Breast Cancer Flashcards
(28 cards)
What are the Canadian Task Force breast cancer screening recommendations in average risk individuals?
Screen women age 50-74 years old with a mammogram every 2-3 years.
What is the Canadian Task Force recommendations on breast exam?
Recommend against self-breast exam or clinical breast exam in asymptomatic individuals.
What are the screening guidelines for breast cancer in high-risk individuals?
Women age 30-69 who are confirmed high-risk are to be screened with a mammogram AND breast MRI annually.
Which women are deemed “high-risk” for breast cancer to alter their screening recommendations?
- Known hereditary gene mutation.
- 1st degree relative with a know hereditary gene mutation.
- High-risk personal or family history of cancer.
- Radiation to the chest when < 30 years old and at least 8 years ago.
Which personal history or family history OF CANCER is concerned high risk to warrant increased breast cancer screening (6)?
- 2 or more cases of breast CA and/or Ovarian CA in 1st degree relatives or grandparents
- Bilateral breast cancer
- Breast cancer onset < 35 years old
- Invasive serous ovarian CA
- breast and/or ovarian CA in Ashkenazi Jewish Female
- Male breast cancer
What are the high risk hereditary gene mutations that put you at higher risk (> 25% lifetime) for breast cancer?
- BRCA 1/2
- TP53
- PTEN
- CDH1
- PALB 1/2 (not in guidelines)
What imaging do you order when a breast cancer is suspected on mammography screening?
- Bilateral diagnostic mammogram
- Bilateral breast ultrasound
- Axillary ultrasound
What is considered Stage I breast cancer?
Tumours < or = 2 cm with NO lymph node involvement.
What is considered Stage II breast cancer?
Tumour is > 2 cm but < or = 5 cm AND there are < or = 3 lymph nodes involved.
OR
Tumour > 5 cm AND no nodes involved.
What is considered Stage III breast cancer?
Any skin or chest wall involvement
OR
> or = 4 lymph nodes
OR
Tumour > 5cm AND > or = 1 lymph node
What is considered Stage IV breast cancer.
Metastatic Disease
What further imaging is needed in patients with breast cancer based on their stage?
Stage I - Node Negative - No further tests.
Stage II - < or = 3 nodes - No further tests unless symptomatic.
Stage III - If > or = 4 lymph nodes involved, the patient warranted a bone scan, as well as a CT C/A/P
What is the typical chemotherapy regimen in breast cancer?
Anthracycline + Taxane
Give two examples of taxanes.
Docetaxel
Paclitaxel
What are the indications for adjuvant chemotherapy in patients with breast cancer?
Stage II/III for ER/PR + Breast Cancer
Stage II/III for HER2+ Breast Cancer
Stage I-III for “Triple Negative” Breast Cancer
Or for metastatic disease if it presents with “visceral crisis” (symptomatic/organ compromise)
What is the anti-hormone (endocrine) therapy recommended for breast cancer patients with ER and/or PR positive tumours?
IN ALL STAGES (I-IV)
Pre-menopausal - Tamoxifen for 5-10 yrs
Post-menopausal - Aromatase inhibitor (ex. Letrozole) for 5-10 years. Tamoxifen is an alternative if AI not tolerated.
What endocrine therapy is indicated in HER2 + breast cancer patients?
In Stage II/III - Trastuzumab (Herceptin) monotherapy.
In Metastatic Cancer - Double HER-2 blockade with trastuzumab AND pertuzumab.
What is the treatment for metastatic ER/PR + breast cancer?
Endocrine therapy + a CDK 4/6 inhibitor.
Get chemotherapy upfront if presents with “visceral crisis” (symptomatic/organ compromise)
What are the CDK 4/6 inhibitors?
Palbociclib
Ribociclib
Abemaciclib
What is the management of HER-2+ metastatic breast cancer?
Double HER-2 blockade and chemotherapy with a taxane.
What is the therapy for triple negative metastatic breast cancer?
Chemotherapy Immunotherapy (in PD-L1 positive disease) - Checkpoint inhibitor such as atezolizumab or pembrolizumab.
What are the common taxane side-effects (5)?
- Peripheral Neuropathy
- Infusion Rxn
- Myalgias/Arthralgias
- Alopecia
- Febrile Neutropenia
What are the anthracycline side-effects to be aware of (4)?
- Secondary leukaemia
- Irreversible cardiomyopathy
- Alopecia
- Extravasation reactions (tissue necrosis)
What are the major herceptin (trastuzumab) side effects?
- Reversible cardiomyopathy
- Diarrhea
- Infusion reactions
