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The Call (a brief tour of breast cancer) Family Medicine Review Course 2011 Christian Cable, MD, FACP
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%
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
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