ECR Breast Cancer

Question 1

What are palapable masses of breat

Answer 1

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

Question 2

Common lesion in 15-25 year olds

Answer 2

Fibroadenoma

Question 3

Characteristic of fibroadenoma

Answer 3

usually fine, round, mobile, nontender

Question 4

Common lesions in 25-50 year old

Answer 4

Cysts- soft to firm, round, mobile, often tender

fibrocystic changes-nodular, ropelike

Cancer- irregular, stellate, firm, not clearly delineated from surrounding tissue

Question 5

over 50 common lesion

Answer 5

cancer until proven otehrwise

Question 6

Pregnancy/lactation

Answer 6

lactating adenomas, cysts, mastitits, cancer

Question 7

what percent of cancers is breast cancer

Answer 7

10% in women

Question 8

what is chace of women getting brast caner

Answer 8

12% or 1/8 chance in liefetime

Question 9

what has lead to declines in new cases of invasive breast cancer

Answer 9

1. decreased mamography screening , which leads to underdiagnosis or delayed diagnosis rather than true decrease in disease incidnece
2. decreased use of hormone replacement therapy (HRT)

Question 10

what are two trends in breast cancer

Answer 10

declines in new cases of invasive breast cancer

earlier and more advanced breast cancer in african american women

Question 11

What is Gail model?

Answer 11

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

Question 12

Claus Model

Answer 12

for women with a family history of second degree maternal or paternal relatives with breast cancer

Question 13

what risk factors are not included in teh Gail or Claus model?

Answer 13

breast density, plasma levels of free estradiol, bone desity, post-menopausal eight gain, or waist-to-hip ration

Question 14

Factors that affect circulating hormoenes and have a 1.1-2.0 risk

Answer 14

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)

Question 15

What is chances of women with BRCA1 mutations to develop breast cancer by age 70>

Answer 15

65%

Question 16

What is percent of women that have BRCA2 mutations will develop breast cancer by age 70

Answer 16

45%

Question 17

What is criteria for Identying women at risk for BRCA1 or 2 mutation?

Answer 17

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

Question 18

Risk of breast cancer and hisotlogy of benigh breast lesions;

Answer 18

No increased risk
Small increased risk
Moderate increased risk

Question 19

No increased risk; relative risk appox 1.3

Answer 19

nonproliferative changes: cysts and ductal ectasia, mild hyperplasia, simple fibroadenoma, mastitits, granuloma, diabetic mastopathy

Question 20

Small increased risk, 1.5-2.0

Answer 20

Proliferative withotu atypia: usual ductal hyperplasia, complex fibroadenoma, papilloma

Question 21

Moderate increased risk o>2 -4.2

Answer 21

Proliferative with atypia: including atypical ductal hyperplasia and atypical lobular hyplasia

Question 22

what is the most undervalued and underused risk factor in ammmograms?

Answer 22

breast density. “ present int he tusses from with cancer arises”

Question 23

60-75% more radiologially dense, have how much greater risk of breast cancer?

Answer 23

4-6x greater risk than those with no brast density

Question 24

use of mammography in women 40-50 years

Answer 24

false positives; mammography every 1-2 years; 15% reduction in breast cancer mortality after 14 years of follow up

Question 25

Use of mammography in women 50 years or older

Answer 25

reduces breast cancer mortality by 15-35%

annually

Question 26

Clinical Breast Examination

Answer 26

ACS recomments CBE every 3 years for 20-40 years and annually after 40 years old

Question 27

BSE- breast self exam

Answer 27

monthy 5-7 days after onset of menses can b

Question 28

MRI

Answer 28

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

Question 29

High Risk 20-25% (Refererals for Breast MRI)

Answer 29

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

Question 30

Moderate risk 15-20% (Referrals for Breast MRI)

Answer 30

Extremely dense breases or unevenely dense breasets

Hx of breast canver, ductal o lobular carcinoma in situ, atypical ductal or lobular hyperplasia

Question 31

Chemoprevention

Answer 31

estrogen-receptor modulator in women at high risk for breast cancer and at low risk for adverse effects