Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
61 Cards in this Set
- Front
- Back
|
True or False: Lung cancer is the number one cause of cancer in males and females
|
False: Breast cancer is the number one cause of cancer in women
|
|
|
T or F: Breast cancer is the number on cause of cancer-death in women
|
F: Breast cancer is the number 2 cause of cancer deaths in women
|
|
|
The lifetime risk of developing breastcancer is __ in __ for women residing in the US.
|
1 in 8 (if you live to age 90)
1 in 200 for women in their 30s |
|
|
What percentage of breast cancers are caused by genetic mutations?
|
10%
|
|
|
What is the number on risk factor for developing breast cancer?
|
Gender
|
|
|
What is the 2nd most important risk factor for breast cancer?
|
Age. Breast cancer increases with age. Women in their 50s or 60s are at the greatest risk
|
|
|
List the risk factors for breast cancer
|
Gender
Age Family history Endogenous estrogen exposure Benign breast disease Radiation exposure Obesity and BMI Physical activity Exogenous estrogen exposure (controversial) Alcohol Race Reproductive history Menstrual history Genetic factors Treatment with DES |
|
|
What race has the highest incidence of breast cancer? the lowest?
|
highest: non-hispanic whites, ashkinaze jews
lowest: asians |
|
|
How does having a baby effect a woman's risk for breast cancer?
|
Before 25 yo: decreases risk
Between 25 and 30: Neutral After 30 or never: increases risk |
|
|
What risk factors for breats cancer can be controlled?
|
Obesity
Exercise Alcohol Not having children Birth Control Pills Hormone Replacement Therapy |
|
|
Which mutations are associated with an increased risk of breast cancer?
|
BRCA1 and BRCA2
|
|
|
What is the most common place (anatomically) that cancer is found?
|
lobes or milk ducts
|
|
|
T or F: Men have a 1 in 100 chance of developing breast cancer
|
True
|
|
|
What drug options do you have fore chemoprevention for breast cancer?
|
Tamoxifen: Overall reduction in breast cancer incidence of 30-40%
Raloxifene had a similar reduction in incidence of invasive breast cancer. Raloxifene is less toxic (endometrial hyperplasia and cataract) Postmenopausal: can consider Raloxifene No data for premenopausal Tamoxifen is cheaper and is dosed once daily and has been studied in pre and post menopausal women |
|
|
When is chemoprevention indicated?
|
Chemoprevention is used to prevent invasive cacner from occuring or to prevent noninvasive cancer from coming back
|
|
|
T or F: Women with a 5-year projected risk for breast cancer greater than or equal to 1.66% may be offered tamoxifen or raloxifene to reduce their risk.
|
True. Monitor SE and toxicities.
Use in women with >1.6% risk |
|
|
Does a mammogram or breast exam prevent a patient from getting breast cancer?
|
NO. Does not prevent just screens
|
|
|
Does tamoxifen given to a woman at high risk of developing breast cancer prevent them from getting breast cancer?
|
Yes
|
|
|
How often is a BSE, CBE, and Mammogram recommended?
|
BSE monthly (>20yo)
CBE q3 years (20-39yo) CBE yearly (<40yo) Mammogram yearly (>40yo) Mammorgram biennially (>50yo) |
|
|
The likelihood of women to get a mammogram for women with less than a high school education and/or no health insurance is _________.
|
Decreased
|
|
|
T or F: About 85% of women >40 yo get the recommended annual mammogram
|
False: only about 50-60% get them
|
|
|
Do we test every single person for the brca1 or 2 mutation?
|
No
|
|
|
What are the criteria for testing for brca1 or 2 mutation?
|
Family history of mutation
Personal history of breast cancer + Dx <40 ashkinaze jew hx of epithelial ovarian cancer If male: personal history + fam member with breast cancer |
|
|
What is the clinical presentation of breast cancer?
|
MOST COMMON: Painless mass (90%)
stabbing or aching pain nipple discharge, retraction, or dimpling 80% of women first detect some abnormality themselves |
|
|
T or F: 10% of patients present with metastatic disease
|
True: very few breast cancer patients present in the metastatic setting because of screening methods
|
|
|
List the sites in the body where mets can be found
|
Bone (MOST COMMON)
Liver Lung Brain Distant lymph nodes (not around breast) |
|
|
What is the survival rate of a patient diagnosed with breast cancer stage 1?
|
100% if get recommended tx
|
|
|
What are good prognostic markers?
|
ER+: generally less aggressive. Can give hormone therapy
Her2- metastasis localized to bone only, not spread to other organs |
|
|
When is trastuzumab indicated?
