Breast Cancer - Board Review Flashcards
What is a average woman’s lifetime risk of breast cancer?
12.3%
According to NCCN, what are high risk factors for developing breast cancer?
- History of breast cancer
- 5 year risk >1.7% using Gail model
- LCIS or atypical ductal or lobular hyperplasia (ADH/ALH)
- Lifetime risk >20% using family history models
- History of thoracic radiation (@ <30 YOA)
- Family with suggested or known genetic predisposition
What is the modified Gail model based on?
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
What is the risk of developing breast cancer by age 70 in women with BRCA1 or BRCA2?
65% risk with BRCA1, 45% with BRCA2
What cancers are associated with BRCA1 and BRCA2?
BRCA1: breast, ovarian, fallopian tube, peritoneal, prostate, pancreatic
BRCA2: ++male breast cancer, female breast cancer, ovarian, prostate, pancreatic
What is the overall sensitivity of screening mammogram?
75%
What is the BI-RADS classification?
0 - incomplete, needs more imaging 1 - negative 2 - benign 3 - probably benign 4 - suspicious (consider biopsy) 5 - highly suspicious (biopsy) 6 - known malignancy
For BI-RADS 3 what is the likelihood of malignancy?
<2%
For BI-RADS 5 what is the likelihood of malignancy?
> 95%
What is Mondor disease?
Superficial thrombophlebitis of the breast
What is fibroadenoma, presentation, and treatment?
Most common solid benign tumor of breast. Composed of stromal and epithelial elements. Estrogen sensitive. Present as solid, firm, mobile mass. Excision or observation.
What is considered a giant fibroadenoma?
<5cm
What is an intraductal papilloma and how does it present, treatment?
True polyp of the epithelium-lined breast ducts; bloody nipple discharge; excisional biopsy (20% a/w malignancy)
What is a phyllodes tumor and how/when does it present? What are the subtypes? Treatment
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)
What is the most important prognostic factor following a breast cancer diagnosis?
Node status
What is the 5 year survival based on stage (in someone receiving appropriate treatment)
I = 98% II = 86% III = 57% IV = 20%
What is the risk associated with LCIS and developing invasive cancer?
10-20% risk over the next 15 years; can decrease risk by doing bilateral mastectomies and tamoxifen
What percentage of invasive carcinomas are ductal in origin?
85-90% ductal, 10% lobular
What is the most common site of disseminated disease?
Bone
Is there a survival benefit in patients undergoing mastectomy rather than lumpectomy with whole breast irradiation?
No
What are the oncologic contraindications for NSM?
- Tumor <2cm away from NAC
- Evidence of nipple involvement (Paget’s, bloody discharge, retraction)
- Positive lymph nodes
- Inflammatory breast cancer
- Skin involvement
What are the reconstructive contraindications for NSM?
- Smokers
- Diabetics
- Grade 3-4 ptosis
- Obese/large breasts
Following total mastectomy, what are the indications for radiation?
- Presence of 4+ positive axillary nodes
- If 1-3 + nodes, strongly consider
- If tumor is >5cm, strongly consider
What is the positive and negative predictive value of successful SNLB?
100%, 95%
What are the levels removed during ALND and how many nodes are necessary to stage?
Levels I and II, 10
If adjuvant chemotherapy is indicated, when should radiation begin?
After chemo
When should preoperative chemo be considered?
Stage IIA, Stage IIB, T3N1M0
Which class of endocrine therapy drugs are associated with osteoporosis?
Aromatase inhibitors
What endocrine therapy drug is associated with increased risk of endometrial cancer and DVT?
Tamoxifen
When is systemic adjuvant chemo indicated?
- Tumor >1cm or positive nodes
- Oncotype DX type
- HER-2 +
What is angiosarcoma and how does it spread?
Highly aggressive sarcoma originating from lymphatic or capillary endothelium, can occur secondary to treatment for breast cancer; spreads hematogenously
What syndrome describes upper extremity sarcoma development associated with lymphedema following mastectomy?
Stewart-Treves syndrome
What is a risk factor for development of angiosarcoma after mastectomy?
Lymphedema
What is Paget’s disease and what is it associated with?
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)
What is inflammatory breast cancer?
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.
What is the treatment for inflammatory breast cancer?
Neoadjuvant chemo, mastectomy +ALND, radiation; Immediate reconstruction is contraindicated
