Breast Cancer

Question 1

Breast Cancer Epidemiology

Answer 1

• number one diagnosed cancer in women - 2nd leading cause of cancer-related death in women - average age between 40-59 - 70-80% of lesions are invasive ductal carcinoma with ductal carcinoma in situ component

Question 2

Breast Cancer weak risk factors

Answer 2

• family history of post-menopausal breast cancer - high socioeconomic status - nulliparity - later age at first birth - early age at first menarche - post-menopausal obesity: adipose tissue holds estrogen - alcohol consumption: the liver metabolizes estrogen - diet

Question 3

Breast Cancer Moderate Risk Factors

Answer 3

• older age - North American/European descent - family history of pre-menopausal breast cancer - breast hyperplasia - mammographic density occupying >50% of breast volume

Question 4

Breast Cancer Strong Risk Factors

Answer 4

• family history of premenopausal bilateral breast cancer or premenopausal breast cancer in mother, grandmother, sister or aunt - evidence of BRCA2 or BRCA2 - personal history of lobular carcinoma in-situ - breast atypical hyperplasia - mammographic density occupying >75% of the breast volume

Question 5

In-situ breast cancer

Answer 5

No penetration through the basement membrane

Question 6

Grades of DCIS

Answer 6

Low grade: low proliferative rate and are typically ER/PR+ High grade: high proliferative rate and tend to be associated with high..

Question 7

LCIS

Answer 7

Lobular carcinoma in-situ is considered a marker for increased risk of development of breast cancer

Question 8

Types of invasive breast cancer

Answer 8

Invasive ductal carcinoma Invasive lobular carcinoma

Question 9

Invasive ductal carcinoma

Answer 9

Penetrates the basement membrane. Allow for mass to be palpable due to the accumulation of cells that cause fibrosis.

Question 10

Invasive lobular carcinoma

Answer 10

The second most common type of breast cancer. Typically does not have fibrosis, grows in a single file pattern. Usually well-differentiated compared to IDC. High frequency in bilateral breasts.

Question 11

Mammography Guidelines

Answer 11

Average risk:

• age 40-49 if the done patient will be recalled every two years - 50-74 routine screening mammograms are recommended every two years

High risk:

• 40-74 with a first-degree relative with breast cancer screening mammograms are recommended every year

Question 12

Types of biopsies used for breast cancer detection

Answer 12

• fine needle aspirate
• core needle biopsy
• fine wire localization
• open biopsy
• axillary node dissection

Question 13

FNA

Answer 13

Fine needle aspirate: most for liquid and few cells only

Question 14

Core needle biopsy

Answer 14

obtains more tissue then a FNA

Question 15

Fine wire localization biopsy

Answer 15

For non-palpable abnormality

Question 16

Open biopsy

Answer 16

Surgical procedure when core needle and FNA are not options

Question 17

Axillary node dissection

Answer 17

Is done in most cases of invasive disease after other biopsies are done