Breast cancer

Question 1

Breast Cancer: The General Practitioner’s role

Answer 1

• First presentation and referral to Breast clinic
• Monitoring treatment toxicity
• Referral to Genetics
• Managing the follow up problems
– Endocrine treatment related
– Psychological impact
– Indication of relapse

Question 2

Breast Cancer: Risk Factors

Answer 2

• advancing age
• family history
• personal history of breast cancer
• positive BRCA mutation
• breast biopsy with atypical hyperplasia, LCIS or DCIS
• early age at menarche
• late age of menopause
• late are of first term pregnancy
• use of COCP or combined estrogen/progesterone
• adult weight gain
• sedentary lifestyle
• alcohol consumption

Question 3

Define Pharmacokinetics vs Pharmacodynamics

Answer 3

• Pharmacokinetics: What the body does to the drug

* Pharmacodynamics: What the drug does to the body

Question 4

At what stage in DNA synthesis do the main cytotoxic drugs work at?

Answer 4

Anti-metabolites: pre DNA synthesis

Alkylating agents: on DNA

Intercalating agents: on DNA transcription and duplication

Spindle poisons: on mitosis

Question 5

Chemotherapy Grading of toxicity (simplified)

Answer 5

• Grade 1: minimal symptoms
• Grade 2: Requires medication
• Grade 3: Needs hospitalisation
• Grade 4: Life threatening

Question 6

Long-Term Complications of Chemotherapy

Answer 6

• Cardiac
• Secondary Malignancies
• Endocrine deficiencies
• Fatigue
• Neuropathy
• Arthropathy

Question 7

What is the most common receptor type of breast cancer?

Answer 7

73% is HR+/HER2- “luminal A”

13% is HR-/HER2- “triple negative”

10% are HR+/HER2+ “luminal B”

5% are HR-/HER2+ “HER2 enriched”

Question 8

What is tamoxifen ?

Answer 8

A competitive inhibitor of oestrogen binding at the oestrogen receptor and blocks oestrogen action in breast cancer cells which contain receptors.

Question 9

Which adjuvant endocrine treatments should be offered to
women with hormone receptor-positive breast cancer who are pre- or perimenopausal?

What is the appropriate duration?

Answer 9

NICE: Treat women who have hormone receptor-positive breast cancer and are premenopausal with 5 years of tamoxifen, and those who are postmenopausal a minimum of 5 years of adjuvant therapy with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor (in sequence)

Question 10

Which adjuvant endocrine treatments should be offered to
women with hormone receptor-positive breast cancer who are postmenopausal?

What is the appropriate duration?

Answer 10

NICE: If women are postmenopausal and have received 5 years of adjuvant tamoxifen, they should be offered the choice of continuing tamoxifen or switching to an aromatase inhibitor for 10 years total adjuvant endocrine therapy.