Breast

Question 1

What is included in breast triple assessment

Answer 1

Clinical assessment
Imaging
Biopsy

Question 2

How is each aspect of the breast triple assessment scored

Answer 2

1 - normal
2 - benign
3 - intermediate/probably benign
4 - suspicious
5 - malignant

Question 3

What is the main risk factor for breast cancer other than being female

Answer 3

Age

Question 4

What is the lifetime risk for developing breast cancer

Answer 4

1 in 8

Question 5

Factors that lower the risk of developing breast cancer

Answer 5

Increasing parity
Earlier age at first birth
Longer duration of breastfeeding

Question 6

Factors that increase the risk of breast cancer

Answer 6

Early menarche
HRT use
Smoking
Alcohol
Nulliparity
Obesity
Radiation
FH
Dense breasts

Question 7

Letters used in assessment for breast cancer

Answer 7

P - palpation
M - mammogram
U - USS
B - biopsy (core biopsy)
C - cytology  (FNAC)

Question 8

What is Pagets disease of the nipple

Answer 8

Eczema like changes that begin in the nipple then spread out to the areola. Red, itchy, scaly, burning.
It is a signs of breast cancer in the tissue behind the nipple

Question 9

What are the two views taken in mammography

Answer 9

MLO - mediolateral oblique

CC - craniocaudal

Question 10

What is the age where you would use USS rather than mammography and why

Answer 10

<40 because breasts are more dense (fibroglandular > fat)

Question 11

What is the name of the ligaments you can see on mammograms

Answer 11

Coopers ligaments

Question 12

What are the two ways you can obtain a breast biopsy

Answer 12

FNAC

Core biopsy

Question 13

What are the subtype of breast cancer B5

Answer 13

5a - non-invasive

5b - invasive

Question 14

What information can core biopsy of the breast provide than FNAC can’t

Answer 14

Whether it is invasive or not

Receptor status

Question 15

Anatomical margins of the breast

Answer 15

2nd - 6th rib
Lateral edge of sternum
Mid-axillary line
Axillary tail extends up into the axilla

Question 16

What are the 3 levels of axillary lymph nodes

Answer 16

Level 1 - nodes inferior to pect minor
Level 2 - nodes behind pec minor
Level 3 - nodes above pec minor

Question 17

Skin tethering Vs skin fixation

Answer 17

Skin tethering means that the lump is attached to the skin, but can be moved in an arc without moving the skin. If the lump is pulled outside the arc, the skin indents. Skin fixation is where the lump cannot be moved without moving the skin.

Question 18

Most breast cancers occur in which part of the breast

Answer 18

Upper outer quadrant

Question 19

When would you perform sentinal node biopsy rather than axillary node clearance

Answer 19

If imaging and FNAC/Biopsy of the node is normal then do SNB, whereas if either were abnormal then you do clearance

Question 20

ER positive breast cancers should be treated with which agent

Answer 20

Tamoxifen (anti-estrogen)

Question 21

HER2 positive breast cancers should be treated with which agent

Answer 21

Herceptin (Trastuzumab - anti-HER2)

Question 22

What are the two most common types of breast cancer

Answer 22

Invasive ductal carinoma

Invasive lobular carcinoma

Question 23

What is the goal of adjuvant chemotherapy in breast cancer

Answer 23

To eradicate micrometastatic disease

Question 24

Triple negative breast cancer is negative for which receptors

Answer 24

ER
PR
HER2

Question 25

What tool can be used to estimate breast cancer survival and estimate the benefits of hormone therapy/chemotherapy

Answer 25

PREDICT tool

Question 26

What drug is Herceptin

Answer 26

Trastuzumab

Question 27

What are the two main classifications of breast pain

Answer 27

Cyclical | Non-cyclical

Question 28

What antibiotic is used to treat infectious lactational mastitis or breast abscess

Answer 28

Flucloxacillin

Question 29

If a woman presents with mastitis or breast abscess who isn't breast feeding what should you think of

Answer 29

Inflammatory breast cancer

Question 30

If you can feel what you think is a fibroadenoma what P score would that be

Answer 30

P2

Question 31

What age group with suspected fibroadenomas will need biopsy as well to complete the triple assessment

Answer 31

Age >25

Question 32

What does popcorn calcification on mammography represent

Answer 32

Multiple calcified fibroadenomas in post menopausal women

Question 33

Most common benign breast lump in a woman >50

Answer 33

Cyst

Question 34

Microcalcifications on mammogram can indicate what

Answer 34

Ductal carcinoma in situ Previous trauma/surgery Can be seen in association with cysts/fibroadenomas

Question 35

Follow up for women after DCIS breast cancer treatment

Answer 35

Annual clinic appointments | Annual mammogram for 5 years

Question 36

FH referral criteria for breast cancer

Answer 36

- one first-degree female relative diagnosed with breast cancer at younger than age 40 years or - one first-degree male relative diagnosed with breast cancer at any age or - one first-degree relative with bilateral breast cancer where the first primary was diagnosed at younger than age 50 years or - two first-degree relatives, or one first-degree and one second-degree relative, diagnosed with breast cancer at any age or - one first-degree or second-degree relative diagnosed with breast cancer at any age and one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative) or - three first-degree or second-degree relatives diagnosed with breast cancer at any age

Question 37

What are the two genes most commonly mutated in cases of familial breast cancer

Answer 37

BRCA1 and BRCA2

Question 38

What are diagnostic and predictive testing in relation to genetic breast cancer screening

Answer 38

Diagnostic testing is where somebody affected has genetic testing to pin point a cause Predictive testing is where relative then have their genes tested for the defect found

Question 39

Siblings of a BRCA1 carrier have what % chance of also being a carrier

Answer 39

50%

Question 40

When is breast cancer screening offered

Answer 40

Age 50 - 71 every 3 years In extension areas age 47-73