ON9 Breast Cancer

Breast Cancer Epidemiology: - Most common form of cancer in women globally​: Leading cause of cancer [blank_start]death[blank_end] in women worldwide​ Survival rates vary worldwide​; >80% in North America​, <[blank_start]40[blank_end]% in low income countries ​ - Third most common cancer in New Zealand​: 600 deaths every year​ [blank_start]3300[blank_end] women diagnosed each year, 25 men ​ [blank_start]80-92[blank_end]% 10 year survival rate ​

Select all the risk factors for BC.

Which of these is NOT a protective factor for BC?

Screening​ strategies depend on estimated risk of cancer​. Mammogram​ [blank_start]Clinical[blank_end] breast exam​ Breast [blank_start]self[blank_end]-exam​ [blank_start]MRI[blank_end] (high risk)​ Biopsy​ CT-scan Follow B.R.A.S: BREAST [blank_start]aware[blank_end], REDUCE [blank_start]risk[blank_end], ACT [blank_start]on changes[blank_end], SCREENING with mammograms [blank_start]over 40[blank_end]

Clinical Presentation is variable. Asymptomatic​ Change in [blank_start]general[blank_end] appearance​ New/persistent [blank_start]skin[blank_end] changes​ New nipple [blank_start]inversion[blank_end]​ Nipple [blank_start]discharge[blank_end]​ Pain​ Variable mass size, [blank_start]texture[blank_end] (nodular, thickened area)​ Classically hard, immovable, single lesion irregular borders ​

Pathophysiology​ - Most common histological types of [blank_start]epithelial[blank_end] breast carcinoma:​ Infiltrating [blank_start]ductal[blank_end] carcinoma (70-80%)​ Infiltrating [blank_start]lobular[blank_end] carcinoma (~8%)​ [blank_start]Mixed[blank_end] ductal/lobular carcinoma (~7%)​

Which of these is NOT a receptor we test for?

Choose the incorrect statement.

Staging​: Stage 0 – Only in [blank_start]ducts and lobules[blank_end] (no spread)​ Stage 1 - Only in [blank_start]breast[blank_end], no nodes Stage 2 - Early, tumour spread to [blank_start]movable axillary[blank_end] nodes Stage 3 - Locally advanced disease, spread to chest [blank_start]wall[blank_end], internal [blank_start]mammary[blank_end] lymph nodes Stage 4 - Advanced or metastatic disease present at [blank_start]distant[blank_end] sites such as bone, liver, lungs, brain

Treatment: 1. Surgery​ - Breast-conserving surgery ([blank_start]lumpectomy[blank_end])​ or modified radial [blank_start]mastectomy[blank_end] (removal of entire breast with or without breast reconstruction)​ 2. Radiation - Mostly used in adjuvant setting​, can be targeted or generalized, dose determined by [blank_start]extent[blank_end] of disease​, may be used in Stage IV to palliate [blank_start]symptoms[blank_end] for metastases ​ 3. Systemic Therapy​ - Adjucant: Chemotherapy​, endocrine / hormonal therapy, targeted therapy. Reason for [blank_start]mortality[blank_end] reduction in developed countries. Chemo: - Chemo regimens [blank_start]similar[blank_end] regardless of hormonal status, but anti-HER2 therapy added on to those HER2 [blank_start]positive[blank_end]​ - [blank_start]Anthracycline-based therapy with taxanes[blank_end] (if node positive) appear to have most evidence​ Endocrine: - Used to decrease risk of [blank_start]recurrence[blank_end]​, initiated [blank_start]after[blank_end] chemotherapy complete​ Targeted Anti-HER2 Therapy​: - All are [blank_start]cardiotoxic[blank_end] – need baseline ECHO and follow up​

Endocrine therapy regimens/options: 1. Pre-menopausal - High risk? = [blank_start]LHRH agonist + exemestane 25mg[blank_end] PO daily, for 5 years​ Low risk? = [blank_start]Tamoxifen 20mg[blank_end] PO daily, for 10 years Alternative is surgical oophorectomy or medical menopause [blank_start](LHRH agonist) +/- aromatase inhibitor[blank_end]​ 2. Post-menopausal​ - [blank_start]Aromatase Inhibitor[blank_end] (Letrozole, Anastrozole, Exemestane) OR tamoxifen ([blank_start]2nd line[blank_end]) ​ Aromatase Inhibitors drugs of choice in metastatic disease

Which of the following is most appropriate hormonal therapy for a post-menopausal woman with ER positive breast cancer who has recently finished adjuvant chemotherapy post-total mastectomy? ​

Choose the incorrect statement about Trastuzumab​.

Select ALL correct statements.

Match the stage to the general Tx: Stage 0 - [blank_start]Surgery, radiation, +/- endocrine[blank_end] Early stage - [blank_start]Surgery, radiation, chemo,[blank_end] +/- endocrine +/- targeted Locally advanced - [blank_start]Surgery, chemo,[blank_end] +/- endocrine +/- targeted Metastatic - [blank_start]Chemo,[blank_end] +/- endocrine +/- targeted

Rachel is a 42 year old pre-menopausal woman attending a breast cancer screening session. Her mother died of breast cancer at age 64. She eats a healthy diet, surfs at least twice weekly, does not smoke, and drinks approximately 3 glasses of wine per week. She works at Dunedin Hospital in the radiotherapy department but adheres to all safety precautions regarding radiation exposure. She has no history of any breast abnormalities. ​ Identify her risk factors: - Female, estrogen, [blank_start]age, alcohol intake, family history[blank_end] Identify two sctreening options for her: - [blank_start]Mammogram, clinical breast exam[blank_end]

Linda is a 63 year old post-menopausal woman presenting with early stage (stage 2) breast cancer to the left breast. She is ER and HER2 receptor positive. Which of the following is LEAST likely to be recommended for Linda?​