breastCancer.json

{"intents": [{"tags": "breast cancer", "patterns": ["what is breast cancer", "what precisely is breast cancer", "define breast cancer", "explain breast cancer"], "responses": "Breast cancer is a malignant tumor that develops from the cells of the breast. It is the most common type of cancer among women in the World. It is most often curable when found early.About 80% of breast cancers start in the ducts.For more information https://www.medscape.com/answers/1947145-155238/what-is-breast-cancer"}, {"tags": "signs symptoms", "patterns": ["what are the signs and symptoms of breast cancer", "what are the indications of breast cancer", "what are the breast cancer signs and symptoms", "what breast cancer symptoms and signs are present"], "responses": "Early breast cancers may be asymptomatic, and pain and discomfort are typically not present. If a lump is discovered, the following may indicate the possible presence of breast cancer:  Change in breast size or shape, Skin dimpling or skin changes, Recent nipple inversion or skin change, or nipple abnormalities, Single-duct discharge, particularly if blood-stained, Axillary lumpFor more information https://www.medscape.com/answers/1947145-155239/what-are-the-signs-and-symptoms-of-breast-cancer"}, {"tags": "evaluation", "patterns": ["what is included in the evaluation of breast cancer", "what is included in a breast cancer evaluation", "what is considered in the assessment of breast cancer", "what aspects of breast cancer are evaluated"], "responses": "Evaluation of breast cancer includes the following:\r\n\r\nClinical examination\r\nImaging\r\nNeedle biopsyFor more information https://www.medscape.com/answers/1947145-155240/what-is-included-in-the-evaluation-of-breast-cancer"}, {"tags": "indicative indicators", "patterns": ["which physical findings suggest breast cancer", "which physical signs point to breast cancer", "which physical signs are indicative of breast cancer", "which physical indicators point to breast cancer"], "responses": "The following physical findings should raise concern:\r\n\r\nLump or contour change\r\nSkin tethering\r\nNipple inversion\r\nDilated veins\r\nUlceration\r\nPaget disease\r\nEdema or peau d\u2019orangeFor more information https://www.medscape.com/answers/1947145-155241/which-physical-findings-suggest-breast-cancer"}, {"tags": "lump palpable", "patterns": ["what features of a palpable lump suggest breast cancer", "what is lump", "what characteristics of a palpable lump indicate breast cancer", "what characteristics of a palpable lump signify breast cancer"], "responses": "If a palpable lump is found and possesses any of the following features, breast cancer may be present:\n\nHardness\nIrregularity\nFocal nodularity\nFixation to skin or muscleFor more information https://www.medscape.com/answers/1947145-155242/what-features-of-a-palpable-lump-suggest-breast-cancer"}, {"tags": "screening", "patterns": ["how is breast cancer screening performed", "how is breast cancer screening carried out", "what is the procedure for screening for breast cancer", "how is breast cancer screening done", "how are breast cancer exams conducted"], "responses": "Early detection remains the primary defense in preventing breast cancer. Screening modalities include the following:\n\nBreast self-examination\nClinical breast examination\nMammography\nUltrasonography\nMagnetic resonance imagingFor more information https://www.medscape.com/answers/1947145-155243/how-is-breast-cancer-screening-performed"}, {"tags": "biopsy diagnosis", "patterns": ["what is the role of biopsy in the workup of breast cancer", "what function does a biopsy have in the diagnosis of breast cancer", "what role does a biopsy play in the treatment of breast cancer", "what part does a breast cancer biopsy play in the treatment plan"], "responses": "Core biopsy with image guidance is the recommended diagnostic approach for newly diagnosed breast cancers. This is a method for obtaining breast tissue without surgery and can eliminate the need for additional surgeries. Open excisional biopsy is the surgical removal of the entire lump.For more information https://www.medscape.com/answers/1947145-155244/what-is-the-role-of-biopsy-in-the-workup-of-breast-cancer"}, {"tags": "treatment ", "patterns": ["how is breast cancer treated", "what is the treatment for breast cancer", "what are the treatment options for breast cancer", "in what ways is breast cancer treated"], "responses": "Surgery and radiation therapy, along with adjuvant hormone or chemotherapy when indicated, are considered primary treatment. Surgical therapy may consist of lumpectomy or total mastectomy. Radiation therapy may follow surgery in an effort to eradicate residual disease while reducing recurrence rates. There are 2 general approaches for delivering radiation therapy: External-beam radiotherapy (EBRT), Partial-breast irradiation (PBI).For more information https://www.medscape.com/answers/1947145-155245/how-is-breast-cancer-treated"}, {"tags": "chemotherapy regimens", "patterns": ["what are the chemotherapy regimens used to treat breast cancer", "what chemotherapy regimens are used to treat breast cancer", "what are the breast cancer chemotherapy regimens", "what chemotherapy protocols are used to treat breast cancer"], "responses": "Hormone therapy and chemotherapy are the 2 main interventions for treating metastatic breast cancer. Common chemotherapeutic regimens include the following:\r\n\r\nDocetaxel\r\nCyclophosphamide\r\nDoxorubicin\r\nCarboplatin\r\nMethotrexate\r\nTrastuzumabFor more information https://www.medscape.com/answers/1947145-155246/what-are-the-chemotherapy-regimens-used-to-treat-breast-cancer"}, {"tags": "medicine medication", "patterns": ["what is the role of drug treatment for breast cancer", "what is the role of breast cancer medicine treatment", "what function does medication treatment play in breast cancer treatment", "what part does medication play in breast cancer treatment"], "responses": "In patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation.For more information https://www.medscape.com/answers/1947145-155247/what-is-the-role-of-drug-treatment-for-breast-cancer"}, {"tags": "fundamentals", "patterns": ["what are basic facts about breast cancer", "what are the fundamentals of breast cancer", "basic information about breast cancer"], "responses": "Many early breast carcinomas are asymptomatic; pain or discomfort is not usually a symptom of breast cancer. Breast cancer is often first detected as an abnormality on a mammogram before it is felt by the patient or healthcare provider.For more information https://www.medscape.com/answers/1947145-155248/what-are-basic-facts-about-breast-cancer"}, {"tags": "anatomy ", "patterns": ["what is the anatomy relevant to breast cancer", "why is anatomy important in relation to breast cancer", "what is the anatomy of breast cancer", "how does anatomy relate to breast cancer"], "responses": "The breasts of an adult woman are milk-producing glands on the front of the chest wall. They rest on the pectoralis major and are supported by and attached to the front of the chest wall on either side of the sternum by ligaments. Each breast contains 15-20 lobes arranged in a circular fashion. For more information, visit: For more information https://www.medscape.com/answers/1947145-155249/what-is-the-anatomy-relevant-to-breast-cancer"}, {"tags": "physiologically pathophysiology ", "patterns": ["what is the pathophysiology of breast cancer", "in what ways does breast cancer develop physiologically", "the pathophysiology of breast cancer is what"], "responses": "The current understanding of breast cancer etiopathogenesis is that invasive cancers arise through a series of molecular alterations at the cell level. These alterations result in breast epithelial cells with immortal features and uncontrolled growth.For more information https://www.medscape.com/answers/1947145-155250/what-is-the-pathophysiology-of-breast-cancer"}, {"tags": "classified categorized", "patterns": ["how is breast cancer categorized", "how is breast cancer classified"], "responses": "various types of breast cancers:\r\nInfiltrating ductal carcinoma is the most commonly diagnosed breast tumor and has a tendency to metastasize via lymphatics.For more information https://www.medscape.com/answers/1947145-155251/how-is-breast-cancer-categorized"}, {"tags": "types found ", "patterns": ["what are the types of breast cancer", "what are the different forms of breast cancer", "what types of breast cancer exist", "what kinds of cancer are found in the breast"], "responses": "The normal breast consists of three main components: the lobules (milk-producing glands), the ducts (thin tubes that connect the lobules to the nipple) and the stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels)For more information https://www.medscape.com/answers/1947145-155252/what-are-the-types-of-breast-cancer"}, {"tags": "exactly develop causes", "patterns": ["what causes breast cancer", "what exactly causes breast cancer", "why do breast cancers develop"], "responses": "Breast cancer develops as a result of genetic mutations or damage to DNA. These can be associated withTrusted Source exposure to estrogen, inherited genetic defects, or inherited genes that can cause cancer, such as the BRCA1 and BRCA2 genes.For more information https://www.medscape.com/answers/1947145-155253/what-causes-breast-cancer"}, {"tags": "ageing genesis age", "patterns": ["what is the role of age in the etiology of breast cancer", "what role does ageing play in the genesis of breast cancer", "what impact does ageing play in the development of breast cancer", "how does age factor into the causes of breast cancer"], "responses": "Increasing age and female sex are established risk factors for breast cancer. Sporadic breast cancer is relatively uncommon among women younger than 40 years but increases significantly thereafter. The effect of age on risk is illustrated in the SEER (Surveillance, Epidemiology and End Results) data, where