Term
| What is the median age for all CA diagnosis? |
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Definition
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Term
| Where does breast CA start? |
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Definition
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Term
| Once cancer invades through the chest wall it is near blood vessels and lymph nodes...what is this called? |
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Definition
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Term
| Which types of breast CA do statistics not account for? |
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Definition
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Term
| What is responsible for 67% of our CA's? |
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Definition
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Term
| Why do we screen for breast CA? |
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Definition
| To find the non-invasive before it becomes invasive. |
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Term
| What drug can those who are at a high risk of developing breast CA take to decrease their risk by 47%? |
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Definition
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Term
| What is the difference between Tamoxifen and Raloxifen? |
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Definition
| Raloxifen doesn't have the hot flash SE or risks to the endometrium but it doesn't prevent non-invasive breast CA. |
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Term
| Name an advantage of Tamoxifen as it relates to bone health. |
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Definition
| It has the lowest fracture rate so it's great for those with osteoporosis. |
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Term
| What phase of life has the highest fibrous connective tissue ratio? |
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Definition
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Term
| What are some differences in the mammogram picture between a young woman and an older woman? |
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Definition
| Normally with less dense tissue (older woman) your looking for a white spot on a dark background...in a young woman it all looks white. |
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Term
| What is the most common type of breast CA? |
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Definition
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Term
| What is the difference between lobular and ductal forms of breast CA? |
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Definition
| Lobular seeps into the tissues and is larger. |
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Term
| Where do 70%-80% of breast lymph node chains drain? |
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Definition
| Into the axillary lymph nodes. |
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Term
| Which lymph node chains need palpated? |
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Definition
| All breast/axillary nodes need palpated including anterior, central, and posterior chains. Internal mammary lymph nodes are assessed through the supra/infraclavicular nodes. |
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Term
| What is the number 1 risk factor for breast CA? |
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Definition
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Term
| African Americans are the ethnicity with the greatest risk for breast CA...T or F? |
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Definition
| False-They have the worst outcomes because of delayed diagnosis from delayed screenings. Eastern European Jews have the biggest ethnicity risk. |
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Term
| What is a common cause of pre-menopausal breast CA? |
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Definition
| Genetics-1st degree relative meaning mom, dad, sister, brother, son, or daughter with breast CA. |
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Term
| Name 15 other risk factors for breast CA? |
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Definition
Family hx of breast or ovarian CA
Age at menarche and menopause (early menarche and late menopause is the worst)
Parity (nullips)
Age at 1st live birth (later is worse)
# of prior breast biopsies
ADH or LCIS on breast biopsy
Prior thoracic radiation therapy(teens w/Hodgkins for example)
Current or prior hormone usage (estrogen/progesterone use)
BMI >25
Mammographic breast density
ETOH consumption (large)
High fat diet
Lack of exercise
Social habits-smoking, increased socioeconomic status. |
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Term
| Name 2 diagnosis you could see on a path report of a biopsy that are serious findings and should never be ignored? |
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Definition
atypical ductal hyperplasia (ADH)
lobular carcinoma in situ (LCIS) |
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Term
| If atypia is found in a core biopsy what is needed? |
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Definition
| a larger sample...cancer is usually next to atypia!!! |
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Term
| What do you never do with a patient that has ADH (atypical ductal hyperplasia) or lobular carcinoma in situ LCIS? |
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Definition
| Give them estrogen. Estrogen feeds these cancers so patients should not even have dietary forms of estrogen like soy or flaxseed. |
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Term
| Which drugs would benefit a patient with atypia or LCIS and why? |
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Definition
| Tamoxifen and Raloxifen because they are estrogen receptor blockers and these tumors need estrogen to grow. |
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Term
| How long does it take breast CA to form? |
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Definition
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Term
| What do you use in a patient with menopausal sx but is at risk for breast CA? |
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Definition
Vagifem for vaginal sx and Effexor is an option for hot flashes.
Patients in general you want to start them at a higher dose to get control of their sx and then taper them down ASAP to get them off estrogens. |
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Term
| Which form of vaginal HRT has a greater systemic uptake of estrogen? |
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Definition
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Term
| Name a common side effect of Tamoxifen. |
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Definition
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Term
| If a patient is at high risk for breast CA b/c of family history, what testing could you send them for? |
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Definition
BRCA 1 and BRCA 2 testing
Mutational risk genes include CHEK2, ATM, BR1P1, PALB2, Cowden syndrome PTEN, Li-Fraumeni syndrome P53 |
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Term
| What familial cancer histories are associated w/increased risks for breast CA? |
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Definition
| Breast, uterine, cervical, ovarian, colorectal, pancreatic, melanoma, prostatic. |
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Term
| List the situations (7) where BRCA testing would be advisable. |
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Definition
1) Breast or ovarian CA in pre-menopause or before 50 in a 1st or 2nd degree relative.
2) 2 or more 1st or 2nd degree relatives w/breast or ovarian CA
3) 1 or more 1*,2*, or 3* relatives w/breast & ovarian CA or 2 seperate or independent breast CA's.
4) Breast and Ovarian CA in same female.
5) Ashkinazi Jewish Heritage
6) Male relative with breast CA
7) 1 or more 1*,2*, or 3* relatives w/BRCA 1 and/or 2 gene mutations. |
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Term
| Weight is a risk factor because fat stores estrogen...T or F? |
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Definition
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Term
| What percent of breast CA is hereditary? |
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Definition
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Term
| Most breast CA's are random in nature without a clear risk profile...T or F? |
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Definition
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Term
| Clinicians are to recommend monthly self breast exams of all their patients regardless of age...T or F? |
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Definition
| False-we no longer promote SBE but rather breast self awareness and yearly clinical breast exams starting at age 20-21. |
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Term
| When should a woman receive her first baseline mammogram if she is asymptomatic and no significant family history? |
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Definition
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Term
| If a patient has a significant family hx of breast CA-1st degree relative w/breast CA dx before age 50..when does she need her first mammogram? |
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Definition
10 years prior to the age at dx of relatives breast CA
Example-Mother diagnosed at age 42
Daughter-Needs 1st mammogram at age 32. |
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Term
| What is the gold standard method of screening? |
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Definition
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Term
| What views are obtained during a mammogram? |
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Definition
| Cephalo-caudil and Medio-Lateral-Oblique |
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Term
| What improvements has digital films made? |
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Definition
Decreased call backs for additional views
Helping detect non-invasive CA better |
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Term
| What is ultrasound used for? |
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Definition
| To diagnose something you can feel, is not generally used to screen. |
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Term
| What non-invasive method is the gold standard for diagnostic? |
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Definition
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Term
| List the pros and cons of MRI |
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Definition
| It is sensitive but not specific so there are lots of false +, which means woman get a biopsy for non-cancer. Use in high risk patients with dense breast tissue and in patients with know breast CA. |
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