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Breast Cancer Flashcards

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1
Q

What are the RFs for breast cancer?

A

Age/gender
Endocrine factors
Genetic factors
Environmental and lifestyle factors

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2
Q

What are the endocrine RFs for breast cancer?

A

Early menarche (< age 12) and late menopause (> age 55)
Nulliparity and late initial pregnancy (after age 30)
HRT

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3
Q

What are genetic RFs for breast cancer?

A

Benign breast disease
Personal hx
FH
BRCA1/BRCA2 mutations: Increased lifetime risk of developing breast cancer
Other genes associated with hereditary breast cancer: TP53, CHK2, PTEN, ATM

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4
Q

What are the environmental and lifestyle RFs for breast cancer?

A 
Obesity
Lack of physical activity
Alcohol use
Prior ionizing radiation (before age 20)
Long-term heavy smoking (particularly before 1st pregnancy)
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5
Q

What ages does the American cancer society make recommendations for breast cancer screening?

A

40-44 can get a yearly mammogram
45-54 should get a yearly mammogram
55+ can transition to every other year or continue annual mammograms

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6
Q

What does the USPSTF recommend for mammogram schedules?

A

Biennial for ages 50-74

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7
Q

What are considered high risk that would require more frequent screening?

A

h/o breast cancer
5-year risk 1.7+ in women > 35 yo
Lifetime risk > 20%
Known genetic predisposition

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8
Q

What is the clinical presentation of early stage breast cancer?

A 
Typically no sx
Hard painless lump
Irregular and nonmobile
Nipple discharge, pain, or inversion
Dimpling/skin irritation
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9
Q

What type of sx may be associate with metastatic breast cancer?

A

Systemic sx

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10
Q

What are lobules?

A

Glands that produce breast milk

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11
Q

What do the ducts connect in the breasts?

A

Lobules to the nipples

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12
Q

What are the types of breast cancer?

A

Ductal Carcinoma In Situ
Lobular Carcinoma In Situ
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma

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13
Q

What is the diagnosis of breast cancer?

A 
History and physical
CBC, plt, LFT, alkaline phosphatase
Mammography
Ultrasound and/or MRI
Biopsy
Pathology review
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14
Q

What is a clinical stage?

A

Determined before surgery (based on PE and imaging)

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15
Q

What is a pathological stage?

A

Determined after surgey (includes information from surgical exploration/resection)

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16
Q

What is luminal A classification?

A

HR-positive

HER-2 Negative

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17
Q

What is Luminal B classification?

A

HR-positive

HER-2 positive

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18
Q

What is the triple negative classification?

A

ER-negative

HER-2 negative (basal subtype)

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19
Q

What is the HER-2 enriched classification?

A

HR-negative

HER-2 positive

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20
Q

What are some potentially modifiable risk factors?

A

Alcohol
Diet
Exercise

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21
Q

What are the prognostic factors for breast cancer?

A 
Stage at presentation
Lifestyle
Patient characteristics
Disease characteristics
Biomarkers
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22
Q

What are the types of proliferation rates in breast cancer?

A

S-Phase fraction

Ki-67

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23
Q

What combination of hormone receptors has the best prognosis?

A

ER +

PR +

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24
Q

What combination of hormone receptors has the worse prognosis?

