Week 21a - Breast Cancer

Question 1

what makes a good screening test

Answer 1

simple
inexpensive
widely available
reliable - detects high proportion of disease
minimal discomfort
effective treatment - good outweighs harm
leads to improved health outcomes

Question 2

cardiovascular disease prevention

Answer 2

hypertension
hyperlipidaemia
obesity
diabetes mellitus

Question 3

cardiovascular disease screening

Answer 3

AAA

Question 4

cancer screening

Answer 4

breast
cervical
bowel

Question 5

pregnancy screening

Answer 5

sickle cell, thalassaemia
hep B, syphilis, HIV
down’s, edward’s and patau syndrome

Question 6

risks of screening

Answer 6

false positives - anxiety causing
false negatives - reassurance
overdiagnosis
risk of test - e.g. x-ray
medicalisation
complications from follow up investigations

Question 7

breast cancer risk factors

Answer 7

family history
obesity post menopause
alcohol
hormone replacement therapy
inactivity
early menarche (before 12) and late menopause (after 55)
pregnancy - early first and more pregnancies reduce risk

Question 8

breast screening

Answer 8

women aged 50-70
mammogram every 3 years

Question 9

positive screening mammogram

Answer 9

breast clinic review
examination
magnified mammogram - tomosynthesis
breast ultrasound
biopsy

Question 10

overdiagnosis

Answer 10

detecting a cancer that wouldnt cause harm during lifetime
~20% all breast cancers detected in screening are over diagnosis

Question 11

downsides of mammogram

Answer 11

can cause pain
radiation exposure
cost

Question 12

presentation of breast cancer

Answer 12

screening mammogram ~50% of cases
breast mass
lymphadenopathy
skin changes
metastatic disease

Question 13

breast cancer assessment

Answer 13

triple assessment
- history and clinical examination
- imaging: ultrasound mammography (tomosynthesis)
- pathology: fine needle aspirate core biopsy

Question 14

breast cancer screening for younger women

Answer 14

more dense breast tissue, particularly women in 20s
tends to be more complicated cases, require MRI

Question 15

what does breast cancer arise from

Answer 15

terminal duct lobular units

Question 16

breast cancer markers

Answer 16

oestrogen receptor
progesterone receptor
human epidermal growth factor receptor 2 (HER2)
triple negative has no markers - worse prognosis, tends to carry BRCA mutation
Ki67 - marker of proliferation - may respond better to chemo but worse prognosis

Question 17

breast cancer management

Answer 17

hormone therapy
surgery
radiotherapy
chemotherapy
targeted therapy

Question 18

breast cancer surgery

Answer 18

main principle - do least possible
remove with margin of at least 1mm or normal tissue
wide local excision most common
usually sample lymph nodes - inject radioactive dye to mark - most times all lymph nodes removed

Question 19

adjuvant treament

Answer 19

local radiotherapy
hormone receptor positive cancer
- aromatase inhibitor - inhibits oestrogen and progesterone synthesis
- tamoxifen - oestrogen receptor inhibitor
HER2 positive - trastuzamab-monoclonal antibody against HER2 receptor
chemo - kills rapidly dividing cells