Final Study Guide 2023 Flashcards
1
Q
Lifetime risk of breast cancer for US women?
A
12%
2
Q
What percent of all breast cancers occur in males?
A
Less than 1%
3
Q
What percent of women have metastatic disease at time of breast cancer diagnosis?
A
6% - Black women are more likely to be diagnosed at later stages and with more aggressive cancers
4
Q
What are hormone-related risk factors for breast cancer?
A
Hormone replacement therapy
Early menarche, late menopause, and late age at first birth also
5
Q
Why did a disparity in mortality for breast cancer between Black and White people emerge after 1983?
A
Mammography screening and adjuvant endocrine therapy were introduced in the 1980s, significantly reducing mortality - however, there were/are racial disparities in access to these interventions
6
Q
(T/F) Black men have a higher risk of getting breast cancer compared to men
A
True
7
Q
(T/F) Higher BMI is associated with breast cancer incidence
A
True
8
Q
Which subtype of breast cancer is most aggressive?
A
TNBC/Basal-like
followed by HER2, Luminal B, Normal-like, and Luminal A
9
Q
What type of cell does breast cancer arise from the most?
A
Most breast cancers are derived from the epithelial lining of ducts or lobules (ductal/lobular carcinoma)
10
Q
Chest radiation increases risk of which subtype of breast cancer?
A
TNBC
11
Q
Which subtype is associated with TNBC?
A
Basal-like
12
Q
Which population is TNBC most common in?
A
TNBC occurs more frequently in African Americans (somatic gene profile differences)
13
Q
Do individuals with lower SES have higher rates of TNBC?
A
Yes, low SES populations have higher TNBC rates. Also linked with younger onset of cancer, later stage at diagnosis
14
Q
Does lobular in situ carcinoma become cancerous?
A
Lobular in situ carcinoma does NOT become cancerous, but is a risk factor for breast cancer
Patients offered chemoprevention but no difference in screenings
15
Q
Is DNA microarray analysis used to determine treatment decisions?
A
DNA microarray analysis is used to detect gene mutations
16
Q
Genes/mutations related to breast cancer?
A
BRCA1/2, RKIP, BACH1, MLH1/PMS2, MSH2/MSH6, PTEN, TP53
17
Q
Is Tamoxifen chemotherapy?
A
No, Tamoxifen is a hormone therapy that acts as an ER antagonist breast tissue
18
Q
Neoadjuvant chemotherapy refers to…?
A
Giving chemo before surgery, often to shrink inoperable tumors
19
Q
What are some common chemotherapeutics for metastatic breast cancer?
A
Cisplatin, gemcitabine, paclitaxel, docetaxel, doxorubicin, etc.
20
Q
Hormone receptor positive breast cancer benefits most from which therapy?
A
HR+ breast cancer responds best to hormone therapy (e.g. targeting estrogen/progesterone receptors)
21
Q
HER2+ tumors respond best to…?
A
HER2 tumors respond best to biologic therapies, e.g. trastuzumab (mAB binding HER2 to inhibit cell growth)
22
Q
Systemic therapy refers to which kind of treatment?
A
Systemic therapies affect the entire body, e.g. chemotherapies that travel through systemic circulation
23
Q
Breast cancer metastasizes primarily to which tissues?
A
Liver, lungs, and bones
24
Q
What drives survival? Primary breast cancer or metastatic disease?
A
Metastasis is the primary cause of death in most cancer cases, so eliminating metastatic disease is essential to survival
25
Should women with BRCA1 be recommended to have their ovaries removed?
Prophylactic oophorectomy is recommended for ages 35-40 in BRCA1 patients. Can reduce risk of ovarian/breast cancer and improve survival
26
What is the lifetime risk of breast cancer in women with BRCA1?
The lifetime risk for BRCA1 of breast cancer is 55-72%
27
When should a physician suspect a hereditary cancer syndrome?
