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Oncology & Palliative Care > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are the Canadian Task Force breast cancer screening recommendations in average risk individuals?

A

Screen women age 50-74 years old with a mammogram every 2-3 years.

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2
Q

What is the Canadian Task Force recommendations on breast exam?

A

Recommend against self-breast exam or clinical breast exam in asymptomatic individuals.

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3
Q

What are the screening guidelines for breast cancer in high-risk individuals?

A

Women age 30-69 who are confirmed high-risk are to be screened with a mammogram AND breast MRI annually.

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4
Q

Which women are deemed “high-risk” for breast cancer to alter their screening recommendations?

A
  1. Known hereditary gene mutation.
  2. 1st degree relative with a know hereditary gene mutation.
  3. High-risk personal or family history of cancer.
  4. Radiation to the chest when < 30 years old and at least 8 years ago.
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5
Q

Which personal history or family history OF CANCER is concerned high risk to warrant increased breast cancer screening (6)?

A
  • 2 or more cases of breast CA and/or Ovarian CA in 1st degree relatives or grandparents
  • Bilateral breast cancer
  • Breast cancer onset < 35 years old
  • Invasive serous ovarian CA
  • breast and/or ovarian CA in Ashkenazi Jewish Female
  • Male breast cancer
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6
Q

What are the high risk hereditary gene mutations that put you at higher risk (> 25% lifetime) for breast cancer?

A
  1. BRCA 1/2
  2. TP53
  3. PTEN
  4. CDH1
  5. PALB 1/2 (not in guidelines)
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7
Q

What imaging do you order when a breast cancer is suspected on mammography screening?

A
  1. Bilateral diagnostic mammogram
  2. Bilateral breast ultrasound
  3. Axillary ultrasound
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8
Q

What is considered Stage I breast cancer?

A

Tumours < or = 2 cm with NO lymph node involvement.

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9
Q

What is considered Stage II breast cancer?

A

Tumour is > 2 cm but < or = 5 cm AND there are < or = 3 lymph nodes involved.

OR

Tumour > 5 cm AND no nodes involved.

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10
Q

What is considered Stage III breast cancer?

A

Any skin or chest wall involvement

OR

> or = 4 lymph nodes

OR

Tumour > 5cm AND > or = 1 lymph node

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11
Q

What is considered Stage IV breast cancer.

A

Metastatic Disease

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12
Q

What further imaging is needed in patients with breast cancer based on their stage?

A

Stage I - Node Negative - No further tests.
Stage II - < or = 3 nodes - No further tests unless symptomatic.
Stage III - If > or = 4 lymph nodes involved, the patient warranted a bone scan, as well as a CT C/A/P

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13
Q

What is the typical chemotherapy regimen in breast cancer?

A

Anthracycline + Taxane

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14
Q

Give two examples of taxanes.

A

Docetaxel

Paclitaxel

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15
Q

What are the indications for adjuvant chemotherapy in patients with breast cancer?

A

Stage II/III for ER/PR + Breast Cancer
Stage II/III for HER2+ Breast Cancer
Stage I-III for “Triple Negative” Breast Cancer
Or for metastatic disease if it presents with “visceral crisis” (symptomatic/organ compromise)

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16
Q

What is the anti-hormone (endocrine) therapy recommended for breast cancer patients with ER and/or PR positive tumours?

A

IN ALL STAGES (I-IV)

Pre-menopausal - Tamoxifen for 5-10 yrs
Post-menopausal - Aromatase inhibitor (ex. Letrozole) for 5-10 years. Tamoxifen is an alternative if AI not tolerated.

17
Q

What endocrine therapy is indicated in HER2 + breast cancer patients?

A

In Stage II/III - Trastuzumab (Herceptin) monotherapy.

In Metastatic Cancer - Double HER-2 blockade with trastuzumab AND pertuzumab.

18
Q

What is the treatment for metastatic ER/PR + breast cancer?

A

Endocrine therapy + a CDK 4/6 inhibitor.

Get chemotherapy upfront if presents with “visceral crisis” (symptomatic/organ compromise)

19
Q

What are the CDK 4/6 inhibitors?

A

Palbociclib
Ribociclib
Abemaciclib

20
Q

What is the management of HER-2+ metastatic breast cancer?

A

Double HER-2 blockade and chemotherapy with a taxane.

21
Q

What is the therapy for triple negative metastatic breast cancer?

A 
Chemotherapy 
Immunotherapy (in PD-L1 positive disease) - Checkpoint inhibitor such as atezolizumab or pembrolizumab.
22
Q

What are the common taxane side-effects (5)?

A
  • Peripheral Neuropathy
  • Infusion Rxn
  • Myalgias/Arthralgias
  • Alopecia
  • Febrile Neutropenia
23
Q

What are the anthracycline side-effects to be aware of (4)?

A
  • Secondary leukaemia
  • Irreversible cardiomyopathy
  • Alopecia
  • Extravasation reactions (tissue necrosis)
24
Q

What are the major herceptin (trastuzumab) side effects?

A
  • Reversible cardiomyopathy
  • Diarrhea
  • Infusion reactions
25
Q

What are the benefits of bisphosphates in breast cancer?

A
  1. Decreases spread to bone.
  2. Protects against AI-induced osteoporosis.
  3. In post-menopausal women with breast cancer undergoing adjuvant systemic therapy, bisphosphonates decrease recurrence and improve survival.
  4. In metastatic disease, bisphosphonates improve pain, QOL, number of skeletal related events and time to 1st skeletal related events, but no survival benefits.
26
Q

What are the criteria for genetic testing breast cancer (7)?

A
  1. Ashkenazi Jewish + Breast CA at < 50 years old.
  2. Breast cancer at < 35
  3. Male breast cancer
  4. Triple negative breast cancer < 60
  5. Serous ovarian CA at any age
  6. Breast + ovarian cancer in the same patient
  7. Gastric, prostate or pancreatic CA with a significant family hx of other BRCA 2-associated malignancies.
27
Q

What are the benefits or prophylactic bilateral mastectomy and bilateral saplings-oophorectomy in patients known to have a BRCA 1 & 2 mutation?

A

Prophylactic Bilateral Mastectomy - Reduces risk of breast cancer by 90% but unclear mortality benefit.

Prophylactic Bilateral Salpingo-Oophorectomy - Reduces risk of ovarian cancer by 70-80% and breast cancer by 40-60% AND reduces all cause mortality.

28
Q

At what age is a risk reducing saplings-oophorectomy recommended for BRAC 1 & 2 carriers/

A

Age 35-40 or when family is complete.

Oncology & Palliative Care (12 decks)

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