Breast Cancer

Question 1

What is the magic number for “high risk” in the Gail Model

Answer 1

> 1.66 yearly risk

Question 2

6 breast cancer predisposition syndromes

Answer 2

BRCA mutation
Li-Fraumeni
Cowden's (PTEN)
Peutz-Jeghers (STK11 mutation)
CDH1 mutation (lobular breast cancer)
PALB2

Question 3

Approved medication(s) for breast cancer prevention in premenopausal women

Answer 3

Tamoxifen

Question 4

Approved Medications for breast cancer prevention in Post menopausal women

Answer 4

Tam
Raloxifene
Exemestane
Anastrazole

Question 5

Recommended Breast cancer Screening rec for BRCA mutants or first degree relatives with BRCA mutants as long as life time breast cancer risk is 20-25% based on BRCAPRO

Answer 5

MRI starting annually at age 25

Mammo starting at age 30

Question 6

What stage does pre-op staging become indicated without symptoms in breast cancer?

Answer 6

T3N1 (IIIa)-> CT chest/abd/pelvis and Bone Scan

Question 7

Margin needed for DCIS

Answer 7

2 mm

Question 8

Who needs adjuvant Tam in DCIS? (3)

Answer 8

ER+
Premenopausal
2 breasts at risk

Question 9

Absolute contraindications to breast conserving therapy (6)

Answer 9

• Pregnancy that can’t be completed in tim efor RT
• Diffuse calcifications on mammogram
• Multifocal disease not amenable to removal with single incision
• Grossly pos margins
• Inflammatory breast cancer(regardless of response to NACT)
• Homozygous ATM mutation

Question 10

Who can omit RT after BCT? (4)

Answer 10

Age >/=70
Tumor <2 cm
Clinically node negative
ER+ and able to take endocrine therapy

Question 11

indications for post-mastectomy radiation (3)

Answer 11

Tumor > 5 cm
Tumor <5 cm and close margins
Positive axillary LNs

Question 12

Which ER pos groups need adjuvant Chemo?

Answer 12

Postmenopausal-> RS >25, LN +/-

Premenopausal-> Node +, Node - with RS >25

Question 13

What is adjuvant treatment for Stage I (T1b-c, N0) Her2+ breast cancer

Answer 13

12 weeks fo TH with 1 year of total Trastuzumab

Question 14

What is adjuvant therapy for Her2+ disease who gets path CR following NACT?

Answer 14

H or HP x 1 year

Question 15

1st line treatment for de novo ER+ MBC

Answer 15

AI + CDKi

Question 16

2nd Line treatment for ER+ MBC

Answer 16

Fulvestrant + Palbo or Ribo or Abema

Question 17

Only CDK4/6i with approval for monotherapy after ET and CT

Answer 17

Abemaciclib

Question 18

CDK4/6i with CNS penetration

Answer 18

Abema

Question 19

CDK4/6i with least cytopenias

Answer 19

Abema

Question 20

CDK4/6i with most nausea/Diarrhea

Answer 20

abema

Question 21

CDK4/6i with QTc Prolongation

Answer 21

Ribociclib

Question 22

Approved in 2nd line HR+ MBC with PIK3CA mutation

Answer 22

Fulvestrant + Alpelisib

Question 23

What are the dose limiting toxicities for TDM1

Answer 23

Thrombocytopenia

LFT elevation

Question 24

Her2 +-> IHC 2+ -> Positive if:

• • Her2/CEP17 ratio >/=_______ and any copy #
• • Her2/CEP17 ratio < ____ and copy # >/= ______

Answer 24

• • Her2/CEP17 ratio >/= 2 and any copy #

- - Her2/CEP17 ratio < 2 and copy # >/= 6

Question 25

Which PARPi are approved in breast cancer?

Answer 25

gBRCA mutants only | Olaparib and Talazoparib

Question 26

CPS cutoff for pembro + chemo in breast cancer

Answer 26

CPS >/=10

Question 27

Pregnancy associated breast cancer typically present with which biomarkers?

Answer 27

TNBC. | 30% are Her2 pos

Question 28

Scans not to do on preggos (3)

Answer 28

Breast MRI Bone Scan CT scans

Question 29

What kind of SLN identification technique do you use with preggos

Answer 29

No Isosulfan blue dye

Question 30

Which chemo combination has most data in pregnant population

Answer 30

AC or FAC

Question 31

What is the complication associated with trastuzumab in pregnancy?

Answer 31

oligohydramnios

Question 32

What is recommended wait time for consideration of pregnancy after breast cancer? Any increase in mortality?

Answer 32

2 years | No

Question 33

What kind of surgery is needed for Phyllodes tumor

Answer 33

Wide excision without axillary staging or adjuvant treatment

Question 34

What biomarker profile does metaplastic breast cancer usually have?

Answer 34

TNBC