Breast Cancer

Question 1

Which patients in Australia get screening mammograms?

Answer 1

Women aged 50-74 2 yearly

Question 2

What clinical factors are associated with BRCA1/2 mutations?

Answer 2

invasive breast cancer < 30 years
triple negative breast cancer < 60 years (BRCA1)
male invasive breast cancer
ovarian or primary peritoneal cancer
ashkenazi jewish heritage

Question 3

What is the role of BRCA1/2 genes?

Answer 3

repair of double stranded DNA breaks using homologous recombination

Question 4

What are some risk management strategies for BRCA1/2 patients?

Answer 4

risk reducing bilateral mastectomy, risk reducing salpingo-oophorectomy, increase surveilance (consider MRI), chemoprevention with tamoxifen, anastrozole, exemestane

Question 5

What is the mechanism of action of PARP inhibitors?

Answer 5

tumour selective cell death via synthetic lethality

Question 6

Which patients would benefit from PARP inhibitors?

Answer 6

BRCA1/2 patients

Question 7

What are some adverse effects of tamoxifen chemoprevention?

Answer 7

increased risk of endometrial cancer, VTE, menopausal symptoms - however not present in low doses

Question 8

Which patients can be treated with curative intent?

Answer 8

stages I-III, some HER-2 positive patients with stage IV or stage IV with oligometastatic disease

Question 9

What are the three breast cancer subtypes?

Answer 9

hormone receptor positive/HER2 negative (65%)
HER2 positive (20%)
triple negative (15%)

Question 10

What is the risk of disease recurrence in hormone receptor positive HER 2 negative breast cancer?

Answer 10

good prognosis but late recurrences can occur

Question 11

What is the risk of disease recurrence in HER 2 positive breast cancer?

Answer 11

previously poor but now now excellent due to effective therapies

Question 12

What is the risk of disease recurrence in triple negative breast cancer?

Answer 12

poor prognosis but late recurrence is uncommon

Question 13

What is an important marker of recurrence?

Answer 13

lymph node positivity

Question 14

Who should get chemotherapy?

Answer 14

lymph node positive patients and lymph node negative patients with other prognostic factors

Question 15

What is the treatment for node positive early breast cancer?

Answer 15

adjuvant chemotherapy post commonly with antracycline and taxane (in dose dense regimens)

Question 16

What is the treatment for HER-2 positive breast cancer?

Answer 16

adjuvant transtuzumab for 52 weeks with chemotherapy for 12 weeks

Question 17

Why is neoadjuvant chemotherapy useful in breast cancer?

Answer 17

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

Question 18

What are the two adjuvant endocrine therapies in breast cancer?

Answer 18

tamoxifen and aromatase inhibitors

Question 19

What is the mechanism of action of tamoxifen?

Answer 19

selective oestrogen receptor modulator

Question 20

What is the mechanism of action of aromatase inhibitors?

Answer 20

reduce oestrogen biosynthesis

Question 21

What are the adverse effects of aromatase inhibitors?

Answer 21

menopause symptoms, accelerated bone loss

Question 22

What else should be given with endocrine adjuvant therapy?

Answer 22

bisphosphonates or denosumab

Question 23

What are the principles of management for metastatic breast cancer?

Answer 23

usually sequential single agent treatment unless rapid clinical progression, life threatening visceral metastases or the need for rapid symptoms or disease control

Question 24

What are some new treatments for breast cancer?

Answer 24

CDK 4/6 inhibitors, PI3-K inhibitors, T-DM1, immune checkpoint blockade

Question 25

What are the principles of treatment for brain metastases?

Answer 25

surgery, sterotatic radiotherapy