What are the risk factors for breast cancer?
- female
- increased oestrogen exposure (earlier onset period, late menopause)
- denser breast tissue
- obesity
- smoking
- family history
- HRT
Chromosome BRCA1
17
Chromosome BRCA 2
13
What are the types of breast cancer?
- ductal carcinoma in situ
- lobular carcinoma in situ
- invasive ductal carcinoma
- invasive lobular carcinoma
- inflammatory breast cancer
- Paget’s disease
What is ductal carcinoma in situ?
- breast ducts
- localised to a single area
- potenital to spread locally or become invasive
- good prognosis if fully excised and adjuvant used
What is lobular carcinoma in situ?
- pre-cancerous
- typically in pre menopausal women
- usually asymptomatic
What is the management of lobular carcinoma in situ?
- close monitoring
- 6 monthly exam
- yearly mammogram
What is inflammatory breast cancer?
- presents similarly to breast abscess
- wont respond to antibiotics
- swollen, warm, tender breast with pitting skin
- worse prognosis
What is paget’s diesase?
- looks like eczema of the nipple
- may represent DCIS or invasive breast cancer
What is the breast cancer screening programme?
- mammogram every 3 years for women aged 50-70
What are the negatives of the breast screening programme?
- anxiety/stress
- exposure to radiation
- false reassurance if cancer is missed
- unnecessary tests/treatments where findings otherwise wouldnt have caused pain
Who are the high risk patients in regards to breast cancer
- 1st degree relatives with breast cancer <40/male/bilateral and<50 first cancer
- 2x first degree relatives with breast cancer
What is done with regards to those with high risk of breast cancer?
- genetic testing and pre test counselling
- annual mammogram
- chemoprevention: tamoxifen if pre menopausal, anastrazole if post
- risk reducing bilateral mastectomy or oophorectomy
What is the presentation of breast cancer?
- hard/irregular/painless or fixed lump
- lump tethered to skin/chest wall
- nipple retraction
- skin dimpling or oedema (peau d’orange)
- lymphadenopathy
Breast cancer referral
- 2 week wait in those with a lump and over aged 30, or unilateral nipple changes in patients 50+
- consider in patients 30+ with an unexplained lump in the axilla, or skin changes suggestive of cancer
- non-urgent referral for a breast lump in <30
Triple assessment
- clinical assessment
- imaging, USS if <30, mammogram if >30
- Biopsy: fine needle aspiration or core biopsy
What are the breast cancer receptors?
- Oestrogen receptors (ER)
- Progesterone receptors (PR)
- Human epidermal growth factor (HER2)
Drugs targeting oestrogen receptors
Tamoxifen if premenopause, aromatase inhibitors if post menopausal
Drugs targeting human epidermal growth factor receptors
Trastuzumab (herceptin), pertuzumab
Where are the most common sites for breast cancer metastasis?
- lung
- liver
- bones
-brain
What is the management of breast cancer
- surgery: breast conserving (wide local excision) pr mastectomy (with or without reconstruction)
- axillary clearance (increased risk of lymphoedema)
- radiotherapy and chemotherapy
What type of drug is tamoxifen?
Selective oestrogen receptor modulator
What are the side effects of tamoxifen?
- Hot flushes
- Period abnormalities: vaginal bleeding, amenorrhoea
- Increased risk of venous thromboembolism
- endometrial cancer
What are the side effects of anastrozole?
- osteoporosis
- hot flushes
- arthralgia
- myalgia
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