Breast Cancer - Board Review

Question 1

What is a average woman’s lifetime risk of breast cancer?

Answer 1

12.3%

Question 2

According to NCCN, what are high risk factors for developing breast cancer?

Answer 2

1. History of breast cancer
2. 5 year risk >1.7% using Gail model
3. LCIS or atypical ductal or lobular hyperplasia (ADH/ALH)
4. Lifetime risk >20% using family history models
5. History of thoracic radiation (@ <30 YOA)
6. Family with suggested or known genetic predisposition

Question 3

What is the modified Gail model based on?

Answer 3

Age, Age at menarche, age at first live birth or nulliparity, number of first degree relatives with breast cancer, number of previous benign breast biopsies, atypical hyperplasia in a previous biopsy, race

Question 4

What is the risk of developing breast cancer by age 70 in women with BRCA1 or BRCA2?

Answer 4

65% risk with BRCA1, 45% with BRCA2

Question 5

What cancers are associated with BRCA1 and BRCA2?

Answer 5

BRCA1: breast, ovarian, fallopian tube, peritoneal, prostate, pancreatic
BRCA2: ++male breast cancer, female breast cancer, ovarian, prostate, pancreatic

Question 6

What is the overall sensitivity of screening mammogram?

Answer 6

75%

Question 7

What is the BI-RADS classification?

Answer 7

0 - incomplete, needs more imaging
1 - negative
2 - benign
3 - probably benign
4 - suspicious (consider biopsy)
5 - highly suspicious (biopsy)
6 - known malignancy

Question 8

For BI-RADS 3 what is the likelihood of malignancy?

Answer 8

<2%

Question 9

For BI-RADS 5 what is the likelihood of malignancy?

Answer 9

> 95%

Question 10

What is Mondor disease?

Answer 10

Superficial thrombophlebitis of the breast

Question 11

What is fibroadenoma, presentation, and treatment?

Answer 11

Most common solid benign tumor of breast. Composed of stromal and epithelial elements. Estrogen sensitive. Present as solid, firm, mobile mass. Excision or observation.

Question 12

What is considered a giant fibroadenoma?

Answer 12

<5cm

Question 13

What is an intraductal papilloma and how does it present, treatment?

Answer 13

True polyp of the epithelium-lined breast ducts; bloody nipple discharge; excisional biopsy (20% a/w malignancy)

Question 14

What is a phyllodes tumor and how/when does it present? What are the subtypes? Treatment

Answer 14

Rapidly enlarging painless breast mass; Histology: stromal hypercellularity and atypical spindle cells and high mitotic rate, around age 40; Subtypes: benign, borderline, malignant; WLE (1cm margins)

Question 15

What is the most important prognostic factor following a breast cancer diagnosis?

Answer 15

Node status

Question 16

What is the 5 year survival based on stage (in someone receiving appropriate treatment)

Answer 16

I = 98%
II = 86%
III = 57%
IV = 20%

Question 17

What is the risk associated with LCIS and developing invasive cancer?

Answer 17

10-20% risk over the next 15 years; can decrease risk by doing bilateral mastectomies and tamoxifen

Question 18

What percentage of invasive carcinomas are ductal in origin?

Answer 18

85-90% ductal, 10% lobular

Question 19

What is the most common site of disseminated disease?

Answer 19

Bone

Question 20

Is there a survival benefit in patients undergoing mastectomy rather than lumpectomy with whole breast irradiation?

Answer 20

No

Question 21

What are the oncologic contraindications for NSM?

Answer 21

1. Tumor <2cm away from NAC
2. Evidence of nipple involvement (Paget’s, bloody discharge, retraction)
3. Positive lymph nodes
4. Inflammatory breast cancer
5. Skin involvement

Question 22

What are the reconstructive contraindications for NSM?

Answer 22

1. Smokers
2. Diabetics
3. Grade 3-4 ptosis
4. Obese/large breasts

Question 23

Following total mastectomy, what are the indications for radiation?

Answer 23

1. Presence of 4+ positive axillary nodes
2. If 1-3 + nodes, strongly consider
3. If tumor is >5cm, strongly consider

Question 24

What is the positive and negative predictive value of successful SNLB?

Answer 24

100%, 95%

Question 25

What are the levels removed during ALND and how many nodes are necessary to stage?

Answer 25

Levels I and II, 10

Question 26

If adjuvant chemotherapy is indicated, when should radiation begin?

Answer 26

After chemo

Question 27

When should preoperative chemo be considered?

Answer 27

Stage IIA, Stage IIB, T3N1M0

Question 28

Which class of endocrine therapy drugs are associated with osteoporosis?

Answer 28

Aromatase inhibitors

Question 29

What endocrine therapy drug is associated with increased risk of endometrial cancer and DVT?

Answer 29

Tamoxifen

Question 30

When is systemic adjuvant chemo indicated?

Answer 30

1. Tumor >1cm or positive nodes 2. Oncotype DX type 3. HER-2 +

Question 31

What is angiosarcoma and how does it spread?

Answer 31

Highly aggressive sarcoma originating from lymphatic or capillary endothelium, can occur secondary to treatment for breast cancer; spreads hematogenously

Question 32

What syndrome describes upper extremity sarcoma development associated with lymphedema following mastectomy?

Answer 32

Stewart-Treves syndrome

Question 33

What is a risk factor for development of angiosarcoma after mastectomy?

Answer 33

Lymphedema

Question 34

What is Paget's disease and what is it associated with?

Answer 34

Rare manifestation of breast cancer characterized by neoplastic cells in the epidermis of the NAC; 80-90% a/w cancer elsewhere in the breast (invasive or DCIS)

Question 35

What is inflammatory breast cancer?

Answer 35

Rare aggressive form of breast cancer with erythema and dermal edema (peau d'orange) of 1/3 or more of the skin of the breast. Diagnosis is clinical +skin biopsy.

Question 36

What is the treatment for inflammatory breast cancer?

Answer 36

Neoadjuvant chemo, mastectomy +ALND, radiation; Immediate reconstruction is contraindicated