Breast Cancer Risk Factors, Diagnosis and treatment

BREAST CANCER

Risk Factors:

• Age >50
• Family History
• LCIS or atypical hyperplasia
• Dense breast tissue
• BRCA mutation
  

Types:

• Invasive
• Ductal
• Lobular
• Mucinous
• Tubular
• Non-invasive
• DCIS (does not metastasize)
  

Diagnosis;

• Mammogram is a SCREENING TOOL
• FNA
• Excisional Bx
• Core BxSterotactic BX
  

Who to MRI;

• Known BRCA mutation
• First degree relative with BRCA mutation
• 20% risk based on validated model (BRACA-Pro)
• Other familial syndrome
• Cowden, Li-Fraummeni, HNPCC
• Hx of chest wall RT btwn 10-30yr of age
• e.g. Hodgkins disease
  

Treatment:

• Surgical Treatment
• Mastectomy
• Breast conversation
• Lumpectomy with XRT
  

Hormonal Treatment:

• ER, PR, Her 2 nu status
• Adjunct therapy to minimize risk of recurrence
• Tamoxifen
• Aromatase inhibitor (Irimidex)
• Herceptin
  

Survival -/+ adjuvant tx:
T1a: 95% 96%
T1b: 90% 93%
T1c: 80% 86.5%
T2aN0: 70% 80%
T2bN1: 60% 73%
T3aN0: 70% 80%
T3bN1: 40% 60%
TXNXM1: <5% style="font-weight: bold;" size="4">Tamoxifen:
5 yrs duration (newer data to support 10)
Decreases recurrence risk by 37-54%
Increases overall survival by 11-34%
Monitor for development of endometrial cancer