Breast Disease Chapter 19

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Questions and Answers

At what age is annual mammography recommended for women with a BRCA1/2 mutation who are not undergoing MRI screening?

30–39 years

60–69 years

40–49 years (correct)

50–59 years

What is the recommended screening strategy for women under 30 with a lifetime risk of >30%?

3-yearly mammography

Annual MRI screening (correct)

No screening recommended

Annual mammography after 30 years

What percentage of breast cancers are classified as interval cancers within the first year after screening?

20% (correct)

10%

30%

40%

For women at medium risk with a lifetime risk of 17–30%, at what age is mammography screening first recommended?

50 years Signup and view all the answers

What percentage of women find mammography uncomfortable, according to the screening statistics?

81% Signup and view all the answers

What is the primary aim of the national breast cancer screening programme in the UK?

To detect breast cancer at an early stage Signup and view all the answers

Which age group is currently the focus for mammographic screening in the UK?

Women aged 50–70 years Signup and view all the answers

What percentage of breast cancers are detected through screening in women aged over 50?

85% Signup and view all the answers

What is the typical prognosis for stage I breast tumours according to the information provided?

5-year survival rate of 84% Signup and view all the answers

What is the recommended frequency of screening for older women who wish to have mammograms?

Every 3 years Signup and view all the answers

What is one of the psychological adverse effects of breast cancer screening?

Anxiety from false positive results Signup and view all the answers

Which of the following is a potential benefit of breast cancer screening?

Less invasive treatment options Signup and view all the answers

What is one reason why false negative results in screening can be problematic?

They can result in later presentation of the disease Signup and view all the answers

How does the geography of breast cancer risk differ in populations?

Migrants adopt the risk of their host country within 2 generations Signup and view all the answers

What is a consequence of overdiagnosis in breast cancer screening?

Unnecessary treatment for conditions with unchanged prognosis Signup and view all the answers

What is the relationship between age and breast cancer risk?

80% of breast cancers occur in women aged 50 and older Signup and view all the answers

How does obesity influence breast cancer risk post-menopause?

Obesity increases the risk after menopause Signup and view all the answers

Which of the following lifestyle factors is associated with a decreased risk of breast cancer?

Regular physical activity Signup and view all the answers

What is the effect of breastfeeding on the relative risk of breast cancer?

Decreases risk by 4.3% for each year of breastfeeding Signup and view all the answers

How does combined hormonal contraception affect breast cancer risk?

It has a slight increasing risk, but the risk disappears within 10 years of stopping Signup and view all the answers

Which of the following factors is NOT associated with an increased risk of breast cancer?

Late menopause Signup and view all the answers

What role does socioeconomic status play in breast cancer incidence?

Higher incidence in more affluent social classes Signup and view all the answers

How does nulliparity affect breast cancer risk?

It increases the risk of breast cancer Signup and view all the answers

Study Notes

Breast Disease

Chapter 19 in a medical textbook covers breast disease, including symptoms, benign breast disease, breast cancer screening, risk factors, diagnosis, and care.
Breast cancer screening is a national program in the UK, started in 1988, aiming to detect early-stage cancers to improve survival rates (84% 5-year survival for stage I, 18% for stage IV).
Screening is primarily for women aged 50–70 (47–73 in some areas), although older women can request it 3-yearly. Screening detects ~85% of cancers in women over 50, and ~70–80% of screening-detected cancers have a good prognosis.
High-risk women (family history) may benefit from early or more frequent screening with mammograms or MRI.
Screening involves 2-view mammograms at designated centers, with normal results leading to 3-year recall and abnormal ones to immediate further investigation.
Interval cancers are those detected between screenings due to missed detection at the time of screening or new events after screening.

Risk Factors for Breast Cancer

Breast cancer is the most common cancer in the UK and affects both men and women. Breast cancer screening is discussed on page 670.
Risk factors include geography (more common in developed countries), age (increases with age), socioeconomic factors (higher in more affluent classes), obesity, high-fat diet, alcohol consumption, physical inactivity, early menarche, late menopause, pregnancy history (fewer pregnancies and nulliparity increases risk), breastfeeding, combined hormonal contraception, and prior breast conditions.
Family history is a strong risk factor; a faulty gene (BRCA1/2 or TP53) or a history of breast cancer in first- or second-degree relatives increases risk. Referral pathways for women with a family history are depicted in Figure 19.3.

Breast Cancer: Diagnosis and Care

Prevention strategies include lifestyle modifications (reduced alcohol, increased exercise, avoiding exogenous hormones), chemoprophylaxis (tamoxifen), and prophylactic surgery.
Common presentation includes breast lumps, breast pain, nipple changes, nipple discharge, and skin changes.
Management involves urgent assessment by a breast surgeon, mammography, ultrasound, and biopsy if necessary.
Treatment options include surgery (lumpectomy, mastectomy), hormone therapy, radiotherapy, and chemotherapy, depending on the stage and type of cancer.
Diagnosis is categorized in stages (in situ, stage I-IV) based on tumor size, lymph node involvement, and metastasis. Stage categorization is outlined in Table 19.4.
Adjuvant endocrine therapies (tamoxifen, aromatase inhibitors, trastuzumab) are important for managing breast cancer's progression, based on responses to oestrogen and progesterone receptors.
Prognosis depends on factors such as age, stage, tumor grade, estrogen receptor status, and patient access to proper care.

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Description

This quiz explores Chapter 19 of a medical textbook on breast disease, detailing symptoms, benign conditions, and breast cancer screening practices. It highlights the importance of early detection and the guidelines for high-risk women. Prepare to assess your knowledge on diagnostic strategies and patient care related to breast health.