Her2+ or Her2-? |
Her2+: Trastuzumab and Lapatinib will be effective
|
|
|
Discuss the prognosis related to histological grade and proliferative rate.
|
histologic grade: poorly differentiated cells have worse prognosis than those well differentiated
proliferative rate: the faster growing may be more responsive to chemo |
|
|
Discuss the prognosis related to lymphatic invasion, Her2 overamplification, and ER.
|
Lymphatic invasion: spread of cancer to other structures within the breast is unfavorable
Her2 overamplification: More aggressive tumor, worse disease outcome ER+ predicts response to hormone therapy and better outcomes |
|
|
Which prognostic factors are also predictive factors?
|
Her2/neu overamplification: NEGATIVE prognostic
ER+: POSITIVE prognostic |
|
|
When is surgery indicated for tx of breast cancer?
|
In all stages but stage 4
|
|
|
When is radiation indicated for tx of breast cancer?
|
Depends on the type of surgery
XRT indicated if: lumpectomy, positive margins, or lymph nodes |
|
|
When is chemo indicated in breast cancer tx?
|
Indicated when there is lymph node involvement or very large tumors
Questionable for stage I |
|
|
Describe the treatment for ER- BC (I, IIa, IIb)
|
Lumpectomy or Masectomy
Adjuvant Chemo Trastuzumab if Her2 *Radiation if lumpectomy, + margins, lymph |
|
|
Describe the treatment for ER+ and/or PR+ BC (I, IIa, IIb)
|
Lumpectomy or Masectomy
Adjuvant Chemo Hormonal Therapy + Trastuzumab if Her2 *Radiation if lumpectomy, + margins, lymph |
|
|
Describe the treatment for ER- BC (IIIA and IIIB)
|
Neoadjuvant chemo
Lumpectomy or Masectomy Trastuzumab if Her2 *Radiation if lumpectomy, + margins, lymph |
|
|
Describe tx for ER+ and/or PR+ BC (IIIA and IIIB)
|
Neoadjuvant chemo
Trastuzumab Lumpectomy or Masectomy Hormonal therapy + Trastuzumab if Her2 *Radiation if lumpectomy, + margins, lymph |
|
|
When do you give neoadjuvant therapy?
|
Before definitive therapy/surgery
|
|
|
How does treatment for I, IIa, IIb differ from treatment for IIIa and IIIb
|
I, IIa, IIb: surgery first then chemo
IIIa, IIIb: chemo first then surgery |
|
|
What are some common chemo regimens?
|
(AC) Doxorubicin + Cyclophosphamide
Single agent Docetaxel (T) Paclitaxel + Trastuzumab FEC (fluorouracil, epirubicin, cyclophosphamide) TC (Docetaxel + Cyclophosphamide) CMF (Cyclophosphamide, MTX, Fluorouracil) |
|
|
What are the three most active agents in breast cancer?
|
Cyclophosphamide
Taxane: Paclitaxel or Docetaxel Anthracycline: Epirubicin or Doxorubicin |
|
|
When would you not want to use epirubicin or doxorubicin?
|
pts with heart problems
|
|
|
When is CMF indicated?
|
Cyclophosphamide, MTX, Fluorouracil
typically given in elderly Not as effective and a longer treatment time Less intensive, less toxic |
|
|
what are the goals for metastatic breast cancer (stage 4)
|
Palliative symptoms
Prolong survival Delay disease progression Improve quality of life |
|
|
What r the pros and cons of combination chemotherapy?
|
pros: rapid response
cons: increased toxicity |
|
|
Will aromatase inhibitors be effective for premenopausal women?
Aromatase inhibitors: Anastrazole, Letrozole, Exemestane |
No. Tamoxifen is effective though
|
|
|
When is Anastrazole indicated?
|
Postmenopausal women, NOT premenopausal
|
|
|
When is tamoxifen indicated?
|
Post and Pre menopausal
|
|
|
How do you pick which aromatase inhibitor to use?
|
Switch from anastrazole to emestane if having toxicity bc these two are the most different
Aromatase inhibitors can increase risk of osteoporosis an dincrease cholesterol. Aches and pains are the most common reason to switch from one AI to another |
|
|
When is ovarian ablation indicated?
|
Premenopausal women
Not standard for most patients Good for patients who would be poorly compliant to meds |
|
|
Which antidepressants are okay to use in pts taking Tamoxifen?
|
Tamoxifen has DDI with AD (3A4 and 2D6 metabolism)
Recommendation: use citalopram, escitalopram, mirtazepine, or venlafaxine |
|
|
Hormone therapy for pre-menopausal women includes:
|
Tamoxifen QD for five years after cancer diagnosis
|
|
|
Hormone therapy for post-menopausal women includes:
|
Anatrazoleor Letrozole for 5 years
Tamoxifen for 2 to 3 years then Anastrazole or Exemestane for remainder total 5 yrs Tamoxifen x5yrs + Letrozole x5yrs |
|
|
When do you use tamoxifen alone as hormone therapy for post menopausal women?
|
NEVER
|
|
|
What happens when you give hormone therapy and chemo at the same time?
|
It decreases survival
|
|
|
How long is trastuzumab given for?
|
1 year, there is only one trial supporting giving it for only 9 weeks
|
|
|
When do you combine trastuzumab with anthracyclines?
|
NEVER. Increases risk of HF
|
|
|
True or False: Genetic testing is done in all women with breast cancer
|
False
|
|
|
What is the goal of treatment for non-metastatic breast cancer?
|
CURE
|
