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Author19 Posts
  #1

A 33-year-old patient presents to you with questions about
breast cancer screening. She began her menses at age 12; she is
gravida 3, para 3; her first pregnancy was at age 22; she breastfed
all of her children for 1 year; and she never took birth control
pills or hormonal replacement therapy. She is concerned
because her mother had breast cancer at age 47 years. There is
no other family history of cancer, including her three sisters,
four maternal aunts, and multiple other family members. What
should you do at this time?

a. Begin annual MRI scans of both breasts.
b. Consider genetic testing to help determine her risk of breast
cancer.
c. Recommend she begin annual screening mammography at
age 37 years.
d. Begin tamoxifen therapy as a preventive step.
e. Recommend bilateral prophylactic mastectomies and
oophrectomies.


  #2

b


  #3

shocked


  #4

shockedgrin

I just took the USMLE practice test yesterday and they had a similar question. The answer was if patient is + for the BRCA gene then do prophylactic oophorectomy. Of course I got that question wrong coz I thought it was overkill.




  #5

yes, that's true

but this is different case and no, answer is not E


  #6

i know. so c then? 10 years younger than age of dx in mom? don't tell me i's dshocked Altho I think I encountered similarQ about tamoxifen as prophylaxisconfused


  #7

answer is C


Current screening recommendations in women with one affected
first-degree relative include beginning annual screening mammography
at an age approximately 10 years younger than the age at diagnosis
for the relative. With only one affected family member, the
presence of an autosomal dominant mutation that increases risk of
cancer is unlikely. MRI scanning is being studied for screening in
high-risk women, but it cannot be routinely recommended at this
time. In this setting, use of tamoxifen for prevention of breast cancer
is highly controversial. Bilateral radical mastectomies and oophrectomies
are relatively radical therapies, typically considered only in
women at extremely high risk for development of cancer, such as
women who have a gene mutation.


  #8

"With only one affected family member, the
presence of an autosomal dominant mutation that increases risk of
cancer is unlikely."

This explains it. Thanks! smiling face


  #9

when do we use tamoxifen??


  #10

www.cancer.gov/cancertopics...sheet/therapy/tamoxifen#q1


  #11

thnx avir....smiling face
it says...'taking tamoxifen for at least 5 years can prevent breast cancer in women who have never been diagnosed with breast cancer but who are at increased risk of developing the disease'

so this lady can be given tamoxifen...right?( she is finish with her family life also)
and for prevention of breast ca in high risk female, when should she start taking tamoxifen??


  #12

Hi Tanha. I remember encountering a question about Tamoxifen used as prophylaxis. I just can't remember whereconfused But I think in this case we can start the screening with mammography starting at 37 yrs old. Tamoxifen can be used for high-risk women (what entails high risk?rolling eyes Having more than one first degree relative and + BRCA gene?).


Edited by drlilac on Jul 05, 2009 - 2:53 PM

  #13

okkki...thnx drlilac


  #14

Tamoxifen is approved for prevention, theoretically
but patient must meet some criteria

here are 2009 guidelines for Tamoxi and Raloxi


http://jco.ascopubs.org/cgi/reprint/JCO.2008.20.5179v1







  #15

thnx avir.....
so it says...we can give tamoxi to any high risk premenopausal female , 35 to 50 years of age..(who are unlikely to experience VTE/Uterine cancer..)
dose 20 mg/day for 5 yrs ..decrease risk of cancer for 8least 10 years..


smthing new i learnt 2day..wink


  #16

Hi Tanha. I haven't read the article yet. Does it say what entails a high risk patient?


  #17

hi drlilac..it says....

""In women with a strong family history of breast cancer (ie, families
with two or more first- or second-degree relatives from the same
side of the family, one or more first- or second-degree relatives
younger than age 50 years diagnosed with breast cancer""


  #18

Uh-oh. One or more first deg relative diagnosed before 50. Her mom was diagnosed at 47confused She's high-risk. So technically we can use Tamoxifen but I don't think the boards will expect us to know thisrolling eyes So I think we can start mammogram at age 37 then start Tamoxifen. How's that?grin


  #19

nodnod agree ...smiling face





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