Breast Cancer Flashcards
Which patients in Australia get screening mammograms?
Women aged 50-74 2 yearly
What clinical factors are associated with BRCA1/2 mutations?
invasive breast cancer < 30 years triple negative breast cancer < 60 years (BRCA1) male invasive breast cancer ovarian or primary peritoneal cancer ashkenazi jewish heritage
What is the role of BRCA1/2 genes?
repair of double stranded DNA breaks using homologous recombination
What are some risk management strategies for BRCA1/2 patients?
risk reducing bilateral mastectomy, risk reducing salpingo-oophorectomy, increase surveilance (consider MRI), chemoprevention with tamoxifen, anastrozole, exemestane
What is the mechanism of action of PARP inhibitors?
tumour selective cell death via synthetic lethality
Which patients would benefit from PARP inhibitors?
BRCA1/2 patients
What are some adverse effects of tamoxifen chemoprevention?
increased risk of endometrial cancer, VTE, menopausal symptoms - however not present in low doses
Which patients can be treated with curative intent?
stages I-III, some HER-2 positive patients with stage IV or stage IV with oligometastatic disease
What are the three breast cancer subtypes?
hormone receptor positive/HER2 negative (65%) HER2 positive (20%) triple negative (15%)
What is the risk of disease recurrence in hormone receptor positive HER 2 negative breast cancer?
good prognosis but late recurrences can occur
What is the risk of disease recurrence in HER 2 positive breast cancer?
previously poor but now now excellent due to effective therapies
What is the risk of disease recurrence in triple negative breast cancer?
poor prognosis but late recurrence is uncommon
What is an important marker of recurrence?
lymph node positivity
Who should get chemotherapy?
lymph node positive patients and lymph node negative patients with other prognostic factors
What is the treatment for node positive early breast cancer?
adjuvant chemotherapy post commonly with antracycline and taxane (in dose dense regimens)
What is the treatment for HER-2 positive breast cancer?
adjuvant transtuzumab for 52 weeks with chemotherapy for 12 weeks
Why is neoadjuvant chemotherapy useful in breast cancer?
it can help identify patients who don’t achieve complete pathological response (high risk patients) and so you can change their treatment, can be used to convert a tumour that is unresectable to resectable
What are the two adjuvant endocrine therapies in breast cancer?
tamoxifen and aromatase inhibitors
What is the mechanism of action of tamoxifen?
selective oestrogen receptor modulator
What is the mechanism of action of aromatase inhibitors?
reduce oestrogen biosynthesis
What are the adverse effects of aromatase inhibitors?
menopause symptoms, accelerated bone loss
What else should be given with endocrine adjuvant therapy?
bisphosphonates or denosumab
What are the principles of management for metastatic breast cancer?
usually sequential single agent treatment unless rapid clinical progression, life threatening visceral metastases or the need for rapid symptoms or disease control
What are some new treatments for breast cancer?
CDK 4/6 inhibitors, PI3-K inhibitors, T-DM1, immune checkpoint blockade
