Breast Cancer Clinical Application

Question 1

8 Br CA risk factors?

Answer 1

1. Age
2. Gender
3. Nulliparity or late parity
4. Early menarche
5. Late menopause
6. Previous breast cancer
7. Family history
8. Proliferative changes on biopsy

Question 2

The Gail Model calculates risk based on: (5)

Answer 2

age
age at menarche
age at first childbirth 
family hx
proliferative

*If calculated risk > 1.67, consider chemoprevention

Question 3

ACS Mammo guidelines:

Answer 3

starting at age 40
annually after 40

*Differ for women with genetic mutation or strong family history

Question 4

ACS Clinical exam guidelines:

Answer 4

every 3 years 20 – 39
annual after 40

*Differ for women with genetic mutation or strong family history

Question 5

USPSTF Recommendations are against

Answer 5

1. routine screening 40 – 49
2. teaching routine self exam

(recommends Biennial screening 50 – 74; lecturer was highly critical of this)

Question 6

Why are MRI’s not favorable breast CA screening tools?

Answer 6

high false (+) rate
\$\$\$\$

Question 7

Why are ultrasounds not favorable breast CA screening tools?

Answer 7

only good with mammogram, not as an isolated screening test

Question 8

CC (craniocaudal) screening view =

Answer 8

shot from above

Question 9

MLO (medial lateral oblique) =

Answer 9

shot at 45 degree angle + includes the lateral pectoral muscle

Question 10

ML (medial lateral) =

Answer 10

shot at 90 degree angle + does not include the lateral pectoral

Question 11

Which of the Mammogram BIRADS Categories should be referred for biopsy?

Answer 11

4 + 5

suspicious/highly suspicious

Question 12

What’s the difference between a diagnostic and screening mammogram?

Answer 12

dx: radiologist looks at imaging BEFORE the patient leaves to determine if more imaging needed

Question 13

Indications for a diagnostic mammo:

Answer 13

1. abnormality on physical exam
2. abnormality on screening
3. history of breast cancer

Question 14

What are some types of suspicious microcalcifications?

Answer 14

pleomorphic
clustered
linear
increasing in number

Question 15

What are some types of suspicious masses?

Answer 15

irregular borders
spiculated
increasing in size

Question 16

In order to do a biopsy of a lesion, it must be:

Answer 16

visible on US

Question 17

How do you do a biopsy for lesions NOT visible on US?

Answer 17

Stereotactic Biopsy (patient is up on a table over your head..)

Question 18

What are the indications following biopsy of a lesion?

Answer 18

6 month followup

Xray evaluation of specimen

Question 19

How does Breast Conservation compare to Mastectomy?

Answer 19

they are equivalent in:

• -Long-term survival
• -Distant disease-free survival
• -Local recurrence (w/ RT)
• -Need for chemo

Question 20

Contraindications to Breast Conserving Surgery?

Answer 20

1. Tumor size (tumor : breast)
2. Previous radiation
3. Multicentric disease (>1 quadrant)
4. Pregnancy
5. Persistent positive margins
6. Relative if:
   collagen vascular disease (e.g. SLE)
   multifocal disease
   large breasts

Question 21

Whether or not a patient needs adjuvant therapy depends on:

Answer 21

Tumor size ≥ 1 cm
ER/PR negative ≥ 5 mm
Her 2 positive ≥ 5 mm
Nodes positive

Question 22

I left off most of the case stuff. She clicked through it, and it seems too complicated for us to really be responsible for.

Answer 22

Maybe if I become a boobie-surgeon I’ll need to learn it in serious depth. But not for today.