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Breast > Screening for Breast Cancer > Flashcards

Screening for Breast Cancer Flashcards

1
Q

When does the American Cancer Society recommend screening

A

Regular annual mammography at age 40

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2
Q

When does the USPSTF recommend screening mammograms?

A

Start at age 50 - caused controversy. Most clinicians stick to 40

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3
Q

Is there a set age at which mammography should be discontinued?

A

No. Although the USPSTF found insufficient evidence to assess additional benefits and harms of screening mammograms in women age 75 and older

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4
Q

What is a general rule of thumb on when to stop breast cancer screening?

A

If the life expectancy is less than 5 years

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5
Q

Women with known BRCA mutation should have breast cancer screening starting at age

A

25 years

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6
Q

Women with a strong fx for breast CA (e.g. 1st-degree relative with premenopausal breast CA) should have screening started at ﾅ

A

5-10 years before the youngest age of breast CA diagnosis in a relative

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7
Q

Why are brease self-examinations no longer a part of breast cancer screening regimens?

A

Large randomized trials failed to show any reduction in breast cancer-specific or all-causes mortality when they were used.

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8
Q

What % of all breast cancers are NOT visible on screening mammography?

A

10-20%

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9
Q

When should clinical breast exams be initiated?

A

Beginning at age 20. Repeat q 2-3 years. Annually after age 40.

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10
Q

Women with a high risk for breast CA should have clinical breast exams how often?

A

q 6 months

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11
Q

Screening mammography has been shown to decrease the mortality of breast cancer by:

A

30%

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12
Q

What is the difference between a screening and a diagnostic mammogram?

A

Screening only has the craniocaudal (CC) and mediolateral oblique (MLO) views. Diagnostic mammograms have more views and manipulations to better view the breast lesion.

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13
Q

What are Eklund views in mammography

A

AKA implant displacement views: implant is pushed back agains the chest wall and the breast is pulled over it to increase the amount of breast tissue for imaging

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14
Q

Should a patient with a BIRADS 5 lesion with benign pathologic findings on core needle biopsy still undergo surgical excision?

A

Yes

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15
Q

What is the BI-RADS assessment and recommendation for a category 0 lesion?

A

Assessment Incomplete. Rec: Need additional imaging or prior studies for comparison

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16
Q

What is the BI-RADS assessment and recommendation for a category 1 lesion?

A

Assessment: Negative. Rec: Resume routine screening mammography

17
Q

What is the BI-RADS assessment and recommendation for a category 2 lesion?

A

Assessment: Benign. Rec: Resume routine screening mammogrphay

18
Q

What is the BI-RADS assessment and recommendation for a category 3 lesion?

A

Assessment: Probably benign. Rec: Risk of malignancy <2%; short-term interval follow-up at 6 months

19
Q

What is the BI-RADS assessment and recommendation for a category 4 lesion?

A

Assessment: Suspicious abnormality. Rec: Intermediate risk of malignancy; bx recommended

20
Q

What is the BI-RADS assessment and recommendation for a category 5 lesion?

A

Assessment: highly suggestive of malignancy. Rec: Chance of malignancy >95%, appropriate action should be taken

21
Q

What is the BI-RADS assessment and recommendation for a category 6 lesion?

A

Assessment: Known bx-proven malignancy. Rec: Treatment of known malignancy

22
Q

What does BIRADS stand for?

A

Breast Imaging Reporting and Data System

23
Q

When is a breast ultrasound indicated?

A

Any patient with a clinically suspicious palpable abnormality but normal mammography

24
Q

Which imaging modality is the best at distinguishing between a cystic and solid breast lesion?

A

US

25
Q

What US characteristics are consistent with malignancy?

A

Lesions that are taller than they are wide, irregular shape, ill-defined margins, posterior acoustic shadowing, hypoechogenicity, increased vascularity

26
Q

What did the ACRIN 6666 trial show with regards to whole-breast screening US?

A

It may improve detection of early breast CA in the moderately-increased risk group who do not currently meet the recommendation for screening MRI

27
Q

The American Cancer Society defines High risk for breast cancer as

A

Greater than 20% lifetime risk

28
Q

The American Cancer Society defines Moderately increased risk for breast cancer as

A

15-20% lifetime risk

29
Q

Annual screening MRI is recommended for what group?

A

Women with 20-25% or greater lifetime riskof breast cancer, include those with strong fx of breast or ovarian CA, or women who received XRT for Hodgkin disease

30
Q

Are there data to support MRI screening in women with personal hx of breast CA, carcinoma in situe, atypic hyperplasia and extremely dense breasts on mammography?

A

No. Although the USPSTF found insufficient evidence to assess additional benefits and harms of screening mammograms in women age 75 and older

31
Q

What is the ACS recommendation for annual breast MRI screening based on evidence?

A

BRCA mutation, 1st degree relative of BRCA carrier but untested, lifetime risk of 20-25% or greater as defined by BRCAPRO or other models that largely depend on fx

32
Q

What is the ACS recommendation for annual breast MRI screening based on expert consensus opinion?

A

XRT to chest between age 10-30 years, Li-Fraumeni syndrome and 1st degree relatives, Cowden and Bannayan-Riley-Ruvalcaba syndromes and 1st degree relatives

33
Q

How does molecular breast imaging work?

A

Provides functional imaging of the breast by detecting uptake of technetium-99m sestamibi in breast lesions

34
Q

What is the most commonly used risk-prediction tool for breast cancer?

A

The Gail model. Available on the NCI web site.

35
Q

What does the Gail model risk-prediction tool use to calculate a woman’s 5 year and lifetime risk of breast cancer?

A

Personal hx of prior bx, age of menarche, age at first live birth, current age and 1st-degree fx

36
Q

In the Gail model for risk-prediction, what 5-year risk is designated as high risk?

A

1.66% indicated high-risk

37
Q

How should men with a known BRCA-1 or BRCA-2 mutation be managed?

A

With monthly self breast exams, clinical breast exams q 6 months, and annual mammography

38
Q

Men with a personal hx of brest cancer are recommended to undergo what kind of screening?

A

Clinical breast exam q 6 months and consider genetic testing

Breast (12 decks)

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