the incidence of invasive breast cancer for women younger than 50 years is 44.0 per 100,000 as compared with 345 per 100,000 for women aged 50 years or older.For more information https://www.medscape.com/answers/1947145-155254/what-is-the-role-of-age-in-the-etiology-of-breast-cancer"}, {"tags": "family history", "patterns": ["what is the role of family history in the etiology of breast cancer", "what role does family history play in the genesis of breast cancer", "what is the significance of family history in the genesis of breast cancer", "how does a family history of breast cancer affect its aetiology"], "responses": "A positive family history of breast cancer is the most widely recognized risk factor for breast cancer. The lifetime risk is up to 4 times higher if a mother and sister are affected, and it is about 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is also greater among women with breast cancer in a single first-degree relative, particularly if the relative was diagnosed at an early age (\u226450 yearsFor more information https://www.medscape.com/answers/1947145-155255/what-is-the-role-of-family-history-in-the-etiology-of-breast-cancer"}, {"tags": "enhance risk ", "patterns": ["which family history factors increase the risk for breast cancer", "which family history characteristics are associated with an increased risk of breast cancer", "which family history factors enhance the risk of breast cancer"], "responses": "The family history characteristics that suggest increased risk of cancer are summarized as follows:\r\n\r\nTwo or more relatives with breast or ovarian cancer\r\nBreast cancer occurring in an affected relative younger than 50 years\r\nRelatives with both breast cancer and ovarian cancerFor more information https://www.medscape.com/answers/1947145-155256/which-family-history-factors-increase-the-risk-for-breast-cancer"}, {"tags": "history assessed", "patterns": ["how is family history\u2013based risk for breast cancer assessed", "how is the risk of breast cancer based on a family history determined", "how is family history-based breast cancer risk evaluated"], "responses": "a number of family history\u2013based risk assessment tools have been developed for clinical use, including the following:\r\n\r\nBRCAPRO\r\nCouch\r\nMyriad I and II\r\nOntario Family History Assessment Tool (FHAT)\r\nManchesterFor more information https://www.medscape.com/answers/1947145-155257/how-is-family-historybased-risk-for-breast-cancer-assessed"}, {"tags": "reproductive ", "patterns": ["what is the role of reproductive factors in the etiology of breast cancer", "what role do reproductive variables have in the development of breast cancer", "how do reproductive variables contribute to the development of breast cancer"], "responses": "Reproductive factors and steroid hormones\r\nLate age at first pregnancy, nulliparity, early onset of menses, and late age of menopause have all been consistently associated with an increased risk of breast cancer. Prolonged exposure to elevated levels of sex hormones has long been postulated as a risk factor for developing breast cancer, explaining the association between breast cancer and reproductive behaviors.For more information https://www.medscape.com/answers/1947145-155258/what-is-the-role-of-reproductive-factors-in-the-etiology-of-breast-cancer"}, {"tags": "estradiol", "patterns": ["what is the role of estradiol in the etiology of breast cancer", "what function does estradiol play in the genesis of breast cancer", "which part of the breast cancer aetiology does estradiol play"], "responses": "Clinical trials of secondary prevention in women with breast cancer have demonstrated the protective effect of selective estrogen receptor modulators (SERMs) and aromatase inhibitors on recurrence and the development of contralateral breast cancers.  Use of SERMs in women at increased risk for breast cancer has prevented invasive ER-positive cancers.  These data support estradiol and its receptor as a primary target for risk reduction but do not establish that circulating hormone levels predict increase risk.For more information https://www.medscape.com/answers/1947145-155259/what-is-the-role-of-estradiol-in-the-etiology-of-breast-cancer"}, {"tags": "oral contraceptives OCs", "patterns": ["what is the role of oral contraceptives (ocs) in the etiology of breast cancer", "what role do oral contraceptives (ocs) have in the development of breast cancer", "what part does the aetiology of breast cancer play for oral contraceptives (ocs)"], "responses": "One of the most widely studied factors in breast cancer etiology is the use of exogenous hormones in the form of oral contraceptives (OCs) and hormone replacement therapy (HRT).  The overall evidence suggests an approximately 25% greater risk of breast cancer among current users of OCs. The risk appears to decrease with age and time since OC discontinuance. For OC users, risk returns to that of the average population risk about 10 years after cessation.For more information https://www.medscape.com/answers/1947145-155260/what-is-the-role-of-oral-contraceptives-ocs-in-the-etiology-of-breast-cancer"}, {"tags": "hormone replacement therapy HRT", "patterns": ["what is the role of hormone replacement therapy (hrt) in the etiology of breast cancer", "what role does hormone replacement therapy (hrt) play in the development of breast cancer", "how does hormone replacement therapy (hrt) factor into the causes of breast cancer"], "responses": "Data obtained from case-control and prospective cohort settings support an increased risk of breast cancer incidence and mortality with the use of postmenopausal HRT. Increased risk of breast cancer has been positively associated with length of exposure, with the greatest risk being observed for hormonally responsive lobular, mixed ductal-lobular, and tubular cancers. Risk is greater among women taking combination HRT than among those taking estrogen-only formulations.For more information https://www.medscape.com/answers/1947145-155261/what-is-the-role-of-hormone-replacement-therapy-hrt-in-the-etiology-of-breast-cancer"}, {"tags": "cancer-prone HRT women", "patterns": ["what are guidelines for hrt in women at high risk of breast cancer", "what standards apply to hrt for breast cancer-prone women", "what recommendations are there for hrt in breast cancer-prone women"], "responses": "There are currently no formal guidelines for the use of HRT in women at high risk for breast cancer (ie, women with a family history of breast cancer, a personal history of breast cancer, or benign breast disease).For more information https://www.medscape.com/answers/1947145-155262/what-are-guidelines-for-hrt-in-women-at-high-risk-of-breast-cancer"}, {"tags": "menopausal", "patterns": ["how should menopausal symptoms be treated in women at high risk of breast cancer", "how should menopausal symptoms be managed in breast cancer-prone women", "treatment options for menopausal symptoms in breast cancer-prone women"], "responses": "Many new treatments for menopausal symptoms have been suggested (eg, clonidine, venlafaxine, gabapentin, and combination venlafaxine plus gabapentin). To date, no randomized clinical trials among women at increased risk of breast cancer or women with a history of breast cancer have assessed the overall efficacy or risks associated with these treatments. Use of these agents is controversial and should target the severity of menopausal symptoms.For more information https://www.medscape.com/answers/1947145-155263/how-should-menopausal-symptoms-be-treated-in-women-at-high-risk-of-breast-cancer"}, {"tags": "historical factors", "patterns": ["which history findings increase the risk for a second primary breast cancer occurrence", "which historical factors enhance the likelihood of a second primary breast cancer occurrence", "what aspects of your medical history put you at risk for developing primary breast cancer again"], "responses": "A history of breast cancer is associated with a 3- to 4-fold increased risk of a second primary cancer in the contralateral breast.  The presence of any premalignant ductal carcinoma in situ (DCIS) or LCIS confers an 8- to 10-fold increase in the risk of developing breast cancer in women who harbor untreated preinvasive lesions. For more information https://www.medscape.com/answers/1947145-155264/which-history-findings-increase-the-risk-for-a-second-primary-breast-cancer-occurrence"}, {"tags": "lifestyle factors", "patterns": ["what is the role of lifestyle factors in the etiology of breast cancer", "the aetiology of breast cancer: what part do lifestyle variables play", "what role do lifestyle variables play in the genesis of breast cancer"], "responses": "As with cancers of the colon and prostate, diets that are rich in grains, fruits, and vegetables; low in saturated fats; low in energy (calories); and low in alcohol\u2014the more common pattern in less industrialized countries\u2014are thought to be protective against breast cancer. For more information https://www.medscape.com/answers/1947145-155265/what-is-the-role-of-lifestyle-factors-in-the-etiology-of-breast-cancer"}, {"tags": "obesity etiology", "patterns": ["what is the role of obesity in the etiology of breast cancer", "how does obesity factor into the causes of breast cancer"], "responses": "Increased risk of postmenopausal breast cancer has been consistently associated with the following:\n\nAdult weight gain of 20-25 kg above body weight at age 18.