Repro Test 2 - Nazar - Breast Cancer In Family Practice

Front 1

T/F: 1 in 8 women will get breast cancer in their life

Back 1

TRUE

Front 2

Whats the deadliest cancer in women? Second most deadliest?

Back 2

Lung Cancer

Second most deadliest? = Breast Cancer

Front 3

How many men will get breast cancer?

Back 3

1 in 1000

Front 4

Whats the 5 year survival for breast cancer with LOCAL disease ie no distant mets or lymph node

Back 4

97%

Front 5

Whats the leading cause of death in women 20-59?

Back 5

Breast cancer (lung cancer is leading cause of death 60 and older)

Front 6

What percentage of women believe they will die of breast cancer?

Back 6

49%

in actuality its 3-4% who will die = MORE FEARED than heart disease, which is much more common

Front 7

What are the risk factors for breast cancer?

Back 7

Early menarche (before age 12)
Late menopause (after age 55)
No pregnancies OR 1st pregnancy after age 30
Hormone replacement therapy (esp with EtOH use)
Lower dose oral contraceptives are NOT found to be a risk in healthy women
Age (80% occur after age 40)
Female gender
Hx of breast cancer
Hx of cervical, ovarian, endometrial, or thyroid cancer
Family Hx of breast cancer (mom, sister, daughter, grandma, aunt)

Front 8

T/F: Successive generations of women with breast cancer may present 10 years earlier

Back 8

TRUE

Front 9

T/F: Only 5-6% are associated with germ line mutations

Back 9

TRUE

Front 10

Does smoking add risk of breast cancer?

Back 10

No risk of GETTING Breast cancer, but smoking decreases SURVIVAL of breast cancer esp if smoking was started early

Front 11

What are some other risk factors for breast cancer?

Back 11

Excessive weight gain after menopause, high alcohol intake, low levels of vit. E, beta carotene, Low physical activity, chemical exposure, heavy radiation exposure, anti-microbial exposure, effect on diet (fat, soy, controversial)

Front 12

What are the genetic risk factors for breast cancer?

Back 12

BRCA1 = 50% risk by age 70

BRCA2 = 37% risk by age 70

Front 13

Besides BRCA1 and 2, what are some OTHER genes that may be affected leading to breast cancer?

Back 13

HER2/neu proto-oncogene: agressive subtype

Front 14

How do we screen for breast cancer?

Back 14

self breast exam, clinical breast exam, mammography, US, MRI

Front 15

How often should self breast exams be done?

Back 15

monthly from age 20

Front 16

How often should clinical breast exams be done?

Back 16

every 3 years from 20-39

Front 17

How often should mammography be done?

Back 17

Yearly at age 40

=Leads to 25% decline in mortality from breast cancer in women screened regularly

Front 18

A pt has to be called in again for another breast cancer screening after her mammography. What do you tell her?

Back 18

REASSURE - we just need to "gather more information", we couldn't see very well

1% will require biopsy, 25-40% will be positive for cancer

Front 19

How does the US preventative task force recommendation differ from beginning screening at age 40?

Back 19

They say to start screening at age 50, and do it every 12-33 months

Front 20

Whats the most common breast mass?

Back 20

Benign cyst

Front 21

Whats the difference in Exam of Benign cyst and Fibroadenoma?

Back 21

Benign Cyst = Round to elliptical, freely mobile, no dipmling or retraction, may be tender pre-menstrual

Fibroadenoma = benign solid mass, usually round, well demarcated, freely mobile, non-tender, rubbery or firm, No retraction or fixation of skin

Front 22

What are some of the classic signs of breast cancer?

Back 22

Irregular in contour, firm to hard consistency, not well delineated from surrounding tissue, nontender, fixation, retraction, dimpling,

SOME OR ALL MAY BE PRESENT - ABSENCE DOES NOT EXCLUDE CANCER

Front 23

You see an orange peel appearance of skin, what are you thinking?

Back 23

cancer

Front 24

Where are most breast cancers (50%) located?

Back 24

Upper outer quadrant

Front 25

Whats the earliest stage of breast cancer?

Back 25

Ductal Carcinoma in situ (DCIS)

Front 26

Define Infiltrating (invasive) ductal carcinoma in situ (IDC)

Back 26

Begins in duct, invades and spreads

Front 27

Define Lobular carcinoma in situ

Back 27

not a TRUE cancer but increases risk = need follow up for cancer

Front 28

Define Infiltrating (invasive) Lobular carcinoma in situ

Back 28

Begins in lobules and spreads

Front 29

What are the two things that bring a pt to biopsy?

Back 29

PALPABLE MASS

ABNORMAL MAMMOGRAM

Front 30

What are the dif types of biopsies we can do?

