Screening for Breast Cancer

Question 1

When does the American Cancer Society recommend screening

Answer 1

Regular annual mammography at age 40

Question 2

When does the USPSTF recommend screening mammograms?

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

If the life expectancy is less than 5 years

Question 5

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

Answer 5

25 years

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

10-20%

Question 9

When should clinical breast exams be initiated?

Answer 9

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

Question 10

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

Answer 10

q 6 months

Question 11

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

Answer 11

30%

Question 12

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

Answer 12

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

Question 13

What are Eklund views in mammography

Answer 13

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

Question 14

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

Answer 14

Yes

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Assessment: Negative. Rec: Resume routine screening mammography

Question 17

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

Answer 17

Assessment: Benign. Rec: Resume routine screening mammogrphay

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

What does BIRADS stand for?

Answer 22

Breast Imaging Reporting and Data System

Question 23

When is a breast ultrasound indicated?

Answer 23

Any patient with a clinically suspicious palpable abnormality but normal mammography

Question 24

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

Answer 24

US

Question 25

What US characteristics are consistent with malignancy?

Answer 25

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

Question 26

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

Answer 26

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

Question 27

The American Cancer Society defines High risk for breast cancer as

Answer 27

Greater than 20% lifetime risk

Question 28

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

Answer 28

15-20% lifetime risk

Question 29

Annual screening MRI is recommended for what group?

Answer 29

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

Question 30

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?

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

How does molecular breast imaging work?

Answer 33

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

Question 34

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

Answer 34

The Gail model. Available on the NCI web site.

Question 35

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

Answer 35

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

Question 36

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

Answer 36

1.66% indicated high-risk

Question 37

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

Answer 37

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

Question 38

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

Answer 38

Clinical breast exam q 6 months and consider genetic testing