Breast

Question 1

Which has the highest risk of developing breast cancer?

<25yo
1st degree relative with breast ca
Previous breast biopsy
Mutation of BRCA1
lobular carcinoma in situ (LCIS)

Answer 1

Mutation of BRCA1 have 56-85% risk of breast ca, 15-45% risk of ovarian cancer.

LCIS has 7% risk over 10 years

Question 2

44yo F with core biopsy of left breast shows lobular carcinoma in situ. What next:?

Left mastectomy
L partial mastectomy and rad therapy
Tamoxifen, mammogram q 2y
Raloxifene, mammogram q6mo
Tamoxifen, mammogram q6mo

Answer 2

Raloxifene (has fewer side effects than tamoxifen).

LCIS findings = 10x risk of subsequent breast ca (bilateral breasts) -> either invasive ductal or lobular cancer. LCIS is NOT an early stage of existing breast ca.

Question 3

Is prophylactic mastectomy appropriate for young women with BRCA1 mutation (but no breast ca yet)?

Answer 3

Yes

Question 4

Main purpose of mammography

Answer 4

Detect nonpalpable breast masses.

Doesn’t increase malignancies, doesn’t identify benign vs malignant lesions.

Question 5

42yo F with atypical ductal hyperplasia detected by core-needle biopsy. What next?

Chemoprevention with tamoxifen
Chemoprevention with raloxifene
L Radical mastectomy
L breast excisional biopsy

Answer 5

Excisional biopsy. 25-40% of patients with ADH by core-needle biopsy have ductal carcinoma in situ.