Breast Conditions

Question 1

What is the GAIL model?

Answer 1

calculate risk invasive CA in next 5 years & overall lifetime risk

Factors: race/ethnicity, Hx breast biopsy, LCIS or DCIS, current age, menarche, age/1st live birth & # 1st degree relatives w/breast CA

Only model validated for AA women

Question 2

What is the CLAUS model?

Answer 2

high risk women

Incorporates age of onset: 1st & 2nd degree male & female relatives; expanded version: family members w/ovarian CA

No personal, lifestyle or reproductive risk factors

Question 3

What is the BRCAPRO model?

Answer 3

high risk women in given family

incorporated: Mutation frequencies, penetration/affected carriers, contralateral breast CA

Age of onset: 1st & 2nd degree male & female relatives

Question 4

What is the HBOC model?

Answer 4

hereditary breast & ovarian cancer (autosomal dominant & associated w/ BRCA 1 & 2 genetic mutations)

Suspect: breast CA

Question 5

What if the HBOC model is POSITIVE?

Answer 5

prophylactic mastectomy &/or oophorectomy

Question 6

Other BRCA mutation screening tests?

Answer 6

BOADICEA: breast & ovarian analysis of disease incidence & carrier estimation algorithm
Tyrer-Cuzick

Question 7

What is primary chemoprevention for women at HIGH RISK?

Answer 7

SERMs and ALs or surgical , can also be used post -CA

Question 8

When are false negatives an issue?

Answer 8

Low sensitivity tests

Question 9

When are false positives and issue?

Answer 9

Low specificity tests

Question 10

Average risk recommendation for CBE?

Answer 10

q 1-3 years from 20-39

annually > 40

Question 11

High risk recommendation for CBE?

Answer 11

Annually at 25, or 5-10 years prior to age of when relative was diagnosed

Question 12

Average risk recommendation for mammogram?

Answer 12

annually >40 y/o

Question 13

High risk recommendation for mammogram/ mri?

Answer 13

Begin annually 25-30, or 5-10 years prior to age of when relative was diagnosed

Question 14

What is the BI-RAD System?

Answer 14

1: negative
2: benign findings
3: probably benign; initial short term interval follow up suggested (

Question 15

What are the factors leading to lifetime risk of >/= 20-25% chance of Breast Cancer? (high risk)

Answer 15

Known BRCA gene mutation
1st degree maternal/paternal relative (parent, brother, sister or child) w/BRCA mutation
Hx chest irradiation between ages 10-30
Patient or 1st degree relative has high risk syndrome

Question 16

Contraindications for MRI?

Answer 16

Pacemakers, cochlear implants
Any non-compatible MRI device/implant (deep brain stimulators)
Claustrophobia unamenable to anxiolytics
Wt/circumference limitations of MRI table

Question 17

What meds cause galactorrhea?

Answer 17

Dopamine antagonists, MOAIs

Question 18

What is the pharm option for pit tumor treatment?

Answer 18

Dopamine agonist : Cabergoline

Question 19

What is the surgical tx for pit tumor and when is it indicated?

Answer 19

Transsephenoidal

Intolerance to meds, resistance to meds, large tumor or mass effect, if patient wants definitive tx

Question 20

When should pt return for f/u after initial meds for tumors?

Answer 20

1 month after initiation to check for dosage and adjustment

Question 21

When should therapeutic levels be checked for tumor meds?

Answer 21

3rd month, 6th month, and every 6 months after that

Question 22

After pt stops taking meds for tumor when should the prolactin level be checked?

Answer 22

q 3 months for first year and if good then annually

Question 23

When should MRI be done when checking tumor?

Answer 23

Baseline then 6 months, 12 months, 24 months

Question 24

What meds can treat mastalgia?

Answer 24

OCPs, depo, SERMs

Question 25

How is pagets diagnosed?

Answer 25

Nipple bx w breast assessment , direct or guided bx to confirm DCIS or invasive CA

Question 26

What is the general spread of breast cancer?

Answer 26

Locally then to LN / bloodstream or both

Question 27

What are early findings or breast cancer?

Answer 27

mass or asymmetry (size, contour or non-diffuse slightly firmer thickening in one breast), eczematous nipple changes

Question 28

What are findings for advanced breast cancer?

Answer 28

mass fixation to chest wall or skin, matted or fixed nodes; Inflammatory: peau d’orange, breast enlargement but usually no mass d/t entire breast involvement

Question 29

What is diagnostic for breast CA?

Answer 29

H&P, mammography + MRI w/indications Oncology referral : Direct or guided imaging w/core biopsy

Question 30

What is the breast cancer grading based on?

Answer 30

1. histology (ductal, lobular, nipple) 2. TNM (tumor, nodes, mets) 3. Receptor status : estrogen, progesterone, and HER2

Question 31

What needs to follow up after biopsy for breast cancer?

Answer 31

Pre treatment work up 1. Evaluate metastatic dx : CBC, CXR, LFT, ab ct, bone scan, 2. MRI : tumor size and #, chest wall involvement

Question 32

What is definitive staging and tx for breast cancer?

Answer 32

1. Surgical and sentinel LN biopsy at oncology referral * Not on focal DCIS * Determines HER2, estrogen, and progesterone status

Question 33

What are surgical options for PDB?

Answer 33

1. Central lumpectomy if lesion confined to NAC with clear margins. 2. Partial mastectomy if tumor

Question 34

What are the surgical options based on sentinel LN - breast CA?

Answer 34

Lumpectomy (breast conservation) Simple mastectomy: excise only the breast Modified radical mastectomy: breast & axillary LN Complete radical mastectomy: reserved for dz invades chest wall - excise breast, axillary LN, pectoral muscles

Question 35

What are adjuvant hormonal tx?

Answer 35

SERMs: tamoxifen and raloxifene

Question 36

When do you use estrogen antagonists?

Answer 36

ER positive CA

Question 37

What are the ADR of adjuvant hormonal tx?

Answer 37

Thromboembolic events, endometrial CA

Question 38

When are adjuvant hormonal aromatase inhibitors (AI) used?

Answer 38

systemic therapy | - primary CA, mets, or prevention along with SERMs

Question 39

What are the ADR or AI?1

Answer 39

Decreased bone density, fracture risk

Question 40

What should be used if HER2 is positive?

Answer 40

TRASTUXZUMAB

Question 41

ADR of Trastuxzumab?

Answer 41

HF Respiratory distress Anaphlyaxis

Question 42

Factors that lead to a poorer prognosis?

Answer 42

Young age, BRCA gene expression Larger primary tumor, high grade tumor (poorly differentiated) Positive LN ER receptor negative, HER2 gene expression

Question 43

What is the MOA of pagets in breast cancer?

Answer 43

Epidermotrophic theory - begins in breast and spread to nipple areolar complex

Question 44

What is the stalk effect?

Answer 44

Non secretory adenopathy or lesion that interferes with dopamine inhibitory control ,leads to increased prolactin

Question 45

What can tumor size cause

Answer 45

Bitemporal Hemianopsia with ha diplopia vision changes