Breast cancer

Question 1

Discuss the epidemiology of breast cancer and the impact of screening

Answer 1

51% 50-69yo (most common)
27% >70yo
16% 40-49yo
5%

Question 2

Discuss the workup and diagnosis of a breast cancer

Answer 2

Screening test - if abnormality detected:
•Clinical examination
•Magnification views
•Targetted breast and axillary ultrasound
•Ultrasound guided biopsy (Core biopsy of breast abnormality)
•Surgical consultation (Mastectomy vs breast conservation (WLE &RT), Sentinel node biopsy vs axillary clearance)
•Medical & radiation oncology consultation

Question 3

Discuss fertility issues in a premenopausal woman undergoing cancer treatment

Answer 3

Fertility issues will affect:

• type of drugs used for Rx (e.g. chemotherapy agents)
• doses of drugs
• time of pregnancy (try avoiding during & around chemotherapy)
• radiation therapy use & its doses if affecting ovaries, uterus, pituitary
• maintenance of reproductive system in surgery

Fertility options for women with cancer include: freezing egg, embryo, ovarian tissue, GnRH treatment, oral contraceptive pill & ovarian transposition.

Question 4

Discuss lifestyle factors that may alter the natural history of breast cancer

Answer 4

Risk factors:

• first childbirth after >30yo
• OCP
• hormone therapy after menopause
• drinking alcohol
• overweight/obesity
• low physical activity

C.f. Breast feeding (protective)

Question 5

What should you ask in a Breast cancer Hx?

Answer 5

• previous breast imaging/pathology
• general health
• age of menarche
• menses
• age of menopause
• child birth/pregnancy
• FMHx of breast/endometrial/ovarian/ prostate/male breast cancer
• known genetic mutations (BRCA1, BRCA2)

Question 6

What is the significance of having either BRCA1 or BRCA2 mutation on a background of Dx of first primary breast cancer?

Answer 6

30-50% chance of developing a second primary breast cancer in the next 25 years

Question 7

What is the significance of having neither BRCA1 nor BRCA2 mutation on a background of Dx of first primary breast cancer?

Answer 7

at least 20% chance of a second primary breast cancer in the next 25 years

Question 8

Discuss the breast cancer screening guidelines

Answer 8

women aged 50–74 to undergo free mammograms every two years.

Women aged 40–49 and those aged over 74 can also be screened free of charge, however they are not sent invitation letters.

Question 9

Treatment comparison b/w ‘ER/PR positive and HER-2 negative’ & ‘ER/PR positive and HER-2 positive’

Answer 9

ER/PR positive: use Tamoxifen (block ER on breast cancer cells). Aromatase inhibitors can stop estrogen production in post-menopausal women only.

HER-2 (growth-promoting protein) positive: use Trastuzumab (Herceptin). More aggressive & fast growing.

Question 10

What is an adjuvant systemic therapy for breast cancer & what are the (3) types?

Answer 10

• Systemic (body-wide) anti-cancer treatment that is given before or after surgery
• prevents cancer cells that may have escaped from the breast before detection from growing into metastases, which are usually not curable. Thus, adjuvant systemic therapy also contributes to the decline in mortality due to breast cancer.

Three types of anticancer agents are used for breast cancer adjuvant therapy:

●Endocrine therapy (Anti-estrogen treatment)
●Chemotherapy
●Molecularly targeted therapy against a protein (termed HER2)