BREAST- FEMALE- CA Flashcards
The most important risk factor is __________;
gender
only ____________of breast cancer cases occur in men.
1%
The risk factors for BREAST CA
- Age
- age at menarche
- age at first live birth
- first degree Relatives with Breast Ca
- Atypical Hyperplasia
- Race/ Ethnicity
- Estrogen Exposure
- Breast density
- Radiation Exposure
- Ca of the Contralateral Breast or Endometrium
- Geographic influence
- Diet
- Obesity
- Exercise
- Breast feeding
- Environmental Toxins
- Tobacco
Carcinoma of the breast is the most common non-skin malignancy in women. A woman who
lives to age 90 has a one in eight chance of developing breast cancer.
DCIS
is almost exclusively detected by mammography, providing an explanation for the sharp
increase in the diagnosis of DCIS since 1980 (see Fig. 23-13 ).
Small node-negative
carcinomas (stage I), which arebest detected by mammography, increased in frequency as the
number of large, advanced-stage breast carcinomas (stages II to IV) diminished modestly ( Fig.
23-14 ). Over the same time period the incidence of breast carcinoma in younger women, for
whom screening is not recommended, did not change.
The incidence rises throughout a woman’s lifetime, peaking at the age of 75–80 years and then
declining slightly thereafter.
The average age at diagnosis is 61 for white women, 56 for
Hispanic women,and46 for African American women.
Only 20% of non-Hispanic white women
are diagnosed under the age of 50, compared with 35% of
African American women and 31% of
Hispanic women.
Breast cancer is very rare in all groups before the age of 25.
Although carcinoma is uncommon in young women, almost half of these are either ER negative
or human epidermal growth factor receptor 2 (HER2/neu) positive, whereas these cancers
make up less than a third of cancers in women over the age of 40.
Age at Menarche.
Women who reach menarche when younger than _____________of age have a 20% increased risk
compared with women who are more than 14 years of age at menarche.
11 years
Late menopause also
increases risk.
Women who experience a first full-term pregnancy at ages younger than 20 years have half the
risk of nulliparous women or women over the age of 35attheir first birth.
It is hypothesized that
pregnancy results in________________. [4]
This protective effect might be overshadowed in
older women by stimulation of proliferation early in pregnancy of cells that have already
undergone preneoplastic changes. It is also possible that the changes in stroma that allow the
growth and expansion of lobules during pregnancy facilitate the transition from in situ to
invasive carcinoma. These pregnancy-related changes may help explain the transient increase
in cancer risk that follows a pregnancy, an effect that is most pronounced in older women. [5]
Age at first live birth is not a strong risk factor for African American women.
terminal differentiation of milk-producing luminal cells, removing them from
the potential pool of cancer precursors
The major risk factors for the development of breast cancer are hormonal and genetic.
Breast carcinomas can therefore be divided into ___________, probably related to hormonal
exposure, and
___________, associated with germline mutations.
sporadic cases
hereditary cases
The inheritance of a susceptibility gene or genes is the primary cause of approximately 12% of
breast cancers. [23,] [24]
The probability of a hereditary etiology increases with multiple
affected first-degree relatives, when individuals are affected before menopauseand/or have
multiple cancers,or there arefamily members with other specific cancers (discussed below).
In some families the increased risk is the result of a single mutation in a highly penetrant breast
cancer gene ( Table 23-2 ).
Mutations in_____________ and ___________ account for the majority of cancers
attributable to single mutations and about 3% of all breast cancers.
Penetrance (the
percentage of carriers who develop breast cancer) varies from 30% to 90% depending on the
specific mutation present.
BRCA1 and BRCA2
___________________ are commonly poorly differentiated, have “medullary
features”(a syncytial growth pattern with pushing margins and a lymphocytic response),anddo
not express hormone receptors or overexpress HER2/neu (the so-called “triple negative”
phenotype).
Their gene profiling signature is very similar to basal-like breast cancers, a distinct
molecular subtype that is discussed later.
BRCA1-associated breast cancers
BRCA1 cancers are also frequently associated with
______________________, resulting in the absence of
the Barr body. [25]
loss of the inactive X chromosome and reduplication of the active X
__________ also tend to be relatively poorly
differentiated, but aremore often ER positive than BRCA1 cancers.
BRCA2-associated breast carcinomas
Other known susceptibility genes are much less commonly implicated; together, this group
accounts for fewer than 10% of hereditary breast carcinomas (see Table 23-2 ).
____________ (due to germline mutations in p53) and____________(due to
- *germline mutations in CHEK2)** together account for about 8% of breast cancers caused by
- *single gene**s.
Li-Fraumeni
syndrome
Li-Fraumeni variant syndrome
