Breast Disease Flashcards
What is the screening test for breast cancer? What ages are included in the national screening protocol for all women
2-view mammography for ages 50-70 every 3 years
What is the national screening protocol for breast cancer?
All women aged 50-70 are invited for a 2-view mammography with breast-check
If normal -> 3 year recall
If abnormal -> Invited for further investigation +/- MRI to diagnose breast cancer
Women who are at increased risk of breast cancer have a different protocol. What genes are considered high risk?
What other imaging modality is used in the screening of breast cancer?
TP53
BRCA1/2
MRI breast
Migrants to a country assume the risk of the host country within 2 generations. What are the RF for breast cancer
Age
Lifestyle: High fat diet, obesity, reduced physical activity, alcohol
Reproductive hx: Early menarche, late menopause, Nulliparity, not breastfeeding, COCP (slight increase, disappears after 10 years of stopping), Oestrogen-only HRT.
Past hx or family hx of breast disease
Genetics: TP53, BRCA1/2
Ionising radiation
A women asks you what can she do to lower her risk of breast cancer. What lifestyle changes can she do?
What medication would reduce the risk?
What is the best prevention technique in terms of reducing risk of breast cancer?
Lifestyle: reduce weight alcohol and fat, increase exercise
Tamoxifen reduces the risk by 40% but increases the risk of VTE and endometrial Ca
Prophylactic surgery
What is the most common location for breast cancer?
Upper outer quadrant of either breast
What is the presentation and examination findings associated with breast Ca?
Breast pain
Lump in breast
Nipple skin change
Skin contour change
A patient comes to you with a red, scaly itchy lesion or eczema around the nipple with excoriation marks. What does this suggest?
Paget’s disease of the breast
=> Intradermal or intraductal cancer (starts in the ducts and spreads to its surface and areola)
Adjuvant endocrine therapy is part of the management of breast Ca. What medications are used along with their indications
Aromatase inhibitors (Letrozole) - First line
Tamoxifen - only in ER+ve tumours
Trastuzumab - only if HER2+ve
What type of medication is Tamoxifen?
SERM => why it is only indicated in ER+ve tumours
What is another name for Trastuzumab?
What is it’s mechanism of action
Herceptin
Monoclonal antibody against HER2 receptor
Recurrence most likely occurs <2 years after treatment. The longer since the treatment, the less the likelihood of recurrence.
A patient presents with the following
Breast pain
Lump in breast
Nipple skin change
Skin contour change
You suspect breast cancer and refer them to the specialist team. Give some investigations the specialist team will carry out.
What is the management in specialist care?
Investigations:
Tumour markers
Mammography, CT, MRI
USS guided FNA/core biopsy
LN evaluation
Liver USS and Bone scan (for metastasis)
Management:
Surgery: Lumpectomy + sentinel node biopsy +/- Axillary clearance (axillary lymph nodes)
OR
Mastectomy
+ Adjuvant Endocrine therapy
Aromatase inhibitors (Letrozole) - First line
Tamoxifen - only in ER+ve tumours
Trastuzumab - only if HER2+ve