Cancer in 2 or more relatives on the same side of the family, early diagnosis age, multiple primary tumors, bilateral/multifocal/rare tumors, clustering of certain tumor types consistent w/ a specific cancer syndrome, evidence of autosomal dominant transmission, part of a popn w/ higher risk for certain cancer gene mutations
28
What percent of women with breast cancer have no identifiable risk factors?
75% of women have no identifiable risk factors
29
High penetrance breast cancer susceptibility genes include?
BRCA1, BRCA2, PTEN, TP53
30
(T/F) Afro-Caribbean backgrounds are more likely to carry BRCA mutations
True
31
Which countries/regions have the highest incidence of breast cancer?
Australia and New Zealand, followed by Western EU, Northern EU, NA...
32
Which US population has the highest incidence of breast cancer?
In US women, White followed closely by Black, then Asian/Pacific Islander, Hispanic, AI/AN
33
What kind of populations experience cancer health disparities?
Racial/ethnic minorities, individuals of different ancestry, low SES, disabled, limited/lacking health insurance, certain geographic (rural areas, Midwest/South), LGBT+, immigrants, refugees/asylum seekers, adolescents/young adults, elderly
34
In the US population, what percent identify as a sexual minority?
5.6% of the US in 2021 identified as belonging to the Sexual and Gender Minority populations
35
Which group of women are most likely to get severe peripheral neuropathy after treatment with paclitaxel?
Higher BMI/diabetics are more likely to get severe peripheral neuropathy
36
Characteristics of cancer diagnosis among racial/ethnic minority patients?
Often diagnosed with later stages and with more aggressive subtypes
37
(T/F) Does earlier testing reduce breast cancer deaths?
True, in a study of Black women over 40 earlier testing was found to reduce breast cancer deaths
38
(T/F) Black Americans are more likely to receive a recommendation for colorectal screening
False, Black Americans are less likely to receive a recommendation for colorectal screening
39
What cancers are more prevalent in Asians/Pacific Islanders than Whites?
Nasopharyngeal, stomach, liver cancers are more prevalent
40
Can Hep B be transmitted to a fetus?
Hep B can easily be transmitted from mother to baby at birth, or even from mother to fetus in the womb
41
Leukemia and liver cancer are __________ in Hispanics
More common
42
Who has higher mortality from cervical cancer: Blacks, Hispanics, non-Hispanic Whites?
Blacks and Hispanics have higher mortality from cervical cancer compared to NHWs
43
Black men who recently migrated from Africa are _______ to die from liver cancer compared to Black men who lived in the US
More likely, immigrants suffer from higher cancer incidence/mortality
44
(T/F) Bisexual women are more likely to be diagnosed with cancer than heterosexual women
True
45
What population is best represented in GWAS studies of cancer?
In 2009, 96% of GWAS participants were of EU descent. Asian representation has increased as of 2016, but other groups are still poorly represented
46
What protein is a key metastasis suppressor and what downstream changes occur?
RKIP is a key metastasis suppressor that regulates Raf and GPCR signaling via a phosphorylation switch. RKIP influences cell growth, survival, proliferation, and metastasis
47
Spatial transcriptomics allow scientists to figure out...?
Spatial transcriptomics allow scientists to capture the positional context of transcriptional activity for tissues/single cells, e.g. determining sub cellular location of mRNA
48
Do metastasis suppressor genes affect tumor growth?
Yes, RKIP plays a role in tumor growth
49
How are BACH1 and TNBC related?
BACH1, a key metastasis promoter, can distinguish survival in TNBC
50
How do cancer cells primarily generate energy and biosynthetic intermediates?
Through aerobic glycolysis (Warburg effect) rather than oxidative phosphorylation. Caused by low-oxygen environs of tumor or possibly damage to mitochondria
51
How is BACH1 related to Metformin resistance and oxidative phosphorylation?
