche, late menopause Oral contraception/HRT Greater height/weight (obesity) Ionising radiation Carcinogen exposure Family hx Alcohol
Peak age for male breast cancer
71 years
Relationship of male breast cancer and gynaecomastia
No increased risk of MBC with gynaecomastia once treated by radiotherapy
Relationship of breast cancer risk to steroid hormones
Longer the duration that the breast epithelium is exposed to steroid hormones - especially in cyclical form - greater risk of malignancy
Risk factors for male breast cancer x4
Work in hot environment (testicular failure)
Males taking oestrogens (transsexuals and prostate carcinoma)
Undescended testis
Mumps >20 years
Genetics and male breast cancer
Almost all male breast cancer of genetic origin is due to BRCA2 mutations
Association of Klinefelters syndrome and breast cancer
Risk of breast cancer is similar to that in females
What is a new risk factor for breast cancer
Higher levels of serum gamma-glutamyl transferase (GGT) in premenopausal women
Serum GGT may be a marker of prior exposure to carcinogens
Protective factors against breast cancer x5
Pregnancy
Oophorectomy (before age of 50)
Lactation
Late menarche and early menopause
Relationship of oral contraception and breast cancer risk
Risk is increased when on oral contraception but decreases when you stop it
Relationship of smoking and breast cancer risk
Smoking has anti-oestrogenic effects therefore induction of earlier menopause, but does not protect against breast cancer - could be because of increase in more aggressive ER- lesions
Role of alcohol and breast cancer
Alcohol increases oestrogens
Relationship of diet and breast cancer
Significant relationship between national mortality rates from breast cancer and fat consumption
Risk of breast cancer and ovarian cancer with BRCA2
50-85% breast cancer
10-30% ovarian cancer
Where are breast cancers derived from?
The epithelial cells that are found within the terminal duct lobular unit - TDLU
Difference between non-invasive (DCIS) and invasive
non-invasive are within the basement membrane of the duct unit whereas invasive has dissemination of cancer cells outside of the basement membrane into adjacent normal tissue
What is the grade of a breast cancer?
It is a characteristic of the tumour which does not change with time - eg. a low grade well-differentiated DCIS evolves slowly into a well-differentiated grade 1 invasive cancer
High grade into high grade
What is the stage of a breast cancer?
Duration of breast cancer and may reflect delay
eg. DCIS stage can develop into a cancer
What do the majority of ER- positive cancers express?
Progesterone receptors therefore also have greatest probability of responding to hormone therapy
Other gene which is associated with increased risk of breast cancer
TP53 gene - also assocaited with other malignancies and Li Fraumeni syndrome (soft tissue/osteosarcoma - early onset breast cancer, glioma and childhood adrenal cancer)
Investigation of breast cancer
2 view mammography, whole breast ultrasound, image-guided core biopsy and if invasive cancer then axillary ultrasound with FNA or core biopsy of suspicious lymph nodes - sentinel node biopsy
What contributes to the grading of a cancer?
Degrees of glandular formation, nuclear pleomorphism and frequency of mitoses - Nottingham modification
What % of breast cancers express significant amounts of oestrogen receptor
75%
