Breast Health Flashcards
Where do most breast cancers occur within the breast?
The largest amount of mammary glandular tissue is found in the upper outer quadrant of the breast, and thus the majority of breast cancers are also found in this region.
What are the 5 main categories of RFs for breast cancer?
Age: the risk increases with increasing age
Reproductive history: increased exposure to estrogen
Diet & Lifestyle: SES, obesity, EtOH
Genetics: BRCA 1 and 2, Li-Fraumeni syndrome, Cowden syndrome
Personal Breast History: proliferative lesions, increased breast density
What is the current screening protocol for breast cancer in Alberta?
Mammography q2 years for women 50-74 years of age. If greater than 74 it is at the discretion of the healthcare provider. If the patient is in good health and life expectancy >5 years complete screening q2 years.
Which of the following screening modalities have a mortality benefit? Breast Self Exam Clinical Breast Exam U/S MRI Mammography
Mammography ONLY. It is the gold standard for screening and detects smaller, non-palpable cancers (1.4 cm in diameter).
What is the Alberta screening guideline for high risk women (BRCA1/2, first degree relative with BRCA 1/2, Lei Fraumeni, p32 mutation, cowden disease)?
Annual mammography and breast MRI starting at 25 years old and clinical breast exam q6months.
What is the treatment for an ER+ breast cancer?
Tamoxifen or aromatase inhibitors
What is the treatment for HER2+ breast cancer?
Herceptin
What is the most common location for metastases of breast cancer?
bone>lungs>pleura>liver>brain
A 56 year old woman, post-menopausal for 3 years presents with a history of unilateral, spontaneous, bloody nipple discharge. On exam there is discharge one duct but no masses or skin changes are apparent. The other breast is normal. What is your DDx?
Intraductal papilloma (most likely cause; most common cause of spontaneous, unilateral, bloody nipple discharge)
Ductal ectasia
Fibrocystic disease
Intraductal carcinoma
A 56 year old woman, post-menopausal for 3 years presents with a history of unilateral, spontaneous, bloody nipple discharge. On exam there is discharge one duct but no masses or skin changes are apparent. The other breast is normal. What investigation do you want to order next?
Galactogram
A woman presents after she noticed a lump in the R breast. On exam the nodule is smooth, rubbery, discrete, and well circumscribed and approximately 2 cm. What investigation is required?
Core/Excisional biopsy (likely fibroadenoma)
A 35 year old female presents to your office with complaints of breast pain and modularity. She states that the pain tends to vary with her menstrual cycle. She recently started the OCP 2 months ago. She is otherwise healthy. What is the likely diagnosis and applicable treatment?
This is likely Fibrocystic Disease/Mastalgia. It is a diagnosis of exclusion (normal breast exam, normal imaging). The treatment includes reassurance of benign condition, analgesia, avoidance of triggers (caffeine, weight gain), and evening primrose oil.
What is the treatment for non-invasive BrCA?
Surgery
+/- chemotherapy
+/- endocrine therapy
+/- targeted therapy
What is the treatment for inflammatory BrCA?
Neoadjuvant chemotherapy Surgery Post-operative radiation therapy \+/- endocrine therapy \+/- targeted therapy
What is the treatment of locally advanced BrCA?
Neoadjuvant chemotherapy Surgery Post-operative radiation therapy \+/- endocrine therapy \+/- targeted therapy
