General Breast Cancer
Background
What are the 3 most commonly diagnosed cancers in women in decreasing order of incidence?
Most commonly diagnosed cancers in women: breast > lung >colorectal
What are the 3 most common causes of cancer death in women in decreasing order of incidence?
Most common causes of cancer death in women: lung > breast > colorectal
Approximately how many women are diagnosed with invasive and noninvasive breast cancer, and how many will die of breast cancer annually?
Incidence: ~180,000 invasive breast cancers and ~65,000 noninvasive breast cancers annually.
Mortality: ~40,000
What is median age of Dx for invasive breast cancer?
The median age for invasive breast cancer is 61 yrs.
What race has the highest rate of breast cancer Dx? What race has the highest rate of breast cancer mortality?
Highest Dx: whites
Highest mortality: blacks
For women born in the U.S. in 2009, approximately what % will be diagnosed with breast cancer in their lifetimes?
~12% (1 in 8) of U.S. women born in 2009 will be diagnosed with breast cancer.
In the U.S. in 2009, was the incidence of breast cancer Dx increasing or decreasing?
The incidence of Dx was increasing.
In the U.S. in 2009, was the incidence of breast cancer mortality increasing or decreasing?
The incidence of mortality was decreasing.
What are the 2 most common hereditary mutations that predispose to breast cancer?
BRCA1 and BRCA2 are the most common mutations.
What ethnic ancestry is associated with the highest risk of carrying a BRCA1/BRCA2 mutation?
Ashknazi Jewish ancestry. As many as 1 in 40 Ashknazi Jews may have a BRCA1 or BRCA2 mutation.
Mutations in which gene, BRCA1 or BRCA2, confer a higher risk of ovarian cancer?
Both BRCA1 and BRCA2 are associated with increased risk of ovarian cancer, but risks are higher with BRCA1 (40%–60% lifetime risk) compared to BRCA2 (10% lifetime risk).
How does familial breast cancer status and pt age affect breast tumor doubling time?
Pts with familial breast cancer and young age have a shorter tumor doubling time, so consider shortening screening intervals for these pts.
Is HRT with estrogen and progestin associated with an increased or decreased risk of breast cancer?
HRT with estrogen and progestin is associated with an increased RR of 1.7.
Separate the following factors into ones that increase or decrease the risk of breast cancer: younger age at menarche, younger age at menopause, nulliparity, prolonged breast-feeding, use of HRT.
Increase risk: younger age at menarche, nulliparity, use of HRT
Decrease risk: younger age at menopause, prolonged breast-feeding
Estimate the annual risk of a contralat breast cancer in pts with a personal Hx of breast cancer.
Premenopausal: 1%/yr
Postmenopausal: 0.5%/yr
What is the definition of menopause?
Menopause criteria for amenorrhea not related to Tx should include (a) bilat oophorectomy, (b) age ≥60 yrs, and (c) age <60 yrs and amenorrheic for ≥12 mos.
If Tx-related amenorrhea, menopausal status must be maintained either from (a) oophorectomy or (b) serial measurements of FSH or estrogen at menopausal levels.
What are the screening recommendations for normal-risk women age 20–40 yrs and women >40 yrs?
For normal-risk women age 20–40 yrs: clinical breast exam every 1–3 yrs and periodic breast exam.
For normal risk women age 40–49 yrs: recommendations are currently controversial, as the U.S. Preventive Services Task Force no longer recommends mammogram for this age group. However, the ACS and ACR still recommend mammograms every 1–2 yrs for this age group and annually for women age ≥50 yrs.
For a woman with prior RT exposure to the breast, when should screening begin for breast cancer and how?
Screening should begin 10 yrs after RT or at age 40 yrs, whichever comes 1st. Screen with an annual mammogram and clinical breast exams every 6–12 mos.
When should a woman be screened for breast cancer using MRI?
Per the American Cancer Society guidelines (2007), screen women who have ~20%–25% or greater lifetime risk of breast cancer based on 1 of many available risk models (e.g., Tyler J et al., Stat Med 2004). This does not include women with dense breast tissue.
According to NCCN 2010, what are the clinical indications and applications of dedicated breast MRI testing?
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