\nWestern dietary pattern (high energy content in the form of animal fats and refined carbohydrates)\nSedentary lifestyle\nRegular, moderate consumption of alcohol (3-5 alcoholic beverages per week)For more information https://www.medscape.com/answers/1947145-155266/what-is-the-role-of-obesity-in-the-etiology-of-breast-cancer"}, {"tags": "traits Western", "patterns": ["which western lifestyle factors increase the risk for breast cancer", "what aspects of western lifestyle contribute to breast cancer risk", "which western lifestyle traits raise the risk of breast cancer"], "responses": "The Western lifestyle (ie, chronic excess energy intake from meat, fat, and carbohydrates and lack of exercise) strongly correlates with development of the following:\r\n\r\nObesity, particularly abdominal obesity\r\nChronic hyperinsulinemiaFor more information https://www.medscape.com/answers/1947145-155267/which-western-lifestyle-factors-increase-the-risk-for-breast-cancer"}, {"tags": "environmental factors", "patterns": ["which environmental factors increase the risk for breast cancer", "which environmental factors are associated with an increased risk of breast cancer", "what external factors raise the chance of breast cancer"], "responses": "A number of environmental exposures have been investigated in relation to breast cancer risk in humans, including the following :\nTobacco smoke (both active and passive exposure)\nDietary (eg, charred and processed meats)\nAlcohol consumption\nEnvironmental carcinogens (eg, exposure to pesticides, radiation, and environmental and dietary estrogens)For more information https://www.medscape.com/answers/1947145-155268/which-environmental-factors-increase-the-risk-for-breast-cancer"}, {"tags": "common worldwide prevalence", "patterns": ["what is the global prevalence of breast cancer", "how common is breast cancer worldwide", "how common is breast cancer on a worldwide scale"], "responses": "The final decades of the 20th century saw worldwide increases in the incidence of breast cancer, with the highest rates reported in Westernized countries. Reasons for this trend are largely attributed to introduction of screening mammography. Changes in reproductive patterns\u2014particularly fewer children and later age at first birth\u2014may also have played a role, as may changes in lifestyle factors, including the following:\r\n\r\nWestern dietary patterns\r\nDecreased physical activity\r\nRising obesity ratesFor more information https://www.medscape.com/answers/1947145-155272/what-is-the-global-prevalence-of-breast-cancer"}, {"tags": "age incidence ", "patterns": ["which age groups have the highest prevalence of breast cancer", "which age groups are most likely to develop breast cancer", "what age ranges have the highest incidence of breast cancer"], "responses": "The incidence rate of breast cancer increases with age, from 1.5 cases per 100,000 in women 20-24 years of age to a peak of 421.3 cases per 100,000 in women 75-79 years of age; 95% of new cases occur in women aged 40 years or older. The median age of women at the time of breast cancer diagnosis is 62 years.For more information https://www.medscape.com/answers/1947145-155273/which-age-groups-have-the-highest-prevalence-of-breast-cancer"}, {"tags": "racial predilections phenotypic", "patterns": ["what are the racial predilections of breast cancer", "what are the phenotypic traits of breast cancer", "what are the racial differences in breast cancer", "what racial characteristics are associated with breast cancer"], "responses": "According to the Cancer Society (CS), breast cancer rates per 100,000 among women from various racial and ethnic groups are as follows  :\n\nNon-Hispanic White: 128.7\nNon-Hispanic Black: 125.5\nAmerican Indian/Alaskan Native: 100.7\nHispanic/Latina: 91.9\nAsian/Pacific Islander: 90.7For more information https://www.medscape.com/answers/1947145-155274/what-are-the-racial-predilections-of-breast-cancer"}, {"tags": "mortality rates", "patterns": ["how do the mortality rates for breast cancer vary among racial and ethnic groups", "how do breast cancer death rates differ by race and ethnicity", "what racial and ethnic differences exist in breast cancer death rates"], "responses": "Among world women from 2006 through 2015, breast cancer death rates declined annually by 2.6% in American Indians/Alaskan Natives, 1.8% in non-Hispanic whites, NHWs, 1.5% in non-Hispanic blacks, 1.4% in Hispanics, and 0.9% in Asians/Pacific islanders.  Breast cancer death rates in black women began to exceed those in white women in the early 1980s, and the disparity remains large; in 2015, breast cancer death rates were 39% higher in black women than white womenFor more information https://www.medscape.com/answers/1947145-155275/how-do-the-mortality-rates-for-breast-cancer-vary-among-racial-and-ethnic-groups"}, {"tags": "prognosis", "patterns": ["what is the prognosis of breast cancer", "what is the outlook for breast cancer", "how likely is breast cancer to spread"], "responses": "The decrease in breast cancer death rates is thought to represent progress in both earlier detection and improved treatment modalities.The 2021 estimates are 44,130 expected breast cancer deaths (43,600 in women, 530 in men).For more information https://www.medscape.com/answers/1947145-155276/what-is-the-prognosis-of-breast-cancer"}, {"tags": "prognostic predictive", "patterns": ["what are the prognostic and predictive factors for breast cancer", "what are the breast cancer prognostic and predictive factors", "what are the risk factors and prognosis variables for breast cancer"], "responses": "Numerous prognostic and predictive factors for breast cancer have been identified by the College of American Pathologists (CAP) to guide the clinical management of women with breast cancer. Breast cancer prognostic factors include the following:\r\n\r\nAxillary lymph node status\r\nTumor size\r\nLymphatic/vascular invasion\r\nPatient age\r\nHistologic gradeFor more information https://www.medscape.com/answers/1947145-155277/what-are-the-prognostic-and-predictive-factors-for-breast-cancer"}, {"tags": "chances survival rates", "patterns": ["what are the survival rates for breast cancer", "what are the chances of surviving breast cancer", "how many people with breast cancer survive"], "responses": "Patients with node-negative disease have an overall 10-year survival rate of 70% and a 5-year recurrence rate of 19%. In patients with lymph nodes that are positive for cancer, the recurrence rates at 5 years are as follows:\r\n\r\nOne to three positive nodes \u2013 30-40%\r\nFour to nine positive nodes \u2013 44-70%\r\n\u226510 positive nodes \u2013 72-82%For more information https://www.medscape.com/answers/1947145-155278/what-are-the-survival-rates-for-breast-cancer"}, {"tags": "HER2-targeted therapies", "patterns": ["what is the prognosis of breast cancer following her2-targeted therapies", "what is the prognosis of breast cancer after her2-targeted therapies", "what is the outlook for breast cancer after her2-targeted therapies", "outlook for breast cancer patients after her2-targeted therapies"], "responses": "In the past, HER2 overexpression was associated with a more aggressive tumor phenotype and a worse prognosis (higher recurrence rate and increased mortality), independent of other clinical features (eg, age, stage, and tumor grade), especially in patients who did not receive adjuvant chemotherapy. Prognosis has improved with the routine use of HER2-targeted therapies, which consist of the following:\r\n\r\nTrastuzumab \u2013 Monoclonal antibody\r\nPertuzumab \u2013 Monoclonal antibody\r\nLapatinib \u2013 A small-molecule oral tyrosine kinase inhibitorFor more information https://www.medscape.com/answers/1947145-155279/what-is-the-prognosis-of-breast-cancer-following-her2-targeted-therapies"}, {"tags": "DCIS ", "patterns": ["what is the prognosis of dcis breast cancer", "what is the outlook for dcis breast cancer", "how does dcis breast cancer fare", "how likely is breast cancer with dcis to progress"], "responses": "DCIS is divided into comedo (ie, cribriform, micropapillary, and solid) and noncomedo subtypes, a division that provides additional prognostic information on the likelihood of progression or local recurrence. Generally, the prognosis is worse for comedo DCIS than for noncomedo DCIS (see Histology).For more information https://www.medscape.com/answers/1947145-155280/what-is-the-prognosis-of-dcis-breast-cancer"}, {"tags": "LCIS", "patterns": ["what is the prognosis of lcis breast cancer", "what is the outlook for lcis breast cancer", "how long does lcis breast cancer have a chance of living"], "responses": "Approximately 10-20% of women with LCIS develop invasive breast cancer within 15 years after their LCIS diagnosis. Thus, LCIS is considered a biomarker of increased breast cancer risk.For more information https://www.medscape.com/answers/1947145-155281/what-is-the-prognosis-of-lcis-breast-cancer"}, {"tags": "infiltrating ductal carcinoma", "patterns": ["what is the prognosis of infiltrating ductal carcinoma breast cancer", "how likely is infiltrating ductal carcinoma breast cancer to progress", "what are the chances of surviving breast cancer with infiltrating ductal carcinoma"], "responses": "Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor and has a tendency to metastasize via lymphatic vessels. Like ductal carcinoma, infiltrating lobular carcinoma typically metastasizes to axillary lymph nodes first. However, it also has a tendency to be more multifocal. Nevertheless, its prognosis is comparable to that of ductal carcinoma.For more information https://www.medscape.com/answers/1947145-155282/what-is-the-prognosis-of-infiltrating-ductal-carcinoma-breast-cancer"}, {"tags": "medullary carcinoma", "patterns": ["what is the prognosis of medullary carcinoma breast cancer", "what is the prognosis of breast cancer with medullary carcinoma", "how likely is medullary carcinoma breast cancer to progress"], "responses": "Typical or classic medullary carcinomas are often associated with a good prognosis despite the unfavorable prognostic features associated with this type of breast cancer, including ER negativity, high tumor grade, and high proliferative rates. However, an analysis of 609 medullary breast cancer specimens from various stage I and II National Surgical Adjuvant Breast and Bowel Project (NSABP) protocols indicates that overall survival and prognosis are not as good as previously reported. Atypical medullary carcinomas also carry a poorer prognosis.For more information