Breast Cancer

Question 1

Endocrine increased risk factors

Answer 1

Early menarche before age 12
Late menopause after age 55
Nulliparity and first birth over 30
Long DUR of HRT and concurrent progestins

Question 2

Endocrine decreased risk factors

Answer 2

Bilateral oophorectomy before age 40

Question 3

Epidemiology

Answer 3

Most common occurrence

1 in 8 lifetime risk

Question 4

Genetic RFs for BC

Answer 4

Dense Breast Tissue
BRCA-1 or 2 mutation
Family History

Question 5

Environmental or Lifestyle Factors for BC

Answer 5

High Dietary Fat
High BMI
No exercise
EtOH
Radiation before age 20

Question 6

Common sites for BC

Answer 6

Ducts and lobules

Question 7

Lymph Nodes commonly removed

Answer 7

Axillary Lymph Nodes

Question 8

Most common form of invasive carcinoma

Answer 8

Infiltrating Ductal Carcinoma
(IDC) 75% of all invasive BC
-Commonly spreads to axillary LN
-Poor prognosis
-Lump characteristic
Metas:
 Bone, Liver, Lung, Brain

Question 9

2nd most common form of invasive BC

Answer 9

Infiltrating Lobular Carcinoma
 (ILC)
-similar to IDC
-less frequent
-thickening of breast
Metas:
 Meninges, GI, Reproductive organs

Question 10

Types of noninvasive BC

Answer 10

DCIS and LCIS

Ductal and Lobular

Question 11

Tx for preinvasive BC

Answer 11

Prevent development of invasive dz
DCIS - whole breast rad (WBR)
LCIS - observation/masectomy
Both goal is Removal
Consider tamoxifen if (+) receptor

Question 12

Mastectomy and oophorectomy suggested in

Answer 12

Pts with BRCA-1 or BRCA-2 mutations

Question 13

Tamoxifen ADEs

Answer 13

Endometrial Cancer

VTEs, clots, PEs, etc.

Question 14

STAR trial

Answer 14

Showed that raloxifine was similar to tamoxifen
BUT it has fewer ADEs of
endometrial cancer and VTEs

Question 15

If done properly, ___ can detect 90% of BCs

Answer 15

Breast Self Examination

• monthly
• note changes that occur

Question 16

Primary screening method for BC

Answer 16

Mammography
 -less than 30% of masses
  found are malignant
 -up to 15% of malignant
  masses are undetectable

Question 17

How often should each screening occur

Answer 17

Mammogram
 -annually starting at 40
CBEs (by Dr.)
 -q 3 yrs 20-30's
 -annually at 40
Breast Self Exam
 -optional starting at 20

Question 18

Based on location of a BC tumor, ___ lymph nodes are where it would be most likely to spread

Answer 18

Sentinel Lymph Nodes
SLNB (biopsy)
If neg, cancer hasn’t spread
-check prior to ALND

Question 19

Poor prognostic factors for BC

Answer 19

Under age 35
Tumor size
Nodal involvement
ER negative status (young pts)
HER-2 (+) dz

Question 20

ER + or ER - pts

Answer 20

ER + is better
means they will respond to hormonal therapy
ER+/PR+ even better

only 5% of - pts respond

Question 21

HER-2

Answer 21

Positive oncogene overexpression undicates

• more aggressive
• increased recurrence
• increased mortality
• poor prognosis

Question 22

Agents for HER-2 (+) pts

Answer 22

Herceptin (trastuzumab)
Perjeta (Pertuzumab)

Adjuvant BIOLOGIC Tx
AC + Paclitaxel + biologic + tamox

Question 23

Tamoxifen or AI

Answer 23

depends on menopausal status

Before menopause = tamoxifen
become post meno, switch to AI

Age over 60 or no menses for 12 mo
= AI

Question 24

When are AIs used?

Answer 24

ONLY POST-MENOPAUSE
AIs do not work pre-meno
b/c estrogen from ovaries
will override

Question 25

Tamoxifen vs AI ADEs

Answer 25

Tamoxifen

• thrombotic events
• endometrial cancer
• vasomotor (also in AIs)

AIs
 -OSTEOPOROSIS
       (Ca+Vit D)
 -Arthralgias/myalgias
 -vasomotor (also in tamox)

Question 26

Tamoxifen drug interactions

Answer 26

Cyp2D6 Inhibitors

• fluoxetine
• duloxetine
• paroxetine

Question 27

Mgmt of hot flashes with AIs and tamoxifen

Answer 27

Can’t use traditional hormonal drugs

Instead use:

• SSRIs
• SNRIs
• Gabapentin

Question 28

Post-op surveillance for BC

Answer 28

Office visits q3-6 months for 3 yrs
then, 6-12 months for 2 yrs
then annually