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Chapter 89. Breast Cancer

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The woman at greatest risk for developing breast cancer is:

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A. African American aged 53 years with no family history of breast cancer

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B. Canadian Caucasian aged 53 years with grandmother having a history of breast cancer

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C. Ashkenazi Jew aged 53 years who tested negative for BRCA 1 and 2 mutations

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D. Hispanic aged 53 years with a history of atypical hyperplasia and a sister with breast cancer

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E. Asian aged 53 years who had taken oral contraceptives between 20 and 30 years of age

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KA, a 58-year-old partner in a large accounting firm, had an abnormal lesion measuring approximately 1.2 cm detected by mammography biopsied. Pathological review confirmed a diagnosis in invasive breast cancer. Standard testing for receptors indicated ER positive, PR negative, and HER2 (1+ by IHC). The intrinsic subtype of this patient’s breast cancer is:

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A. Luminal A

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B. Luminal B (HER2 negative)

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C. Luminal B (HER2 positive)

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D. HER2 enriched

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E. Basal-like

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Complete workup of KA (previous question) indicated stage 1 breast cancer. With regards to this patient, the primary treatment modality is:

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A. Neoadjuvant therapy

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B. Surgery, sentinel node biopsy, and radiation (if BCS is performed)

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C. Adjuvant tamoxifen alone

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D. Trastuzumab monotherapy

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E. Trastuzumab + chemotherapy

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If adjuvant therapy is indicated in KA (same patient), appropriate systemic treatment could include:

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A. Trastuzumab monotherapy (only) for 12 months

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B. Trastuzumab + lapatinib doublet for 12 months

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C. Surgical castration or LHRH agonist

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D. Cyclophosphamide + doxorubicin for four cycles, followed by trastuzumab for 12 months and anastrozole for 5 years

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E. Anastrozole for 5 years +/- cyclophosphamide/docetaxel for four cycles

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A 36-year-old woman is diagnosed with stage 2, intrinsic subtype HER2-amplified (by FISH) breast cancer. Rational management of the disease in this patient could include:

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A. Pertuzumab + trastuzumab + docetaxel as first-line therapy

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