https://www.medscape.com/answers/1947145-155283/what-is-the-prognosis-of-medullary-carcinoma-breast-cancer"}, {"tags": "mucinous carcinoma", "patterns": ["what is the prognosis of mucinous carcinoma breast cancer", "how likely are you to develop mucinous carcinoma breast cancer"], "responses": "Overall, patients with mucinous carcinoma have an excellent prognosis, with better than 80% 10-year survival. Similarly, tubular carcinoma has a low incidence of lymph node involvement and a very high overall survival rate. Because of the favorable prognosis, these patients are often treated with only breast-conserving surgery and local radiation therapy.For more information https://www.medscape.com/answers/1947145-155284/what-is-the-prognosis-of-mucinous-carcinoma-breast-cancer"}, {"tags": "cystic papillary carcinoma", "patterns": ["what is the prognosis of cystic papillary carcinoma breast cancer", "what is the outlook for cystic papillary carcinoma of the breast", "how likely is a woman to develop cystic papillary breast cancer"], "responses": "Overall, patients with mucinous carcinoma have an excellent prognosis, with better than 80% 10-year survival. Similarly, tubular carcinoma has a low incidence of lymph node involvement and a very high overall survival rate. Because of the favorable prognosis, these patients are often treated with only breast-conserving surgery and local radiation therapy.For more information https://www.medscape.com/answers/1947145-155285/what-is-the-prognosis-of-cystic-papillary-carcinoma-breast-cancer"}, {"tags": "metaplastic", "patterns": ["what is the prognosis of metaplastic breast cancer", "what are the chances of surviving metaplastic breast cancer", "what is the outlook for patients with metaplastic breast cancer", "how likely is metaplastic breast cancer to progress"], "responses": "For metaplastic breast cancer, the majority of published case series have demonstrated a worse prognosis than with infiltrating ductal carcinoma, even when adjusted for stage, with a 3-year overall survival rate of 48-71% and 3-year disease-free survival rate of 15-60%. In most case series, large tumor size and advanced stage have emerged as predictors of poor overall survival and prognosis. Nodal status does not appear to impact survival in metaplastic breast cancer.For more information https://www.medscape.com/answers/1947145-155286/what-is-the-prognosis-of-metaplastic-breast-cancer"}, {"tags": "mammary Paget disease", "patterns": ["what is the prognosis of mammary paget disease", "what is the outlook for mammary paget disease", "what are the chances of developing mammary paget disease", "the outcome of mammary paget disease is uncertain"], "responses": "Paget disease of the breast is associated with an underlying breast cancer in 75% of cases. Breast-conserving surgery can achieve satisfactory results, but at the risk of local recurrence. Poor prognostic factors include a palpable breast tumor, lymph node involvement, histologic type, and an age of less than 60 years. Paget disease with a palpable mass usually has an invasive component and a lower 5-year survival rate (20-60%). Those that do not have an underlying palpable mass have a higher 5-year survival rate (75-100%).For more information https://www.medscape.com/answers/1947145-155287/what-is-the-prognosis-of-mammary-paget-disease"}, {"tags": "cardiovascular heart disease", "patterns": ["what is the association between breast cancer and cardiovascular disease (cvd)", "what exactly is the link between breast cancer and cardiovascular disease (cvd)", "what is the link between breast cancer and heart disease (cvd)", "how do breast cancer and cardiovascular disease relate to one another (cvd)"], "responses": "Cardiovascular disease (CVD) risk is increased in women with breast cancer. The increase is due in part to the cardiotoxic effects of some breast cancer treatments (eg, chemotherapy, radiotherapy, targeted therapy such as trastuzumab). In addition, breast cancer and CVD, share several risk factors, including smoking, obesity, and the typical Western diet.For more information https://www.medscape.com/answers/1947145-155288/what-is-the-association-between-breast-cancer-and-cardiovascular-disease-cvd"}, {"tags": "clinical", "patterns": ["which clinical history findings are characteristic of breast cancer", "clinical history findings of breast cancer", "characteristics of breast cancer based on clinical history findings"], "responses": "Many early breast carcinomas are asymptomatic, particularly if they were discovered during a breast-screening program. Larger tumors may present as a painless mass. Pain or discomfort is not usually a symptom of breast cancer; only 5% of patients with a malignant mass present with breast pain.\r\n\r\nOften, the purpose of the history is not diagnosis but risk assessment. A family history of breast cancer in a first-degree relative is the most widely recognized breast cancer risk factor.For more information https://www.medscape.com/answers/1947145-155289/which-clinical-history-findings-are-characteristic-of-breast-cancer"}, {"tags": "BCRA guidelines ", "patterns": ["what are the uspstf guidelines on risk assessment for brca-related breast cancer", "guidelines on risk assessment for brca-related breast cancer"], "responses": "The current USPSTF recommendations are as follows:\n\nWomen who have family members with breast, ovarian, tubal, or peritoneal cancer should be screened to identify a family history that may be associated with an increased risk for mutations in the breast cancer susceptibility genes BRCA1 or BRCA2\n\nWomen who have positive screening results should receive genetic counseling and then BRCA testing if warranted\n\nWomen without a family history associated with an increased risk for mutations should not receive routine genetic counseling or BRCA testingFor more information https://www.medscape.com/answers/1947145-155290/what-are-the-uspstf-guidelines-on-risk-assessment-for-brca-related-breast-cancer"}, {"tags": "signs symptoms", "patterns": ["what are the signs and symptoms of breast cancer", "signs of breast cancer", "symptoms of breast cancer"], "responses": "If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer may include the following:\r\n\r\nChange in breast size or shape\r\nSkin dimpling or skin changes (eg, thickening, swelling, or redness)\r\nRecent nipple inversion or skin change or other nipple abnormalities (eg, ulceration, retraction, or spontaneous bloody discharge)\r\nNipple discharge, particularly if bloodstained\r\nAxillary lumpFor more information https://www.medscape.com/answers/1947145-155291/what-are-the-signs-and-symptoms-of-breast-cancer"}, {"tags": "breast exam findings", "patterns": ["which breast exam findings suggest breast cancer", "breast exam findings of breast cancer"], "responses": "The clinician should be alert to symptoms of metastatic spread, such as the following:\r\n\r\nBone pain\r\nSymptoms of hypercalcemia\r\nBreathing difficulties\r\nAbdominal distention\r\nJaundice\r\nLocalizing neurologic signs\r\nAltered cognitive function\r\nHeadacheFor more information https://www.medscape.com/answers/1947145-155292/which-breast-exam-findings-suggest-breast-cancer"}, {"tags": "palpable lumps", "patterns": ["how are palpable lumps characterized in breast cancer"], "responses": "The nature of palpable lumps is often difficult to determine clinically, but the following features should raise concern:\r\n\r\nHardness\r\n\r\nIrregularity\r\n\r\nFocal nodularity\r\n\r\nAsymmetry with the other breast\r\n\r\nFixation to skin or muscle (assess fixation to muscle by moving the lump in the line of the pectoral muscle fibers with the patient bracing her arms against her hips)For more information https://www.medscape.com/answers/1947145-155293/how-are-palpable-lumps-characterized-in-breast-cancer"}, {"tags": "signs metastatic symptoms metastatic", "patterns": ["what are the signs and symptoms of metastatic breast cancer", "metastatic breast cancer signs"], "responses": "If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer may include the following:\r\n\r\nChange in breast size or shape\r\nSkin dimpling or skin changes (eg, thickening, swelling, or redness)\r\nRecent nipple inversion or skin change or other nipple abnormalities (eg, ulceration, retraction, or spontaneous bloody discharge)\r\nNipple discharge, particularly if bloodstained\r\nAxillary lumpFor more information https://www.medscape.com/answers/1947145-155294/what-are-the-signs-and-symptoms-of-metastatic-breast-cancer"}, {"tags": "differential diagnosis", "patterns": ["which conditions should be included in the differential diagnosis of breast cancer"], "responses": "The differential diagnosis includes the following:\r\n\r\nCircumscribed breast lesions \u2013 Benign breast disease (eg, fibroadenomas and cysts), breast cancer, breast lymphoma, and metastasis to the breast from other primary sites (eg, neuroendocrine or extramedullary acute myeloid leukemia)\r\n\r\nSkin thickening \u2013 Inflammatory carcinoma and mastitis\r\n\r\nStellate lesions \u2013 Breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma\r\n\r\nDilated ducts with or without nipple discharge \u2013 Papilloma, ductal carcinoma, duct ectasia, and fibrocystic diseaseFor more information https://www.medscape.com/answers/1947145-155295/which-conditions-should-be-included-in-the-differential-diagnosis-of-breast-cancer"}, {"tags": "differential diagnosis", "patterns": ["what are the differential diagnoses for breast cancer"], "responses": "The differential diagnosis includes the following:\r\n\r\nCircumscribed breast lesions \u2013 Benign breast disease (eg, fibroadenomas and cysts), breast cancer, breast lymphoma, and metastasis to the breast from other primary sites (eg, neuroendocrine or extramedullary acute myeloid leukemia)\r\n\r\nSkin thickening \u2013 Inflammatory carcinoma and mastitis\r\n\r\nStellate lesions \u2013 Breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma\r\n\r\nDilated ducts with or without nipple discharge \u2013 