The Call (a brief tour of breast cancer)

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