Devita, Hellman, and Rosenberg's Cancer

LWBK1006-24 LWW-Govindan-Review December 12, 2011 19:15

342 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

abnormal mammograms was apparent at 1 year. Hormone replacement

therapy users were more likely to have nodal involvement or distant

metastases at diagnosis.

Answer 24.9. The answer is B.

Hormonal risk factors typically have relative risks of less than 2. Mam-

mographic breast density is an underappreciated risk factor with a relative

risk of 2 to 4. Factors associated with a relative risk more than 4 include

atypical hyperplasia, LCIS, BRCA1, or BRCA2 mutation and radiation

exposure before age 40 years.

Answer 24.10. The answer is B.

American Society of Clinical Oncology guidelines for MR screening were

revised in 2007. Current evidence supports screening MR in patients with

a known BRCA mutation, untested first-degree relatives of BRCA muta-

tion carriers, or patients with an estimated 20% to 25% lifetime risk

of breast cancer (e.g., someone who received mantle radiation at age

16 years). There is currently insufficient evidence to recommend for or

against MR screening for patients with a personal history of breast cancer.

Answer 24.11. The answer is D.

The Gail model estimates a woman’s risk of developing breast cancer

on the basis of age at menarche, age at first live birth, number of pre-

vious breast biopsies and presence of atypia, and the number of first-

degree female relatives with breast cancer. It may underestimate the risk

in women with a strong family history because it does not include second-

degree relatives, men with breast cancer, or relatives with ovarian cancer.

Answer 24.12. The answer is B.

In the P1 trial, tamoxifen reduced the risk of breast cancer by 84% in

patients with atypical hyperplasia. Although raloxifene provided simi-

lar benefits with a more favorable safety profile than tamoxifen in the

STAR trial, this trial only included postmenopausal women. Oophorec-

tomy before menopause decreases the risk of breast cancer by 50% to

65% depending on age at the time of surgery. Although bilateral mas-

tectomy decreases the risk by more than 90%, the risk is not completely

eliminated.

Answer 24.13. The answer is C.

If cytopathologist expertise is available, FNA can reliably diagnosis cancer

but cannot distinguish DCIS from invasive disease. The false-negative rate

is 5% to 10% for FNA but less than 4% for core biopsy. In a prospective

study of 1550 patients undergoing biopsy for mammographic abnormal-

ities, core biopsy reduced the number of surgical procedures.

Answer 24.14. The answer is A.

Ductal hyperplasia without atypia (a.k.a. usual type hyperplasia) is not

an indication for surgical biopsy.