Papilloma, ductal carcinoma, duct ectasia, and fibrocystic diseaseFor more information https://www.medscape.com/answers/1947145-155947/what-are-the-differential-diagnoses-for-breast-cancer"}, {"tags": "triple assessment algorithm", "patterns": ["what is the triple assessment algorithm for breast cancer diagnosis", "triple assessment algorithm", "breast cancer assessment algorithm"], "responses": "Breast cancer evaluation should be an ordered inquiry that begins with symptoms and a general clinical history. This is followed by a sequence that has become formalized as triple assessment, which includes the following components:\r\n\r\nClinical examination\r\nImaging (usually mammography, ultrasonography, or both)\r\nNeedle biopsyFor more information https://www.medscape.com/answers/1947145-155296/what-is-the-triple-assessment-algorithm-for-breast-cancer-diagnosis"}, {"tags": "screening eficacy", "patterns": ["what is the efficacy of breast cancer screening in the early detection of breast cancer", "breast cancer screening eficacy"], "responses": "Whereas early detection has been advocated as a primary defense against the development of life-threatening breast cancer, questions have been raised in the past few years regarding the age at which to initiate, the modality to use, the interval between screenings, whether to screen older women, and even the impact on breast cancer\u2212related deaths. It is widely believed that breast tumors that are smaller or nonpalpable and that present with a favorable tumor marker profile are more treatable when detected early.For more information https://www.medscape.com/answers/1947145-155297/what-is-the-efficacy-of-breast-cancer-screening-in-the-early-detection-of-breast-cancer"}, {"tags": "screeing modalties", "patterns": ["which modalities are used to screen for breast cancer", "breast cancer screeing modalties"], "responses": "A number of screening modalities exist for breast cancer, including clinical breast examination, mammography, ultrasonography, and MRI.For more information https://www.medscape.com/answers/1947145-155298/which-modalities-are-used-to-screen-for-breast-cancer"}, {"tags": "mammography role", "patterns": ["what is the role of mammography in the workup of breast cancer"], "responses": "A survival benefit of early detection with mammography screening has been demonstrated. A review that used seven statistical models determined that the use of screening mammography reduced the rate of death from breast cancer by 28\u201365% (median, 46%). A meta-analysis found that screening mammography reduces breast cancer mortality by about 20\u201335% in women 50\u201369 years old and slightly less in women 40\u201349 years old at 14 years of follow-up.For more information https://www.medscape.com/answers/1947145-155299/what-is-the-role-of-mammography-in-the-workup-of-breast-cancer"}, {"tags": "screening mammogram", "patterns": ["which factors affect a women's decision to undergo a breast cancer screening mammogram"], "responses": "Although mammography guidelines have been in place for more than 30 years, 20-30% of women still do not undergo screening as indicated. The 2 most significant factors governing a woman\u2019s decision to undergo mammography are physician recommendation and access to health insurance. Nonwhite women and those of lower socioeconomic status remain less likely to obtain mammography services and more likely to present with life-threatening, advanced stage disease.For more information https://www.medscape.com/answers/1947145-155300/which-factors-affect-a-women39s-decision-to-undergo-a-breast-cancer-screening-mammogram"}, {"tags": "ACS guidelines", "patterns": ["what are the acs guidelines for breast cancer screening"], "responses": "The 2015 ACS recommendations for women at average risk of breast cancer are as follows:\r\n\r\nWomen should have the opportunity to begin annual screening at 40-44 years of age (qualified recommendation)\r\nWomen should begin regular screening mammography at age 45 years (strong recommendation)\r\nWomen aged 45-54 years should be screened annually (qualified recommendation)\r\nWomen 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation)\r\nWomen should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation)\r\nClinical breast examination is not recommended for breast cancer screening in average-risk women at any ageFor more information https://www.medscape.com/answers/1947145-155301/what-are-the-acs-guidelines-for-breast-cancer-screening"}, {"tags": "USPSTF guidelines", "patterns": ["what are the uspstf guidelines for breast cancer screening"], "responses": "Instead of routine screening for women 40-49 years old, the USPSTF recommends that clinicians provide screening to selected patients in this age range, depending on individual circumstances and patient preferences. The USPSTF further concluded that for most individuals without signs or symptoms, there is likely to be only a small benefit from screening.\r\n\r\nFinally, the USPSTF recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination in women aged 40 years or older or the benefits and harms of screening mammography in women aged 75 years or older.For more information https://www.medscape.com/answers/1947145-155302/what-are-the-uspstf-guidelines-for-breast-cancer-screening"}, {"tags": "ACP guidelines", "patterns": ["what are the acp guidelines for breast cancer screening"], "responses": "2019 review by the American College of Physicians (ACP) provides the following guidance statements regarding screening of asymptomatic women at average risk and in good health:\r\n\r\nWomen 40-49 years of age: Discuss benefits and harms of screening mammography (potential harms outweigh the benefits in most cases).\r\nWomen 50-74 years of age: Offer biennial mammography.\r\nDiscontinue screening in women \u226575 years of age and in those with a life expectancy of \u226410 years.\r\nDo not use clinical breast examination to screen for breast cancer in women of any age.For more information https://www.medscape.com/answers/1947145-155303/what-are-the-acp-guidelines-for-breast-cancer-screening"}, {"tags": "ACR guidelines", "patterns": ["what are the acr guidelines for breast cancer screening"], "responses": "In contrast to the ACP recommendation against the use of tomosynthesis (3D mammography) in breast cancer screening, the American College of Radiology (ACR) states that, \u201cbreast tomosynthesis has shown to be an advance over digital mammography, with higher cancer detection rates and fewer patient recalls for additional testing.\u201d The ACR notes that further studies will be needed to determine which subgroups of women are likely to benefit most from tomosynthesis screening.For more information https://www.medscape.com/answers/1947145-155304/what-are-the-acr-guidelines-for-breast-cancer-screening"}, {"tags": "3D mammography efficacy", "patterns": ["what is the efficacy of 3d mammography for breast cancer screening"], "responses": "In the Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study\u2014a prospective population-based screening study in 9672 women that compared integrated 3D mammography with 2D mammography\u20143D mammography detected more cases of breast cancer than 2D mammography but increased the percentage of false-positive recalls in sequential screen-reading. Thus, the benefit of significantly increased breast cancer detection with tomosynthesis screening must be weighed against the possible risk of overdiagnosis.For more information https://www.medscape.com/answers/1947145-155305/what-is-the-efficacy-of-3d-mammography-for-breast-cancer-screening"}, {"tags": "breast density affect", "patterns": ["how does breast density affect the risk for breast cancer"], "responses": "High interval cancer rates were observed for women with a 5-year BCSC risk of 1.67% or greater and extremely dense breasts or a 5-year risk of 2.50% or greater and heterogeneously dense breasts. However, study participants who met those criteria accounted for only 24% of all women with dense breasts.\r\n\r\nThe highest rate of advanced-stage breast cancer, >0.4 case per 1000 examinations, was seen in women with 5-year BCSC risk of 2.50% or greater and heterogeneously or extremely dense breasts. Such patients comprised 21% of all women with dense breasts.For more information https://www.medscape.com/answers/1947145-155306/how-does-breast-density-affect-the-risk-for-breast-cancer"}, {"tags": "diagnostic mammography role", "patterns": ["what is the role of diagnostic mammography in the evaluation of breast cancer"], "responses": "Mammography is used both for screening to detect a cancer and for diagnostic workup of patients after a tumor is detected. Screening mammography is performed in asymptomatic women, whereas diagnostic mammography is performed in symptomatic women (ie, when a breast lump or nipple discharge is present or when an abnormality is found during screening mammography).For more information https://www.medscape.com/answers/1947145-155307/what-is-the-role-of-diagnostic-mammography-in-the-evaluation-of-breast-cancer"}, {"tags": "ultrasonography role", "patterns": ["what is the role of ultrasonography in the workup of breast cancer"], "responses": "Ultrasonography has become a widely available and useful adjunct to mammography in the clinical setting. It is generally employed to assist the clinical examination of a suspicious lesion detected on mammography or physical examination. As a screening tool, ultrasonography is limited by a number of factors, most notably its failure to detect microcalcifications and its poor specificity (34%).For more information https://www.medscape.com/answers/1947145-155308/what-is-the-role-of-ultrasonography-in-the-workup-of-breast-cancer"}, {"tags": "MRI role", "patterns": ["what is the role of mri in the workup of breast cancer"], "responses": "In an effort to overcome the limitations of mammography and ultrasonography, MRI has been explored as a modality for detecting breast cancer in women at high risk and in younger women. A combination of T1, T2, and 3-D contrast-enhanced MRI techniques has been found to possess high sensitivity (approximating 86-100% in combination with mammography and clinical breast examination) to malignant changes in the breast.For more information https://www.medscape.com/answers/1947145-155309/what-is-the-role-of-mri-in-the-workup-of-breast-cancer"}, {"tags": "MRI indication", "patterns": ["when is mri indicated for the diagnosis of breast cancer"], "responses": "The principal indications for MRI of the breast are screening for breast cancer in women at increased risk, staging of known cancer, and evaluation of response to neoadjuvant chemotherapy. Breast MRI is based on T1-weighted contrast-enhanced imaging, but multiparametric assessment, including T2-weighted, ultrafast, and diffusion-weighted imaging, may be used to improve the characterization of lesionsFor more information https://www.medscape.com/answers/1947145-155310/when-is-mri-indicated-for-the-diagnosis-of-breast-cancer"}, {"tags": "radiotracers scintimammography", "patterns": ["which radiotracers are used in scintimammography for the diagnosis of breast cancer"], "responses": "Using a wide range of labeled metabolites (eg, fluorinated glucose [18 FDG]), positron emission tomography (PET) can detect changes in metabolic activity, vascularization, oxygen consumption, and tumor receptor status.