Devita, Hellman, and Rosenberg's Cancer

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

Chapter 24•Cancer of the Breast 343

Answer 24.15. The answer is B.

DCIS is most common among women ages 49 to 69 years. Several studies

have reported an increased risk of local recurrence in younger women.

Initial studies suggested that MRI can both over- and underestimate the

extent of DCIS and does not improve surgical planning.

Answer 24.16. The answer is D.

The use of RT after BCS for DCIS reduces both invasive and noninvasive

recurrences but does not alter OS.

Answer 24.17. The answer is C.

Subtypes with a more favorable prognosis include breast cancers with

tubular, mucinous, papillary, or cribriform features.

Answer 24.18. The answer is C.

The patient has T2 (tumor size between 2 and 5 cm), N1 (movable ipsi-

lateral level 1 lymph node) M0. T2N1M0 represents stage IIB.

Answer 24.19. The answer is D.

There is not enough evidence in favor or against annual screening MRI in

patients with personal history of breast cancer. The recommendation for

annual screening MRI inBRCAmutation is evidence-based whereas it is

based on expert opinion for previously radiated patients between ages of

10 and 30 and first-degree relatives of Cowden syndrome.

Answer 24.20. The answer is B.

This patient has multiple risk factors for local recurrence, including young

age (<35 to 40 years), close (though not frankly involved) margins, high-

grade histology, and lack of use of systemic therapy.

Answer 24.21. The answer is A.

The absolute contraindications for breast-conserving therapy include

pregnancy, more than one primary in different quadrants, previous radi-

ation to the breast, and persistent margins after a reasonable number of

surgical attempts. Collagen vascular disease, tumor size, and relationship

between the sizes of the tumor and breast are all relative contraindica-

tions.

Answer 24.22. The answer is A.

Although administering chemotherapy in the neoadjuvant setting does

not confer a survival benefit, it may allow breast conservation in patients

who would have otherwise required mastectomy. However, there is a

slightly higher risk of local recurrence in patients who require neoadjuvant

chemotherapy to undergo BCS compared with patients who are initial

candidates for BCS.