Breast Cancer

Katie Anderson MSIV Texas A&M College of Medicine

ABSITE
Which of the following hormones is primarily responsible for differentiation of the breast ductal epithelium?
A. Estrogen B. Testosterone C. Progesterone D. Prolactin

 Estrogen-> ductal epithelial proliferation Progesterone-> ductal dilation and epithelial differentiation into secretory cells

ABSITE
Which of the following conditions increases a womens risk of breast cancer?
A. Sclerosing adenosis B. Fibroadenoma C. Atypical lobular hyperplasia D. Intraductal papilloma

Cancer risk associated with breast disorders

No increased risk Nonproliferative lesions Sclerosing adenosis Intraductal papilloma Increased risk Hyperplasia: 1.5 to 2-fold
Ductal hyperplasia, papillomatosis, radial scar,

Atypical hyperplasia: 4-fold DCIS and LCIS: 10-fold

ABSITE
Which of the following is true regarding patients with BRCA1 and BRCA2 mutations?
A. In women, both mutations have a similar lifetime risk of breast cancer B. In men, both mutations have a similar lifetime risk of breast cancer C. Both are found on chromosome 13 D. Both have a similar risk of ovarian cancer E. Breast cancer in women with BRCA1 is more likely to be hormone receptor positive than that in women with BRCA2

Genetics- BRCA
Autosomal Dominant Lifetime risk: 80-90% By age 40, 15-18% have cancer Prophylactic mastectomies decreases risk 90% BRCA-1 Chromosome 17q Poorly differentiated, hormone receptor negative Lifetime risk of Ovarian cancer- 40%

BRCA-2
Chromosome 13q Well differentiated, hormone receptor positive MALE breast cancer (lifetime risk 6%) Lifetime risk of Ovarian cancer- 19%

HER2/neu
HER2- epidermal growth factor Associated with worse prognosis, increased risk of recurrence Found in 15-20% of breast cancers HERCEPTIN- monoclonal ab that binds with high affinity to HER2
Cardiotoxic (Get ECHO before giving)

ABSITE
Early-onset breast cancer, sarcomas, leukemia, and brain and adrenocortical tumors would be most consistent with:
A. Cowden disease B. Li-Fraumeni syndrome C. Peutz-Jeghers syndrome D. Ataxia-telangiectasia E. BRCA2

Syndromes Associated with Breast Cancer

Li-Fraumeni
P53 mutation (sarcomas, lymphomas and adrenocortical tumors)

Cowdens
PTEN mutation (thyroid, GI tract, skin nodules)

Peutz-Jeghers
STK11 mutation (GI hamartomas, pigmented lesions, breast cancer)

Ataxia-telangiectasia HNPCC

Screening

BI-RADS
BI-RADS 3: < 2% chance of malignancy BI-RADS 4: needs biopsy

Fibroadenoma

Most common solid breast lesion in women <30 years - well circumscribed, firm, tan colored, solitary, moveable - increases size during pregnancy and the menstrual cycle ***no risk of malignancy

Intraductal Papilloma
Most common cause of bloody discharge benign intraepithelial tumor Rule out Invasive ductal carcinoma

ABSITE
Which of the following types of DCIS has worst prognosis?
A. Cribiform B. Comedo C. Solid D. Papillary E. focal papillary

All of the following are true regarding a patient with LCIS except:
A. patients are at increased risk of invasive lobular carcinoma B. it is a marker for increased risk of invasive cancer C. it tends to occur at a younger age than DCIS D. can be treated with tamoxifen E. Is most commonly detected by its distinctive pattern of calcifications on mammography

 Breast cancer without invasion of basement membrane- proliferation of ductal epithelium 5-fold risk in IPSI-lateral breast Ductal adenocarcinoma precursor

DCIS

DCIS
The DCIS subtypes are: papillary, micropapillary, solid, cribiform and comedo. Most aggressive- comedo type, associated with a central necrosis. more likely than any other DCIS type to become invasive (malignant).

LCIS
Proliferation of terminal duct lobules MARKER for risk of malignancy in BOTH breasts
Invasive breast cancer develops in ~1/3 of women

Usually estrogen receptor +

Tamoxifen or Raloxifene can reduce risk 46%

Not found on Imaging- occasionally neighborhood calcifications 2/3 premenopausal

Ductal Adenocarcinoma
Most common cancer in females

Lobular carcinoma
10% of breast cancers More likely to be ER+ Histology reveals Indian -filing of tumor cells

Pagets disease of breast

Can be confused with contact dermatitis, eczema, or melanoma Paget cell- large vacuolated cells CEA + Associated with DCIS

ABSITE
Which of the following is true regarding phyllodes tumor?
A. The majority are benign B. They are of epithelial origin C. Benign lesions are managed in a manner similar to that for a fibroadenoma D. Malignant lesions spread via lymphatics

Phyllodes tumor
Leaf-like appearance form from periductal stromal cells of the breast Most common nonepithelial breast tumor Spreads hematogenously, rarely metastasizes to lymph nodes Typically large, fast growing Majority are benign (65%)

Tubular carcinoma
Most favorable prognosis- rarely metastasizes ~90% estrogen receptor positive survival of 97% at 10 years

 Most common breast cancer- Ductal carcinoma Carcinoma with most favorable prognosistubular carcinoma Most common non-epithelial breast tumorphyllodes tumor Most common cause of Bloody dischargeintraductal papilloma

ABSITE
Which of the following conditions increases a womens risk of breast cancer?
A. Sclerosing adenosis B. Fibroadenoma C. Atypical lobular hyperplasia D. Intraductal papilloma

ABSITE
Which of the following hormones is primarily responsible for differentiation of the breast ductal epithelium?
A. Estrogen B. Testosterone C. Progesterone D. Prolactin

ABSITE
Which of the following is true regarding patients with BRCA1 and BRCA2 mutations?
A. In women, both mutations have a similar lifetime risk of breast cancer B. In men, both mutations have a similar lifetime risk of breast cancer C. Both are found on chromosome 13 D. Both have a similar risk of ovarian cancer E. Breast cancer in women with BRCA1 is more likely to be hormone receptor positive than that in women with BRCA2

ABSITE
Early-onset breast cancer, sarcomas, leukemia, and brain and adrenocortical tumors would be most consistent with:
A. Cowden disease B. Li-Fraumeni syndrome C. Peutz-Jeghers syndrome D. Ataxia-telangiectasia E. BRCA2

ABSITE
Which of the following types of DCIS has worst prognosis?
A. Cribiform B. Comedo C. Solid D. Papillary E. focal papillary

All of the following are true regarding a patient with LCIS except:
A. Patients are at increased risk of invasive lobular carcinoma B. It is a marker for increased risk of invasive cancer C. It tends to occur at a younger age than DCIS D. It can be treated with tamoxifen E. Is most commonly detected by its distinctive pattern of calcifications on mammography

ABSITE
Which of the following is true regarding phyllodes tumor?
A. The majority are benign B. They are of epithelial origin C. Benign lesions are managed in a manner similar to that for a fibroadenoma D. Malignant lesions spread via lymphatics

Summary

Outline
Anatomy and histology Screen