275 - Breast Cancer Flashcards
In which age group do mammograms show the greatest reduction for breast cancer?
What is the recommended age to start screening?
Most impact in 60-69 age group
Start screening at age 40
Less consensus when to stop screening
List the aytpical hyperplastic breast lesions (2)
What is their risk for transformation to breast cancer?
What is the treatment?
- Atypical ductal hyperplasia
- Atypical lobular hyperplasia
3.7-5.5x increased risk
Excise if associated wtih concerning calcifications
Consider chemoprevention (anti-estrogen pill)
What are the indications for genetic testing for breast cancer?
In general, cancer diagnosed in a young person (<50) with extensive family hx of breast cancer (especially if family also had young age at dx)
How does hormone recpetor status inform treatment fo breast cancer?
- ER+, PR+
- Treat with estrogen blocker (Tamoxifen, raloxifene)
- Does not require chemotherapy after lumpectomy
- HER-2
- Treat with HER-2 targeted therapy (Trastusumab) in addition to chemotherapy (after lumpectomy)
- Triple negative
- Treat with chemotherapy after lumpectomy
In which populations would we consider risk reducing strategies for breast cancer?
- Genetic predisposition
- Proliferative breast lesions
- In-situ lesions
Who is an MRI for breast cancer screening recommended for?
Women with higher than average (>20%) lifetime risk
What are the 2 most common biological subtypes of breast cancer?
Ductal
Lobular
D
Lumpectomy + radiation is usually just as good as full mastectomy, and avoids complications
List the proliferative without atypia breast lesions (4)
What is their risk for transformation to breast cancer?
- Usual ductal hyperplasia
- Intraductal papilloma
- Radial scar
- Simple fibroadenoma
1.5-2x increased risk
Excision not recommended
What is the general approach to surgery for breast cancer?
-
Lumpectomy > radical mastectomy
- Same outcomes for cancer, fewer complications
-
Sentinal LN biopsy
- Avoids morbidity of full axillary dissection
- Equivalent outcomes
- Only do axillary if the nodes are actually involved
What is the treament approach for breast cancer?
- Early:
- Metastatic:
- Early: Surgery = cornerstone
- Systemic or radiation therapy can increase chance of cure, decrease risk of recurrence
- Metastatic: Systemic therapy = cornerstone
- Surgery or radiation can be used for palliation
List the nonproliferative breast lesions (2)
What is their risk for transformation to breast cancer?
Simple cysts
Fibrocystic changes
No increased risk of breast cancer
How does the management of ductal vs. lobular carcinoma in situ differ?
- Ductal
- Considered premalignant
- Requires lumpectomy +/- radiation
- Consider chemoprevention
- Lobular
- Not considered premalignant
- Marker of increased risk
- Consider chemoprevention
