Chapter 17: Breast Cancer

Question 1

Breast cancer is the most commonly diagnosed cancer in the US with approximate _______% lifetime risk

Answer 1

13%

*Relatively high 5 year survival rates

Question 2

Breast cancer typically starts in the _____ or ______ cells

Answer 2

Ductal or lobular

Question 3

Breast cancer that has spread to surrounded to other tissue is called _____ or _____ cancer

Answer 3

Infiltrative or invasive cancer

Question 4

What are 5 modifiable risk factors for breast cancer?

Answer 4

1. Alcohol
2. Overweight/obesity
3. Low physical activity
4. Using oral contraceptives/hormone replacement
5. Childbearing/breastfeeding

Question 5

What are 6 non-modifiable risk factors for breast cancer?

Answer 5

1. Genes (i.e. BRCA1 & BRCA2)
2. Having dense breast tissue
3. Late menopause (>55 y/o)
4. Early menstruation (<12 y/o)
5. Chest radiation
6. Rece/ethnicity (Jews)

Question 6

What is the difference between ductal cancer in situ & infiltrative/invasive breast cancer

Answer 6

Hasn’t yet spread to the fatty tissue outside of the duct

Question 7

What are the 3 receptors looked at with breast cancer?

Answer 7

ER, PR, HER2

Question 8

What is triple “triple positive” breast cancer?

Answer 8

ER+, PR+, HER2+

Question 9

T/F: HER2+ (aka ERBB2) breast cancers are more likely to spread

Answer 9

True

Question 10

What does hormone receptor positive mean?

Answer 10

Estrogen and/or progesterone receptors are present. Hormone therapy WILL be given. Chemo may also be given

Question 11

How are hormone receptor negative breast cancers treated?

Answer 11

With chemotherapy, they tend to respond well to chemo but not hormone therapy

Question 12

Is HER2 a hormone receptor? How is it treated?

Answer 12

No, it’s a protein marker that drives treatment

Grows faster but good targeted therapies available

Question 13

T/F: HR+ breast tumors grow more quickly than HR-?

Answer 13

False - HR- grow more quickly

Question 14

What is the Oncotype Dx?

Answer 14

Recurrence score for breast cancer (how likely it’ll return in 10 years)

Question 15

Define Sentinel lymph node biopsy

Answer 15

Removes and tests the first lymph node in which the cancer would likely spread. More will be tested if positive

Question 16

Define Axillary lymph node dissection

Answer 16

Removes armpit lymph nodes (more than in the sentinel

Question 17

Define breast-conserving surgery

Answer 17

AKA lumpectomy or partial mastectomy, removes cancerous tissue and a surgical margin

Question 18

Define total mastectomy

Answer 18

Whole breast is removed

Question 19

Define modified radical mastectomy

Answer 19

Removes entire breast + lymph nodes under the arm

Question 20

Define radicial mastectomy

Answer 20

Removes breast, lymph nodes, and underlying chest muscles

Question 21

Define contralateral prophylactic mastectomy

Answer 21

Removal of the unaffected other breast

Question 22

Ovarian ablation

Answer 22

Permanent surgical oophrectomy to reduce estrogen

Question 23

It’s best to try to limit wt loss during breast cancer treatment to < ____-_____ lbs/week, but the patient also shouldn’t gain much wt

Answer 23

1-2 lbs/week

**ACS says wt loss programs are actually appropriate for breast cancer pts as long as there’s no contraindications

Question 24

Kcal & protein recommendations w/ breast cancer

Answer 24

25 kcal/kg
1.2-1.5 g/kg body wt

Question 25

________ is the most common side effect of breast cancer treatment, affecting an estimated 60-96% of patients

Answer 25

Fatigue *associated w/ BMI > 25, pre-menopausal status, hormone therapy

Question 26

Is multivitamin beneficial for reducing fatigue with breast cancer?

Answer 26

No, actually increased fatigue in a study However, increased exercise and a diet higher in soy & omega 3 can lower fatigue

Question 27

What are 5 risk factors for breast-cancer related lymphadema?

