Imaging

Question 1

Screening Results

Answer 1

20-35% decrease in BC mortality (50-69)
Less impact on 40-49yo
10% of BC mammographically occult

Question 2

Recommended Clinical exam

Answer 2

Breast exam 1-3 years w/ period self-exam (no longer recommended)
Annual exam 40-50yo

Question 3

Early start to mammography (>30yo)

Answer 3

Prior thoracic RT (mantle-field RT)
genetic predisposition, strong Family Hx
H/o LCIS or atypical hyperplasia
Papable mass

Question 4

Mammography grading

Answer 4

0: Indeterminate/additional imaging needed
1: Negative
2: Benign finding (routine f/u)
3: Probably benign: (f/u 6mo, then 6-12 month for 1-2 years)
4: Suspicious abnormality (biopsy)
5: highly suspicious malignancy (biopsy & treatment)
6: Known biopsy-proven malignancy

Question 5

MRI indications

Answer 5

• BRCA1/2
• 1st-degree relative w/ BRCA 1/2 and pt untested
• Lifetime risk >20-25%: BRCAPRO, Claus, Tyler-Cuzick)
• RT to chest age 10-30 (hodgkins disease)
• 1st degree relative with TP53 (Li Fraumeni) or PTEN (Cowden & Bannayan-Riley-Ruvalcaba syndrome)

Question 6

Li-Fraumeni Syndrome

Answer 6

Remember SBLA Syndrome
Sarcoma
Brain/Breast
Leukemia
Adrenals

Question 7

Diagnostic Study

Answer 7

Bilateral diagnostic mammogram

Sensitivity & specificity >90%