Back 30

Fine needle, core needle, incisional, excisional, guided needle

Front 31

What happens if the biopsy comes back positive?

Back 31

Clinical Staging = to evaluate extent of disease (T, N, M)

T = Size
N = Node Inolvement
M = Mets presence

Front 32

Whats the most important prognostic value in identifying the severity of breast cancer

Back 32

Lymph Nodes

Front 33

What are the two ways we analyze lymph nodes?

Back 33

Axillary Lymph node dissection

Sentinel Lymph node biopsy

Front 34

A pt says her breast cancer analysis came back negative for E2 and P4 receptors. What does this mean?

Back 34

Tx won't work as well as if it were positive for E2 and P4 receptors

Front 35

Prognostic factors give info on what? vs Predictive factor?

Back 35

Prognostic = clinical outcomes, independent of therapy

ex = lymph node status

Predictive = Likelihood of response to therapy
ex = hormone receptor assay ie is it responsive to E2/P4, = predictive

Front 36

What is included in the metastatic work up?

Back 36

Blood tests, Chest x-ray, bone scan, CT of brain/abdomen if indicated, PET scan maybe

Front 37

What are the treatment options for Breast cancer

Back 37

MANY!

Sx = lumpectomy, Modified radical mastectomy

Radiation = Externally, 35 doses over 7 weeks
Internally via implant

Drugs therapy = chemo, hormone, biological target therapy

Front 38

Whats the treatment strategy of Sx, Radiation, Chemo, hormones, and biologic therapies?

Back 38

Sx = remove, debulk
Radiation = target cell DNA to destroy
Chemo = toxins to kill rapidly dividing cells
hormones = interfere with tumor's access to hormones needed to grow/thrive
biologic therapies = specific target Abs

Front 39

T/F: The earlier the breast cancer is Dx'ed, the better the cure rate and the more tx options

Back 39

TRUE

Front 40

What are the benefits of mastectomy?

Back 40

One Sx, recovery of 1 week, usually no radiation needed

DISADVANTAGES = long recovery in some women, emotional/sexual implications of loss of breast, cosmetically less acceptable for some

Front 41

What are the benefits of Lumpectomy?

Back 41

Breast is preserved, quicker recovery period b/c its a more limited Sx than mastectomy, Cosmetically generally good

DISADVANTAGE = ALL WOMEN HAVE TO GET RADIATION (6-7 weeks)

Front 42

A women with breast cancer has a mastectomy. She is preggo, has a skin connective tissue disorder (SLE and RA), had a previous XRT to breast, her breasts are too big and too large, she has a multicentric disease, and previous Hx of Hodgkins-mantle. Can she get breast reconstruction

Back 42

NO, all these are contraindications

Front 43

Is there a difference between lumpectomy and mastectomy in survival?

Back 43

NO

Front 44

Whats the difference between lumpectomy vs. mastectomy?

Back 44

ONLY difference is likelihood of recurrence

Front 45

Whats the general treatment strategy for pts of breast cancer?

Back 45

Radiation = target cell DNA to destroy

Front 46

Whats the major problem with chemo?

Back 46

Chemo can't determine WHICH cells it SHOULD be killing = MANY SIDE EFFECTS

Front 47

When do we give chemo?

Back 47

IF the cancer has spread

Front 48

Whats the GOLD STANDARD SERM used for breast cancer?

Back 48

tamoxifen = give for 5 years after Sx

Front 49

What are the Aromatase Inhibitors used in POST-MENOPAUSAL breast cancer treatment?

Back 49

Arimedex (anastrozole), Aromasin, Femara, Fadozole
= block E2 production

Front 50

***KNOW: What are the Biologically targeted therapies that specifically target Abs?

Back 50

Herceptin, Avastin, Tykerb

Front 51

How does HERCEPTIN work in breast cancer treatment?

Back 51

Herceptin, Humanized HER-2 = targets Abs

Front 52

T/F: For all breast cancer survivors there are recommended follow-up schedules

Back 52

TRUE= there's still value in screening

Front 53

What are the recommended follow-ups for breast cancer survivors?

Back 53

Hx and PE, Mammography yearly, MRI, self breast exam monthly, pelvic exam yearly, chest film, bone scan whle clinically indicated, blood counts, tumor markers NOT recommended Except in advanced cases

Front 54

Pt has a local breast cancer....whats her chance of survival?

Back 54

Local = 97%
Regional = 76%
Distant = 21%

Front 55

What factors go into the gail model to ascertain risk of breast cancer?

Back 55

Hx DCIS, LCIS, Age, Menarche start age, Age of first born child, Number of first degree relatives with breast cancer, Number of breast biopsies, Any biopsy reporting atypia, Race