The Call (a brief tour of breast cancer)
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The Call(a brief tour of breast cancer)
Family Medicine Review Course 2011Christian Cable, MD, FACP
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The Case
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Could the mammogram be wrong?
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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
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What will happen with the biopsy?
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What will be learned from the biopsy?
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• Invasive ductal CA confirmed• Estrogen Receptor• Progesterone Receptor• HER-2 Expression• Histologic grade
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If it is breast cancer, then what?
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• Surgery: primary, reconstructive• Medical Oncology: adjuvant therapy• Radiation Oncology: allows breast
conservation
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What are the surgical options?
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What will be learned from surgery?
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When will I see a medical oncologist?
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What is adjuvant therapy?
• anti-estrogen pills (tamoxifen, anastrazole)• chemotherapy• trastuzamab (monoclonal ab to HER2)
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How will I know if I need it?
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ER+, LN-
• Low recurrence score: 50%• High recurrence score: 25%
• Intermediate recurrence score: 25%
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Adjuvant Therapy
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Side effects?
• anti-estrogen pills (tamoxifen, anastrazole)• chemotherapy• trastuzamab (monoclonal ab to HER2)
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How much good will it do?(absolute survival benefit at 15 yrs)
• tamoxifen: 9%• chemo (women under 50): 10%• chemo (women 50-59): 3%
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What about radiation?
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Allows Breast Conservation
• whole breast (traditional)• partial breast
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Survivorship
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