Answer: The two basic options are lumpectomy with axillary dissection and radiation or modified radical mastectomy. Lumpectomy/radiotherapy is used if cosmesis is important, complete excision is possible, and > 6000 rads can be delivered to the tumor bed. Modified radical mastectomy is used if cosmesis is unimportant, lesion size is large relative to breast size, [...]

Answer: Estrogen or progesterone receptors negative Positive HER-2/neu status Premenopausal patient Large tumor size Positive axillary nodes Local skin involvement Fixed axillary nodes Distant metastasis Aneuploidy and high cathepsin D Nuclear grade 3 (poor) High S-phase fraction Reference: Casciato DA, Lowitz BB (eds): Manual of Clinical Oncology, 5th ed. Boston, Little, Brown, 2000.

Answer: Factors associated with a 1.2- to 1.5-fold increase in risk include the following: Early menarche or late menopause Oral estrogens History of cancer of the ovary, uterus, or colon Alcoholic beverages (?) Obesity Reference: Tannock IF, Hill RP (eds): The Basic Science of Oncology, 3rd ed. New York, McGraw-Hill, 1998.

Answer: The primary care physician must identify high-risk patients who may have a mutation in a dominant breast cancer susceptibility gene. Such families have a history of breast or ovarian cancer in as many as half of all female relatives, with early age of onset and/or bilateral or multifocal disease. These patients have been shown [...]

Answer: There are currently several sets of recommendations from the various specialty organizations whose members are engaged in breast cancer screening RECOMMENDED FREQUENCY OF SCREENING FOR BREAST CANCER AGE > 50 AGE < 50 Organization Mammogram Breast Exam Mammogram Breast Exam ACS Annual Annual Age 40-49, annual Age 20-39, every 3 yr Age 40-49, annual [...]

Answer: Factors associated with a threefold or more increase in risk include the following: Age > 40 yr Previous cancer in one breast Breast cancer in a first- or second-degree family member History of multiple breast biopsies Parity: nulliparous, or first pregnancy after age 31 years Lobular carcinoma in situ Gene mutations: BRCA1, BRCA2, hMSH2, [...]

Answer: By tissue examination. This may be done by percutaneous fine-needle aspirate, with or without x-ray direction, or by incisional or excisional biopsy. While mammograms are essential in screening and localizing tumors, up to 15% of breast cancers may not be seen on mammogram, and the diagnosis cannot be made definitively without tissue confirmation. Any [...]