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

2. The Case

4. Could the mammogram be wrong?

5. 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

6. What will happen with the biopsy?

7. What will be learned from the biopsy?

8. Invasive ductal CA confirmed Estrogen Receptor Progesterone Receptor HER-2 Expression Histologic grade

9. If it is breast cancer, then what?

10. Surgery: primary, reconstructive Medical Oncology: adjuvant therapy Radiation Oncology: allows breast conservation

11. What are the surgical options?

18. What will be learned from surgery?

19. When will I see a medical oncologist?

20. What is adjuvant therapy? anti-estrogen pills (tamoxifen, anastrazole) chemotherapy trastuzamab (monoclonal ab to HER2)

21. How will I know if I need it?

23. ER+, LN- Low recurrence score: 50% High recurrence score: 25% Intermediate recurrence score: 25%

26. Adjuvant Therapy

27. Side effects? anti-estrogen pills (tamoxifen, anastrazole) chemotherapy trastuzamab (monoclonal ab to HER2)

28. How much good will it do? (absolute survival benefit at 15 yrs) tamoxifen: 9% chemo (women under 50): 10% chemo (women 50-59): 3%

29. What about radiation?

30. Allows Breast Conservation whole breast (traditional) partial breast

34. Survivorship