Breast cancer

Question 1

Define breast cancer

Answer 1

malignancy arising from the breast tissue

•	More common in LHS
•	50% arise in upper outer quadrant  
•	Il
o	DCIS (ductal carcinoma in situ)
o	Invasive ductal carcinoma
o	Invasive lobular carcinoma
o	In situ/ invasive papillary carcinoma

Question 2

Aetiology of breast cancer

Answer 2

o	Genetics
	1st degree relative – particularly pre-menopausal
	BRCA-1, BRCA-2
	FH is the strongest predictor of risk
o	Hormones – oestrogen exposure
	Late age of first pregnancy
	Nulliparity
	Early menarche
	Late menopause
	Obesity
	OCP
	HRT
o	Dietary
	Processed meats
	High fat intake
	Alcohol 
o	Exposures
	Tobacco smoke
	Environmental carcinogens
	Radiation exposure

Question 3

Risk factors

Answer 3

•	FH
•	Previous breast disease
•	Hereditary breast-ovarian cancer syndrome
o	85% caused by BRCA1/2 mutations
o	Up to 80% lifetime risk
•	Old age of menopause
•	Old age of first pregnancy (>30years)
•	Nulliparity
•	Low exercise/obesity
•	HRT
•	Not breast feeding

Question 4

Epidemiology of breast cancer

Answer 4

•	Lifetime risk of 1 in 9 for UK women
•	20% of all malignancies
•	20,000 new cases in the UK each year
o	Incidence is increasing 1% a year 
•	Most common female cancer
o	Rare in men (only 1% of all cases)
•	Rare below age 30

Question 5

Presenting symptoms of breast cancer

Answer 5

25% present as abnormal mammogram
•	Breast lump
•	Nipple discharge/inversion
o	Unilateral
o	May be bloody
•	Breast tenderness

Question 6

Signs of breast cancer on examination

Answer 6

•	Breast lump
o	Smooth or nodular
•	Skin change
o	Peau d’orange 
•	Axillary lymphadenopathy

Question 7

Investigations for breast cancer

Answer 7

•	Triple assessment
o	Clinical examination
o	Mammography/US
	IF >35 – both
	IF <35 – US only
o	Histology/cytology
	FNA – best for cystic lumps
	Core biopsy – best for new lumps or solid lumps
	Hormone receptor testing (oestrogen, progesterone)
•	Genetic testing for BRCA-1/2