Breast Cancer

_____ is the most common non-skin malignancy in women.
Breast carcinoma
A woman who lives to age 90 has a 1 in _____ chance of developing breast cancer.
1 in 8
What is the leading cause of cancer death in women in the US?
Lung cancer
What is the second leading cause of cancer death in women in the US?
Breast cancer
75-80% of all invasive breast cancers are _____ receptor positive.
Estrogen receptor
True or False: In the early 80’s the incidence of breast cancer began to decrease in older women due to the introduction of mammographic screening.
False, in the early 80’s the incidence of breast cancer began to increase in older women due to the introduction of mammographic screening. The main benefit of screening was the detection of small, invasive carcinomas and in situ carcinomas.
True or False: The breast cancer mortality rate for all women has slowly declined over the last decade.
True
What is the most significant risk factor for breast cancer?
Being female
True or False: The risk of breast cancer increases with age.
True
The incidence of breast cancer rises throughout a woman’s lifetime, peaking at the age of _____ years.
75-80
True or False: Women who experience a first full-term pregnancy at ages younger than 20 years have half the risk developing breast cancer of nulliparous women or women over the age of 35 at their first birth.
True
Which of the following is NOT a risk factor for breast cancer? A) Age at menarche B) Age at first live birth C) First degree relative with breast cancer D) Smoking E) Race
D) Smoking
Which of the following is NOT a risk factor for breast cancer? A) Diet B) Obesity C) Aromatase inhibitors D) Atypical hyperplasia E) Geography
C) Aromatase inhibitors
What racial group is most likely to develop breast cancer?
Caucasians
What racial group is most likely to die from breast cancer?
African americans (and hispanics)
True or False: Estrogen exposure decreases the risk of breast cancer.
False, estrogen exposure increases the risk of breast cancer.
True or False: Progesterone exposure decreases the risk of breast cancer.
False, progesterone exposure increases the risk of breast cancer.
The moderate or heavy consumption of _____ increases the risk of breast cancer.
Alcohol
The risk of breast cancer is _____ in obese premenopausal women and _____ in obese postmenopausal women.
Decreased, Increased
Patients with the _____ gene mutation have an increased risk for breast and ovarian cancers.
BRCA
What form of the BRCA gene is associated with an increase in the risk of developing ovarian carcinoma as well as breast cancer?
BRCA1
What form of the BRCA gene is associated with a small increase in the risk of developing ovarian carcinoma but is associated more frequently with male breast cancer?
BRCA2
True or False: Most women diagnosed with breast cancer have a family history of breast cancer.
False, 15% of women diagnosed with breast cancer have a family history, conversely 85% of new diagnosis have no family history of breast cancer.
True or False: Genetic testing for breast cancer is usually limited to individuals with a strong family history or those belonging to certain ethnic groups.
True
True or False: The major susceptibility genes for breast cancer are proto oncogenes.
False, the major susceptibility genes for breast cancer are tumor suppressors.
True or False: The majority of sporadic cancers occur in postmenopausal women and are estrogen receptor negative.
False, the majority of sporadic cancers occur in postmenopausal women and are estrogen receptor positive.
The _____ proposes that malignant changes occur in a stem cell population that has unique properties distinguishing them from more differentiated cells.
Cancer stem cell hypothesis
The most likely cell type of origin for the majority of breast carcinomas is the _____ cell.
Estrogen receptor-expressing luminal cell
The most likely cell type of origin for estrogen receptor negative breast carcinomas is the _____ cell.
Estrogen receptor-negative myoepithelial cell
Place the following inorder according to the proposed precursor-carcinoma sequences in breast cancer: High grade DCIS, Proliferative disease, Atypical hyperplasia, Non-proliferative disease, Low/moderate grade DCIS
Non-proliferative disease > Proliferative disease > Atypical hyperplasia > Low/moderate grade DCIS > High grade DCIS
True or False: Greater than 95% of breast malignancies are squamous cell carcinomas.
False, greater than 95% of breast malignancies are adenocarcinomas.
Breast carcinomas are divided into in situ carcinomas and invasive carcinomas. _____ refers to a neoplastic proliferation that is limited to ducts and lobules by the basement membrane.
Carcinoma in situ
Breast carcinomas are divided into in situ carcinomas and invasive carcinomas. _____ refers to a neoplastic proliferation that has penetrated through the basement membrane into the stroma.
Invasive carcinoma
What are the two different histological types of breast cancer?
