Breast Cancer

Question 1

What is the 2ww referral criteria for breast cancer?

Answer 1

Aged 30 and over with an unexplained breast lump with or without pain

Aged 50 or over with discharge, retraction or other changes of concern in one nipple only

Question 2

What is the criteria for non 2ww referral in breast cancer?

Answer 2

Aged 30 and under with an unexplained breast lump with or without pain

Question 3

What key symptoms might breast cancer present with?

Answer 3

Lump
Lymphadenopathy
Nipple retraction
Discharge
Skin changes- peau d’orange, pagets disease

Question 4

Which ethnic group is breast cancer most common in?§

Answer 4

White

Question 5

Does risk of breast cancer increase or decrease with age?

Answer 5

Increase

Question 6

Are females or males more likely to get breast cancer?

Answer 6

Females

Question 7

What lifestyle factors are risk factors for developing breast cancer?

Answer 7

Smoking
Unopposed oestrogen: HRT use (combination, oestrogen only after hysterectomy not assx with increased risk) , COCP use, early menarche, late menopause, nulliparity

Question 8

What genetic factors are risk factors for developing breast cancer?

Answer 8

Personal history of cancer
Family history of cancer
Hereditary cancer syndromes- Peutz Jeghers Syndrome
Li Fraumeni
Neurofibromatosis

BRCA1+BRCA 2 mutations

Question 9

What mode of inheritance are the BRCA genes?

Answer 9

Autosomal dominant

Question 10

What is the overall lifetime risk of developing breast cancer if you have a BRCA mutation?

Answer 10

80-90%

Question 11

What investigations will help confirm a diagnosis of breast cancer?

Answer 11

Triple assessment-
clinical examination
XR mammography
Ultrasound and biopsy if appropriate

Further investigations: Chest CT if pulmonary Sx, abdo/pelvic CT if abdo sx, elevated LFTs or abnormal examination findings
Bone scan if presenting with bone pain or elevated ALP

Question 12

How will the breast biopsy be analysed?

Answer 12

Receptor status- ER, progesterone, HER

Histology- either DCIS, invasive ductal carcinoma, lobular carcinoma (others less common)

Question 13

What is the differential diagnosis for a breast lump?

Answer 13

Breast cyst
Fibrocystic change
Fibroadenoma
Fat necrosis
Breast abcess

Question 14

How is breast cancer treated?

Answer 14

DCIS- either total mastectomy or breast conserving surgery +- radiotherapy. Tamoxifen if ER +ve

Lobular carcinoma- wide excision. If premenopausal then tamoxifen for at least 5 years. If post menopausal then SERM or aromatase inhibitor

Invasive breast cancer at early stage- breast conserving surgery + radiotherapy/ total mastectomy with axillary staging plus reconstruction. Adjuvant radiotherapy

Question 15

What might make you refer a woman with breast cancer to clinical genetics?

Answer 15

If breast cancer diagnosis < 50y