ABSITE- Breast

Current Edition 13 - Breast chapters Flashcards

46 flashcards · Other · by Arielle Thomas

1. What did recent analyses of data pooled from screening trials suggest about annual mammography starting at age 40?

   Recent analyses of data pooled from screening trials have suggested that there is an elevated number of false-positive results and unnecessary biopsies for woman aged 40 to 49 years.

2. What led the USPSTF to raise the age at which they recommended initiating mammographic screening?

   The trends of elevated number of false-positive results and unnecessary biopsies for woman aged 40 to 49 years led the USPSTF to raise the age at which they recommended initiating mammographic screening from 40 to 50.

3. What did the ACS recommend about breast self-examination (BSE) and clinical breast examination (CBE) in their latest guidelines?

   BSE and CBE were eliminated from the ACS recommendations entirely in their latest guidelines.

4. What age does the ACS recommend to start annual mammography screening?

   The ACS recommends to start annual mammography screening at the age of 45 years.

5. What does the NCCN recommend for breast cancer screening?

   The NCCN recommends clinical breast examination (CBE) every 1 to 3 years, and annual screening mammogram starting at age 40 accompanied by annual CBE.

6. What are the American College of Physicians' recommendations for mammography screening in women aged 40-49?

   The American College of Physicians recommends that clinicians inform women aged 40 to 49 years about the potential benefits and harms of screening mammography.

7. What does the joint recommendation by the American College of Radiology and the Society for Breast Imaging state about mammography screening in African-American women?

   The joint recommendation by the American College of Radiology and the Society for Breast Imaging recognizes that African-American women are at high risk for breast cancer and recommends that risk assessment should begin at age 30. Screening should begin annually at age 40 and continue until life expectancy is less than 5 to 7 years, or when abnormal results of screening would not be acted on due to age or comorbid conditions.

8. What are the guidelines for screening women at high risk for breast cancer?

   The greatest evidence-based risk is in women with BRCA1 and BRCA2 mutations, with 37% to 87% risk of being diagnosed with invasive breast cancer by the age of 70.

9. Who are at highest risk for breast cancer?

   Women who have had a prior diagnosis of breast cancer, atypical ductal hyperplasia, atypical lobular hyperplasia, or lobular carcinoma in situ, as well as those with a family history of familial breast and/or ovarian cancer or a first-degree relative who has tested positive for a breast cancer–associated genetic mutation are also at high risk. Women who received mantle cell irradiation between the ages of 10 and 30 years of age qualify for the high-risk screening approach.

10. The Gail Model

    This model is based on a woman's age, number of first-degree relatives with breast cancer, age at menarche, age at first live birth, number of previous biopsies (including the presence of atypia), and race or ethnicity. The Gail model is widely used to predict a woman's risk of developing invasive breast cancer.

11. The Claus model:

    This model is based on a more comprehensive family history that includes second-degree relatives, as well as first-degree relatives. The Claus model is useful for women with a strong family history of breast cancer.

12. The BRCAPRO model:

    This model is used to assess the probability that an individual carries a germline deleterious mutation in the BRCA1 and BRCA2 genes based on personal and family history data, including a history of breast and ovarian cancer, male breast cancer, and Jewish ancestry.

13. The Tyrer-Cuzick model:

    This model incorporates both family history and gynecologic history to estimate a woman's risk of developing breast cancer. The Tyrer-Cuzick model is especially useful for women with a strong family history of breast and ovarian cancer, as well as for women who have a history of benign breast disease, early menarche, or late menopause.

14. What is the preferred initial biopsy method for breast lesions?

    Percutaneous biopsy is the preferred initial biopsy method for breast lesions.

15. What are the four percutaneous biopsy methods?

    The four percutaneous biopsy methods are ultrasound, stereotactic, magnetic resonance imaging, and tomosynthesis biopsies.

16. INdications for surgical biopsy?

    Imaging findings and pathologic findings do not correlate (discordance) • Atypical ductal hyperplasia • Atypical lobular hyperplasia • Radial scar, complex sclerosing lesion • Papillary lesions • Cellular fibroepithelial lesions and Phyllodes tumors • Lobular carcinoma in situ • Mucocele-like lesions

17. Blood supply and lymphatic drainage of the breast

    Arterial blood supply of the breast: branches of the axillary, internal thoracic, and intercostal arteries Lymphatic drainage: 75% through axillary lymph nodes, 5% through internal mammary lymph nodes Axillary lymph nodes: 3 levels (I, II, III) and Rotter nodes

18. What are the three main tissue types of the breast?

    The three main tissue types of the breast are glandular epithelium, fibrous stroma, and adipose tissue.

19. What do lobules of the breast contain?

    Lobules of the breast contain secretory acini and ducts, surrounded by intralobular stroma containing capillaries, lymphocytes, lymphatics, and nerves.

20. Follow-up mammogram after biopsy

    This follow-up mammogram is recommended at approximately 6-12 months after the biopsy

21. What is the sensitivity of core needle biopsies performed stereotactically or with ultrasound guidance?

    The sensitivity of core needle biopsies performed stereotactically or with ultrasound guidance is 97% to 99%.

