Chapter 17: Breast Cancer Flashcards
Breast cancer is the most commonly diagnosed cancer in the US with approximate _______% lifetime risk
13%
*Relatively high 5 year survival rates
Breast cancer typically starts in the _____ or ______ cells
Ductal or lobular
Breast cancer that has spread to surrounded to other tissue is called _____ or _____ cancer
Infiltrative or invasive cancer
What are 5 modifiable risk factors for breast cancer?
- Alcohol
- Overweight/obesity
- Low physical activity
- Using oral contraceptives/hormone replacement
- Childbearing/breastfeeding
What are 6 non-modifiable risk factors for breast cancer?
- Genes (i.e. BRCA1 & BRCA2)
- Having dense breast tissue
- Late menopause (>55 y/o)
- Early menstruation (<12 y/o)
- Chest radiation
- Rece/ethnicity (Jews)
What is the difference between ductal cancer in situ & infiltrative/invasive breast cancer
Hasn’t yet spread to the fatty tissue outside of the duct
What are the 3 receptors looked at with breast cancer?
ER, PR, HER2
What is triple “triple positive” breast cancer?
ER+, PR+, HER2+
T/F: HER2+ (aka ERBB2) breast cancers are more likely to spread
True
What does hormone receptor positive mean?
Estrogen and/or progesterone receptors are present. Hormone therapy WILL be given. Chemo may also be given
How are hormone receptor negative breast cancers treated?
With chemotherapy, they tend to respond well to chemo but not hormone therapy
Is HER2 a hormone receptor? How is it treated?
No, it’s a protein marker that drives treatment
Grows faster but good targeted therapies available
T/F: HR+ breast tumors grow more quickly than HR-?
False - HR- grow more quickly
What is the Oncotype Dx?
Recurrence score for breast cancer (how likely it’ll return in 10 years)
Define Sentinel lymph node biopsy
Removes and tests the first lymph node in which the cancer would likely spread. More will be tested if positive
Define Axillary lymph node dissection
Removes armpit lymph nodes (more than in the sentinel
Define breast-conserving surgery
AKA lumpectomy or partial mastectomy, removes cancerous tissue and a surgical margin
Define total mastectomy
Whole breast is removed
Define modified radical mastectomy
Removes entire breast + lymph nodes under the arm
Define radicial mastectomy
Removes breast, lymph nodes, and underlying chest muscles
Define contralateral prophylactic mastectomy
Removal of the unaffected other breast
Ovarian ablation
Permanent surgical oophrectomy to reduce estrogen
It’s best to try to limit wt loss during breast cancer treatment to < ____-_____ lbs/week, but the patient also shouldn’t gain much wt
1-2 lbs/week
**ACS says wt loss programs are actually appropriate for breast cancer pts as long as there’s no contraindications
Kcal & protein recommendations w/ breast cancer
25 kcal/kg
1.2-1.5 g/kg body wt
________ is the most common side effect of breast cancer treatment, affecting an estimated 60-96% of patients
Fatigue
*associated w/ BMI > 25, pre-menopausal status, hormone therapy
Is multivitamin beneficial for reducing fatigue with breast cancer?
No, actually increased fatigue in a study
However, increased exercise and a diet higher in soy & omega 3 can lower fatigue
What are 5 risk factors for breast-cancer related lymphadema?
-Age
-Overweight
-Lymph node dissection
-Adjuvant radiation to regional
lymph nodes
-Some cardiovascular conditions
What are the 3 most common remedies for breast-cancer lymphadema?
- Compression bandages
- Manual lymphatic drainage
- Exercise
**weight loss may help but more research is needed
What are vasomotor symptoms?
Hot flashes, sweating, flushing
Occur in 2/3 of breast cancer patients
Nutrition interventions for vasomotor symptoms
Isoflavones (phytoestrogen) such as soy (but not supplements) and potentially vitamin E
Are muscoskeletal symptoms (“every bone in my body hurts”) typically more common w/ aromatase inhibitors or SERMS?
Aromatase inhibitors (think post-menopause)
*No strong nutrition evidence
Calcium is recommended w/ bisphosphonate therapy d/t bone loss associated w/ breast cancer. When is the best time to take for max absorption?
2 hours before or after bisphosphonates
Peripheral neuropathy has been associated with _______ - based chemotherapy
Taxane
(think ataxia = difficulty walking)
*many nutrition studies done, omega 3 supplements may help
What is the PATHWAYS study?
long term breast cancer study
________ & _______ can be considered in addition to anti-emetics for breast cancer patients
Acupuncture & accupressure
Taste changes are likely to resolve within ______ months after completing chemo
3
Those with BMI < ______ or with recent ______ % wt loss should be discouraged from fasting in attempt to mitigate chemo side effects
20.5
10
T/F: Women closer to their IBW, younger, and who receive chemo are at a higher risk for weight gain during breast cancer treatment
True
CMF chemotherapy regimen is associated with a significantly higher risk for wt gain during treatment
“call me fat”
Cyclophosphamide, methotrexate, fluorouracil
T/F: Contrary to popular belief, Tamoxifen is not associated with significant wt gain
True
Soy may help which 2 side effects of breast cancer treatment
Fatigue & hot flashes
Vitamin E may help which side effect of breast cancer treatment?
Hot flashes
(E=extinguisher)
Weight loss may help which 1 side effect of breast cancer treatment?
Lymphadema
Omega 3 may help these 2 side effects of breast cancer treatment?
Fatigue
Peripheral neuropathy
In the WHEL study, highest levels of plasma __________ were associated with decreased breast cancer reurrence
Carotenoids
Does soy or flax interfere with Tamoxifen?
No
_______ (increased/decreased) risk for breast cancer w/ low fat dairy
Decreased - should be encouraged to consume 2-3 servings/day
Has research found associations between red/processed meats and breast cancer?
Yes, limit
What is a-linolenic acid
Form of omega-3 that comes from plants
Inverse relationship with omega-3s and breast cancer risk, name 3 fish sources high in DHA/AHA
- salmon
- herring
- sardines
- mackerol
- tuna (not as high as the others)
aim for 1-2 servings/week
CHOICE Study
We loss study, no significant difference between low fat & low CHO group on success w/ losing wt (though some studies have shown benefits of low fat diet w/ breast cancer)
T/F: Nighttime fasting may lower breast cancer risk
True. May
improve BG control and diabetes is also a concern for BG risk
(recommend 13 hours/night)
Soy recommendations for breast cancer?
1-2 servings/day (provides 10-40 mg soy isoflavones)
Consensus on supplements with breast cancer
Results are all over the place with almost all supplements. More research is needed, best not to recommend unless deficient.
