Flashcards in Breast Cancer Deck (21):
T or F: breast cancer is the most common cancer in women?
What are the risk factors for breast cancer?
The most significant risk factor for beast cancer is AGE. Risk rises in 60s and peaks in 70s, then declines.
- mutation of BRAC1 (85% chance of developing cancer), or mutation of BRAC2.
- Mutation of the tumor suppressor gene p53.
- Compelling family history: diagnosed with breast cancer before 50, two relatives with breast cancer.
- Risk of developing breast cancer if an immediate family member has breast cancer doubles!
- Nulliparous women or women who’s first full term pregnancy after 30 have an increased risk.
- Estrogen replacement has links to breast cancner
- Alcohol, high fat intake, and lack of exercise
- Fibrocystic breast conditions have an increased risk.
- Whites> blacks
- Endometrial cancer, cancer in the other breast
- Early menarche (before age 12) or late menopause (after age 50
T/F: most women with breast cancer do not have a specific frisk factor to which you can relate the development of disease?
How can breast cancer can "prevented"
1. no smoking
3. limit alcohol intake
4. increase intake of fruits and veggies
5. breast feeding slightly protective
6. chemoprophylaxis for high risk patients (tamoxifen)
Is chemoprophylaxis indicated in high risk patients?
yes, tamoxifen. there was a 50% reduction rate
What are the current screening recommendations?
USPSTF: mammography every other year for women 50-75, and high risk starting at 40. MRI not recommended for screening due to insufficient evidence of decreased mortality. BSE NOT RECOMMENDED.
ACS: mammography annually for all women in good health from age 40 on. MRI recommended annually for women at high risk after 30. BSE is "an option".
has a BSE been shown to improve mortality?
How does mammography sensitivity vary based on breast tissue?
Mammography sensitivity varies depending on breast tissue
i. 60-90% sensitive.
ii. Young breast tissue is more fibrous and harder to see
iii. Old breast tissue is fatter
If you do have the patient do a SBE, then how should it be performed?
Should be performed a week after the start of the menstrual period. Exam in front of a mirror with hands at sides, overhead, and pressed firmly on the hips to contract the pec muscles causing masses, asymmetry of the breasts, and slight dimpling. Breats should also be examined supine
What is the clinical presentation of breast cancer?
Early findings: single, non-tender, firm to hard mass ill defined margins; mammographic abnormalities and no palpable mass.
Later findings: skin or nipple retraction; axillary lymphadenopathy; breast enlargement, erythema, edema, pain, fixation of mass to skin or chest wall
What is the differential diagnosis for breast cancer?
Fibroadenoma: benign, usually <30 years, firm solitary mass that may increase in size over month. better diagnosed with U/S.
Fibrocystic breast changes: single most COMMON disorder of the breast. frequently found in 20-40 year old, peaks before menopause.
What are some diagnostics that are indicated for helping identify if it is cancer or not?
2. Core needle aspiration
4. CBC, CMP, LFTs, CXR/CT/bone scan/PET=mets
What is the staging system for breast cancer?
What are the molecular markers for treatment of breast cancer?
1. estrogen receptor
2. progesterone receptor
3. HER 2-neu
"triple negative" is the worst because there is nothing to aim the treatment at.
When is breast sparing surgery NOT available?
When tumors are more than 4 cm
What are the different surgical options for treatment?
3. lymph node assessment
Adjuvant therapy includes:
chemo, radiation, and hormonal manipulation.
What are some toxicities you can see with chemo?
1. bone marrow suppression--anemia, thrombocytopenia, leukopenia
2. GI upset
3. organ toxicities
What are some toxicities with radiation?
1. skin: erythema, swelling, tenderness, burns.
What is hormonal manipulation?
It can be used with women who have ER/PR positive tumors.
Estrogen blockers: tamoxifen