22. What is the molecular expression of luminal breast cancers compared to normal breast tissue?

    The term "luminal" indicates a similar molecular expression of these tumors when compared with the epithelium of normal breast tissue.

23. What is the prognosis for luminal A breast cancers compared to other breast cancer subtypes?

    Luminal A breast cancers represent the most common subtype (40%) and have the best prognosis compared with other breast cancer subtypes. They express high levels of ER and demonstrate the best response rate to endocrine therapy.

24. What are the characteristics of luminal B breast cancers that make them more aggressive than luminal A tumors?

    Luminal B breast cancers are less common (20%) and demonstrate more aggressiveness and a worse prognosis compared with luminal A tumors. They display a higher grade, lower levels of ER positivity, and higher expression of the proliferation cluster (Ki-67) compared with luminal A tumors.

25. What is the difference in response to endocrine therapy and traditional chemotherapy between luminal A and luminal B breast cancers?

    their response to endocrine therapy is lower than luminal A tumors; however, their response to traditional chemotherapy is superior to luminal A tumors

26. What is the purpose of sentinel lymph node biopsy (SLNB)?

    To identify the first few lymph nodes that drain the breast and determine if cancer has spread beyond the primary tumor site

27. What imaging techniques can be used to identify the sentinel lymph node?

    Lymphoscintigraphy and intraoperative gamma probe detection

28. What are the potential complications of SLNB?

    Lymphedema, seroma formation, hematoma, infection, and nerve injury

29. What is the role of SLNB in DCIS or LCIS?

    SLNB is not routinely recommended for DCIS, but may be considered in cases where there is a high risk of invasion based on imaging or other factors

30. What are some of the molecular targets in breast cancer?

    HER2, estrogen receptor, progesterone receptor, androgen receptor, and PI3K/AKT/mTOR pathway

31. What is HER2?

    A protein that is overexpressed in approximately 15-20% of breast cancers and promotes cell growth and survival

32. What are some examples of HER2-targeted therapies?

    Trastuzumab, pertuzumab, ado-trastuzumab emtansine, and lapatinib

33. What are some examples of estrogen receptor-targeted therapies?

    Tamoxifen, aromatase inhibitors (such as letrozole, anastrozole, and exemestane), and fulvestrant

34. What is the role of PI3K/AKT/mTOR-targeted therapies? What are some examples of PI3K/AKT/mTOR-targeted therapies?

    A signaling pathway that is activated in approximately 70% of breast cancers and plays a role in promoting cell growth and survival Everolimus and alpelisib

35. What is the Oncotype DX test?

    A gene expression profiling test that analyzes the activity of 21 genes in breast cancer cells to predict the likelihood of recurrence and the potential benefit of chemotherapy.

36. What is the MammaPrint test?

    A gene expression profiling test that analyzes the activity of 70 genes in breast cancer cells to predict the likelihood of recurrence and the potential benefit of chemotherapy.

37. What is the Prosigna test?

    A gene expression profiling test that analyzes the activity of 50 genes in breast cancer cells to predict the likelihood of recurrence and the potential benefit of endocrine therapy.

38. What are PARP inhibitors

    A type of targeted therapy that inhibits the activity of PARP enzymes, which are involved in DNA repair. PARP inhibitors may be effective in breast cancers that have defects in DNA repair pathways, such as those caused by mutations in the BRCA1 or BRCA2 genes.

39. What is CDK4/6?

    A protein complex that regulates cell division and is often overactive in breast cancer cells.

40. What are the T categories for each stage of breast cancer?

    Stage 0: Tis, Stage I: T1, Stage II: T1-2, Stage III: T1-3, Stage IV: any T

41. What are the N categories for each stage of breast cancer

    tage 0: N0, Stage I: N0, Stage II: N0-1, Stage III: N1-3, Stage IV: any N N1 - 1-3 nodes, N2 - 4-9 nodes, N3- 10+ nodes

42. Stage 0:

    Tumor size: Tis (no tumor) Lymph node involvement: N0 Distant metastases: M0 TNM grouping: Tis N0 M0

43. STage 1

    Tumor size: T1 (less than or equal to 2 cm) Lymph node involvement: N0 Distant metastases: M0 TNM grouping: T1 N0 M0

44. Stage 2

    Tumor size: T2 (2-5 cm) or T1 if the cancer has spread to nearby lymph nodes Lymph node involvement: N0 or N1 (cancer has spread to nearby lymph nodes) Distant metastases: M0 TNM grouping: T1-2 N0-1 M0

45. Stage 3

    Tumor size: T3 (greater than 5 cm) or T4 (cancer has spread to chest wall or skin) Lymph node involvement: N1-3 (cancer has spread to nearby lymph nodes) Distant metastases: M0-1 TNM grouping: T1-3 N1-3 M0-1

46. Stage 4

    Tumor size: Any size Lymph node involvement: Any N Distant metastases: M1 (cancer has spread to distant sites) TNM grouping: Any T Any N M1