Breast Cancer Screening: Pritchard Flashcards
What is the most common cancer in women?
Breast
What is the number one and two cancer killers in women?
Lung
Breast
How many people die per year avg due to breast cancer?
41,000 in USA
What are the risk factors?
Age Gender: men find later Delayed menopause Family history previous breast cancer proliferative changes on biopsy
What is the risk of contralateral bc in women who has had bc?
0.5-1.5% per year
At 15 years: 10%
What are the proliferative changes on biopsy?
Atypia Atypical ductal hyperplasia Atypical lobular hyperplasia Ductal Carcinoma in Situ Lobular Carcinoma in Sity
What is the youngest bc patient she has seen?
24 yo
How do you calculate the bc risk?
Gail Model
What does the Gail model have as first question?
Have you had DCIS/LCIS: risk is high and this model does not count.
Other questions base risk on logical answers.
What are some of the questions of the Gail model?
First peril
First live birth
Age
What cut off indicates chemoprevention in the Gail model?
> 1.67 at 5 years
What are the prophylactic chemopreventions used for high risk?
Tamoxifen (SERM)
Raloxifen (SERM)
Exemestane (aromatase)
When does bc mammogram screening begin?
After age 40, annually after that
When does clinical exam screening begin?
20-39: every three years
>40: annually
If a woman has bc in her family or a genetic mutation, when does mammogram and annual clinical screening begin?
Earlier: 10 years before normal
If they have a high risk mutation, what is the screening method?
Mammogram once a year
MRI 6 mo later…
cycle
When you examine the breast, what should always be palpated well?
Axillary nodes
Tail of breast in pectoral muscle
What part of hand used in clinical exam?
flat part of hand, not tips… you will find something with tips
What point does screening stop per the USPSTF?
75… she doesn’t like these
How much does a breast MRI cost?
8,000-10,000
What is the USPSTF guidelines compared to ACA?
Much more against screening… doesn’t
What is notable about breast MRI?
High false positive
$$$$
What is not a good screening test without a mammogram?
Ultrasound… needs X-ray due to its picking up too much…
What are the BIRADS scores of mammograms?
0-5
0: needs additional info
further views
usg
old films
1: normal
2: benign
3: probably benign
4: suspicious for malignancy
5: highly suspicious!!!!What do BIRAD score 0-2 mean?
No worries!
What do BIRAD score 3 mean?
Followup in 6 months, rather than a year. Track growth. (5% are cancer)
What is the biopsy cutoff in BIRADS
Score 4
How many biopsies are cancer in BIRADS 4?
1/5: 20-25%
So… low likelihood it is cancer but still possible
What percentage of BIRADS 5 are cancer?
85%!!!
What BIRADS need biopsy?
4 and 5
What is the difference between a diagnostic mammogram and a screening mammogram?
Radiologist does not let them leave until they have viewed it with compression view or ultrasound.
When is a diagnostic mammogram needed?
Abnormality on:
physical exam
screening
history of breast cancer
What are the suspicious findings on mammogram?
Microcalcifications pleomorphism cluster linear increasing in number Mass irregular borders spiculated increasing in size
When calcifications increase in number, what is the indication?
Biopsy
How do you tell the difference between benign and malignant calcifications, generally?
Spicules of calcifications: malignancy
Round dots that don’t grow/increase: benign
What are the two types of mobile?
Round: movable: marble: benign
Big space with no edges: invasive: cancer
What is suspicious on ultrasound?
Mass that is not round
How is biopsy needle guided in breast?
Ultrasound
If a ultrasound cannot be used to visualize biopsy a breast, what is the next step?
Stereotactic Biopsy: Table with live mammogram guided biopsy and computer guided needle
If you have a image guided biopsy, what is the follow up?
6 month follow up
Xray of specimen
Ki67 cutoff for aggressive tumor is what?
<5%
What is Ki67 a marker of?
Agressiveness of mitosis in tumor cells
What is the reduction in breast conservation recurrence with radiation?
35% no radiation
5% with radiation
What is the differences between breast conservation and total mastectomy?
Same: Long term survival, distant disease free survival
Differ: Local recurrence (if you have breast, 35% chance of recurrence without radiation, 5% with radiation)
Lumpectomy with radiation is comparable to what without radiation?
Mastectomy: 5% recurrence risk
Lump+Rads: 5% recurrence risk (reduced from 35%)
What is the mechanism of bc chemo fatigue?
Unknown
When does bc chemo fatigue set in?
2-4 wks after treatment starts
What does radiation do to breast?
Sunburn
What is the only difference between mastectomy and lumpectomy?
Radiation
What are contraindications to breast conservation?
Tumor size >2cm (relative to breast size…)
Previous radiation
Multicentric disease
Pregnancy
Persistant positive margins
Relative: collagen vascular disease, multifocal disease, large breasts
If you have had radiation to your chest wall, what can never happen again?
Radiation… one time shot
Can you radiate a pregnant woman?
No!!!!
What is the cut off for mastectomy>lumpectomy?
1/3 of the breast
What are the cutoffs for adjuvant chemo after lump/mast?
Tumor >1cm
ER/PR negative >5 MILIMETERS
HER2 positive > 5 MILLIMETERS
ANY NODES POSITIVE!!!
What tumor markers are BAD?
ER/PR negative
HER2 positive (opposes apoptosis… bad if positive since it is out of control, but if positive we can target treat it with trastuzumab/pertuzumab)
Ki67 high percentage (>5%)
What is the shorthand for a ER/PR/HER2 - tumor?
Triple negative (most therapies target one of these three, so bad if all negative…)
Do you treat DCIS with systemic chemo? prevention?
No chemo
Chemoprevention: ENDOCRINE THERAPY: tamoxifen/raloxifen/exemestane
Basic summary of chemo?
Larger, more markers positive, nodes
