Know your risk
Radiation, atypia, and models, "Oh my!"
Angelina Jolie
Screening, what on Earth do we do with these patients?
Pills or Knife
100
The average American female's lifetime risk of developing breast cancer.
What is 11%
100
These types of radiation increase a woman's risk for breast cancer.
What are: 1. mantle radiation (especially during adolescence) 2. thymic radiation 3. breast radiation 4. nuclear war
100
The lifetime risk of developing breast cancer in a BRCA 1 or 2 mutation carrier
What is 35-85%?
100
In a 38 yo female with no family history of breast cancer, and no concerning physical exam findings on clinical breast exam, mammography should start at this age.
What is 40?
100
Tamoxifen or raloxifene therapy in patients at high risk for breast cancer reduces the incidence of invasive breast cancer by what percentage?
What is 50%
200
The most common breast cancer risk factor.
What is age? - half of a woman's risk occurs after 65
200
A benign breast biopsy which shows a benign fibroadenoma increases a woman's risk of breast cancer. TRUE or FALSE.
What is FALSE - nonproliferative breast disease is not associated with an increased risk of breast cancer
200
BRCA 2 families have a higher incidence of this in their pedigrees (other than breast and ovarian cancer).
What are male breast cancer, prostate cancer, pancreatic cancer?
200
A woman diagnosed with breast cancer at 65 (no family history) should undergo screening mammography at this interval.
What is annually?
200
There are the risk factors associated with tamoxifen therapy.
What are: 1. hot flashes 2. vaginal discharge 3. endometrial cancer 4. DVT and PE
300
Percentage of women diagnosed with breast cancer who have a family history of breast cancer.
What is 20-30%?
300
Atypical ductal hyperplasia increases a woman's lifetime risk of breast cancer. TRUE or FALSE
What is TRUE - ADH and ALH increase lifetime risk 4-5x and 9x if there is a family history
300
BRCA 1 and BRCA 2 gene mutations have this inheritance pattern.
What is autosomal dominant?
300
For a 28 yo woman who had mantle radiation for Hodgkin's lymphoma at age 13, her breast screening should start at this age and should consist of this.
What are: 1. screening to start now, and 2. screening with annual mammogram, MRI, and breast exam.
300
Patients with a 5 year predicted risk for breast cancer over this value should be referred to discuss chemoprevention.
What is a Gail Model risk of at least 1.66% at five years?
400
Percentage of women diagnosed with breast cancer who have an inherited mutation in a breast cancer susceptibility gene.
What is 5-10%
400
These characteristics are included in the Gail model for risk evaluation.
What are: 1. age 2. age at menarche 3. age at first live birth 4. # first-degree relatives with breast cancer 5. breast biopsy with atypical hyperplasia (ductal or lobular) 6. race Gail Risk Calculator can be found at www.cancer.gov
400
A 35 yo F comes in for risk assessment. She does not have cancer. Her mother was diagnosed at 35 with breast cancer (deceased). Her maternal aunt was diagnosed with breast cancer at 42 (alive). Her other maternal aunt was diagnosed with ovarian cancer at 38 (deceased). Should this patient be tested?
What is NO? The best person to test would be the maternal aunt who is still living.
400
A 32 you known BRCA 1 mutation carrier has not yet completed her family and wishes to postpone prophylactic mastectomies until she has completed her family. Her screening program should include these.
What are: 1. annual mammography 2. alternating at 6 month intervals with annual MRI 3. ovarian cancer screening (CA-125 and pelvic US)
400
Prophylactic mastectomies should be considered in these patients.
What are: - known genetic mutation carriers - compelling family history (NCCN guidelines) - possibly in those with LCIS or prior thoracic radiation at a young age (NCCN guidelines) Reports suggest a 90% risk reduction, though many patients had bilateral subcutaneous mastectomies, which is not appropriate for prophylaxis.
500
Age and menarche, age at menopause, and age a first pregnancy all have this in common with regards to breast cancer risk.
What is lifetime exposure to estrogens? - OCPs have not been shown to increase risk - postmenopausal HRT - combo estrogen + progesterone = increase risk - estrogen alone = no increase in risk
500
These factors are not included in the Gail model, and therefore, can cause the Gail model to underestimate risk in certain patients.
What are: 1. second-degree family members with breast cancer 2. personal or family history of ovarian cancer
500
Name 5 NCCN guidelines for genetic evaluation and testing.
What are: 1. a known genetic mutation in the family 2. early onset breast cancer (<50) 3. triple negative breast cancer (<60) 4. 2 breast primaries in a single individual 5. invasive ovarian cancer 6. male breast cancer 7. breast cancer and: - close relative with breast cancer < 50 - close relative with ovarian cancer - 2 relatives with breast and/or pancreas cancer (any age)
500
Increased surveillance in high risk patients decreases breast cancer mortality. TRUE or FALSE
What is FALSE.
500
Nipple sparing mastectomy is safe in the setting of a known genetic mutation. TRUE or FALSE
What is TRUE?
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