(1) Ductal (2) Lobular
Breast cancers are divided histologically into ductal and lobular. By current convention, _____ refers to carcinomas of a specific type, and _____ is used more generally for adenocarcinomas that have no other designation.
Lobular, Ductal
Among cancers detected mammographically, almost half are _____.
Ductal carcinoma in situ (DCIS)
In terms of breast cancer, _____ consists of a malignant clonal population of cells limited to ducts and lobules by the basement membrane.
Ductal carcinoma in situ (DCIS)
What are the five architectural types of ductal carcinoma in situ (DCIS)?
(1) Comedocarcinoma (2) Solid (3) Cribriform (4) Papillary (5) Micropapillary
Ductal carcinoma in situ (DCIS) can be divided into comedocarcinoma and noncomedo DCIS. _____ is characterized by the presence of solid sheets of pleomorphic cells with high-grade hyperchromatic nuclei and areas of central necrosis?
Comedocarcinoma
Ductal carcinoma in situ (DCIS) can be divided into comedocarcinoma and noncomedo DCIS. _____ consists of a monomorphic population of cells with nuclear grades ranging from low to high.
Noncomedo
What noncomedo architectural type of ductal carcinoma in situ (DCIS) has intraepithelial spaces are evenly distributed and regular in shape (cookie cutter-like)?
Cribriform
What noncomedo architectural type of ductal carcinoma in situ (DCIS) completely fills the involved spaces?
Solid
What noncomedo architectural type of ductal carcinoma in situ (DCIS) grows into spaces along fibrovascular cores that typically lack the normal myoepithelial cell layer?
Papillary
What noncomedo architectural type of ductal carcinoma in situ (DCIS) is recognized by bulbous protrusions without a fibrovascular core, often arranged in complex intraductal pattern?
Micropapillary
_____ is a rare manifestation of breast cancer (1% to 4% of cases) that presents as a unilateral erythematous eruption with a scale crust. It often associated with pruritus and is sometimes mistaken for eczema.
Pagets disease
True or False: Paget’s disease is rarely associated with an underlying breast cancer.
False, 95% of patients with paget’s disease will have breast cancer.
True or False: The breast carcinomas associated with pagets disease are usually well differentiated, estrogen receptor positive, and underexpress HER2/neu.
False, the breast carcinomas associated with pagets disease are usually poorly differentiated, estrogen receptor negative, and overexpress HER2/neu.
DCIS with microinvasion is diagnosed when there is an area of invasion through the basement membrane into stroma measuring no more than _____ cm.
0.1
Ductal carcinoma in situ (DCIS) can be divided into comedocarcinoma and noncomedo DCIS. What type is most commonly associated with microinvasion?
Comedocarcinoma
True or False: Ductal carcinoma in situ (DCIS) usually progresses to invasive cancer if not treated appropiately.
True
What are the three major risk factors for recurrence of breast cancer?
(1) Grade (2) Size (3) Margins
True or False: Breast conservation is appropriate for most women with ductal carcinoma in situ (DCIS).
True
_____ for ductal carcinoma in situ (DCIS) is curative for over 95% of patients and is associated with the smalled risk of recurrence.
Mastectomy
What type of carcinoma in situ is always an incidental biopsy finding, since it is not associated with calcifications or stromal reactions that produce mammographic densities?
Lobular carcinoma in situ
True or False: Lobular carcinoma in situ (LCIS) is bilateral in most cases.
False, lobular carcinoma in situ is bilateral in 20-40% of cases.
True or False: Lobular carcinoma in situ (LCIS) is most common in postmenopausal women.
False, lobular carcinoma in situ is more common in young women, with 80% to 90% of cases occurring before menopause.
What type of carcinoma in situ is associated with a loss of expression of e-cadherin, a transmembrane cell adhesion protein that contributes to the cohesion of normal breast epithelial cells?
Lobular carcinoma in situ
What type of carcinoma in situ is often said to be dyscohesive?
Lobular carcinoma in situ
True or False: Overexpression of HER2/neu is common in patients with lobular carcinoma in situ.
False, overexpression of HER2/neu is not observed in patients with lobular carcinoma in situ.
True or False: Lobular carcinoma in situ and ductal carcinoma in situ progress to invasive carcinomas at similar frequencies.
True
In the absence of mammographic screening, invasive carcinoma almost always presents as a _____.
Palpable mass
What percent of palpable breast tumors are associated with axillary lymph node metastases?
