repro. Mehl. breast screening 12-22 (1)

Question 1

when is done mammography in usmle?

Answer 1

every two years between ages 50-74.

Question 2

usmle do not borderline students, age 50-74. it differs between guidelines

Answer 2

They will just give you a patient who’s, e.g., 56 who needs a mammogram since she hasn’t had one for two years.

Question 3

If first degree family member (i.e., parent or sibling) has Hx of breast cancer, when do mammography?

Answer 3

then start mammography at age 40, not 50.

Question 4

Any breast screening done for a women under 30, do not do mammography on USMLE. what do method?

Answer 4

Ultrasound is typically done. This is because younger women have denser breast tissue, making mammography less specific (i.e., more false-
positives) and hence less reliable of a diagnostic modality.

Question 5

what is better correlates with better prognosis?

Answer 5

Estrogen and progesterone receptor (ER/PR) positivity is correlated with better prognosis for breast cancers. This is partially because SERMs and aromatase inhibitors can be used as Tx.

Question 6

what is correlated with worse prognosis?

Answer 6

HER2/neu positivity is correlated with worse prognosis. Trastuzumab
(Herceptin) can be used to target HER2/neu.

Question 7

what is assoc with bad prognosis?

Answer 7

Triple-negative ER/PR/HER2/neu is associated with bad prognosis due to ­
aggressiveness, ­rates of recurrence, and risk of metastasis to lungs/brain.

Question 8

patients who have confirmed BRCA mutation. what Mx 2CK wants?

Answer 8

2CK NBME wants “bilateral mastectomy + oophorectomy” in patients who have confirmed BRCA mutation.

Question 9

Breast cancer risk is increased­ as a result of HRT (hormone replacement therapy), even when progesterone is given as part of it. Breast cancer risk is increased­ as a result of ­ increased absolute estrogen exposure the female has in her life. This has nothing to do with unopposed estrogen, which is
the major risk factor for endometrial cancer.

Answer 9

.

Question 10

Combined OCPs have been suggested in some literature as ­ the risk of breast
cancer, but there is no significance. They won’t assess this on USMLE either way. But they do assess ­breast cancer risk as a result of HRT.

Answer 10

.

Question 11

As I talked about before, the reason the only approved indication of HRT is
severe vasomotor Sx (i.e., and not to maintain bone density, etc.) is because
HRT ­incr. the risk of breast cancer, thromboembolic events, MI, and stroke.
This is because estrogen upregulates fibrinogen and factors V and VIII.

Answer 11

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