Early
What is the next step in therapy for a TisN0, 1.9cm mass, HR+ HER2- following lumpectomy with 1mm margin, -LVSI?
Re-excision should be considered
What are the diagnostic criteria for inflammatory breast cancer?
1. Rapid onset (<6 months) of breast erythema, edema and/or peau d’orange, and/or warm breast, with or without an underlying palpable mass.
2. Erythema occupying at least one-third of the breast.
3. Pathologic confirmation of invasive carcinoma.
Which premenopausal node-positive patients need chemo based on Oncotype?
ALL premenopausal N1 patients (regardless of score)
For which decade of life (30s, 40s, etc) does the use of screening mammography reduce the most breast cancer deaths?
60s
A projection of breast tissue that courses superolaterally into the apex of the axilla
Tail of spence
Name 3 absolute contraindications for breast conserving surgery
Persistent positive margins after re-excision(s)
Early trimester pregnancy
Homozygous ATM mutations
Diffuse malignant appearing microcalcifications
~Unacceptable cosmetic outcome~
~Multi-centric disease~
~Prior therapeutic chest RT~
Per KROG 08-06, which tumor location showed the most benefit from internal mammary node irradiation?
Medial/central tumors
Per RxSponder, which N+ (1-3) breast cancer patients qualify for chemoendocrine therapy? (3)
T1-2, ER/PR+ Her2-, node+ (1-3)
Premenopausal
Oncotype <=25
Which BI-RADS category states findings are probably benign with <2% malignancy, and what follow-up do you recommend?
BI-RADS 3, 6 months
Per Atkins et al, what LAD consraint is associated with a reduction in major cardiac events?
LAD V15 < 10%
EBCTCG meta-analysis established that preventing how many local recurrences at 10 years prevents one breast cancer death by 15 years? (# +/- 0)
Approximately 4 local recurrences at 10 years prevents one breast cancer death by 15 years
In the FABREC trial comparing hypofractionated to conventional PMRT with reconstruction, which age group showed significantly higher physical well-being scores with hypofractionation?
Patients <45 years old
For BRCA-mutated, HER2- breast cancer after neoadjuvant or adjuvant chemotherapy w HR features, what targeted therapy given for how long improves DFS?
Olaparib for 1 year
A 22yo female just found out she is a BRCA1 carrier, what screening guidelines would you recommend for breast cancer? (2)
Annual breast MRI starting at age 25, and annual mammography with tomosynthesis starting at age 30
Per AMAROS, what is the 5-year lymphedema rate comaparing axillary RT vs ALND?
11.9% (RT) vs 24.5% (ALND)
What margin requirement was used in ECOG-ACRIN E5194 for observation in DCIS? (# +/- 0)
3mm margins
What approach did the Danish Breast Cancer Group IMN study use to allocate patients to internal mammary node irradiation?
Right-sided breast cancers received IMNI (48 Gy) while left-sided breast cancers did not receive IMNI
How does trastuzumab differ from pertuzumab in mechanism?
Trastuzumab blocks downstream signaling (binds HER2, inhibits PI3K/AKT signaling, and triggers ADCC).
Pertuzumab prevents HER2 activation (binds a different domain, blocking HER2 dimerization and ligand-driven signaling)
When to start breast cancer screening with what imaging modality following thoracic RT for a 14-year-old?
Age 25 (screening starts 8 years after RT completion but not before age 25), with annual mammography with tomosynthesis AND annual breast MRI?
Per HypoG-01, what was the difference in Grade 2+ dermatitis comapring 40Gy/15fx to 50Gy/25fx? (% +/- 4%)
Grade ≥ 2 Dermatitis: 14.3% (95% CI 11.5–17.0) vs 31.2% (95% CI 27.5–34.8)
Per the LUMINA trial, patients meeting which 5 criteria are candidates for omitting radiation following breast conserving surgery?
1. 55+yo
2. T1N0
3. G1-2
4. Luminal A (ER >1%+, PR >20%, HER2-, Ki-67 <13.25%)
5. Adj ET
A 42-year-old patient with cT2N1 breast cancer gets neoadjuvant chemotherapy. At surgery, you want to do sentinel lymph node biopsy. What technical factors are needed to keep the false negative rate acceptable?
Dual tracer mapping, removal of ≥3 sentinel nodes, AND removal of the clipped node (the node that was biopsied pre-treatment and marked with a clip).
In MonarchE, what high-risk criteria qualified patients for adjuvant abemaciclib? (4)
≥4 nodes OR
1-3 nodes + with...
grade 3 OR
tumor ≥5cm OR
Ki67≥20%
Per ACR's appropriateness criteria, for which patient(s) should ultrasound be the first-line imaging modality instead of mammography? (2)
Women <30yo with palpable breast masses
For pregnant/lactating women with breast complaints
Injuring which nerve during ALND can cause winged scapula?
Long thoracic nerve