Answer 27

-Age -Overweight -Lymph node dissection -Adjuvant radiation to regional lymph nodes -Some cardiovascular conditions

Question 28

What are the 3 most common remedies for breast-cancer lymphadema?

Answer 28

1. Compression bandages 2. Manual lymphatic drainage 3. Exercise **weight loss may help but more research is needed

Question 29

What are vasomotor symptoms?

Answer 29

Hot flashes, sweating, flushing Occur in 2/3 of breast cancer patients

Question 30

Nutrition interventions for vasomotor symptoms

Answer 30

Isoflavones (phytoestrogen) such as soy (but not supplements) and potentially vitamin E

Question 31

Are muscoskeletal symptoms ("every bone in my body hurts") typically more common w/ aromatase inhibitors or SERMS?

Answer 31

Aromatase inhibitors (think post-menopause) *No strong nutrition evidence

Question 32

Calcium is recommended w/ bisphosphonate therapy d/t bone loss associated w/ breast cancer. When is the best time to take for max absorption?

Answer 32

2 hours before or after bisphosphonates

Question 33

Peripheral neuropathy has been associated with _______ - based chemotherapy

Answer 33

Taxane (think ataxia = difficulty walking) *many nutrition studies done, omega 3 supplements may help

Question 34

What is the PATHWAYS study?

Answer 34

long term breast cancer study

Question 35

________ & _______ can be considered in addition to anti-emetics for breast cancer patients

Answer 35

Acupuncture & accupressure

Question 36

Taste changes are likely to resolve within ______ months after completing chemo

Answer 36

3

Question 37

Those with BMI < ______ or with recent ______ % wt loss should be discouraged from fasting in attempt to mitigate chemo side effects

Answer 37

20.5 10

Question 38

T/F: Women closer to their IBW, younger, and who receive chemo are at a higher risk for weight gain during breast cancer treatment

Answer 38

True

Question 39

CMF chemotherapy regimen is associated with a significantly higher risk for wt gain during treatment

Answer 39

"call me fat" Cyclophosphamide, methotrexate, fluorouracil

Question 40

T/F: Contrary to popular belief, Tamoxifen is not associated with significant wt gain

Answer 40

True

Question 41

Soy may help which 2 side effects of breast cancer treatment

Answer 41

Fatigue & hot flashes

Question 42

Vitamin E may help which side effect of breast cancer treatment?

Answer 42

Hot flashes (E=extinguisher)

Question 43

Weight loss may help which 1 side effect of breast cancer treatment?

Answer 43

Lymphadema

Question 44

Omega 3 may help these 2 side effects of breast cancer treatment?

Answer 44

Fatigue Peripheral neuropathy

Question 45

In the WHEL study, highest levels of plasma __________ were associated with decreased breast cancer reurrence

Answer 45

Carotenoids

Question 46

Does soy or flax interfere with Tamoxifen?

Answer 46

No

Question 47

_______ (increased/decreased) risk for breast cancer w/ low fat dairy

Answer 47

Decreased - should be encouraged to consume 2-3 servings/day

Question 48

Has research found associations between red/processed meats and breast cancer?

Answer 48

Yes, limit

Question 49

What is a-linolenic acid

Answer 49

Form of omega-3 that comes from plants

Question 50

Inverse relationship with omega-3s and breast cancer risk, name 3 fish sources high in DHA/AHA

Answer 50

1. salmon 2. herring 3. sardines 4. mackerol 5. tuna (not as high as the others) aim for 1-2 servings/week

Question 51

CHOICE Study

Answer 51

We loss study, no significant difference between low fat & low CHO group on success w/ losing wt (though some studies have shown benefits of low fat diet w/ breast cancer)

Question 52

T/F: Nighttime fasting may lower breast cancer risk

Answer 52

True. May improve BG control and diabetes is also a concern for BG risk (recommend 13 hours/night)

Question 53

Soy recommendations for breast cancer?

Answer 53

1-2 servings/day (provides 10-40 mg soy isoflavones)

Question 54

Consensus on supplements with breast cancer

Answer 54

Results are all over the place with almost all supplements. More research is needed, best not to recommend unless deficient.