Clinical Aspects of Breast Disease Flashcards
Risk Factors in Development of Breast Cancer
Age (risk increases as age increases) Female Gender Family hx of breast cancer Genetic predisposition Prior personal hx of breast cancer Increased estrogen exposure (early menarche, late menopause, HRT) Nulliparity (1st preg after 30) Diet and lifestyle Radiation exposure before age 40 Prior benign or premalignant breast changes (in situ cancer, atypical ductal hyperplasia (ADH))
Atypical Ductal Hyperplasia
- Describe
- What is it associated with?
- hyperplasia within a duct
2. increased risk of breast cancer development in either breast; marker of breast cancer risk
What factors does the Gail Model take into account? (6)
- age
- age at menarche
- age at 1st birth/nulliparity
- number of 1st degree relatives w/ breast cancer
- number of breast biopsies
- pathological diagnosis of atypia
Selective Estrogen Receptor Modulators
- Two drugs
- Approved for what
- Mechanism
- How effective are they
- Tamoxifen and Raloxifene
- reduce breast cancer risk in women w/ Gail risk >1.66%; Raloxifene only for postmenopausal women
- estrogen agonist and antagonist properties based on specific tissue target and hormonal milieu
- reduce risk of developing invasive breast ca by 50% when taken daily for 5 years
Side Effects of Tamoxifen (5)
- what is a protective effect?
- how does raloxifene differ?
- reduces cholesterol
- uterine stimulation, bothersome GYN side effects, uterine cancer
- hot flashes/sweats
- anti-estrogenic against breast cancer; no agonist activity
- increased risk of thromboembolism
- maintains bone density
- no increased risk of uterine ca or thromboembolism
Aromatase Inhibitors: What might they do?
reduce incidence of developing breast cancer
Screening Mammography
- What do they do to breast cancer mortality?
- Recommendation
- reduces mortality
2. at least biennial mammography between ages 50-74
What are some adverse side effects of Hormone Replacement Therapy? (4)
5. What was a benefit?
- increased risk of breast cancer
- Coronary-heart disease
- stroke
- Venous thromboembolism
- reduced rate of fractures
- What is the benefit of Modified Radical Mastectomy vs Breast Conserving surgery?
- What is a sentinel node biopsy?
- none, likelihood of cure is the same
2. removes lymph nodes that receive drainage from site of neoplasm; less invasive, fewer complications, more accurate
- Radiation Therapy: used after what other treatment?
2. What are the goals of adjuvant therapy? (3)
- breast conserving therapy
- reduce burden of clinically undetectable, distant micrometastatic disease
- improve relapse-free survival
- improve overall survival
Tamoxifen
- What cancer types is it used for?
- What does it do?
- Side effects?
- Is raloxifene used for breast cancer treatment?
- pre and post-menopausal women with ER/PR positive tumors
- decreases risk of tumor recurrence by approximately 50%
- endomett
Aromatase Inhibitors
- Name the drugs
- Mechanism
- Who are they indicated in?
- Side effects (2)
- How long are they used?
- Anastrozole, Letrozole, Exemestane
- blocks aromatase enzyme in the final step of estrogen biosynthesis (adipose tissue); blocks conversion of androgens to estrogens
- post-menopausal women
- arthralgias, bone loss (important)
- 5 years
Adjuvant Chemotherapy
- What does it reduce? (2)
- Optimal duration
- Used with what?
- What is used if the tumor is HER2+?
- reduces recurrence rates by 30%, decrease mortality by 20%
- 3-6 months
- in addition to hormone therapy
- trastuzumab
Questions to ask in the Hx of Breast Mass
Location of Mass How it was first noted How long has it been there Presence of discharge any change in size whether lump changes w/ menstrual cycle pts reproductive hx, last menstrual cycle, history of HRT Family hx of breast cancer
Physical Inspection of Breast Mass (3)
4. What are some characteristics of a malignant mass.
Inspection and Palpation
Neck, supraclavicular area, chest wall, both breasts, axillae
Examination supine and erect
4. Single lesion, hard, immovable, irregular borders, size >= 2cm