50%
True or False: In older women undergoing mammography, invasive carcinomas most commonly present as a radiopaque mass.
False, in older women undergoing mammography, invasive carcinomas most commonly present as a radiodense mass.
What is the most common type of carcinoma in situ?
Ductal carcinoma in situ (DCIS)
True or False: Most invasive breast carcinomas are no special type carcinomas.
True
What type of invasive carcinoma is often described as scirrhous/hard?
No special type (NST)
_____ differentiated ductal carcinomas show prominent tubule formation, small round nuclei, and rare mitotic figures.
Well-differentiated
_____ differentiated ductal carcinomas may have tubules, but solid clusters or single infiltrating cells are also present.
Moderately differentiated
_____ differentiated ductal carcinomas often invade as ragged nests or solid sheets of cells with enlarged irregular nuclei.
Poorly differentiated
In terms of invasive ductal breast cancer, what profile of gene expression is the largest group and consists of cancers that are estrogen receptor positive and HER2/neu negative?
Luminal A
In terms of invasive ductal breast cancer, what profile of gene expression is estrogen receptor positive, has an increased poliferative rate, and is HER2/neu positive?
Luminal B
In terms of invasive ductal breast cancer, what profile of gene expression is estrogen receptor-positive, HER2/neu-negative, and characterized by the similarity of its gene expression pattern to normal tissue?
Normal breask-like
In terms of invasive ductal breast cancer, what profile of gene expression is notable for its absence of estrogen receptor, PR, and HER2/neu (triple-negative) and the expression of markers typical of myoepithelial cells?
Basal-like
Many basal like carcinomas are associated with the _____ gene mutation.
BRCA1
In terms of invasive ductal breast cancer, what profile of gene expression is estrogen receptor negative with an overexpress HER2/neu?
HER2 positive
A HER2 positive gene profile is associated with an elevated risk of _____ metastasis.
Brain
_____ receptor positive breast cancers are very responsive to chemotherapy and herceptin (or trastuzumab)
Her2/neu receptor
_____ receptor positive breast cancers are less responsive to chemotherapy and more responsive to hormonal therapy (tamoxifen).
Estrogen receptor
What type of invasive carcinoma has been reported to have a greater incidence of bilaterality?
Invasive lobular carcinomas
What type of invasive carcinoma is associated with the presence of dyscohesive infiltrating tumor cells, often arranged in single (“indian”) file or in loose clusters or sheets?
Invasive lobular carcinomas
What type of invasive carcinoma is most common in women in the sixth decade and presents as a soft well-circumscribed mass?
Medullary carcinoma
Medullary carcinomas have a _____ gene expression profile.
Basal-like
What type of invasive carcinoma is most common in older women and tends to grow slowly over the course of many years?
Mucinous (colloid) carcinoma
What type of invasive carcinoma is has the consistency and appearance of pale gray-blue gelatin?
Mucinous (colloid) carcinoma
What type of invasive carcinoma is typically detected as small irregular mammographic densities in women in their late 40s?
Tubular carcinoma
More than 95% of tubular carcinomas are estrogen receptor _____ and HER2/neu _____.
Positive, Negative
True or False: Tubular carcinoma has a poor prognosis.
False, tubular carcinoma has an excellent prognosis.
What type of invasive carcinoma is composed of well-formed angulated tubules lined by a single layer of cells with small uniform nuclei?
Tubular carcinoma
Metaplastic carcinomas have a _____ gene expression profile.
Basal-like
What two type of invasive carcinoma have a basal-like pattern of gene expression?
(1) Medullary (2) Metaplastic
True or False: Invasive carcinomas with basal like gene expression profiles have a relatively good prognosis.
False, invasive carcinomas with basal like gene expression profiles have a relatively poor prognosis.
What are the six major prognostic factors of breast cancer?
(1) Invasive carcinoma vs. in situ disease (2) Distant metastases (3) Lymph node metastases (4) Tumor size (5) Locally advanced disease (6) Inflammatory carcinoma
_____ is an enlargement of the male breast.
Gynecomastia
What is the most important cause of hyperestrinism in men?
Cirrhosis of the liver
Gynecomastia can occur anytime in adult life when there is cause for _____.
Hyperestrinism
What form of the BRCA gene is most associated with an increase in the risk of developing male breast cancer?
BRCA2
What chromosomal abnormality is sometimes associated with male breast carcinoma?
Klinefelter syndrome
True or False: The majority of all male breast cancers are estrogen receptor positive.
True
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