Week 3: BRCA screening

Question 1

At what age would a pt with breast cancer be referred for BRCA testing

Answer 1

Diagnosed <40yo

Question 2

What is considered a significant Manchester score

Answer 2

17: send unaffected individual for BRCA testing
15: send pt with breast cancer for BRCA testing

Question 3

Family history of which type of cancers are considered higher risk (refer pt to secondary care)

Answer 3

1. Bilateral breast Ca
2. Male breast Ca
3. Ovarian Ca
4. Triple negative breast Ca <40yo
5. Sarcoma <45yo
6. Glioma
7. Childhood adrenal cortical carcinoma
8. Complicated patterns of multiple cancers at a young age
9. Paternal hx of breast cancer

Question 4

Between BRCA1/2, which is associated with higher risk of breast and ovarian cancer

Answer 4

BRCA1

Question 5

Between BRCA1/2, which is associated with higher risk of breast and prostate cancer in men

Answer 5

BRCA2

Question 6

Most common type of breast cancer associated with BRCA1

Answer 6

Triple negative basal type

Question 7

Most common type of ovarian cancer associated with BRCA1/2

Answer 7

Epithelial serous papillary carcinoma

Question 8

Patients with breast cancer must fulfil at least 1 of 7 criteria to undergo BRCA testing.

What are the 7 criteria?

Answer 8

1. Diagnosed <40yo
2. Bilateral breast cancer (both diagnosed <60yo)
3. Triple negative breast cancer
4. Also have ovarian cancer
5. Male
6. Diagnosed <50yo + relative with breast cancer diagnosed <50yo
7. Family hx of cancer and Manchester score 15 or more

Question 9

How often is routine breast cancer screening for women 50-70yo

Answer 9

Every 3 years

Question 10

How often is routine breast cancer screening for men with BRCA1/2 mutation

Answer 10

NO screening for men even if they carry gene

Question 11

How often is routine breast cancer screening for women with TP53 mutation

Answer 11

Annual MRI

Question 12

How often is routine breast cancer screening for women with BRCA1/2 mutation

Answer 12

Annual
30-49yo: MRI + mammogram
50-59yo: mammogram

Question 13

How often is breast cancer screening for women with hx of breast cancer, but unknown genetics

Answer 13

Annual
30-49yo: MRI
50-69yo: mammogram

Question 14

From what age does every woman (regardless of risk) get a mammogram as part of the NHS screening programme

Answer 14

60yo

Question 15

If a woman’s genetic test result comes back as “variant of uncertain significance”, how should she be managed

Answer 15

Consider doing a segregation study (testing relatives for same gene mutation)

Question 16

What are risk factors for breast cancer

Answer 16

1. Over 35yo + using COCP (with family history of breast cancer)
2. Breastfeeding reduces risk
3. HRT
4. Alcohol
5. Smoking
6. Obesity/ sedentary lifestyle

Question 17

Tamoxifen may be offered to reduce risk of breast cancer.

From what age would it be offered

Answer 17

From 35yo

give for max 5 years