SM_275b: Breast Cancer Flashcards
___ is most commonly diagnosed cancer worldwide
Breast cancer is most commonly diagnosed cancer worldwide
- Mortality decreasing
- Incidence stays largely the same
- Risk of developing breast cancer and of dying from breast cancer increase with age
Describe general risk factors for breast cancer
General risk factors for breast cancer
- Increasing age
- Female gener
- Ionizing radiation (i.e. chest radiation for Hodgkin lymphoma)
- Lifestyle: obesity, decreased physical activity, and alcohol
Describe hormonal risk factors for breast cancer
Hormonal risk factors for breast cancer
- Reproductive factors: early menarche (< 12 years), late menopause, late age of first pregnancy (> 30 years), nulliparity
- Hormone intake: hormone replacement therapy, oral contraceptive therapy
- Increased breast density
Majority of hereditary breast cancer is due to germ line mutations in ___ and ___
Majority of hereditary breast cancer is due to germ line mutations in BRCA1 and BRCA2
Describe pathological risk factors for breast cancer
Pathological risk factors for breast cancer
- Proliferative lesions without atypia: usual ductal hyperplasia, intraductal papillomas, radial scars, simple fibroadenoma
- Atypical hyperplasias: atypical ductal hyperplasia, atypical lobular hyperplasia
- In situ pathology, ductal carcinoma in situ (pre-malignant), lobular carcinoma in situ (not pre-malignant)
- Hx of invaisve breast cancer
Describe risk-reducing strategies for breast cancer
Risk-reducing strategies for breast cancer
- Bilateral prophylactic mastectomies
- Enhanced screening MRI
- Chemoprevention: premenopausal (tamoxifen) or postmenopausal (tamoxifen, raloxifene, aromatase inhibitor)
- Lifestyle modifications: limit alcohol to < 1 drink/day, exercise, weight control, smoking cessation
Describe breast cancer screening
Breast cancer screening
- Mammogram: low dose x-ray procedure
- Ultrasound: to further evaluate abnormalities on mammogram or exam, may be useful with dense breasts
- MRI: used for women at higher risk of breast cancer
___ reduce the risk of dying from breast cancer and facilitate early treatment
Screening mammograms reduce the risk of dying from breast cancer and facilitate early treatment
- Advances in adjuvant therapies also help
___ is the most common type of breast cancer
Invasive ductal carcinoma is the most common type of breast cancer
Describe types of breast cancer
Types of breast cancer
- Invasive ductal carcinoma
- Invasive lobular carcinoma: high risk of bilateral and multicentric disease, tend to be estrogen responsive with favorable prognosis
- Metaplastic: typically aggressive with less favorable prognosis
- Mucinous: favorable prognosis
- Tubular: favorable prognosis, metastases rare
- Medullary
Describe hormone positive breast cancer
Hormone positive breast cancer
- Most common subtype
- Overexpress estrogen receptor or progesterone receptor
- Anti-estrogen therapy: tamoxifen, aromatase inhibitors
- Overall favorable prognosis
- Gene expression similar to luminal epithelial
Hormone positive breast cancer is molecularly subclassified into ___ and ___
Hormone positive breast cancer is molecularly subclassified into luminal A and B
- Luminal A has better prognosis
Describe HER2 positive breast cancer
HER2 positive breast cancer
- 20% of all
- Now has excellent outcomes with combos of chemo and HER2 targeted therapy
- Diagnosed by IHC and FISH
- Defines therapeutic options
- Triple positive: ER, PR, and HER2 positive
Describe triple negative breast cancer
Triple negative breast cancer
- Does not express ER/PR/HER2
- 15-20% of breast cancers
- Gene expression similar to basal epithelial cells
- Tend to be aggressive and prognosis inferior
- Novel immunotherapies including immunotherapy and PARP inhibitors
Describe staging breast cancer
Staging breast cancer
- Stage 1 and 2: only if symptoms
- Stage 3: irrespective of symptoms
Early stage cancer is treated with ___
Early stage cancer is treated with combos of surgery, radiation, and systemic (medical) therapy
Describe current breast cancer surgery
Breast cancer surgery
- Mastectomy: radical is almost never used, routine contralateral prophylactic mastectomy
- Partial mastectomy (lumpectomy): radiation required
- Sentinel lymph node biopsy / dissection: limited to avoid morbidity
- Axillary lymph node dissection: only required if lymph nodes clinically involved or in some situations where sentinel lymph nodes are involved
Radiation therapy for breast cancer works by ___
Radiation therapy for breast cancer works by eliciting double strand breaks in DNA (DNA repair mechanisms usually aberrant in cancer)
- May target breast ± regional lymph nodes
- Usually required in context of lumpectomy
- Often recommended after mastectomy for node positive disease
- Axillary radiation can increase risk of lymphedema
Describe systemic therapy for breast cancer
Systemic therapy for breast cancer
- Aimed at elimination of micrometastatic disease
- Endocrine therapy: after surgery for ER/PR early stage breast cancer
- Chemotherapy
- Targeted (i.e. HER-2 targeted therapy)
- Other novel therapies
Tamoxifen is used for ____ women with breast cancer and is a ____
Tamoxifen is used for pre-menopausal women with breast cancer and is a SERM
- Antagonist in breast, agonist in uterus
Aromatase inhibitors are used for ____ women with breast cancer and ____
Aromatase inhibitors are used for post-menopausal women with breast cancer and inhibits enzymatic conversion of androgen to estrogen
Describe endocrine therapy toxicity
Endocrine therapy toxicity
- Estrogen deprivation: hot flashes, decreased libido, vaginal dryness
- Uterine cancer (tamoxifen)
- Thromboembolic disease (tamoxifen)
- Arthralgias (aromatase inhibitors)
- Decreases in bone density (aromatase inhibitors)
Describe adjuvant chemo for breast cancer
Adjuvant chemo for breast cancer
- Triple negative and HER2 positive: almost always receive chemotherapy
- Node positive: almost always receive
- ER+: not really
- Anthracyclines ± taxanes
- Pre or postop
- Neoadjuvant: shrink tumor to convert to breast conserving therapy, inflammatory breast cancer, inoperable
Anti-HER2 therapy involves ___ and ___
Anti-HER2 therapy involves trastuzumab and pertuzumab
Trastuzumab is a ___ that comprises ___
Trastuzumab is a monoclonal antibody against HER2 and HER4 that comprises anti-HER2 therapy
Pertuzumab is a ___ that comprises ___
Pertuzumab is a monoclonal antibody against HER2 and HER3 that comprises anti-HER2 therapy
Describe chemo toxicities
Chemo toxicities
- Anthracyclines: cardiac toxicity
- Taxanes: neurotoxicity / neuropathy, pulmonary toxicity (pneumonitis), hepatotoxicity, myalgias / arthralgias
- HER2 targeted
- Trastuzumab: cardiac toxicity
- Pertuzumab: diarrhea
___ is mainstay of treatment for metastatic breast cancer
Systemic therapy is mainstay of treatment for metastatic breast cancer
- Not curable but treatable
