Lecture 19 - Breast Cancer Flashcards
(31 cards)
What 4 3’s do I need to know for the exam?
- Describe 3 risk factors for breast cancer
- Name 3 sub-types of breast cancer
- What is triple assessment?
- Discuss 3 treatment options
Describe the incidence of breast cancer
- most common cancer in UK
- around 50,000 women and 400 men diagnosed each year
- 1/8 women will be diagnosed in her lifetime
- 12,000 women and 8- men will die from breast cancer each year
What is the trend in incidence and mortality of breast cancer?
incidence = rising mortality = decreasing
How does survival rate vary by stage? Why is this important?
survival decreases dramatically with each increasing stage
- early diagnosis essential
What are the risk factors for breast cancer?
- age
- geographic location
- oestrogen exposure
- family history
- previous breast cancer
- exogenous hormones
- BMI
- ionising radiation
Describe the NHS breast screening programme
- introduced in 1988
- 50-70
- 3 yearly intervals
- digital mammograms
- estimated 1000 deaths prevented
What socioeconomic factors affect breast cancer risk?
- high SES
- age at first pregnancy - younger = protection
- number of children - more = protection
What reproductive factors affect breast cancer risk?
- early onset menarche
- late menopause
- older age at first pregnancy
- nulliparity, each birth reduces the risk by 7% (15% in women with a twin birth)
- longer duration of breastfeeding
What lifestyle factors affect breast cancer risk and the molecular basis for their risk?
Obesity
- activation of IGF-1 and insulin signalling pathways
- activation of PI3K/Akt/mTOR signalling pathways
- increased production of oestrogen
- increased production of adipokines (e.g. leptin)
Alcohol
- effect of actaldehyde
- epigenetic changes (DNA methylation)
What is the prevalence of the BRCA genes?
0.2-0.3% in general population
3% in women with breast cancer
6% in women with breast cancer onset before age 40
What subtype are most of the BRCA1 cancers?
- basal-like
What gene is the major high-penetrance predisposition gene for luminal (ER positive) breast cancers?
BRCA2
What are the two major histological types of breast cancer
Ductal carcinoma in situ = DCIS
- incidence increasing
- 30-50% chance of processing to invasive cancer
Lobule carcinoma in situ = LCIS
- marker of increased risk (8-10 fold) for ILC rather than a true precursor
What are the main types of invasive breast cancer?
ductal/NST lobular tubular mucinous papillary others
Describe the transition from in situ to metastatic breast cancer
BM intact
in situ changes, including nuclear changes
invasion –> BM disruption
blood vessels and lymph invasion
What are the major molecular subtypes of breast cancer?
- Basal-like (BRCA1/triple-begative)
- Luminal A (ER+, HER2-)
- Luminal B (ER+, HER2+)
- HER2
- Claudin-low
- Normal like
Why is it important to find out the molecular characteristics of a breast cancer?
- guide treatment
- estimate prognosis
Which is the worst and best molecular profile of a breast cancer?
triple negative = worst
O, P +ve = best
What are the 3 things involved in the management?
diagnosis
surgery
adjuvant therapy
Who forms part of the diagnostic team?
- breast clinician (consultant surgeon)
- radiologist and radiographer
- pathologist
- breast care nurse
- nurse practitioner
- clinic staff
- administrative staff
- dedicated MDT coordinator
Who forms part of the treatment team?
- clinical oncologist
- medical oncologist
- breast surgeon
- medical geneticist
- data management personnel
- research nurse
- lymphedema specialist
- medical prosthetist
- clinical psychologist
- palliative care team
What is the triple assessment?
- Clinical
- Radiological
- Pathological
Describe the clinical aspect of triple assessment
- inspection and palpation of the breast
- checking lymph nodes in the neck and axilla
Describe the radiological aspect of triple assessment
mammogram and ultrasound
