Chapter 34 Benign and Malignant Disease of the Breast

Question 1

__ simulate the proliferation of breast epithelial cells, and may also have direct genotoxic effects and induce aneuploidy.

Answer 1

estrogen.

Question 2

tamoxifen use is associated with __ reduction in prevalence of benign breast disease

Answer 2

38%

Question 3

breast mass that fluctuates with menstrual cycles or has been present and stable for years is more likely to be benign

Answer 3

true

Question 4

in absence of a surgical scar, a mass associated with skin dimpling is malignant until proven otherwise

Answer 4

true

Question 5

triple test of breast mass includes

Answer 5

palpation, imaging and core needle biopsy for pathologic diagnosis.

Question 6

hormonal kexposure and a risk of breast cancer:

Answer 6

oral contraceptive pill use associated with 1.25 of increased breast cancer risk among current users

Question 7

postmenopausal hormone replacement therapy (HRT) estrogen plus progestin use is associated with a two to threefold higher risk for developing invasive breast cancer, and risk is directly associated with length of exposure.

Answer 7

true

Question 8

Tamoxifen and raloxifene (evista) equally effective in reducing risk of __ breast cancer in postmenopausal women.

Answer 8

estrogen receptor positive breast cancer

Question 9

mammography screening often reveals a lesion before it is palpable by clinical breast examination and on average __ before it is noted by breast self examination

Answer 9

1-2 years.

Question 10

human epidermal growth factor receptor - 2 (HER-1) overexpression occurs in 20-30% of breast cancers and is associated with increased incidence of recurrence and reduced survival

Answer 10

true

Question 11

__ screening is recommended for high-risk women including those with BRCA1 or BRCA2 mutations, women who have greater than 20% lifetime risk of developing breast cancer, and women who have been treated for Hodgkin’s lymphoma

Answer 11

MRI

Question 12

initial work of a suspicious breast mass includes the following:

Answer 12

1. bilateral diagnostic mammogram and breast US if necessary
2. core needle biopsy image guided or nonimage guided for palpable lesions
3. pathology review (tumor type and grade)
4. determination of estrogen/progesterone receptor and HER-2 status
5. genetic counseling is recommended if a patient is considered at high risk of hereditary breast cancer.

Question 13

treatment of noninvasive cancers (stage 0) three types: what are they?

Answer 13

1. LOBULAR carcinoma in situ (LCIS) - otamoxifen; complete excision for pleomorphic LCIS, bilateral mastectomy (special cases.)
2. DUCTAL CARCINOMA IN SITU (DCIS) - lumpectomy without lymph node surgery plus whole breast radiation therapy OR total mastectomy with or without sentinel node iopsy plus reconstruction OR lumpectomy without lymph node surgery and without radiation therapy.

Question 14

side effects of chemotherapy:

Answer 14

alopecia, nausea/vomiting, mucositis, lowering of blood counts, fatigue, and peripheral sensory neuropathy.

Question 15

long term toxicities:

Answer 15

cardiomyopathy, secondary leukemia, and premature menopause.

Question 16

antiestrogen therapy (tamoxifen and aromatase inhibitors) for patients with hormone receptor (ER) or progesterone receptor (PR) positive tumors.

Answer 16

true

Question 17

mammography is safe for evaluation of the breast in pregnant women, and radiation dose to properly shielded fetus is only 0.01 rad, well below accepted 5 rad limit. mammography is less sensitive during pregnancy because of the higher breast density. breast US is 93% accurate for evaluation of masses during pregnancy

Answer 17

true