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What percentage of breast cancers occurs in men?
At what age does the incidence of breast cancer begin to increase significantly in women?
Which of the following describes the most common classification of breast cancer based on hormone receptor expression?
What is the crude incidence rate of female breast cancer in Hong Kong per 100,000 female population in 2021?
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What percentage of breast cancers are attributed to highly penetrant germline mutations in tumor suppressor genes?
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In which region is the breast cancer risk significantly higher?
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What is the approximate lifetime risk of breast cancer for individuals with certain inherited highly penetrant mutations?
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What is the most common type of breast cancer?
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Which characteristic is commonly associated with luminal A carcinomas?
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What is a common treatment for patients with ER-positive breast cancers?
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What type of breast tumor is most similar to myoepithelial cells?
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HER-2-positive tumors account for what percentage of breast cancer cases?
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Which breast cancer type is associated with germ line mutations in BRCA1 and BRCA2?
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What is a characteristic of HER-2 overexpressing carcinomas?
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Which statement best describes luminal B tumors?
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What distinguishes triple-negative tumors in breast cancer classification?
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What should women who are sexually active do before deciding on HPV vaccination?
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Which of the following groups is recommended for cervical screening?
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What is the recommended screening interval for women after two consecutive normal annual cytology tests?
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Which of the following is considered a risk factor for HPV infection?
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What type of virus is Human Papillomavirus (HPV)?
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How does HPV primarily spread among individuals?
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What percentage of sexually active individuals is estimated to be infected with HPV at some point in their lives?
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What type of HPV is most associated with cervical cancer?
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Which of the following tests is primarily used to identify brain changes associated with Alzheimer's disease?
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Which medication class is primarily used to enhance memory and thinking in Alzheimer's patients?
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Which lifestyle factor is emphasized as a preventive measure against cognitive decline in Alzheimer's disease?
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What type of therapy aims to manage behavioral changes in Alzheimer's patients?
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Which component of a healthy lifestyle is associated with lower Alzheimer's risk and focuses on nutrient-dense foods?
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Which laboratory test is commonly performed to eliminate other potential causes of symptoms in Alzheimer's diagnosis?
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In the context of Alzheimer's management, which of the following statements about caregiver support is true?
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Which cognitive activity is suggested to help maintain cognitive function and reduce Alzheimer's risk?
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What role does the E6 protein play in cell immortalization?
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How do E7 proteins from high-risk HPV types differ from those of low-risk types?
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What is a consequence of HPV genome integration into the host genome?
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Why are high-risk HPV types more likely to lead to carcinoma?
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Which of the following statements about E7 and CDK inhibitors is true?
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What is the primary risk factor for developing squamous intraepithelial lesions (SIL)?
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Which types of HPV are most commonly associated with cervical carcinoma?
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What is the effect of high-risk HPV types on the duration of infection?
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Study Notes
Breast Cancer
- Breast cancer caused 670,000 deaths globally in 2022.
- Roughly half of all breast cancers occur in women with no specific risk factors other than sex and age.
- Breast cancer was the most common cancer in women in 157 countries out of 185 in 2022.
- Breast cancer occurs in every country in the world.
- Approximately 0.5–1% of breast cancers occur in men.
- Breast cancer was the commonest cancer among females in Hong Kong.
- 28.5% of all new cancers in females diagnosed in Hong Kong in 2021 rarely occurred in males.
- In 2021, 5565 new cases of female breast cancer were diagnosed.
- The crude incidence rate of female breast cancer was 138.1 per 100 000 female population.
- The age-standardised incidence rate of female breast cancer was 79.6 per 100 000 standard population.
- Almost all breast malignancies are adenocarcinomas (>95%).
- In the most clinically useful classification system, breast cancers are divided based on the expression of hormone receptors—estrogen receptor (ER) and progesterone receptor (PR)—and the expression of the human epidermal growth factor receptor 2 (HER2, also known as ERBB2), into three major groups:
- ER positive (HER2 negative; 50%–65% of cancers)
- HER2 positive (ER positive or negative; 10%–20% of cancers)
- Triple negative (ER, PR, and HER2 negative; 10%–20% of cancers)
Epidemiology and Risk Factors
- Breast cancer is rare in women younger than age 25, but increases in incidence rapidly after age 30.
- 75% of women with breast cancer are older than 50 years of age, and only 5% are younger than 40.
- The incidence in men is only 1% of that in women.
- Approximately 5% to 10% of breast cancers occur in persons who inherit highly penetrant germline mutations in tumor suppressor genes.
- For these individuals, the lifetime risk of breast cancer may be greater than 90%.
- The risk is significantly higher in the Americas and Europe than in Asia and Africa.
- The incidence and mortality rates are five times higher in the United States than in Japan.
Pathogenesis
- Germ line mutations in two genes, BRCA1 and BRCA2, account for 50% of cases of familial breast cancer.
Cervical Cancer
- For women who have been sexually active, the effectiveness of HPV vaccine varies.
- Women should discuss with their doctor first before deciding on having vaccination.
- Vaccination is not 100% effective in preventing cervical cancer.
- No matter they have been vaccinated or not, all sexually active women should have regular cervical screening.
