Week 10: more breast cancer and risk assessment

Question 1

What is the purpose of risk assessment

Answer 1

To identify individuals who benefit from early or supplemental screening and risk reduction strategies other than healthy behaviors

Question 2

How does race and ethnicity play into risk for breast cancer

Answer 2

-Incidence is highest among nonhispanic whites
-Non Hispanic black women have the highest breast cancer death rates
- Asian/Pacific islander women have lowest incidence and death rates

Question 3

Compare the relative risk for breast cancer between high penetrant mutations and moderate penetrant mutations

Answer 3

-High penetrant (BRCA, TP53, CDH1, PTEN, STK11, PALB2): 8-10x
-Moderate penetrant (CHEK2, BARD1, RAD51D, ATM): 2-3x

Question 4

T/F Being obese premenopause increases risk of breast cancer

Answer 4

False!
Risk is increased only if obese post menopause

Question 5

Is ductal hyperplasia cancer?

Answer 5

No- it is an increase in the number of cells but the cells are normal

Question 6

What age should women with known variants in BRCA, PTEN, CDH1, NF1, PALB2, STK11 begin screening

Answer 6

age 30

Question 7

What age should women with variants in ATM, CHEK2, NBN, RAD51C, RAD51D, BARD1 begin screening

Answer 7

age 40

Question 8

What is tomosynthesis (3D mammography)?

Answer 8

-Xrays of breast taken at different angles to generate cross sections
-Improved detection
-Decreases risk of false positive results and fewer call backs

Question 9

What is an automated breast ultrasound (ABUS) and what are some patient concerns it would be good for?

Answer 9

-FDA approved screening for women with dense breasts
-Indicated as an adjuvant to mammography for breast ca screening
-Good for evaluating widespread abnormalities
-Also good for those who are claustrophobic for MRI or allergic to MRI contrast

Question 10

T/F Breast MRI efficacy is affected by dense breast tissue

Answer 10

False!

Question 11

Information about breast MRI

Answer 11

-Contrast enhancement features
-Higher detection of early stage ca
-Used for screening women with 20%+ lifetime risk
-Use in individuals with PHBC
-Not recommended for avg risk women with dense breasts

Question 12

List some limitations of breast ultrasound

Answer 12

-Increases false positives
-Lower PPV
-Unnecessary biopsies

Question 13

List some limitations of breast MRI

Answer 13

-Increased false positive rate
-Lower specificity
-High cost
-Time to perform
-Claustrophobia

Question 14

What is the main pharmacotherapy for preventing breast cancer? How does it work?

Answer 14

Tamoxifen: binds to estrogen receptors in breast and blocks uptake of estrogen

Taken for 5 yr reduces breast ca risk by 50%

Question 15

Name the two types of selective estrogen receptor modulators, who they are used in, and side effects

Answer 15

-Tamoxifen: both pre and post menopausal females, hot flashes, cataracts, blood clots, thickening of uterus and possible uterine ca
-Raloxifene: post menopause, hot flashes, vaginal dryness, blood clots

Question 16

What are aromatase inhibitors, who are they used for, and side effects

Answer 16

-Block the conversion of androstenedione to estrone and testosterone to E2
-Used in post menopausal females
-Hot flashes, vaginal dryness, joint/muscle pain, bone density loss, increase risk of bone fractures to hip and spine

Question 17

Name the three types of mastectomies

Answer 17

-Simple mastectomy
-Skin sparing mastectomy
-Nipple sparing mastectomy

Question 18

Name benefits and limitations/side effects to RRM

Answer 18

Benefits
-Reduces anxiety
-Eliminates need for future imaging

Side effects
-Complications from surgery, risk increased with reconstruction
-Body image issues
-Eliminates breast as sexual organ
-Psychological counseling may be part of preoperative counsling