BACH1 promotes an anaerobic energy profile. Loss of BACH1 sensitizes cells to Metformin treatment because Metformin inhibits ETC Complex 1 and loss of BACH1 increases tumor reliance on oxidative phosphorylation
52
Is there over expression of BACH1 in some cancers?
Many cancers have over expression of BACH1 in ~50% of patients
53
BACH1's role in regulation of hypoxia and metastasis
Hypoxia is a major driver of metastasis. BACH1 is an oxygen sensor that regulates hypoxia response, and can promote motility, invasion, cell-ECM interactions, and metastasis
54
What are some physiological responses to acute stress?
1. Increased energy mobilization (increasing BP, HR, RR, glucose in blood)
2. Cognitive/sensory shifts (aspects of memory improve, senses sharpen)
55
Social circumstances can lead to what kind of changes in a person?
Social circumstances can lead to psychological changes, leading to neuroendocrine changes, which can affect cell survival/tumor growth through changes in protein/gene expression
56
Why is unrelenting stress biologically harmful?
Chronic stress increases stress reactivity, inflammation, hypertension, reproductive abnormalities, metabolic diseases, etc. Disturbance of homeostatic processes
57
Social isolation as a chronic stressor in female mice results in?
Acquired vigilant behavioral phenotype, increased cortisol response to acute stressors, increased mammary tumor growth
58
Prior to development of cancer, isolated mice have up regulation of what genes?
Hexokinase (HK2), ATP Citrate-Lyase (ACLY), acetyl-CoA carboxylase alpha (ACACA) - metabolic genes involved in energy mobilization
59
Where do metabolic changes occur in stressed mice?
ONLY in adipocytes from mammary glands
60
Factors like low SES, low self esteem/limited social support, and racial discrimination link what with breast cancer?
These are contributing factors to low grade chronic stress, which is linked with breast cancer
61
What's the relationship between social isolation, the glucocorticoid response, and mammary stem cells?
Social isolation increases stress reactivity (manifesting in the glucocorticoid response) and mammary stem cell popns. More undifferentiated cells of origin are theorized to turn into more aggressive cancers
62
Term for heightened response to secondary stress, increased vigilance in socially isolated animals
Increased stress reactivity, represented by cortisol serum levels
63
How could chronic stress contribute to metastasis?
Chronic stress results in increased lysophosphatidic choline (LPC), which is converted to lysophosphatidic acid (LPA). LPA signaling is involved in migration, invasion, proliferation, and survival in cancer
64
Social isolation is associated with a significant decrease in ductal epithelium forming. What is the implication of this?
Reduced mammary gland differentiation (aka MaSC/progenitor preservation), which could generate more aggressive cancers
65
Can progenitors not used to make ductal cells come back and increase the risk of cancer later in life?
Possibly, depending on preservation of progenitors. Puberty/early adulthood may be a critical developmental window for mammary cancer risk later
66
Relationship between social isolation and breast cancer development
Changes in stress exposure and reproductive maturity affect mammary gland development and breast cancer risk
67
What is the Stress Process Model?
This model provides a means to understand how stress affects health. Different social statuses contribute to different levels of stress exposure which leads to different psychological outcomes
68
Is there an association between low SES and higher cortisol levels?
Low SES contributes to chronic stress, leading to higher stress reactivity, so likely higher cortisol
69
How does the prevalence of hypertension compare between Black and White women?
Hypertension is more prevalent in Black women and an indicator of chronic stress
70
How is stress measured in the blood?
Corticosterone (aka cortisol) levels
71
What is allostatic load?
The cumulative burden of chronic stress and life events - involves the interaction of different physiological systems at different levels of activity - "wear and tear"
72
Cervical cancer can arise from?
HPV infections, some of which turn into precancers
73
(T/F) HPV vaccination can prevent cancers in boys
True. HPV vaccination also protects against anal, mouth, throat, neck, and head cancers in women and men
74
What is an intervention method that results in higher HPV vaccine uptake?
Self-persuasion intervention strategy - direct individuals to generate their own arguments for a health behavior
75
What are the main reasons for vaccine hesitancy?