\r\n\r\nWhen PET is combined with computed tomography (CT) to assist in anatomic localization (PET-CT), scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences.For more information https://www.medscape.com/answers/1947145-155312/which-radiotracers-are-used-in-scintimammography-for-the-diagnosis-of-breast-cancer"}, {"tags": "contraindications scintimammography", "patterns": ["what are contraindications for scintimammography in the workup of breast cancer"], "responses": "Scintimammography is not indicated as a screening procedure for the detection of breast cancer. However, it may play a role in various specific clinical indications, as in cases of nondiagnostic or difficult mammography and in the evaluation of high-risk patients, tumor response to chemotherapy, and metastatic involvement of axillary lymph nodes.For more information https://www.medscape.com/answers/1947145-155313/what-are-contraindications-for-scintimammography-in-the-workup-of-breast-cancer"}, {"tags": "PET scanning role", "patterns": ["what is the role of pet scanning in the workup of breast cancer"], "responses": "Using a wide range of labeled metabolites (eg, fluorinated glucose [18 FDG]), positron emission tomography (PET) can detect changes in metabolic activity, vascularization, oxygen consumption, and tumor receptor status.\r\n\r\nWhen PET is combined with computed tomography (CT) to assist in anatomic localization (PET-CT), scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences.For more information https://www.medscape.com/answers/1947145-155314/what-is-the-role-of-pet-scanning-in-the-workup-of-breast-cancer"}, {"tags": "breast biospy role", "patterns": ["what is the role of breast biopsy in the diagnosis of breast cancer"], "responses": "Percutaneous vacuum-assisted large-gauge core-needle biopsy (VACNB) with image guidance is the recommended diagnostic approach for newly diagnosed breast tumors. Core biopsies can minimize the need for operative intervention (and subsequent scarring, and provide accurate pathologic diagnosis for appropriate management.\r\n\r\nExcisional biopsy, as the initial operative approach, has been shown to increase the rate of positive margins. Open excisional biopsy is reserved for lesions where the diagnosis remains equivocal despite imaging and core biopsy assessment or for benign lesions that the patient chooses to have removed. Because wide clearance of the lesion is usually not the goal in diagnostic biopsies, unnecessary distortion of the breast is thereby avoided. Ongoing audit is essential to help reduce an excessive benign-to-malignant biopsy ratio.For more information https://www.medscape.com/answers/1947145-155316/what-is-the-role-of-breast-biopsy-in-the-diagnosis-of-breast-cancer"}, {"tags": "lobular carcinoma", "patterns": ["what are the histologic findings of lobular carcinoma in situ breast cancer"], "responses": "Breast cancers usually are epithelial tumors of ductal or lobular origin. All of the following features are important in deciding on a course of treatment for any breast tumor:\n\nSize\nStatus of surgical margin\nPresence or absence of estrogen receptor (ER) and progesterone receptor (PR)\nNuclear and histologic grade\nProliferation\nVascular invasion\nTumor necrosis\nQuantity of intraductal component\nHER2 statusFor more information https://www.medscape.com/answers/1947145-155320/what-are-the-histologic-findings-of-lobular-carcinoma-in-situ-breast-cancer"}, {"tags": " ductal carcinoma", "patterns": ["what are the histologic findings of infiltrating ductal carcinoma breast cancer"], "responses": "Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor (accounting for 75% of breast cancers) and has a tendency to metastasize via lymphatic vessels. This lesion has no specific histologic characteristics other than invasion through the basement membrane. DCIS is a frequently associated finding on pathologic examination.For more information https://www.medscape.com/answers/1947145-155321/what-are-the-histologic-findings-of-infiltrating-ductal-carcinoma-breast-cancer"}, {"tags": "medullary carcinoma", "patterns": ["what are the histologic findings of medullary carcinoma breast cancer"], "responses": "Lobular carcinoma in situ (LCIS) arises from the terminal duct apparatus and shows a rather diffuse distribution throughout the breast, which explains its presentation as a nonpalpable mass in most cases. Over the past 25 years, the incidence of LCIS has doubled, currently standing at 2.8 per 100,000 women. The peak incidence is in women aged 40-50 years.For more information https://www.medscape.com/answers/1947145-155323/what-are-the-histologic-findings-of-medullary-carcinoma-breast-cancer"}, {"tags": "tumor treatment selection", "patterns": ["which tumor features affect treatment selection for breast cancer"], "responses": "Breast cancers usually are epithelial tumors of ductal or lobular origin. All of the following features are important in deciding on a course of treatment for any breast tumor:\r\n\r\nSize\r\nStatus of surgical margin\r\nPresence or absence of estrogen receptor (ER) and progesterone receptor (PR)\r\nNuclear and histologic grade\r\nProliferation\r\nVascular invasion\r\nTumor necrosis\r\nQuantity of intraductal component\r\nHER2 statusFor more information https://www.medscape.com/answers/1947145-155317/which-tumor-features-affect-treatment-selection-for-breast-cancer"}, {"tags": "historical grades", "patterns": ["what are the histologic grades for breast cancer"], "responses": "Histologic grade is the best predictor of disease prognosis in carcinoma in situ, but it is dependent on the grading system used, such as the Van Nuys classification (high-grade, low-grade comedo, low-grade noncomedo). The grading of invasive carcinoma is also important as a prognostic indicator, with higher grades indicating a worse prognosisFor more information https://www.medscape.com/answers/1947145-155318/what-are-the-histologic-grades-for-breast-cancer"}, {"tags": "DCIS breast cancer", "patterns": ["what are the histologic characteristics of dcis breast cancer"], "responses": "Increased use of screening mammography has resulted in a dramatic increase in the detection of ductal carcinoma in situ (DCIS). Approximately 64,000 cases of DCIS are diagnosed annually in the United States. About 90% of DCIS cases are identified on mammography as suspicious calcifications: linear, clustered, segmental, focal, or mixed distribution.\r\n\r\nDCIS is broadly divided into 2 subtypes: comedo (ie, cribriform, micropapillary, and solid; and noncomedo. The likelihood of progression or local recurrence, as well as the prognosis, varies in accordance with the DCIS subtype present.For more information https://www.medscape.com/answers/1947145-155319/what-are-the-histologic-characteristics-of-dcis-breast-cancer"}, {"tags": "infiltrating lobular", "patterns": ["what are the histologic findings of infiltrating lobular carcinoma breast cancer"], "responses": "Infiltrating lobular carcinoma has a much lower incidence than infiltrating ductal carcinoma, accounting for 15-20% of invasive breast cancers. Histologically, it is characterized by the \"single-file\" arrangement of small tumor cells. Like ductal carcinoma, infiltrating lobular carcinoma typically metastasizes to axillary lymph nodes first. However, it also has a tendency to be multifocal and have discontinuous areas of involvement, making mammographic and even MRI staging imprecise.For more information https://www.medscape.com/answers/1947145-155322/what-are-the-histologic-findings-of-infiltrating-lobular-carcinoma-breast-cancer"}, {"tags": "mucinous carcinoma", "patterns": ["what are the histologic findings of mucinous carcinoma breast cancer"], "responses": "Mucinous (colloid) carcinoma is another rare histologic type, seen in fewer than 5% of invasive breast cancer cases. It usually presents during the seventh decade of life as a palpable mass or appears mammographically as a poorly defined tumor with rare calcifications.\r\n\r\nMucin production is the histologic hallmark. There are 2 main types of lesions, A and B, with AB lesions possessing features of both. Type A mucinous carcinoma represents the classic variety, with larger quantities of extracellular mucin, whereas type B is a distinct variant with endocrine differentiation.For more information https://www.medscape.com/answers/1947145-155324/what-are-the-histologic-findings-of-mucinous-carcinoma-breast-cancer"}, {"tags": "tubular carcinoma", "patterns": ["what are the histologic findings of tubular carcinoma breast cancer"], "responses": "Tubular carcinoma of the breast is an uncommon histologic type, accounting for only 1-2% of all breast cancers. Characteristic features of this type include a single layer of epithelial cells with low-grade nuclei and apical cytoplasmic snoutings arranged in well-formed tubules and glands.