Breasts

Question 1

what happens to the sensitivity of mammography as the density of breasts DECREASES?

what does it mean for younger women?

Answer 1

inversely related so as density decreased (as with age) sensitivity increases

so younger women = denser breasts = mammography not as sensitive and can miss abnormalities

Question 2

what test is used to screen women for breast cancers in over 40? and what views are required?

Answer 2

mammography

2 views
CC- craniocaudal
MLO - mediolateral oblique

Question 3

what imaging is used first line to look for breast cancer in symptomatic women under 40 years old and why?

Answer 3

ultrasound because their breasts are denser

Question 4

what imaging is used to screen for breast cancer in women under 40 with a strong positive family history of breast cancer or previous radiotherapy?

Answer 4

MRI

Question 5

what proportion of women will develop breast cancer in the western world?

Answer 5

1 in 8

Question 6

what western lifestyle factors are increasing the incidence of breast cancer in the UK?

Answer 6

OCP 
HRT 
not breastfeeding (using formula) 
nulliparous 
late age at first birth 
alcohol (even low)
obesity in post menopause 
low levels of exercise 

NOT SMOKING

Question 7

what ages does the breast screening programme screen?

how often?

Answer 7

47 up to 73

(50-70 originally)

every 3 years

Question 8

what genes are associated with breast and ovarian cancer?

Answer 8

BRCA1 and BRCA2

Question 9

clinical features of breast cancer

Answer 9

painless lump - irregular, hard, fixed
nipple inversion/indrawing
nipple discharge
paeu d’orange - inflammatory

pathological fractures (breast cancer mets to the bone)

Question 10

diagnosis of breast cancer is based on…

Answer 10

triple assessment

clinical score (1-5) 
imaging score (1-5)
biopsy score (1-5)

Question 11

what things do you see that are worrying on mammography?

Answer 11

calcification - which is tracking through

white lump

Question 12

what breast imaging tests do you use on people with implants in?

Answer 12

MRI

Question 13

what do you take a breast biopsy with?

Answer 13

core biopsy

Question 14

what are the two options for surgical treatment of primary operable breast cancer?

what might decide which one you use?

Answer 14

breast conservation -
mastectomy - more likely to do if: multi-focal, if the tumour is really big in relative to the size of the breast,

+ sentinel lymph node biopsy
+/- reconstruction

patient choice

Question 15

what other type of surgery might you need to do in breast surgery?

Answer 15

surgery to the axilla

• full axillary clearence
• limited axillary surgery

Question 16

complication of axillary surgery?

Answer 16

lymphaedma to the arm

Question 17

what do you do in sentinel lymph node biopsy?

Answer 17

inject radioactive dye to the tumour and use a gieger counter to locate the lymph node biopsy site

Question 18

which types of breast cancer are there and which is most common?

Answer 18

ductal - most common

lobal - less common, but more hard to feel/visualise on mammogram

Question 19

what is the difference between stage and grade of cancer?

Answer 19

stage - location (TNM)
1-4 
stage 1 = just in the breast 
stage 2 - breast and axilla 
stage 3
stage 4 - mets

grade - what it looks like under the microscope (1-3, grade is 3 is worse)

Question 20

what receptors are tested for in breast cancer? which is better?

Answer 20

oestrogen receptor - better

her-2 receptor - worse
use herceptin/trastuzumab

Question 21

what tool is used to calculate breast cancer survival?

Answer 21

‘predict’

Question 22

what multi gene array do we use in the UK to work out if we should use chemotherapy?

Answer 22

oncotype Dx

Question 23

what adjacent therapies can we give in breast cancer?

Answer 23

endocrine - anti oestrogen therapy in all oestroen receptor positive cancers
- tamoxifen if premenopausal, aromatase inhibitors if post menopausal (both reduce oestrogen stimulation) 5 years if low risk, 10 if high

radiotherapy - lumpectomy or bad cancer with mastectomy

chemo - agressive disease

transtuzumab/pertuzimab - (herceptin) - in her 2 pos

bisphosphonates - for high risk cancer in post men with ER positive disease - prevents mets

Question 24

what adjacent do you have after lumpectomy/wide local excision?

Answer 24

radiotherapy!

Question 25

what prognostic score do you use for breast cancer?

Answer 25

nottingham prognostic score

Question 26

how might you try and remove or shrink the breast cancer without surgery/prior to surgery

Answer 26

chemotherapy and hormone receptor therapy
- which might actually shrink it almost that it disappears!

then do WLE on the area where the cancer was (clip will be there to indicate it)

Question 27

if you’re a BRAC1 carrier what kind of cancer are you most likely to have? what kind of treatment will you need?

Answer 27

triple negative and will be really difficult with low prognosis

chemotherapy first
mastectomy with reconstruction