The 3 C's: Confidence, Complacency, Convenience
76
How is HPV detected?
Pap tests, primary HPV screening, and now HPV self sampling
77
Lynch Syndrome, also known as non-polyposis colorectal cancer, is also associated with what cancers?
Colorectal, endometrial, ovarian, stomach, small intestine, hepatobiliary cancers
78
Lynch Syndrome is due to inherited mutations in genes that affect...?
MLH1/PMS2, MSH2/MSH6 - dimerized pairs involved in DNA mismatch repair
79
What makes a successful Advanced Care Planning discussion?
1. Starting early
2. Ongoing, routine conversations throughout care
3. Empowering the patient
4. Involving stakeholders (family, care team)
5. Aligning goals and wishes
80
What is needed to understand the experience of Black patients?
Cultural awareness, historic injustices/prior interactions with healthcare, misconceptions of role of palliative/supportive care, building trust as a process, family roles/obligations
81
What is Advanced Care Planning?
ACP includes goals/preferences for future care (e.g. living will, DNR) and is crucial to increasing preparedness for end of life care. Reduces hospitalizations/intensive care that can be deleterious to quality of life
82
What percent of Black women have ACPs?
Less than 25%
83
What are some social determinants of health?
Education access/quality, healthcare access/quality, neighborhood/built environs, social/community context, economic stability
84
What are some ways we can use the sociome to look at exposure to environmental factors?
Sociome factors can disrupt environmental security required for best health
85
What is the main finding of the Reasons for Geographic and Racial Differences in Stroke study?
The REGARDS study showed that SDOH cluster together and greater numbers of SDOH were significantly associated with increased risk of cancer mortality
86
Social Vulnerability Index uses what kind of data?
The SVI uses population census data
87
How can segregation lead to different exposures in air pollution?
Air pollution levels in a region depend on land use, employment options, transportation, etc.
88
Pollution is related to cancer incidence.
Legislation can impact air pollutants in different areas
| idk i hate this section
89
What does intersectionality refer to?
Intersectionality refers to the interconnected nature of social categorizations like race, class, gender as they apply to an individual/group, creating overlapping systems of discrimination/disadvantage
90
What are factors that play into structural racism?
Legislation, organizations/corporations/businesses, education
91
Are menthol cigarettes more or less addictive than non-menthol?
Mentholated cigarettes are more addictive; users show increased nicotine dependence and lower smoking cessation. Menthol use is more prevalent among Blacks than whites
92
How does smoking cessation compare among Blacks vs. whites?
Smoking cessation is lower amongst Blacks despite higher likelihood of reporting a willingness to quit
93
What percent of US citizens smoke?
12.5 (~15% according to slides)
94
What population has the highest rates of cigarette use compared to all other racial/ethnic groups?
AI/AN (American Indian/Alaskan Native)
95
Are high risk patients exposed to info on tobacco cessation?
High risk patients are often not exposed to info on tobacco cessation or recommended to quit. Tobacco companies often target these groups with advertising
96
Which groups have higher rates of smoking in the US?
Rural popns, low SES, lacking health insurance, disabled, uneducated, LGBT, mental health conditions, AI/AN popns
97
Roughly what percent of smoking cessation attempts w/o assistance are successful?
Around 7% of attempts without assistance are successful (~15% with assistance)
98
What is a community health worker?
CHWs are frontline public health workers considered trusted members of the community they serve. CHWs work as a liaison/intermediary between the community and health/social services
99
Are all CHWs trained in chronic health conditions?
Yes, CHWs are trained to assist with chronic disease management as well as cultural mediation, appropriate health education/info, and to advocate for individual/community needs
100
Who declared the war on cancer?
Richard Nixon, signing the National Cancer Act in 1971
101
political figures around breast cancer idk
Mary Lasker - cancer activist, lobbyist to found the NCI, turned the ASCC into the ACS through advertising/funding
