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Reproductive > Breast Cancer Screening: Pritchard > Flashcards

Breast Cancer Screening: Pritchard Flashcards

1
Q

What is the most common cancer in women?

A

Breast

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2
Q

What is the number one and two cancer killers in women?

A

Lung

Breast

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3
Q

How many people die per year avg due to breast cancer?

A

41,000 in USA

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4
Q

What are the risk factors?

A 
Age
Gender: men find later
Delayed menopause
Family history
previous breast cancer
proliferative changes on biopsy
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5
Q

What is the risk of contralateral bc in women who has had bc?

A

0.5-1.5% per year

At 15 years: 10%

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6
Q

What are the proliferative changes on biopsy?

A 
Atypia
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Ductal Carcinoma in Situ
Lobular Carcinoma in Sity
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7
Q

What is the youngest bc patient she has seen?

A

24 yo

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8
Q

How do you calculate the bc risk?

A

Gail Model

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9
Q

What does the Gail model have as first question?

A

Have you had DCIS/LCIS: risk is high and this model does not count.
Other questions base risk on logical answers.

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10
Q

What are some of the questions of the Gail model?

A

First peril
First live birth
Age

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11
Q

What cut off indicates chemoprevention in the Gail model?

A

> 1.67 at 5 years

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12
Q

What are the prophylactic chemopreventions used for high risk?

A

Tamoxifen (SERM)
Raloxifen (SERM)
Exemestane (aromatase)

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13
Q

When does bc mammogram screening begin?

A

After age 40, annually after that

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14
Q

When does clinical exam screening begin?

A

20-39: every three years

>40: annually

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15
Q

If a woman has bc in her family or a genetic mutation, when does mammogram and annual clinical screening begin?

A

Earlier: 10 years before normal

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16
Q

If they have a high risk mutation, what is the screening method?

A

Mammogram once a year
MRI 6 mo later…
cycle

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17
Q

When you examine the breast, what should always be palpated well?

A

Axillary nodes

Tail of breast in pectoral muscle

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18
Q

What part of hand used in clinical exam?

A

flat part of hand, not tips… you will find something with tips

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19
Q

What point does screening stop per the USPSTF?

A

75… she doesn’t like these

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20
Q

How much does a breast MRI cost?

A

8,000-10,000

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21
Q

What is the USPSTF guidelines compared to ACA?

A

Much more against screening… doesn’t

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22
Q

What is notable about breast MRI?

A

High false positive

$$$$

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23
Q

What is not a good screening test without a mammogram?

A

Ultrasound… needs X-ray due to its picking up too much…

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24
Q

What are the BIRADS scores of mammograms?

A 
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!!!!
25
Q

What do BIRAD score 0-2 mean?

A

No worries!

26
Q

What do BIRAD score 3 mean?

A

Followup in 6 months, rather than a year. Track growth. (5% are cancer)

27
Q

What is the biopsy cutoff in BIRADS

A

Score 4

28
Q

How many biopsies are cancer in BIRADS 4?

A

1/5: 20-25%

So… low likelihood it is cancer but still possible

29
Q

What percentage of BIRADS 5 are cancer?

A

85%!!!

30
Q

What BIRADS need biopsy?

A

4 and 5

31
Q

What is the difference between a diagnostic mammogram and a screening mammogram?

A

Radiologist does not let them leave until they have viewed it with compression view or ultrasound.

32
Q

When is a diagnostic mammogram needed?

A

Abnormality on:
physical exam
screening
history of breast cancer

33
Q

What are the suspicious findings on mammogram?

A 
Microcalcifications
   pleomorphism
   cluster
   linear
   increasing in number
Mass
   irregular borders
   spiculated
   increasing in size
34
Q

When calcifications increase in number, what is the indication?

A

Biopsy

35
Q

How do you tell the difference between benign and malignant calcifications, generally?

A

Spicules of calcifications: malignancy

Round dots that don’t grow/increase: benign

36
Q

What are the two types of mobile?

A

Round: movable: marble: benign

Big space with no edges: invasive: cancer

37
Q

What is suspicious on ultrasound?

A

Mass that is not round

38
Q

How is biopsy needle guided in breast?

A

Ultrasound

39
Q

If a ultrasound cannot be used to visualize biopsy a breast, what is the next step?

A

Stereotactic Biopsy: Table with live mammogram guided biopsy and computer guided needle

40
Q

If you have a image guided biopsy, what is the follow up?

A

6 month follow up

Xray of specimen

41
Q

Ki67 cutoff for aggressive tumor is what?

A

<5%

42
Q

What is Ki67 a marker of?

A

Agressiveness of mitosis in tumor cells

43
Q

What is the reduction in breast conservation recurrence with radiation?

A

35% no radiation

5% with radiation

44
Q

What is the differences between breast conservation and total mastectomy?

A

Same: Long term survival, distant disease free survival
Differ: Local recurrence (if you have breast, 35% chance of recurrence without radiation, 5% with radiation)

45
Q

Lumpectomy with radiation is comparable to what without radiation?

A

Mastectomy: 5% recurrence risk

Lump+Rads: 5% recurrence risk (reduced from 35%)

46
Q

What is the mechanism of bc chemo fatigue?

A

Unknown

47
Q

When does bc chemo fatigue set in?

A

2-4 wks after treatment starts

48
Q

What does radiation do to breast?

A

Sunburn

49
Q

What is the only difference between mastectomy and lumpectomy?

A

Radiation

50
Q

What are contraindications to breast conservation?

A

Tumor size >2cm (relative to breast size…)
Previous radiation
Multicentric disease
Pregnancy
Persistant positive margins
Relative: collagen vascular disease, multifocal disease, large breasts

51
Q

If you have had radiation to your chest wall, what can never happen again?

A

Radiation… one time shot

52
Q

Can you radiate a pregnant woman?

A

No!!!!

53
Q

What is the cut off for mastectomy>lumpectomy?

A

1/3 of the breast

54
Q

What are the cutoffs for adjuvant chemo after lump/mast?

A

Tumor >1cm
ER/PR negative >5 MILIMETERS
HER2 positive > 5 MILLIMETERS

ANY NODES POSITIVE!!!

55
Q

What tumor markers are BAD?

A

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%)

56
Q

What is the shorthand for a ER/PR/HER2 - tumor?

A

Triple negative (most therapies target one of these three, so bad if all negative…)

57
Q

Do you treat DCIS with systemic chemo? prevention?

A

No chemo

Chemoprevention: ENDOCRINE THERAPY: tamoxifen/raloxifen/exemestane

58
Q

Basic summary of chemo?

A

Larger, more markers positive, nodes

Reproductive (31 decks)

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