Breast Cancer

Question 1

What are the risk factors for breast cancer?

Answer 1

• gender (99% Female)
• Age (80% >40yo)
• Prior br ca or biopsy
• 1st degree relative with breast ca
• High breast density, nullparity or first child over 30, menarche

Question 2

What can decrease your risk of breast cancer?

Answer 2

• Lactation
• Early child birth
• Early menopause

Question 3

What are the current guidelines for mammography screening in women?

Answer 3

• Age 50-74 routine screening every 2-3 years

Question 4

What features on mammography are suspicious for malignancy?

Answer 4

• mass is poorly defined, spiculated border
• microcalcifications
• architectural distortion
• Interval changes

Question 5

What are some imaging investigations that can be performed with suspected breast cancer?

Answer 5

• Mammography
• U/S (differentiates between cystic and solid)
• MRI (high sensitivity, low specificity)
• galactogram/ductogram
• • Bone scan, CT chest,abdo, pelvis is cancer is detected to look for mets

Question 6

What are some diagnostic procedures for breast cancer?

Answer 6

• Needle aspiration (send fluid for cytology if mass does not resolve)
• U/S/mammo guided core biopsy
• Fine needle aspiration (for palpable solid masses)

Question 7

Which genetic mutations are associated with breast cancer?

Answer 7

BRCA 1 and 2

Question 8

BRCA 1 and 2 Increase your risk of what? When should you consider screening?

Answer 8

• Breast and Ovarian cancer
  Screen if:
• Affected at younger age (

Question 9

What are the different types of breast cancer? (4 categories)

Answer 9

1) Lobular carcinoma (in situ and invasive)
2) Ductal carcinoma (in situ and invasive)
3) Inflammatory
4) Sarcoma (phyllodes tumor)

Question 10

What is the most common type of breast cancer?

Answer 10

• Invasive ductal carcinoma (80% of cases)

- Invastive lobular is 8-15%

Question 11

What is Paget’s disease of the nipple?

Answer 11

Ductal carcinoma that invades the nipple with scaling, eczematoid lesions

Question 12

What is inflammatory breast cancer? How does it present?

Answer 12

Ductal carcinoma that invades the dermal lymphatics.

• The most aggressive form of breast cancer
• Presents with erythema, skin edema, warm, swollen or tender breast
• Peau d’orange indicates advanced disease

Question 13

What is a phyllodes tumour?

Answer 13

A variant of fibroadenoma with potential for malignancy

Question 14

Where are the top 5 places breast cancer will metastasize?

Answer 14

1) Bone
2) Lung
3) Pleura
4) Liver
5) Brain

Question 15

What are the surgical treatment options for breast cancer?

Answer 15

1) Lumpectomy with wide local excision
- must be combined with radiation for survival equivalent to mastectomy

2) Mastectomy
3) Axillary lymph node dissection and sentinel lymph node biopsy.

4) Sentinel lymph node biopsy
- technetium 99 and often blue dye injected at tumor site prior to surgery to identify sentinel nodes