Breast Cancer Screening: Pritchard

Question 1

What is the most common cancer in women?

Answer 1

Breast

Question 2

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

Answer 2

Lung

Breast

Question 3

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

Answer 3

41,000 in USA

Question 4

What are the risk factors?

Answer 4

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

Question 5

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

Answer 5

0.5-1.5% per year

At 15 years: 10%

Question 6

What are the proliferative changes on biopsy?

Answer 6

Atypia
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Ductal Carcinoma in Situ
Lobular Carcinoma in Sity

Question 7

What is the youngest bc patient she has seen?

Answer 7

24 yo

Question 8

How do you calculate the bc risk?

Answer 8

Gail Model

Question 9

What does the Gail model have as first question?

Answer 9

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

Question 10

What are some of the questions of the Gail model?

Answer 10

First peril
First live birth
Age

Question 11

What cut off indicates chemoprevention in the Gail model?

Answer 11

> 1.67 at 5 years

Question 12

What are the prophylactic chemopreventions used for high risk?

Answer 12

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

Question 13

When does bc mammogram screening begin?

Answer 13

After age 40, annually after that

Question 14

When does clinical exam screening begin?

Answer 14

20-39: every three years

>40: annually

Question 15

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

Answer 15

Earlier: 10 years before normal

Question 16

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

Answer 16

Mammogram once a year
MRI 6 mo later…
cycle

Question 17

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

Answer 17

Axillary nodes

Tail of breast in pectoral muscle

Question 18

What part of hand used in clinical exam?

Answer 18

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

Question 19

What point does screening stop per the USPSTF?

Answer 19

75… she doesn’t like these

Question 20

How much does a breast MRI cost?

Answer 20

8,000-10,000

Question 21

What is the USPSTF guidelines compared to ACA?

Answer 21

Much more against screening… doesn’t

Question 22

What is notable about breast MRI?

Answer 22

High false positive

$$$$

Question 23

What is not a good screening test without a mammogram?

Answer 23

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

Question 24

What are the BIRADS scores of mammograms?

Answer 24

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!!!!

Question 25

What do BIRAD score 0-2 mean?

Answer 25

No worries!

Question 26

What do BIRAD score 3 mean?

Answer 26

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

Question 27

What is the biopsy cutoff in BIRADS

Answer 27

Score 4

Question 28

How many biopsies are cancer in BIRADS 4?

Answer 28

1/5: 20-25% | So... low likelihood it is cancer but still possible

Question 29

What percentage of BIRADS 5 are cancer?

Answer 29

85%!!!

Question 30

What BIRADS need biopsy?

Answer 30

4 and 5

Question 31

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

Answer 31

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

Question 32

When is a diagnostic mammogram needed?

Answer 32

Abnormality on: physical exam screening history of breast cancer

Question 33

What are the suspicious findings on mammogram?

Answer 33

``` Microcalcifications pleomorphism cluster linear increasing in number Mass irregular borders spiculated increasing in size ```

Question 34

When calcifications increase in number, what is the indication?

Answer 34

Biopsy

Question 35

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

Answer 35

Spicules of calcifications: malignancy | Round dots that don't grow/increase: benign

Question 36

What are the two types of mobile?

Answer 36

Round: movable: marble: benign | Big space with no edges: invasive: cancer

Question 37

What is suspicious on ultrasound?

Answer 37

Mass that is not round

Question 38

How is biopsy needle guided in breast?

Answer 38

Ultrasound

Question 39

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

Answer 39

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

Question 40

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

Answer 40

6 month follow up | Xray of specimen

Question 41

Ki67 cutoff for aggressive tumor is what?

Answer 41

<5%

Question 42

What is Ki67 a marker of?

Answer 42

Agressiveness of mitosis in tumor cells

Question 43

What is the reduction in breast conservation recurrence with radiation?

Answer 43

35% no radiation | 5% with radiation

Question 44

What is the differences between breast conservation and total mastectomy?

Answer 44

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

Question 45

Lumpectomy with radiation is comparable to what without radiation?

Answer 45

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

Question 46

What is the mechanism of bc chemo fatigue?

Answer 46

Unknown

Question 47

When does bc chemo fatigue set in?

Answer 47

2-4 wks after treatment starts

Question 48

What does radiation do to breast?

Answer 48

Sunburn

Question 49

What is the only difference between mastectomy and lumpectomy?

Answer 49

Radiation

Question 50

What are contraindications to breast conservation?

Answer 50

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

Question 51

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

Answer 51

Radiation... one time shot

Question 52

Can you radiate a pregnant woman?

Answer 52

No!!!!

Question 53

What is the cut off for mastectomy>lumpectomy?

Answer 53

1/3 of the breast

Question 54

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

Answer 54

Tumor >1cm ER/PR negative >5 MILIMETERS HER2 positive > 5 MILLIMETERS ANY NODES POSITIVE!!!

Question 55

What tumor markers are BAD?

Answer 55

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%)

Question 56

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

Answer 56

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

Question 57

Do you treat DCIS with systemic chemo? prevention?

Answer 57

No chemo | Chemoprevention: ENDOCRINE THERAPY: tamoxifen/raloxifen/exemestane

Question 58

Basic summary of chemo?

Answer 58

Larger, more markers positive, nodes