The Call(a brief tour of breast cancer)

Family Medicine Review Course 2011Christian Cable, MD, FACP

The Case

Could the mammogram be wrong?

BI-RADS

0: Incomplete 1: Negative 2: Benign finding(s) 3: Probably benign 4: Suspicious abnormality 5: Highly suggestive of malignancy 6: Known biopsy – proven malignancy

What will happen with the biopsy?

What will be learned from the biopsy?

• Invasive ductal CA confirmed• Estrogen Receptor• Progesterone Receptor• HER-2 Expression• Histologic grade

If it is breast cancer, then what?

• Surgery: primary, reconstructive• Medical Oncology: adjuvant therapy• Radiation Oncology: allows breast

conservation

What are the surgical options?

What will be learned from surgery?

When will I see a medical oncologist?

What is adjuvant therapy?

• anti-estrogen pills (tamoxifen, anastrazole)• chemotherapy• trastuzamab (monoclonal ab to HER2)

How will I know if I need it?

ER+, LN-

• Low recurrence score: 50%• High recurrence score: 25%

• Intermediate recurrence score: 25%

Adjuvant Therapy

Side effects?

• anti-estrogen pills (tamoxifen, anastrazole)• chemotherapy• trastuzamab (monoclonal ab to HER2)

How much good will it do?(absolute survival benefit at 15 yrs)

• tamoxifen: 9%• chemo (women under 50): 10%• chemo (women 50-59): 3%

What about radiation?

Allows Breast Conservation

• whole breast (traditional)• partial breast

Survivorship