\r\n\r\nTubular components make up more than 90% of pure tubular carcinomas and at least 75% of mixed tubular carcinomas. This type of breast cancer has a low incidence of lymph node involvement and a very high overall survival rate. Because of its favorable prognosis, patients are often treated with only breast-conserving surgery and local radiation therapy.For more information https://www.medscape.com/answers/1947145-155325/what-are-the-histologic-findings-of-tubular-carcinoma-breast-cancer"}, {"tags": "papillary carcinoma", "patterns": ["what are the histologic findings of papillary carcinoma breast cancer"], "responses": "Papillary carcinoma of the breast encompasses a spectrum of histologic subtypes. There are 2 common types: cystic (noninvasive form) and micropapillary ductal carcinoma (invasive form). This form of breast cancer is usually seen in women older than 60 years and accounts for approximately 1-2% of all breast cancers. Papillary carcinomas are centrally located in the breast and can present as bloody nipple discharge. They are strongly ER- and PR-positive.For more information https://www.medscape.com/answers/1947145-155326/what-are-the-histologic-findings-of-papillary-carcinoma-breast-cancer"}, {"tags": "metaplastic", "patterns": ["what are histologic findings of metaplastic breast cancer"], "responses": "Metaplastic breast cancer (MBC) accounts for fewer than 1% of breast cancer cases. It tends to occur in older women (average age of onset in the sixth decade) and has a higher incidence in Black women. It is characterized by a combination of adenocarcinoma plus mesenchymal and epithelial components.\r\n\r\nA wide variety of histologic patterns includes the following:\r\n\r\nSpindle-cell carcinoma\r\nCarcinosarcoma\r\nSquamous cell carcinoma of ductal origin\r\nAdenosquamous carcinoma\r\nCarcinoma with pseudosarcomatous metaplasia\r\nMatrix-producing carcinomaFor more information https://www.medscape.com/answers/1947145-155327/what-are-histologic-findings-of-metaplastic-breast-cancer"}, {"tags": "mammary Paget", "patterns": ["what are the histologic findings of mammary paget disease"], "responses": "Mammary Paget disease is relatively rare, accounting for 1-4% of all breast cancers. The peak incidence is seen in the sixth decade of life. This adenocarcinoma is localized within the epidermis of the nipple-areola complex and is composed of the histologic hallmark Paget cells within the basement membrane. Paget cells are large, pale epithelial cells with hyperchromatic, atypical nuclei, dispersed between the keratinocytes singly or as a cluster of cells.For more information https://www.medscape.com/answers/1947145-155328/what-are-the-histologic-findings-of-mammary-paget-disease"}, {"tags": "AJCC staging system", "patterns": ["what is the ajcc staging system for breast cancer"], "responses": "The American Joint Committee on Cancer (AJCC) provides two principal groups for breast cancer staging: anatomic, which is based on extent of cancer as defined by tumor size (T), lymph node status (N), and distant metastasis (M); and prognostic, which includes anatomic TNM plus tumor grade and the status of the biomarkers human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR). The prognostic stage group is preferred for patient care and is to be used for reporting of all cancer patients in the United States.For more information https://www.medscape.com/answers/1947145-155329/what-is-the-ajcc-staging-system-for-breast-cancer"}, {"tags": "prognostic stages", "patterns": ["what are the prognostic stages for breast cancer"], "responses": "\r\nHistologic grade (G)\r\n\r\nGX\r\n\r\nGrade cannot be assessed\r\n\r\nG1\r\n\r\nLow combined histologic grade (favorable)\r\n\r\nG2\r\n\r\nIntermediate combined histologic grade (moderately favorable)\r\n\r\nG3\r\n\r\nHigh combined histologic grade (unfavorable)For more information https://www.medscape.com/answers/1947145-155333/what-are-the-prognostic-stages-for-breast-cancer"}, {"tags": "sentinel lymph node (SLN)", "patterns": ["according to asco guidelines, which patients with breast cancer should be offered sentinel lymph node (sln) biopsy"], "responses": "Evaluation of lymph node involvement by means of sentinel lymph node biopsy or axillary lymph node dissection (ALND) has also been considered necessary for staging and prognosis.\r\n\r\nA 2014 update on sentinel lymph node biopsy for patients with early-stage breast cancer by the American Society of Clinical Oncology (ASCO) advises that sentinel lymph node biopsy may be offered to the following patients:\r\n\r\nWomen with operable breast cancer and multicentric tumors\r\n\r\nWomen with DCIS who will be undergoing mastectomy\r\n\r\nWomen who previously underwent breast and/or axillary surgery\r\n\r\nWomen who received preoperative/neoadjuvant systemic therapyFor more information https://www.medscape.com/answers/1947145-155334/according-to-asco-guidelines-which-patients-with-breast-cancer-should-be-offered-sentinel-lymph-node-sln-biopsy"}, {"tags": "sentinel lymph node (SLN)", "patterns": ["what are the contraindications for sentinel lymph node (sln) biopsy in breast cancer"], "responses": "According to the ASCO guidelines, sentinel lymph node biopsy should not be performed in patients with any of the following:\n\n1) Large or locally advanced invasive breast cancer (tumor size T3/T4)\n\n2) Inflammatory breast cancer\n\n3) DCIS (when breast-conserving surgery is planned)\n\n4) PregnancyFor more information https://www.medscape.com/answers/1947145-155335/what-are-the-contraindications-for-sentinel-lymph-node-sln-biopsy-in-breast-cancer"}, {"tags": "axillary lymph node dissection", "patterns": ["what are the asco guidelines for axillary lymph node dissection (alnd) in breast cancer", "guidelines for axillary lymph node dissection (alnd) in breast cancer"], "responses": "ASCO recommendations regarding ALND in patients who have undergone sentinel lymph node biopsy are as follows:\r\n\r\n1) ALND should not be performed in women with no sentinel lymph node (SLN) metastases\r\n\r\n2) In most cases, ALND should not be performed in women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy\r\n\r\n3) ALND should be offered to women with SLN metastases who will be undergoing mastectomyFor more information https://www.medscape.com/answers/1947145-155336/what-are-the-asco-guidelines-for-axillary-lymph-node-dissection-alnd-in-breast-cancer"}, {"tags": "guidelines sentinel lymph", "patterns": ["what are the nccn guidelines for sentinel lymph node (sln) biopsy in breast cancer", "nccn guidelines for sentinel lymph node (sln) biopsy in breast cancer", "sln biopsy in breast cancer guidelines from nccn"], "responses": "National Comprehensive Cancer Network (NCCN) recommendations differ from those of ASCO in that the NCCN considers that women with clinical stage as high as IIIA T3, N1, M0 may be candidates for SLN biopsy. In addition, the NCCN concluded that there is insufficient evidence to make recommendations for or against SLN biopsy in pregnant patients; the NCCN recommends that decisions regarding use of SLN biopsy in pregnancy be individualized. However, isosulfan blue or methylene blue dye is contraindicated for SLNB in pregnancy; radiolabeled sulfur colloid appears to be safe.For more information https://www.medscape.com/answers/1947145-155337/what-are-the-nccn-guidelines-for-sentinel-lymph-node-sln-biopsy-in-breast-cancer"}, {"tags": "guidelines axillary lymph node dissection", "patterns": ["what are the nccn guidelines for axillary lymph node dissection (alnd) in breast cancer", "nccn guidelines for axillary lymph node dissection (alnd)  in breast cancer", "alnd in breast cancer guidelines from nccn"], "responses": "The NCCN breast cancer guidelines state that lymph node dissection is optional in the following cases:\r\n\r\n1) Strongly favorable tumors\r\n2) When no result would affect the choice of adjuvant systemic therapy\r\n3) Elderly patients\r\n4) Patients with comorbid conditionsFor more information https://www.medscape.com/answers/1947145-155338/what-are-the-nccn-guidelines-for-axillary-lymph-node-dissection-alnd-in-breast-cancer"}, {"tags": "guidelines early-stage", "patterns": ["what are the nccn guidelines for evaluation of asymptomatic women with early-stage breast cancer (stages i\u2013iib)", "nccn guidelines for evaluation of asymptomatic women with early-stage breast cancer (stages i\u2013iib)", "for evaluation of asymptomatic women with early-stage breast cancer (stages i\u2013iib) guidelines from nccn"], "responses": "The NCCN guidelines [72] recommend the following laboratory studies for all asymptomatic women with early-stage breast cancer (stages I\u2013IIB):\r\n\r\n1) Complete blood count (CBC) with differential\r\n2) Comprehensive metabolic panel, with liver function tests (LFTs) and alkaline phosphatase\r\n\r\n\r\nAdditional studies indicated in specific settings include the following:\r\n\r\n1) Bone scan, in patients with localized bone pain or alkaline phosphatase elevation\r\n2) Abdominal \u00b1 pelvic diagnostic CT with contrast or MRI with contrast, in patients with elevated alkaline phosphatase, abnormal liver function tests, abdominal symptoms, or abnormal physical examination of the abdomen or pelvis\r\n3) Chest diagnostic CT with contrast, in patients with pulmonary symptoms\r\n\r\nFor women with clinical stage lllA (T3, N1, M0) disease, tests to consider are as follows:\r\n1) CBC\r\n2) Comprehensive metabolic panel, including LFTs and alkaline phosphatase\r\n3) Chest diagnostic CT with contrast\r\n4) Abdominal \u00b1 pelvic diagnostic CT with contrast or MRI with contrast\r\n5) Bone scan or sodium fluoride PET/CT (category 2B)\r\n6) FDG PET/CT (optional)For more information https://www.medscape.com/answers/1947145-155339/what-are-the-nccn-guidelines-for-evaluation-of-asymptomatic-women-with-early-stage-breast-cancer-stages-iiib"}, {"tags": "guidelines