SESAP Breast

Question 1

Is conjugated estrogen therapy after hysterectomy associated with increase in breast cancer risk?

Answer 1

No

Question 2

How is a decrease in bone density associated with an increase in breast cancer risk?

Answer 2

The Women’s Health Initiative Estrogen Alone Trial post hoc analysis showed that low bone mass = PPV of increase in invasive ER+ breast cancer.

Question 3

Is increased breast density associated with increase in breast cancer development risk?

Answer 3

Yes.

Question 4

What % of breast cancer patients report a positive family history?

Answer 4

15-20%.

Question 5

What gene mutations are associated with breast cancer risk?

Answer 5

BRCA1, BRCA2, p53, ATM, PTEN

Question 6

What is ATM in relation to breast cancer risk?

Answer 6

ATM= Ataxia telangiectasia mutants. Certain mutants increase the risk of breast cancer.

Question 7

How is the increase in breast density associated with an increase in breast cancer?

Answer 7

An increase in breast density of mammogram is associated with an increase risk of atypical hyperplasia and in situ breast cancer.

Question 8

Patients with BRCA1 or BRCA2 mutation should consider what surgeries?

Answer 8

Bilateral mastectomy and bilateral oophrectomy.

Question 9

What is the differential in an adolescent girl with a large breast lesion?

Answer 9

Giant fibroadenoma, phyllodes tumor, virginal hypertrophy.

Question 10

What defines a giant fibroadenoma?

Answer 10

> 5 cm

Question 11

How do giant fibroadenomas usually present?

Answer 11

Firm, rapid doubling time, usually solitary, NONtender.

Question 12

What is the purpose of breast surgery for cancer?

Answer 12

Identification of cancer, staging and local control.

Question 13

What is the difference between and macro-metastases and a micro-metastases in a lymph node?

Answer 13

Microscopic met cutoff: 2mm.

Question 14

What % of patient with a + LN after SNLBx will have more +LNs?

Answer 14

10-20% of the time.

Question 15

What kind of gene is the HEr2/neu gene?

Answer 15

It is a proto-oncogene.

Question 16

What kind of receptor is the Her2/neu receptor?

Answer 16

Transmembrane glycoprotein receptor.

Question 17

What is trastuzumab directed against?

Answer 17

erb-2 extracellular binding domain.

Question 18

Why is the Her2/neu receptor considered an orphan receptor?

Answer 18

Because there is no epithelial growth factor/ligand that has been identified.

Question 19

What intracellular pathways are associated with Her2/neu activity?

Answer 19

Cell proliferation, inhibition of apoptosis, cell differentiation and angiogenesis.

Question 20

How does Her2/neu-R become activated?

Answer 20

It binds to itself or other tyrosine kinase receptors (check this).

Question 21

What gene is responsible for Her2/neu?

Answer 21

Long arm 17: 17q11.2-q12

Question 22

How is the Her2/neu gene identified?

Answer 22

Over expression found on either metastatic disease or primary tumor on parafin blocks.

Question 23

What kind of breast cancer is associated with Her2/neu carriers?

Answer 23

Agressive, short-disease-free interval, high rate of occurrence after adjuvent therapy.

Question 24

Are Toll-like receptors associated with cancer?

Answer 24

No. They are associated with infections.

Question 25

How does trastuzumab work?

Answer 25

It is a monoclonal antibody that binds to the tyrosine kinase ligand and shuts it off.

Question 26

Does the Her2/neu receptor have a direct effect on efficacy of chemotherapy?

Answer 26

No. Herceptin works synergistically with chemotherapy agents anthracycline and cisplatin.