Breast cancer

Question 1

What is the number one cause of cancer in women

Answer 1

breast cancer

Question 2

What is the median age of diagnosis for breast cancer

Answer 2

63

Question 3

What are some risk factors for developing breast cancer

Answer 3

increased lifetime exposure to estrogen

early menarche
late menopause
advanced maternal age

Question 4

What are some protective factors of breast cancer

Answer 4

lack of ovaries
no prior HRT
Early menopause
longer duration of breast feeding
early age of first pregnancy
low dose ASA

Question 5

Where on the breast is breast cancer most common

Answer 5

outer, upper quadrant

Question 6

How is breast cancer classified

Answer 6

histologic type

Question 7

What are the histological types of breast cancer

Answer 7

non-invasive
invasive
Paget carcinoma
inflammatory carcinoma

Question 8

what is the most common type of breast cancer

Answer 8

infiltrative ductal carcinoma

Question 9

Which types of breast cancer have a better prognosis

Answer 9

ER/PR positive tumors

Question 10

What control hormone responsiveness in breast cancer

Answer 10

HER2/neu (+/-)
Estrogen ER (+/-)
Progesterone PR(+/-)

Question 11

Which type of breast cancer has the worst prognosis

Answer 11

triple negative tumors

Question 12

Who are triple negative tumors most common in

Answer 12

<40
Black
BRCA1+

Question 13

Which BRCA gene is more likely to cause breast cancer

Answer 13

BRCA 1
(typically triple negative)

Question 14

Who are BRCA driven breast cancer most common in

Answer 14

Ashkenazi jewish

Question 15

What are the indications for BRCA screening

Answer 15

Breast cancer in 2+ first degree relatives

+FH prior to age 50
+FH ovarian cancer
+FH male breast cancer
1st degree w/ bilateral breast CA
breast + ovarian CA in 1 individual
Ashkenazi Jew ancestry

Question 16

What are the common signs and symptoms for breast cancer

Answer 16

painless, palpable lump that is firm and has ill defined margins

Question 17

What are the symptoms for Paget carcinoma

Answer 17

Starts as nipple itching/burning

often misdiagnosed as dermatitis/bacterial infection

Often no discrete breast mass

Question 18

What are the symptoms of inflammatory carcinoma

Answer 18

Rapidly growing, large, painful mass
breast enlargement
often misdiagnosed as infection (then wont respond to abx)

Question 19

Does the USPSTF recommend teaching self breast exams?

Answer 19

no

*just wants them aware of what is normal so they can report any changes

Question 20

What is the gold standard for screening for breast cancer

Answer 20

mammography

Question 21

What age range should have screenings for breast cancer and how often

Answer 21

women 40-74, every 2 years

Question 22

How are mammography results reported

Answer 22

via BIRADS SCORE

Question 23

What are the most commonly identified abnormalities seen on breast exams

Answer 23

calcifications

Question 24

What abnormality on breast imaging is most likely malignant

Answer 24

<.5mm
various sizes / shapes
clustered in 1 area

Question 25

What is US useful in differentiating between in regards to

Answer 25

cystic vs solid masses

Question 26

which patients will get an MRI for their breast imaging

Answer 26

negative mammo but still suspicious more info needed breast implants adjunct to mamma if high risk

Question 27

What type of biopsy is is preferred when working up a breast cancer

Answer 27

core needle because it is less prone to sampling error *able to test for HER2/neu, ER, PR

Question 28

What are the following steps if there is a concern for advanced disease

Answer 28

CXR to eval for lung mets Abdominal CT for liver mets +/- PET scan +/- DEXA

Question 29

What are the common metastatic locations with breast cancer

Answer 29

Liver lung bone brain

Question 30

Which form of breast cancer is most likely to lead to brain mets

Answer 30

Triple negative HER2/neu

Question 31

If clustered pleomorphic micro calcifications are seen on a mammogram, what are you concerned for

Answer 31

Breast cancer

Question 32

What are the stages of breast cancer

Answer 32

0 - abnormal cells 1- early stage 2- localized 3- regional spread 4 - distant spread

Question 33

What are the primary treatment strategies for breast cancer

Answer 33

Surgical resection + axillary lymph node dissection or sentinel node biopsy radiation

Question 34

What is the first line treatment for stage 1 and 2 breast cancer

Answer 34

breast conserving lumpectomy

Question 35

What are the contraindications for breast conserving lumpectomy

Answer 35

>4cm multifocal fixation to chest wall skin involvement

Question 36

What is a mastectomy

Answer 36

Removal of entire breast, overlying skin, nipple/areola, and pectorals fascia

Question 37

What is the major advantage for a mastectomy

Answer 37

may not need radiation

Question 38

When is Chemo useful with breast cancer

Answer 38

Reduces recurrence and mortality for all stages EXCEPT stage 4

Question 39

Which age group is most benefited by chemo for breast cancer

Answer 39

patients < 50

Question 40

How long is a chemo treatment with breast cancer

Answer 40

3-6 months

Question 41

What are common side effects to chemo

Answer 41

N/V Infertility Premature ovarian failure

Question 42

What are less common but important side effects of chemo

Answer 42

Neutropenia Cardiomyopathy peripheral neuropathy leukemia cognitive dysfunction

Question 43

What are some anti-HER2 treatments

Answer 43

Mab drugs (pertuzumab) Kinase inhibitors (Neratinib)

Question 44

What are some hormonal treatments with breast cancer

Answer 44

tamoxifen (SERM) aromatase inhibitor (letrozole) Bisphosphonates (early stages)

Question 45

Which age group are more susceptible to aggressive breast cancer / worse prognosis

Answer 45

Younger patients

Question 46

How often to women who have had breast cancer need to be evaluated

Answer 46

q6 months for 2 years, then annual exams

Question 47

What is the average age for breast cancer in men

Answer 47

70

Question 48

What symptoms will men present with with breast cancer

Answer 48

gynecomastia nipple discharge

Question 49

What is the most common cause of breast cancer in men

Answer 49

ER positive (tomoxifen is used)