A) Breast cancer is rare in women under 50 = INCORRECT
Average age at dx is 58. 70% of presentations are in women over 50, 30% in those their 40s and 6% under 40.
b) Nulliparity and older age at first full-term pregnancy are factors associated with an increased risk of breast cancer = CORRECT
Prolonged exposure to oestrogens = risk factor.
Parity --> 30% lower risk, which is reduced further the more children a woman has and the younger her age at the first full-term pregnancy.
c) Breastfeeding is protective against breast cancer = CORRECT
Breastfeeding --> decreased risk, as it reduces the number of ovulatory cycles.
d) The increased risk of breast cancer associated with use of the contraceptive pill persists after discontinuation = INCORRECT.
OCP may --> slightly increased risk, but the risk resolves after stopping use of the OCP for 10 years .
Which TWO statements are correct?
D) The increased risk of breast cancer associated with HRT is greater for oestrogen-only formulations = INCORRECT
HRT --> increased risk; risk is more evident with combined HRT.
b) Mutations in BRCA1 and BRCA2 tumoursuppressor genes can increase the lifetimerisk of breast cancer from 11% to up to 85% = CORRECT
c) Hereditary BRCA1/BRCA2 mutations account for most cases of breast cancer = INCORRECT
5-10% of all breast cancers are hereditary.
Mostly due to mutations in the BRCA1 and BRCA2 genes on chromosomes 17 and 13.
d) MRI screening is superior to standard mammographic screening in women with a BRCA1/BRCA2 mutation = CORRECT
In Australia, women with a proven BRCA1/BRCA2 mutation have access to Medicare-funded MRI screening, which has been shown in this population to be superior to standard screening.
Which TWO statements are correct?
a) A screening mammogram differs from a diagnostic mammogram in that it images the breast in two planes only
b) One-third of breast cancers detected by screening are impalpable
c) Women over 70 who request breast screening should be dissuaded from having it, as the incidence of breast cancer decreases after this age
d) Women who detect a breast lump by breast self-examination should have a screening mammogram
a) A screening mammogram differs from a diagnostic mammogram in that it images the breast in two planes only = CORRECT
A screening mammogram images the breast in two planes only. The diagnostic mammogram takes longer, as it examines the breast from multiple angles to identify the palpable lesion or concerning sign.
b) One-third of breast cancers detected by screening are impalpable = CORRECT
c) Women over 70 who request breast screening should be dissuaded from having it, as the incidence of breast cancer decreases after this age = INCORRECT
Women aged 40-49 or 70+ who attend BreastScreen for a mammogram are not refused, but these age groups are not actively recruited.
Women >70 are still at risk of developing breast cancer - the incidence increases with age.
d) Women who detect a breast lump by breast self-examination should have a screening mammogram = INCORRECT
Do not send symptomatic women to breast screening programs.
TRIPLE ASSESSMENT: Hx and examination, imaging (mammogram and U/S) and core tissue biopsy should be applied to almost all women with a breast lump.
Which TWO statements are correct?
D) Breast fibroadenomas and cysts increase the risk of breast cancer - INCORRECT
Benign lesions that do not increase breast cancer risk: fibroadenomas, adenosis, ductal ectasia, cysts squamous metaplasia.
Benign lesions that do increase breast cancer risk:
b) Atypical ductal or lobular hyperplasia increase the risk of breast cancer - CORRECT
c) Lobular carcinoma in situ (LCIS) has the potential to develop into either ductal or lobular invasive disease, and has a propensity to be multifocal and bilateral - CORRECT
d) Most invasive breast cancers are the lobular type - INCORRECT
Invasive breast cancer and the precursor lesions arise from either cells lining the ducts (invasive ductal carcinoma - about 80%) or the lobules (invasive lobular carcinoma - 10-15%). There are tubular, papillary and mucinous variants. Rare tumours include sarcomas, lymphomas and metastases.
A woman presents with a lump in her breast - list the important things that you need to ask about when taking her history.
- About the lump: location, change in size, when first noticed, tenderness, associated skin changes.
- Hx of breast lumps, cysts, fibroadenomas etc...
- Reproductive hx - age at menarche, menstrual history, parity, age at first full-term pregnancy, breastfeeding, age at menopause.
- Medications - particularly the OCP and HRT.
- Family hx - particularly relatives affected by cancer.
- Ethnic background - Ashkenazi Jewish women are at higher risk. Lower risk in Indigenous women and Asian women.
