Breast Cancer

Question 1

What is the greates risk fator for breast cancer?

Answer 1

Age

Question 2

Other risk factors for breast cancer?

Answer 2

• Early menarche or late menopause
• lack of breastfeeding
• family history
• high density
• obesity when postmenopausal
• alcohol consumption

Question 3

breast cancer signs and symptoms?

Answer 3

• A lump or thickening in or near the breast/underarm
• change in size or shape of breast
• dipling or puckering of the skin, scaly, red or swollen
• changes in the nipple (for ex. turning inward)
• nipple discharge or crusting, particularly if bloody
• breast pain
• non-healing ulcer on the breast

Question 4

• Non-metastatic
• cancer detected only in breast and local lymph nodes
• goal of therapy is curative
• prevent local tumor growth
• prevent local recurrance after removal
• treat any non-visable cancer cells that have spread distantly and would have eventually become metastacic breast cancer

Answer 4

(Stage I-III)

Question 5

• cancer detected outside of the breast and local lymph nodes
• life limiting and cannot be cured- goal of therapy is to prolong life with cancer

Answer 5

Metastatic (stage IV)

Question 6

• second major factor in prognosis besides stage
• determined by tumor cell expession of three proteins on pathology specimen

Answer 6

Breast cancer subtype: Estrogen receptor (ER). Progesterone Receptor (PR), HER2 receptor

Question 7

• 70% of breast cancer are this type
• tumor growth stimulated by estrogen
• drugs blocking estrogen are effective therapies
• associated with best outcomes and survival across all stages

Answer 7

Hormone Receptor (ER/PR) positive subtype

Question 8

• 15-20% of breast cancers
• tumor growth stimulated by signaling
• Prognosis has improved dramatically in the past 15 years due to new due to new treatments blocking the receptor

Answer 8

HER2 positive subtype

Question 9

• Has neither ER/PR nor HER2 expression
• 10% of breast cancers
• most aggressive and worse prognosis
• standard chemotherapy is mainstay of treatment

Answer 9

Triple negative subtype

Question 10

• used to treat/eliminate any residual cancer cells in the breast and lymph nodes after surgery
• typically recommened after breast conserving surgery or if lymph nodes are involved, or after a mastectomy for large/high risk tumors
• Routinely given 5 days a week for 5-6 weeks; sometimes shorter courses

Answer 10

Adjuvant radiation

Question 11

Targeted therapies for breast cancer?

Answer 11

• ER/PR positive: Endocrine therapy AFTER any chemotherapy
• HER2 positive: anti-HER2 therapy WITH and AFTER chemotherapy
• Triple negative: immunotherapy WITH and AFTER chemotherapy
• Germline BRCA 1/2 carriers: PARP inhibitor olaparib (inhibits DNA repair)

Question 12

• Endocrine therapy (ER/PR positive)

Answer 12

• 5-10 years of a daily pill
• reduces recurrence risk by 40-50%
• reduces risk of contralateral primary by 50%
• reduces breast cancer mortality by 30%

Question 13

ex. of endocrine therapy (ER/PR positive)

Answer 13

Tamoxifen

• blocks estrogen signaling in pre or post -menopausal women
• side effects: hot flashes, mood changes, abnormal menses, vaginal dishcarge, endometrial cancer, thromboembolism

Aromatase Inhibitors: Anastrozole, exemestane, and letrozole

• modestly more effective than tomoxifen
• side effects: hot flashes, mood changes, vaginal dryness, athralgies, loss of bone density/fractures