Introduction and Risk Factors for Breast Cancer

Question 1

At what age group is the largest incidence of breast cancer? Within this group, what is the biggest peak?

Answer 1

45-69, with the biggest peak being 65-69

Question 2

How common is breast cancer?

Answer 2

The commonest cancer in women, and the 2nd commonest cause of cancer death in women

Question 3

What is the relationship between incidence and prevalence of breast cancer and mortality at the moment?

Answer 3

Incidence and prevalence are increasing, mortality is decreasing

Question 4

What are the two major generic risk factors for breast cancer?

Answer 4

Increasing age and female sex

Question 5

In terms of genetics and family history, what conveys A) low risk? B) high risk?

Answer 5

A) first degree relative affected B) a relative with cancer at a young age/bilateral carcinomas

Question 6

What are some reproductive risk factors for breast cancer?

Answer 6

Early menarche (< 12), late menopause, increased age at first birth (> 30), low/no parity, no breastfeeding

Question 7

The presence of which hormone is a risk factor for breast cancer both endogenously and exogenously? What are some exogenous ways of becoming exposed to this?

Answer 7

Oestrogen - combined oral contraceptive pill, hormone replacement therapy

Question 8

Which geographical locations have the highest risk of breast cancer?

Answer 8

Northern and Western Europe, USA

Question 9

What are some lifestyle factors which increase the risk of breast cancer?

Answer 9

High body weight (post-menopausally) and significant weight gain in adult life, little physical activity, alcohol consumption, poor diet, smoking

Question 10

What risk factors for breast cancer convey a relative risk of < 2?

Answer 10

Early menarche/late menopause, nulliparity, lifestyle factors, HRT, benign proliferative disease

Question 11

What risk factors for breast cancer convey a relative risk of 2-4?

Answer 11

Aged > 35 at first birth, 1st degree relative with breast cancer, radiation exposure, previous breast cancer

Question 12

What risk factors for breast cancer convey a relative risk of > 4?

Answer 12

Gene mutation, lobular/ductal carcinoma in situ, atypical hyperplasia of any kind

Question 13

Which two modifiable lifestyle risk factors for breast cancer are associated with epidemiological decreased risk of breast cancer?

Answer 13

Routine vigourous activity and maintenance of healthy body weight

Question 14

BRCA1 and BRCA2 mutations are each present in what percent of the population? Approximately 1 in how many people carry a mutation in one of these genes?

Answer 14

0.1%, 1 in 450

Question 15

BRCA mutations are responsible for what % of breast cancers?

Answer 15

2%

Question 16

If you have a BRCA1 or 2 mutation, what is your lifetime risk of developing breast cancer?

Answer 16

45-64%

Question 17

What are the two main ways that breast cancer is detected? How common is each?

Answer 17

50% asymptomatic and detected via screening, 50% symptomatic and present with symptoms

Question 18

Of all the women presenting with breast cancer, what symptom do 50% of them complain of?

Answer 18

Breast lump

Question 19

What are the 6 main symptoms of breast cancer?

Answer 19

Visible/palpable lump, nipple change e.g. inversion, dimpled or depressed skin, bloody nipple discharge, skin texture change, skin colour change

Question 20

What investigation is helpful in defining a malignant solid mass, particularly in younger women?

Answer 20

Ultrasound

Question 21

What sign of breast cancer on imaging is often not picked up by ultrasound?

Answer 21

Calcifications

Question 22

What investigation makes the definitive diagnosis of a breast cancer?

Answer 22

Image guided core-needle biopsy