Breast Conference 7/13/2011

RC AAF presenting with abnormal mammogram

RC Menarche: 12 y G1P1 (40y), breastfeeding: none OCP: none HRT: none Premenopausal Hx breast bx: none Hx breast Ca: none Fhx: aunt – breast ca, father – prostate ca, grandmother – colon ca Shx: caffeine(-), soy(-), tobacco(-), ETOH(-) Bra: 40DD

RC PMH: none PSH: none Meds: Lorazepam NKDA

RC PE: –Right breast: no masses, no skin changes –Left breast: hard mass 12:00, diameter 2cm –Left axillary lymphadenopathy

RC Radiology: –Screening mammogram: lt. breast asymmetry, enlarged LN –Diagnostic mammogram: lt. breast nodular densities, enlarged LN – US: lt. breast 0.9*0.8*0.8cm lesion, 1.9*1.1*1.5cm axillary LN –MRI: lt. breast 11-12:00, 1.1*2.2*1.1cm lesion, axillary adenopathy –PET/CT: lt. breast and axillary hypermetabolic activity

RC

RC Pathology: –Breast lesion: Invasive Ductal Carcinoma, grade 3 ER(-) PR(-), HER2(+1) –Axillary lesion: metastatic Ductal Carcinoma

RC Clinical stage IIb: T2N1M0

RC

Surgery – lumpectomy + ALND Medical oncology – Radiation oncology – Plastic surgery – Genetics – Psychosocial –

First mention in publication – Oct 2005 Mostly Basal-like carcinoma, but also Claudin low and Normal-like Basal-like: triple negative + CK5 or EGFR

15% of invasive Breast Carcinoma High grade, larger More likely to be node negative Young, African American and Hispanic women Earlier menarche, higher BMI, higher parity, lower duration of breast feeding Adverse prognosis Distant relapse is uncommon after 3-5 years from diagnosis

Breast tumors are heterogeneous Cells of origin of different tumors correspond with normal mammary cells in the differentiation path Triple Negative tumors possess phenotypic characteristics of mammary stem cells Basal-like carcinoma probably arises from luminal progenitor cells, which express both luminal and basal markers

Visvader, 2009

>75% of tumors in BRCA1 pts are Triple Negative, Basal-like or both Tumors in women with BRCA1 mutation have similarities in morphology and gene expression with Basal-like cancer

Rapid growth Over-represented in woman with interval cancers More likely to recur locally than ER+ cancer

Treatment: –Patients do not benefit from endocrine therapy –No specific chemotherapy –Use of targeted agents is investigated – bevacizumab, cetuximab, PARP inhibitors

Multidisciplinary Breast Cancer Conference Laleh Amiri

Case CB 48 y/o f. 1/18/2011 screening mgm : calcifications in both breasts + a mass in the L breast. 4/5/2011 diagnostic mgm & US with comparison to old films: 2 new clusters of calcifications in the LUI & 10:00 + cyst. 5/6/11 stereotactic bxs :sclerosing adenosis and calcifications + focal atypical lobular hyperplasia in 3:00 bx site. 6/21/11 excisional biopsy: focal ALH.

All: Gluten Med: MVI PMH: h/o depression. vitamin D deficiency. PSH: Cholecystectomy, rhinoplasty, hemorrhoidectomy GynHx:G1P1, first 1st menstrual period:13, OCP <1y, LMP 6/23/11. FHx: PGM BC 60s. 1 st cousin with mBC 40s. SoHx: Born in Ireland. Married,8 y/o son. lives in Rockville. works for FDA. Drinks rarely. Never tob. ROS: negative Ph/EX: negative

Questions Does she really have ALH? Was excisional biopsy necessary? What is her risk for developing IDC? Management of ALH? Role of MRI for screening?

Questions Does she really have ALH? Was excisional biopsy necessary? What is her risk for developing IDC? Management of ALH? Role of MRI for screening?

Breast J Jan-Feb;13(1):55-61.

Questions Does she really have ALH? Was excisional biopsy necessary? What is her risk for developing IDC? Management of ALH? Role of MRI for screening?

Questions Does she really have ALH? Was excisional biopsy necessary? What is her risk for developing IDC? Management of ALH in premenopausal woman? Role of MRI for screening?

NSABP P1 Fisher J Natl Cancer Inst, 2005

NSABP P1 Fisher J Natl Cancer Inst, 2005

Benefits and risks associated with tamoxifen use for breast cancer risk Reduction. NSABP P1

Fisher J Natl Cancer Inst, 2005

Questions Does she really have ALH? Was excisional biopsy necessary? What is her risk for developing IDC? Management of ALH? Role of MRI for screening?

American Cancer Society Guidelines CA Cancer J Clin 2007;57:75– 89

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