Screening Mammorgraphy is for who? When do women get them? When do you get them earlier?
Annual screening begins at age 40 for asymptomatic women w/ average rate of breast cancer
Results sent in a letter to patient and physician
Earlier screening if:
Familty Hx 1st degree relative - 5-10 yrs before age of their dx
BRCA1/2 Start at 30
After Mantle Radiation - 8 years after treatment but not before age 25
What are the 2 standard mammorgram views for a Screening mammorgram of each breast?
MLO view - Medio-lateral-oblique
- pectoral muscle to nipple - good for inf/sup lesions
- gets inframammillary fold and axilla
- might midd medial breast
CC view - Cranio-Caudal
- gets medial breast tissue
What is/who gets a diagnostic mammogram?
SYMPTOMATIC PATIENTS > 30 yo
anyone w/ new symptoms, history, or followup abnormal screening or benign lesions
Uses different views - 4 standard instead of 2 - spot compression and magnification for calcifications
INTERPRETED IN REAL TIME at the time of exam
What if you see calcifications or other findings but they are non-palpable?
then use the SAME imaging modality to biopsy lesion!!!!
When do you do a breast ultrasound?
US for EVERY patient w/ a clinical problem
and for under age 30!!!!
ex. 30 yo with lump then order US
Suspicous findings on mammography?
Pleomorphic microcalcifciations w/ linear or branching patterns (linear implies necrotic tissue in ducts...bad!) MUST biopsy
Neodensities and architectural distortions
What are the official indications for a braeast ultrasound?
All palpable breast and axillary lumps
eval of new mammograpphic findings (masses, asymmetries, distortions, calficications)
Nipple discharge - serous or blood, unilateral or spontaneous
*STUDY OF CHOICE in women < 30 yo, PRegnant/lactating for eval of lumps
Screening breat US in women w/ dense breasts on mammography or intermediate risk for BC
Sonographic features of bresat cancer?
irreulgar margins, ill-defined masses - most are hypoechoic
Posterior acoustic shadowing
*Taller - than - wide or antiparallel orientation
Cyst w/ mural nodule
Unilateral axillary adenopathy
Indications for BReast MRI?
Screening for HIGH RISK Patients
Diagnostic Exam for:
- newly diagnosed or history of BC
- breast implant rupture - SILICONE IMPLANTS
MRI is MOST sensitive TEST!!!
Indications for breast MRI in newly diagnosed BC?
to get extent of disease in young patients/dense breasts
Screen for Contralateral Brest cancer
Response to neo-adjuvant CTX
VERY sensitive - Angiogenesis!!!
3 facts TO KNOW ABOUT MRI?
1) should BEVER be first line diagnostic imaging
2) must be read in conjunction w/ mammography
3) most problems solved w/out MRI
RF for breast cancer?
Reproductive - estrogens etc
Breast feeding protective!!!
High breast tissue density
BRCA and family history
Prior radiation therapy
Obseity, Lack of exercise, ETOH
Treatment options for early stage BC?
Local therapy - surgery or radiation to breast + axilla LN
Systemic Adjuvant therapy - CTX, hormonal, Abs, etc
what LN are not sampled surgically?
Internal Mammillary LN
What are the different levels of LN - matters for Sentinel LN biopsy?
Level 1: Lateral to Pec minor
Level 2: deep to pec minor
Level 3: Medial to Pec Minor
Level 4: Interpectora/Rotter's nodes
Different types of reconstructive flaps?
TRAMP-Flap = tranverse rectus abdominus myocutaneous
DIEP- deep inferior epigastric perforator
SIEA = superficial inferior epigastric artery
Latissimus Dorsi flap
Inferior gluteal perforator flap
Pros and Cons of TRAM-FLAP?
Feels like normal tissue
Get a tummy tuck!!!
Risk of HERNIA!
Who needs radiaiton therapy?
all patients w/ Lumpectomy or PArtial mestectomy
When / Why would radiation therapy delayed?
started after CTX completeled
Difference btween STage 1 and 2 Breast cancer?
STage 1 < 2 cm and LN negative
Stage 2 2-5 cm and LN involvement at surgery
What kinds of patients get more absolute benefit from adjuvant chemotherapy?
Younger Premenopausal women < 50 yo
ER negative disease get more benefit from CTX than ER+
What is required to treat pts w/ Trastuzumab?
evidence of HER2 overexpression defined as 3+ ICH or FISH amplicifcation ratio > 2
What are adjuvant CTX to give w/ Trastuzumab? Effects?
Adriamycin + Cyclophosphamide + Taxol
Taxotere + Carboplatin-AUC
ER+ Tumor treatment in pre vs post menopausal women!
Post-menopausal women - Aromatase inhibitors
Pre-menopausal women - Tamoxifen