Breast Cancer Screening

Question 1

Breast cancer is the most commonly diagnosed noncutaneous cancer in women in the united states second to

Answer 1

Lung cancer

Question 2

Breast cancer accounts for what percentage of all new cases of cancer diagnosed in women

Answer 2

27%

Question 3

Breast cancer screening traditionally included which three elements?

Answer 3

1. Breast imaging (primarily mammogram)
2. Clinical breast examination
3. Patient self-screening (self breast screening or self breast awareness)

Question 4

Probability of developing invasive breast cancer in the next 10 years if current age is 20

Answer 4

0.06% or 1 in 1,760

Question 5

Probability of developing invasive breast cancer in the next 10 years if current age is 40

Answer 5

1.44% or 1 in 69

Question 6

Probability of developing invasive breast cancer in the next 10 years if current age is 50

Answer 6

2.39% or 1 in 42

Question 7

Tumors detected at an early stage that are small and confined are more likely to be successfully treated with a

Answer 7

98% 5 year survival for localized disease

Question 8

A typical ductal adenocarcinoma with constant doubling time of 100 days would have been present for more than 11 years before it grew to a palpable size of

Answer 8

2cm

Question 9

Mammography screening could potentially identify a mass measuring 1mm-1cm during it’s preclinical phase, or

Answer 9

3 years before it becomes palpable

Question 10

What is sojourn time

Answer 10

The time interval when cancer may be detected by screening before it becomes symptomatic

Question 11

Sojourn time dependent on what?

Answer 11

Type of cancer. The

More biologically aggressive tumors typically have shorter sojourn times. The greatest predictor of sojourn time is age

Question 12

What is used in evaluating inconclusive mammographic findings, in evaluating young patients and other women with dense breast tissue, in guiding tissue core needle biopsy and other biopsy techniques, and in differentiating a cyst from a solid mass

Answer 12

Ultrasonography

Question 13

Ultrasonography may be an option for additional screening in women at high risk who are candidates for MRI screening butcannot receive MRI because of

Answer 13

Gadolinium contrast allergy, claustrophobia , or other barriers

Question 14

MRI can be useful adjunct but

Answer 14

Cost, duration of exam, and injection of contrast material prohibit it as a routine technique

Question 15

American cancer society recommends MRI screening for women with 20% or greater lifetime risk of developing breast cancer with what?

Answer 15

1. Known brca1 or brca2 gene mutation
2. First degree relative with brca1 or brca2 gene mutation and not tested
   Themselves
3. Lifetime risk of breast cancer of 20% or greater according to risk assessment tools based mainly On family history
4. Hx of radiationto the chest between 10-30 y.o
5. Li faumeni syndrome, Bowden syndrome, bannayan Riley ruvalcaba syndrome

Question 16

What is breast self-exam

Answer 16

Performance of an exam in a consistent, systematic way by the individual ona regular basis, typically monthly

Question 17

Currently there is an evolution away from teahing breast self-exam toward concept of breast self-awareness which is….?

Answer 17

Defined as womans awareness of the normal appearance and feel of their breasts

Question 18

Why is there an evolution away from breast self exam?

Answer 18

1/2 of all cases of breast cancer in women 50 yrs and older and 70% of cases in women younger than 50 are detected by women themselves frequently as incidental finding

Question 19

what is breast self awareness?

Answer 19

women’s awareness of the normal appearance and feel of her breasts. Breast self-awareness should be encouraged and can include breast self-examination as part of this breast self-awareness strategy. emphasis is not on examination techniques.

Question 20

Why is breast self-awareness an important screening strategy?

Answer 20

Some women may falsely assume that negative mammography or clinical breast examination results definitively exclude the presence of breast cancer. New cases of cancer can arise during screening intervals and breast self-awareness may prompt women’ not to delay in reporting breast changes based on false reassurance of negative screening result.

Question 21

Why did United States Preventive Services Task Force recommend against teaching breast self-examination?

Answer 21

Based on a lack of evidence to show benefit and potential harm resulting from evaluation of false-positive findings and undergo breast biopsy for benign lesions

Question 22

Is clinical breast eamination effective for breast cancer screening? If so, how frequently should it be performed?

Answer 22

A study showed that women aged 40 years and older who underwent clinical breast examination had sensitivity for cancer detection of 58.8% with a specificity of 93.4%. 5 cases of cancer were detected per 1,000 clinical breast examination. The American Cancer Society and the National Comprehensive Cancer Network recommended that clinical breast examination should be performed annually for women aged 40 years and older. For women of age 20-39, 1-3 years of clinical breast examination is recommended.

Question 23

When should mammography begin, and how frequently should mammography be performed?

Answer 23

The American Cancer Society recommends that women aged 40 and older be offered screening mammography annually.

Question 24

what are the factors that increase a woman’s relative risk of breast cancer?

Answer 24

Most of the women diagnosed with invasive breast cancer do not hav unique identifiable risk factors; however, women with certain characteristics do have an increaed lifetime prevalence of breast cancer compared with the general population. The incidence of breast CA increases with advancing age

Question 25

what reproductive risk factors influence breast cancer risk?

Answer 25

1. late age at first full-term pregnancy (>30 years) 2. Early menarche (55 yrs) 4. No full-term pregnancies 5. Never breastfed a child 6. Recent oral contraceptive use 7. Recent and long-term use of estrogen and progestin 8. Obesity

Question 26

Factors that increase risk of breast cancer >4.0

Answer 26

1. female 2. age - risk increases across all ages until age 80 3. Certain inherited genetic mutations for breast cancer (BRCA1 and / or BRCA2) 4. two or more first degree relatives with breast cancer dx at an early age 5. personal hx of breast cancer 6. high breast tissue density 7. biopsy-confirmed atypical hyperplasia

Question 27

Other factors that increase risk of breast cancer

Answer 27

1. Personal history of endometrial or ovarian cancer 2. alcohol consumption 3. height (tall) 4. high socioeconomic status 5. Ashkenazi Jewish heritage

Question 28

What screening is appropriate for women at high risk?

Answer 28

Women who test + for BRCA1 or BRCA2 mutations should have enhanced screening and risk reduction discussed. Enhanced screening includes: 1. twice-yearly clinical breast examinations 2. annual mammography 3. annual breast MRI 4. instruction in breast self-examination Women who have first-degree relatives with these mutations but who are untested are generally managed as if they carry these mutations until their BRCA status is known.