Breast Cancer Screening

Question 1

When does the USPSTF recommend breast cancer screening?

Answer 1

Every 2 years from ages 50-74

Question 2

What is the best screening test for breast cancer?

Answer 2

Mammogram

Question 3

When do you start screening in a patient with a family history of breast cancer?

Answer 3

Age 40

Question 4

What patients are recommended for BRCA screening?

Answer 4

Fam hx of ovarian, fallopian tube, primary peritoneal ancer
2 family members with breast cancer <50
2 or more primary breast cancers
Hx of Triple (-) breast cancer <60
Male family member with breast cancer
Breast, prostate or pancreatic cancer in any 2 relatives
Hx of breast cancer age <50

Question 5

What is the preferred method of breast cancer chemoprophylaxis in Postmenopausal women?

Answer 5

Aromatise Inhibitors

Question 6

What are common Aromatase Inhibitor drugs?

Answer 6

Anastrozole and Exemestane

Question 7

What is another use of Aromatase Inhibitors?

Answer 7

prevention of recurrence in women previously diagnosed with breast cancer

Question 8

What is a possible adverse of Aromatase inhibitors?

Answer 8

Decreased bone density

Question 9

What is the preferred method of breast cancer chemoprophylaxis in Premenopausal women?

Answer 9

Selective Estrogen Receptor Modulator (SERM) Drugs

Question 10

What are common SERM drugs?

Answer 10

tamoxifen or Raloxifene

Question 11

How do SERMS work?

Answer 11

Agonist in endometrial tissue: can increase risk of endometrial cancer

Agonist in breast tissue

Also risk of thrombosis

Question 12

What is offered for breast cancer prophylaxis for patients with BRCA mutations?

Answer 12

Prophylactic bilateral Mastectomy

Question 13

What are common Malignant and premalignant breast lesions?

Answer 13

Paget Disease of the breast
Phyllodes Tumor
Lobular Carcinoma in Situ
Ductal Carcinoma in Situ
Lobular Carcinoma
Ductal Carcinoma

Question 14

What is the etiology of Paget Disease of breast?

Answer 14

Migration of neoplastic ductal epithelial cells to the nipple

Question 15

What are common physical exam findings for Paget Disease of breast?

Answer 15

Scaly, vesicular, ulcerated lesion +/- bloody nipple discharge

Question 16

How do you diagnose Paget Disease of breast?

Answer 16

B/L mammogram
Wedge or punch biopsy

Question 17

How do you manage Paget Disease of breast?

Answer 17

Simple Mastectomy
Breast conservation surgery in select cases

Question 18

What is the etiology of Phyllodes tumor?

Answer 18

Papillary projections of epithelial-lined stroma with varying degrees of hyperplasia and atypic

Question 19

What physical exam findings are common in Phyllodes tumor?

Answer 19

Smooth mobile rapidly growing breast mass or abnormal radiographic findings

Question 20

How do you diagnose Phyllodes tumor?

Answer 20

US, Core needle biopsy

Question 21

How do you manage Phyllodes tumor?

Answer 21

Excision

Question 22

What is the Etiology of Lobular Carcinoma In Situ (LCIS)?

Answer 22

Atypical proliferation within terminal duct lobules

Question 23

What are common Physical exam findings of Lobular Carcinoma In Situ (LCIS)?

Answer 23

Usually incidental findings

Question 24

How do you diagnose Lobular Carcinoma In Situ (LCIS)?

Answer 24

Core biopsy

Question 25

How do you manage Lobular Carcinoma In Situ (LCIS)?

Answer 25

Surgical Excision

Question 26

What is the Etiology of Ductal Carcinoma In Situ (DCIS)?

Answer 26

Proliferation of neoplastic epithelial cells within mammary ducts without stromal invasion

Question 27

What are common physical exam findings of Ductal Carcinoma In Situ (DCIS)?

Answer 27

Suspicious microcalcifcations on mammography

Question 28

How do you diagnose Ductal Carcinoma In Situ (DCIS)?

Answer 28

Core biopsy

Question 29

How do you manage Ductal Carcinoma In Situ (DCIS)?

Answer 29

Lumpectomy with radiation or mastectomy

Question 30

What is the etiology of Lobular carcinoma?

Answer 30

Invasion of neoplastic cells into mammary stroma and adipose in a single-file pattern

Question 31

What is seen on Physical exam for Lobular carcinoma?

Answer 31

Hard, immovable, Single dominant lesion with irregular borders

Question 32

How do you diagnose Lobular Carcinoma?

Answer 32

Mammogram Core Biopsy

Question 33

How do you manage Lobular carcinoma?

Answer 33

Surgery: +/- Radiation, +/- chemo

Question 34

What is the etiology of Ductal carcioma?

Answer 34

Nests of tumor cells within glandular tissue

Question 35

What is seen on physical exam for Ductal Carcinoma?

Answer 35

Hard, immovable, Single dominant lesion with irregular borders

Question 36

How do you diagnose Ductal Carcinoma?

Answer 36

Mammogram Core Biopsy

Question 37

How do you manage ductal carcinoma?

Answer 37

Surgery: +/- Radiation, +/- chemo