ECR Breast Cancer Flashcards
What are palapable masses of breat
Breast cancer occurs in up to 4% women with brst copleints, 5% women reproting nipple discharge, and up to 11% of women specifically complaining of a breast lump or mass
Common lesion in 15-25 year olds
Fibroadenoma
Characteristic of fibroadenoma
usually fine, round, mobile, nontender
Common lesions in 25-50 year old
Cysts- soft to firm, round, mobile, often tender
fibrocystic changes-nodular, ropelike
Cancer- irregular, stellate, firm, not clearly delineated from surrounding tissue
over 50 common lesion
cancer until proven otehrwise
Pregnancy/lactation
lactating adenomas, cysts, mastitits, cancer
what percent of cancers is breast cancer
10% in women
what is chace of women getting brast caner
12% or 1/8 chance in liefetime
what has lead to declines in new cases of invasive breast cancer
- decreased mamography screening , which leads to underdiagnosis or delayed diagnosis rather than true decrease in disease incidnece
- decreased use of hormone replacement therapy (HRT)
what are two trends in breast cancer
declines in new cases of invasive breast cancer
earlier and more advanced breast cancer in african american women
What is Gail model?
tool incorproates risk factors of age, first degree relatives with breast cancer, previosu breast biopsies and presence of hyperplasia, age at menarche, and age at first delivery. It assumes annual screenign and no pateinte history of breast cancer
Claus Model
for women with a family history of second degree maternal or paternal relatives with breast cancer
what risk factors are not included in teh Gail or Claus model?
breast density, plasma levels of free estradiol, bone desity, post-menopausal eight gain, or waist-to-hip ration
Factors that affect circulating hormoenes and have a 1.1-2.0 risk
late age at first full term preancy (>30 years) Early menarhce (55) No full-term pregnancies Never breast-fed child Recent oral contraceptive use Recent and long-term use of HRT Obesity (postmenopausal)
What is chances of women with BRCA1 mutations to develop breast cancer by age 70>
65%
What is percent of women that have BRCA2 mutations will develop breast cancer by age 70
45%
What is criteria for Identying women at risk for BRCA1 or 2 mutation?
using risk calculation
establish one of the following risk factors
-1st dgree relative with known BRCA1 or 2 mutaiton
- > 2 relatives with diagnosis of breast caner and >1 occured before age 50
- > 2 relatives with a diagnosis of ovarian cancer
- > 1 relative with a dignosis of breast cancer and >1 reltive has a diagnosis of ovarian cancer
Risk of breast cancer and hisotlogy of benigh breast lesions;
No increased risk
Small increased risk
Moderate increased risk
No increased risk; relative risk appox 1.3
nonproliferative changes: cysts and ductal ectasia, mild hyperplasia, simple fibroadenoma, mastitits, granuloma, diabetic mastopathy
Small increased risk, 1.5-2.0
Proliferative withotu atypia: usual ductal hyperplasia, complex fibroadenoma, papilloma
Moderate increased risk o>2 -4.2
Proliferative with atypia: including atypical ductal hyperplasia and atypical lobular hyplasia
what is the most undervalued and underused risk factor in ammmograms?
breast density. “ present int he tusses from with cancer arises”
60-75% more radiologially dense, have how much greater risk of breast cancer?
4-6x greater risk than those with no brast density
use of mammography in women 40-50 years
false positives; mammography every 1-2 years; 15% reduction in breast cancer mortality after 14 years of follow up
Use of mammography in women 50 years or older
reduces breast cancer mortality by 15-35%
annually
Clinical Breast Examination
ACS recomments CBE every 3 years for 20-40 years and annually after 40 years old
BSE- breast self exam
monthy 5-7 days after onset of menses can b
MRI
helps detect multicentric or contralateral breast cancer prior to managmetn decisiona bout breast-conserving strategies
ACS recommneds brast MRI for women at high lifetime risk or risk of 20% or more
High Risk 20-25% (Refererals for Breast MRI)
known BRCA1 or 2 mutation
Known 1st degree rlative, including father, brother, with BRCA1 or 2 mutation, but woman not tested
lifetime risk 20-25% using assessment tools
Hx of chest radiation between agest 10-30
High risk genetic syndeome or first degree relative with high risk syndrome
Moderate risk 15-20% (Referrals for Breast MRI)
Extremely dense breases or unevenely dense breasets
Hx of breast canver, ductal o lobular carcinoma in situ, atypical ductal or lobular hyperplasia
Chemoprevention
estrogen-receptor modulator in women at high risk for breast cancer and at low risk for adverse effects