Secondary Prevention - Cervical Screening
- Target population:
- All women from age 25 or the time of commencing sexual activity (whichever is later) until the age of 64.
- Women over 65 years who have never had cervical cytology and have a history of being sexually active, should be screened.
- Screening Interval (Cytology):
- Screening at 3-yearly intervals, after 2 consecutive normal annual cytology tests, is recommended.
- Chronically immunosuppressed women will need annual screening.
Risk Factors
- Early age at first intercourse
- Multiple sexual partners
- Male partner with multiple previous sexual partners
- Persistent infection by high-risk strains of papillomavirus
Human Papillomavirus (HPV)
- Papillomaviruses are a large group of non-enveloped double-stranded DNA viruses that belong to the papillomavirus genus of the Papillomaviridae family.
- HPV can infect epithelial cells of the skin as well as oral and genital mucosa.
- HPV spreads through intimate skin-to-skin contact, including vaginal, anal, or oral sex.
- More than 100 types of HPV have been detected so far, which have been further categorized as cutaneous or mucosal depending on their tissue tropism and as high risk (HR) or low risk (LR) depending on their oncogenic capacity.
- HPV is currently among the most common sexually transmitted infections worldwide.
- According to the Centers for Disease Control and Prevention (CDC), around 13 million new cases of HPV are detected each year.
- It is estimated that around 80 percent of sexually active men and women get infected with HPV at some point in their lives.
Pathogenesis
- The E6 protein binds to and mediates the degradation of p53, and also stimulates the expression of TERT, the catalytic subunit of telomerase, which contributes to the immortalization of cells.
- E6 from high-risk HPV types has a higher affinity for p53 than E6 from low-risk HPV types, a property that is likely to contribute to oncogenesis.
- The E7 protein has effects that complement those of E6, all of which are centered on speeding cells through the G1-S cell cycle checkpoint.
- It binds to the RB protein and displaces the E2F transcription factors that are normally sequestered by RB, promoting progression through the cell cycle.
- As with E6 proteins and p53, E7 proteins from high-risk HPV types have a higher affinity for RB than do E7 proteins from low-risk HPV types.
- E7 also inactivates the CDK inhibitors p21 and p27, and binds and presumably activates cyclins E and A.
- An additional factor that contributes to the oncogenic potential of HPVs is viral integration into the host genome.
- In benign warts, the HPV genome is maintained in a nonintegrated episomal form, while in cancers, the HPV genome is randomly integrated into the host genome.
- Integration interrupts a negative regulatory region in the viral DNA, resulting in overexpression of the E6 and E7 oncoproteins.
- Furthermore, cells in which the viral genome has integrated show significantly more genomic instability, which may contribute to the acquisition of pro-oncogenic mutations in host cancer genes.
Possible consequences of HPV infection
Alzheimer Disease
- The formation of tangles is an important component of AD, but the mechanism of tangle injury to neurons remains poorly understood.
Diagnosis
- Medical History:
- Review of symptoms, family history, and medical conditions.
- Cognitive and Neuropsychological Tests:
- Assess memory, problem-solving, attention, and language skills.
- Physical and Neurological Exams:
- Evaluate overall health and check for signs of neurological issues.
- Laboratory Tests:
- Blood tests to rule out other causes of symptoms.
- Brain Imaging:
- MRI or CT Scan: Detects brain changes, such as atrophy or other abnormalities.
- Cerebrospinal Fluid Analysis:
- Tests for biomarkers associated with Alzheimer's.
- Genetic Testing:
- In certain cases, tests for genetic markers linked to Alzheimer's risk.
Treatment
- Medications:
- Cholinesterase Inhibitors: Donepezil, rivastigmine, and galantamine help with memory and thinking.
- Memantine: Regulates glutamate activity to improve cognition and daily functioning.
- Lifestyle and Supportive Therapies:
- Cognitive Stimulation: Engaging activities to boost mental function.
- Exercise: Regular physical activity to improve mood and health.
- Diet: Balanced nutrition, like the Mediterranean diet, supports brain health.
- Behavioral Strategies:
- Establishing routines and using reminders to help with daily tasks.
- Managing behavioral changes with therapy and support.
- Support for Caregivers:
- Education, resources, and support groups to assist those caring for individuals with Alzheimer's.
Prevention
- Regular Physical Exercise: Engaging in regular physical activity can help improve blood flow to the brain, reduce the risk of cardiovascular diseases, and promote overall brain health.
- Healthy Diet: Following a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can provide essential nutrients for brain health. Consider a Mediterranean diet, which has been associated with a lower risk of Alzheimer's disease.
- Mental Stimulation: Keeping the brain active through activities such as reading, puzzles, learning new skills, and social interactions can help maintain cognitive function and reduce the risk of cognitive decline.
- Quality Sleep: Prioritize getting enough high-quality sleep, as sleep plays a crucial role in memory consolidation and overall brain health.
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Description
This quiz covers critical statistics and information about breast cancer, including its prevalence, incidence rates, and impact on various populations worldwide. Learn about the demographics affected most and the types of breast cancer that occur based on hormone receptors.
