Breast Lump

Question 1

What are the endogenous (breast specific) risk factors for developing breast cancer?

Answer 1

1. High sex hormone levels - oestrogen, progesterone and testosterone
2. Breast density - BrCa is 3-5x more common in women with denser breasts.

Question 2

What are the reproductive risk factors for developing breast cancer?

Answer 2

1. Older age at first gestation
2. Younger age at menarche
3. Older age at menopause
4. Removal of reproductive organs reduces the risk
5. Nulliparity - the more children a woman has, the lower the risk of breast cancer
6. Never breastfeeding

Question 3

What are the drug risk factors for breast cancer?

Answer 3

1. Oral contraceptives - very few BrCa cases are caused by this, however can still theoretically occur
2. HRT - very low risk, more common in women with high BMI

Question 4

What are the modifiable risk factors for developing breast cancer?

Answer 4

1. High BMI - more adipose tissue = more oestrogen
2. Alcohol intake
3. Smoking

Question 5

What are the 2 common genes that can be mutated to increase the risk of developing breast cancer?

Answer 5

1. BRCA1

2. BRCA2

Question 6

Define ‘Skin Tethering’.

Answer 6

The lump is attached to the skin but can be moved in an arc without moving the skin. If the lump is pulled outside the arc, the skin indents

Question 7

Define ‘Skin Fixation’

Answer 7

The lump cannot be moved without moving the skin

Question 8

Where is the most common site of breast cancers to occur?

Answer 8

The Upper Outer Quadrant (UoQ) of the breast (50% of BrCa)

Question 9

How much radiation does an individual receive from a mammogram?

Answer 9

The equivalent of 2 months of background radiation

Question 10

Is mammography painful?

Answer 10

Most women experience discomfort, only a few find it painful

Question 11

Are there male and female mammographers?

Answer 11

No, the profession is exempt from the Sex Discrimination Act. All mammographers are female.

Question 12

What are the 3 advantages of performing a cord biopsy under US guidance rather than mammographic guidance?

Answer 12

1. The patient is less likely to faint
2. There is no ionising radiation involved
3. The biopsy needle can be visualised in real time

Question 13

What is the ‘grade’ of a cancer and why is it useful?

Answer 13

The grade of a cancer represents it’s ‘aggressive potential’ which helps to guide clinicians in their prognosis and treatment options.

Question 14

What are the 3 factors a pathologist takes into account when considering the grade of a tumour?

Answer 14

1. The amount of gland formation (differentiation) AKA how well the tumour recreates normal glands
2. The nuclear features
3. The mitotic activity of the tumour

Question 15

What is the most common type of breast cancer (histologically)?

Answer 15

Invasive ductal carcinoma

Question 16

What is the 2nd most common type of breast cancer (histologically)?

Answer 16

Invasive lobular carcinoma

Question 17

In what pattern do lobular carcinomas infiltrate the breast tissue?

Answer 17

In a single file pattern

Question 18

What scan is appropriate to arrange for a patient with invasive lobular carcinoma of the breast before surgical planning?

Answer 18

MRI scan to define the extent of the cancer

Question 19

Averagely, how many women are diagnosed with breast cancer annually in the UK?

Answer 19

55,000

Question 20

Name an anti-oestrogen treatment.

Answer 20

Tamoxifen

Question 21

Name a monoclonal anti-HER2 therapy

Answer 21

Trastuzumab