Breast Cancer Risk Factors
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Questions and Answers

What is the hereditary risk percentage of breast cancers related to family history?

5-10%

Which group has an increased risk of breast cancer?

  • Individuals with entirely fatty breast tissue
  • Individuals who are not of Ashkenazi Jewish ancestry
  • Individuals with multiple close relatives affected by breast or ovarian cancer (correct)
  • Individuals with no family history of breast cancer
  • Mutation of the tumour suppressing gene is associated with ____ gene.

    BRCA

    Match the breast density level with its description:

    <p>A = Almost entirely fatty composed of fat meaning it is non-dense. B = Scattered areas of fibroglandular tissue indicating scattered areas of density, but majority of breast is still non-dense. C = Heterogeneously dense meaning there are some areas of non-dense tissue, but majority is of the breast tissue is dense. D = Extremely dense indicates nearly all of breast tissue is fibroglandular and dense.</p> Signup and view all the answers

    Breast compression helps reduce scatter and dose, increasing contrast in mammograms.

    <p>True</p> Signup and view all the answers

    How often should females aged 45-69 have screening mammograms?

    <p>Every 2 years</p> Signup and view all the answers

    What do Cooper's ligaments in the breast help to maintain?

    <p>structure and shape</p> Signup and view all the answers

    What do Montgomery glands on the areola provide?

    <p>lubrication for lactation</p> Signup and view all the answers

    Which type of breast cancer cell does not have receptors for estrogen and progesterone hormones?

    <p>Triple-negative breast cancer</p> Signup and view all the answers

    What is the purpose of a face shield during mammography?

    <p>reduce dose to eyes and thyroid</p> Signup and view all the answers

    Study Notes

    Risk Factors

    • 5-10% of breast cancers are hereditary, increasing risk if:
      • Parent/sibling/child have breast/ovarian cancer, especially under 50 years old
      • Multiple close relatives are affected by breast or ovarian cancer
      • Relatives have both breast and ovarian cancer
      • Relatives were diagnosed with breast cancer before menopause
      • Relatives have bilateral breast cancer
      • Are of Ashkenazi (Eastern European) Jewish ancestry
    • BRCA gene: hereditary, Ashkenazi (Eastern European) Jewish ancestry, mutation of the tumor-suppressing gene

    Breast Density

    • BI-RADS (Breast Imaging Reporting and Data System) levels of breast density:
      • A: Almost entirely fatty (1 in 10 women)
      • B: Scattered areas of fibroglandular tissue (4 in 10 women)
      • C: Heterogeneously dense (4 in 10 women)
      • D: Extremely dense (1 in 10 women)

    MIQ Classification

    • Perfect:
      • Maximum breast tissue imaged
      • Appropriate exposure
      • Appropriate compression
      • Absence of movement/geometric blur
      • Absence of artifacts
      • Skin fold free
      • Symmetrical images
      • Correct annotations
    • Good:
      • As with excellent, but with minor exceptions
    • Moderate:
      • As with good, but with minor exceptions
    • Inadequate:
      • Part of breast not imaged
      • Inadequate identification/annotation
      • Incorrect exposure
      • Inadequate compression
      • Movement/geometric blur
      • Overlying artifacts

    Views

    • CC:
      • Medial aspect shown
      • As much axillary tail as possible
      • Pectoral muscle shadow at chest wall
    • MLO:
      • Pectoral muscle shadow to nipple level
      • Pectoral muscle at appropriate angle
      • Nipples in profile
      • Infra-mammary angle clearly demonstrated
    • Additional views:
      • Lateral: better localize medial or lateral lesions, shows effects of gravity on air-fluid levels
      • Extended view: for imaging axillary tail
      • Cleavage view: for imaging medial and posterior breast tissue
      • Compression spot views: provides better tissue separation and visualization
      • Magnification views: similar to spot views, but with additional platform to reduce SID
      • Tomosynthesis: 2D views taken at multiple angles to provide a 3D view
      • Push back views: for breast implants

    Breast Compression

    • Advantages:
      • Immobilizes breast, reducing chance of movement unsharpness
      • Reduces scatter and dose, increases contrast
      • Decreases OFD, reducing geometric unsharpness
      • Breast tissue is more evenly distributed, making it easier to diagnose
      • Decreases exposure time, reducing movement unsharpness and dose

    Screening vs Diagnostic

    • Screening:
      • Every 2 years for females aged 45-69
      • Have not had a mammogram within the previous 12 months
      • Not pregnant or breastfeeding
      • Free from cancer
      • Asymptomatic
      • Eligible for public health services in NZ
    • Diagnostic:
      • For males or females who are symptomatic, of any age
      • Referred by GP
      • Additional imaging used initially
      • Under 35 will have U/S first

    Anatomy

    • Cooper's ligaments: help maintain structure and shape of breast, connecting lobules to skin surface
    • Montgomery glands: protrusions on the surface of the areola, providing lubrication during lactation

    Pathologies

    • Ultrasound:
      • For women under 35
      • Assess lesions for size, shape, density
      • Useful for helping to diagnose cancer in people with dense breast tissue
      • Best modality for looking at lesions and localized areas
    • Appearance on U/S:
      • Benign:
        • Cysts: fluid accumulation inside gland/s in the breast
        • Fibroadenoma: lumps from excess proliferation of connective tissue
      • Malignant:
        • DCIS: ductal carcinoma in situ, cells lining milk ducts become cancerous
        • Lobular carcinoma: starts in milk-producing glands (lobules) of the breast
        • Inflammatory breast cancer: rare, aggressive, occurs in younger women, worse prognosis
        • Triple-negative breast cancer: a type of breast cancer where cells lack receptors for estrogen and progesterone hormones and the HER2 protein

    Symptoms of Breast Cancer

    • Lumps
    • Pain
    • New nipple inversion
    • Swelling
    • Dimming
    • Orange peel skin
    • Enlarged axillary lymph nodes

    MRI

    • Advantages:
      • For high-risk patients
      • Patients with extremely dense breast tissue
      • Gold standard for implant ruptures
      • Assessing chest wall invasion and axillary pathology
      • No compression necessary
    • Disadvantages:
      • Expensive
      • Does not show calcifications
      • Low specificity for malignant vs benign lesions
      • Metal contraindications
      • Long scan times

    Sentinel Node

    • First lymph node to receive lymphatic fluid from the breast
    • Sentinel node is biopsied (sentinel node biopsy) and tested to determine breast cancer staging

    Treatment

    • Surgery
    • Chemotherapy
    • Radiation therapy
    • Hormone replacement therapy

    Equipment

    • kVp range: 24-35 kVp
    • Tube angle: 20-24 degrees
    • Tube heads: tilted to cover entire image field, utilize anode heel effect, and get tube parallel to chest wall
    • Filters: commonly made of Molybdenum (Mo) or Rhodium (Rh)
    • Target material: made of Molybdenum (Mo) or Rhodium (Rh)
    • Ideal target/filter combinations: Rhodium/Rhodium or Tungsten/Rhodium
    • AEC: positioned behind the detector to reduce OID and improve spatial resolution
    • Detector: composed of Cesium Iodide crystals (Indirect) or Amorphous silicon (Direct)
    • Preferred detector composition: Direct
    • Focal spot sizes: 0.1mm or 0.3mm
    • Face shield: to ensure no artifacts from the head in the x-ray beam and to reduce dose to the eyes and thyroid

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    Description

    Learn about the risk factors associated with breast cancer, including family history, genetics, and more. Identify the signs that may indicate a higher risk of developing breast cancer.

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