A

ER -

PR -

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25
What biomarker is amplified/overexpressed in 25% of breast cancers?
HER-2 Neu | erB-2
26
What are the two testing methods under investigation?
Immunochemistry (IHC) | Fluorescence in-situ hybridization (FISH)
27
What stages do we use OncotypeDX?
Mostly Stage I or II ER+ invasive breast cancer ER+ HER-2 -
28
What types of surgery are available?
``` Lumpectomy Simple mastectomy Radical mastectomy Modified radical mastectomy Axillary lymph node dissection Sentinel lymph node biopsy Reconstruction surgery ```
29
What is a lumpectomy?
Breast conserving
30
What is a simple mastectomy?
Entire breast/nipple (leaves lymph node and muscle)
31
What is a radical mastectomy?
Removal of breast, lymph nodes, pectoralis muscles
32
What is a modifiedradical mastectomy?
Removal of entire breast w/some axillary lymph nodes
33
What is axillary lymph node dissection?
Removal of multiple lymph nodes
34
What is sentinel lymph node biopsy?
First lymph node that receives drainage from primary tumor
35
Which type of treatment is recommended with lumpectomies?
Radiation
36
Which medication has an interaction with 2D6?
Tamoxifen | Inhibition may decrease tamoxifen active metabolite
37
What are options for adjuvant endocrine therapy for women if they are premenopausal at diagnosis?
Tamoxifen x 10 years | If post-menopausal after 5 years = aromatase inhibitor or tamoxifen x 5 more years
38
Which hormonal therapy can only be used in post-menopausal women?
Aromatase inhibitors (Anastrozole, letrozole, exemastane)
39
What are options for adjuvant endocrine therapy for women if they are postmenopausal at diagnosis?
Aromatase inhibitor x 2-3 years then tamoxifen to complete 5 years Tamoxifen x 2-3 years than aromatase inhibitor to complete 5 years Aromatase inhibitor x 5-10 years Tamoxifen x 5-10 years
40
What is the premenopausal endocrine therapy for recurrent or stage IV breast cancer?
Tamoxifen or ovarian ablation/suppression, then follow postmenopausal guidelines
41
What is the postmenopausal endocrine therapy for recurrent or stage IV breast cancer?
``` Antiestrogens Aromatase inhibitors Palbociclib Ribociclib Everolimus ```
42
What are additional therapies for breast cancer if there is bone involvement?
Bisphosphonates: Zoledronic/Pamidronate RANK ligand inhibitor (Denosumab) Calcium and Vit D
43
Which hormonal agents can be used regardless of menopausal status?
Antiestrogens
44
Which hormonal agents can only be used in post-menopausal women?
Aromatase inhibitors
45
What are AEs for antiestrogens?
Flushing/hot flashes Thromboembolic events Endometrial cancer
46
What are the AEs of aromatase inhibitors?
Flushing/hot flashes Bone pain/osteoporosis Arthralgias/myalgias
47
What interactions must we watch for with tamoxifen?
2D6 inhibition
48
What is the goal of treatment for DCIS?
Cure
49
What are the potential treatment plans for DCIS?
Surgery | Consider risk reduction options
50
What is the goal of treatment for LCIS?
Cure
51
What is the potential treatment plan for LCIS?
Consider risk reduction options
52
What is DCIS?
Ductal carcinoma in situ
53
What is LCIS?
Lobular carcinoma in situ
54
What is the goal of treatment for Invasive breast cancer for stages I, II or some stage III
Cure
55
What are possible treatments for invasive breast cancer (Stage I-III)?
``` Surgery Lymph node evaluation +/- radiation (if lumpectomy/high risk) +/- adjuvant chemotherapy +/- adjuvant hormonal therapy ```
56
What is the goal of treatment for invasive breast cancer with large clinical stages II, III and some circumstances where neoadjuvant therapy may shrink tumor or otherwise offer benefit?
Cure
57
What are potential treatment plans for invasive breast cancer with large clinical stages II, III and some circumstances where neoadjuvant therapy may shrink tumor or otherwise offer benefit?
Neoadjuvant chemotherapy or endocrine therapy Surgery +/- Adjuvant chemotherapy +/- Adjuvant hormonal therapy
58
What is the goal of stage IV/recurrent invasive breast cancer?
Comfort Prolong life Prevent progression Sxs
59
What are the treatment options for stage IV/recurrent invasive breast cancer?
Surgery/radiation Hormonal therapy Chemotherapy Bisphosphonate/ denosumab - if bone disease present
60
When can we use endocrine therapy for neoadjuvant chemo regimens?
ER/PR + AND Postmenopausal
61
Which medications are included in neoadjuvant chemo regimens if they are HER2 +?
Trastuzumab +/- pertuzumab
62
If there is local recurrence what therapy do we consider?
Surgical
63
What adjuvant regimens does the NCCN prefer that do not contain trastuzumab?
Dose dense AC Doxorubicin/ cyclophosphamide TC: Docetaxel/ cyclophosphamide
64
What adjuvant regimens does the NCCN prefer that do contain trastuzumab?
T + Trastuzumab +/- pertuzumab | TCH: Docetaxel/ carboplatin/ trastuzumab +/- pertuzumab
65
What are the preferred single agents for recurrent/metastatic breast cancer?
Doxorubicin (regular/liposomal) Paclitaxel Antimetabolites: capecitabine, gemcitabine Vinorelbine, eribulin
66
Which study looked at patients with metastatic breast cancer taking trastuzumab + docetaxel + pertuzumab/placebo?
CLEOPATRA
67
Which medications do we use if the patient is HER-2 +?
Pertuzumab + Trastuzumab w/ paclitaxel/docetaxel
68
What are metastatic complications of breast cancer?
Bone metastasis | Oncologic emergencies
69
How do we follow up with a patient with breast cancer?
Routine follow up Annual mammography Endocrine therapy follow up Lifestyle factors
70
What is hematologic supportive care?
MGF | ESA
71
How many months should a woman wait after receiving treatment for breast cancer?
6 motnhs
72
Does fertility correlate to menses?
Not really
73
What causes lymphedema?
Consequence of surgery but may be chemotherapy as well
74
What populations are appropriate candidates for breast cancer intervention?
Lifetime risk > 20% or genetic predisposition | Life expectancy 10+ years
75
What are the types of breast cancer surgery for prevention and risk reduction?
Prophylactic mastectomy | Bilateral oophorectomy
76
Which medication has shown to reduce breast cancer incidence in patients with ER+ tumors?
Tamoxifen
77
What did the STAR trial look at?
Raloxifene | Tamoxifen
78
Tamoxifen has an increased incidence of what?
Endometrial cancer Thromboembolic events Hot flashes
79
Between tamoxifen and raloxifene, which had a reduced incidence of breast cancer compared to placebo?
Tamoxifen
80
Compared to raloxifene, tamoxifen has an increased incidence of what?
Cataracts
81
While they are category 1 recommendations for breast cancer reduction, the FDA does not recommend these?
Exemestane | Anastrozole

Heme/Onc (20 decks)

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