clinical-stage", "patterns": ["what are the nccn guidelines for evaluation of women with clinical stage iiia (t3, n1, m0) breast cancer", "nccn guidelines for evaluation of  women with clinical stage iiia (t3, n1, m0) breast cancer", "for evaluation of women with clinical stage iiia (t3, n1, m0) breast cancer guidelines from nccn"], "responses": "For women with clinical stage lllA (T3, N1, M0) disease, tests to consider are as follows:\n\n1) CBC\n2) Comprehensive metabolic panel, including LFTs and alkaline phosphatase\n3) Chest diagnostic CT with contrast\n4) Abdominal \u00b1 pelvic diagnostic CT with contrast or MRI with contrast\n5) Bone scan or sodium fluoride PET/CT (category 2B)\n6) FDG PET/CT (optional)For more information https://www.medscape.com/answers/1947145-155340/what-are-the-nccn-guidelines-for-evaluation-of-women-with-clinical-stage-iiia-t3-n1-m0-breast-cancer"}, {"tags": "HER2 testing", "patterns": ["how is her2 testing performed in the evaluation of breast cancer", "her2 testing in the evaluation of breast cancer", "procedure to perfrom her2 testing in the evaluation of breast cancer"], "responses": "Although several methods for HER2 testing have been developed, approximately 20% of current HER2 testing may be inaccurate; accordingly, the American Society of Clinical Oncology (ASCO) and CAP have recommended guidelines to ensure the accuracy of HER2 testing. Breast cancer specimens should initially undergo HER2 testing by a validated immunohistochemistry (IHC) assay (eg, HercepTest; Dako, Glostrup, Denmark) for HER2 protein expression. For more visit: (https://www.medscape.com/answers/1947145-155341/how-is-her2-testing-performed-in-the-evaluation-of-breast-cancer)For more information https://www.medscape.com/answers/1947145-155341/how-is-her2-testing-performed-in-the-evaluation-of-breast-cancer"}, {"tags": "molecular profiling assay", "patterns": ["what is the role of molecular profiling assays in the workup of breast cancer", "role of molecular profiling assays in the workup of breast cancer", "what part does molecular profiling assays play in workup of breast cancer"], "responses": "Molecular profiling assays\nThe Onco type Dx assay (Genomic Health, Inc, Redwood City, CA) has been approved by the US Food and Drug Administration (FDA) for women with early-stage ER-positive, node-negative breast cancer treated with tamoxifen, where the recurrence score (RS) correlated with both relapse-free interval and overall survival. This assay is an RT-PCR\u2013based assay of 21 genes (16 cancer genes and 5 reference genes) performed on paraffin-embedded breast tumor tissue.\n\nBy using a formula based on the expression of these genes, an RS can be calculated that correlates with the likelihood of distant recurrence at 10 years. Breast tumor RSs and risk levels are as follows:\n\n< 18, low risk\n18-30, intermediate risk\n>30, high risk    For more visit: https://emedicine.medscape.com/article/1947145-workup#c14For more information https://www.medscape.com/answers/1947145-155342/what-is-the-role-of-molecular-profiling-assays-in-the-workup-of-breast-cancer"}, {"tags": " MammaPrint assay", "patterns": ["what is the mammaprint assay for breast cancer", "mammaprint assay for breast cancer", "mammaprint test for breast cancer"], "responses": "The MammaPrint assay (Agendia, The Netherlands) is a genetic test that measures the activity of 70 genes to determine the 5- to 10-year relapse risk for women diagnosed with early breast cancer. It was approved for use by the FDA in 2007 and is an alternative platform to Oncotype DX. MammaPrint test results are reported as either a low-risk or a high-risk RS:\r\n\r\n1) A low-risk score means that the cancer has a 10% risk of coming back within 10 years without any additional treatments after surgery\r\n\r\n2) A high-risk score means that the cancer has a 29% risk of coming back within 10 years without any additional treatments after surgeryFor more information https://www.medscape.com/answers/1947145-155343/what-is-the-mammaprint-assay-for-breast-cancer"}, {"tags": "breast cancer treatment ", "patterns": ["how is breast cancer treated", "how does breast cancer treatment go", "treatment for breast cancer"], "responses": "Surgery is considered primary treatment for early-stage breast cancer; many patients are cured with surgery alone.Adjuvant treatment of breast cancer is designed to treat micrometastatic disease (ie, breast cancer cells that have escaped the breast and regional lymph nodes but which have not yet had an established identifiable metastasis)For more information https://www.medscape.com/answers/1947145-155344/how-is-breast-cancer-treated"}, {"tags": "invasive Breast cancer treatment ", "patterns": ["how is invasive breast cancer treated", "how does in invasive breast cancer treatment go", "treatment for invasive breast cancer"], "responses": "There are many treatments for invasive breast cancer. They include:\r\n\r\n1) Surgery. A lumpectomy is a surgical procedure in which a surgeon removes the cancer and a small area of healthy tissue around it. A mastectomy may be performed after chemotherapy. This procedure removes all of your breast.\r\n\r\n2) Chemotherapy. This drug treatment may be done before surgery to shrink the tumor and make the cancer operable. It\u2019s also sometimes given after surgery to try to prevent the cancer from coming back.\r\n\r\n3) Radiation. Often, radiation treatments are given after chemotherapy and surgery to prevent the cancer from coming back.\r\n\r\n4) Hormone therapy. Certain medications may be given if the cancer cells have hormone receptors.\r\n\r\n5) Targeted therapy. If the cancer cells have the gene HER2, you may be given drug treatments specifically for that.\r\n\r\n\r\nTo know more about invasive breast cancer visit: https://www.webmd.com/breast-cancer/invasive-breast-cancer For more information https://www.webmd.com/breast-cancer/invasive-breast-cancer"}, {"tags": "surgery WBI guidelines", "patterns": ["what are the guidelines for breast-conserving surgery with whole-breast irradiation (wbi) in stages i and ii invasive breast cancer", "guidelines for breast-conserving surgery with whole-breast irradiation (wbi) in stages i and ii invasive breast cancer", "breast-conserving surgery with whole-breast irradiation (wbi) in stages i and ii invasive breast cancer guidelines"], "responses": "The following are guidelines, released by the Society of Surgical Oncology and the American Society for Radiation Oncology:\r\n\r\n1) Positive margins are associated with at least a 2-fold increase in ipsilateral breast tumor recurrence (IBTR)\r\n\r\n2) Negative margins optimize IBTR; this risk is not significantly lowered by wider margin widths\r\n\r\n3) IBTR rates are reduced with the use of systemic therapy; in patients who do not receive adjuvant systemic therapy, margins wider than no ink on tumor are not needed\r\n\r\n4) Biologic subtypes do not indicate the need for margins wider than no ink on tumor\r\n\r\n5) Margin width should not determine the choice of WBI delivery technique, fractionation, and boost dose.\r\n\r\n6) Wider negative margins than no ink on tumor are not indicated for patients with invasive lobular cancer; classic lobular carcinoma in situ (LCIS) at the margin is not an indication for reexcision; the significance of pleomorphic LCIS at the margin is not clear\r\n\r\n7)  Young age is associated with an increased risk for IBTR after breast-conserving therapy, an increased risk for local relapse on the chest wall after mastectomy, and adverse biologic and pathologic features; an increased margin width does not nullify the increased risk for IBTR in young patients\r\n\r\n8) An extensive intraductal component (EIC) identifies patients who may have a large residual ductal carcinoma in situ (DCIS) burden after lumpectomy; when margins are negative, there is no evidence of an association between an increased risk for IBTR and EICFor more information https://www.medscape.com/answers/1947145-155346/what-are-the-guidelines-for-breast-conserving-surgery-with-whole-breast-irradiation-wbi-in-stages-i-and-ii-invasive-breast-cancer"}, {"tags": "post lumpectomy radiation", "patterns": ["what is the role of post lumpectomy radiation therapy in the treatment of breast cancer", "role of post lumpectomy radiation therapy in the treatment of breast cancer", "what part does post lumpectomy radiation therapy play in treatment of breast cancer"], "responses": "> The purpose of radiation therapy after breast-conserving surgery is to eradicate local subclinical residual disease while reducing local recurrence rates by approximately 75%. On the basis of results from several randomized controlled studies, irradiation of the intact breast is considered standard of care, even in the lowest-risk disease with the most favorable prognostic features.\r\n\r\n> There are 2 general approaches used to deliver radiation therapy: conventional external-beam radiotherapy (EBRT) and partial-breast irradiation (PBI). Whole-breast radiotherapy (WBRT) consists of EBRT delivered to the breast at a dose of 50-55 Gy over 5-6 weeks. This is often followed by a boost dose specifically directed to the area in the breast where the tumor was removed.For more information https://www.medscape.com/answers/1947145-155347/what-is-the-role-of-post-lumpectomy-radiation-therapy-in-the-treatment-of-breast-cancer"}, {"tags": "ASBrS selection criteria", "patterns": ["what are the asbrs selection criteria for treatment of breast cancer with accelerated partial breast irradiation (pbi)", "asbrs selection criteria for treatment of breast cancer with accelerated partial breast irradiation (pbi)", "selection criteria for treatment of breast cancer with accelerated partial breast irradiation (pbi) by asbrs"], "responses": "The American Society of Breast Surgeons (ASBrS) recommends the following selection criteria when patients are being considered for treatment with accelerated PBI :\n\n1) Age \u226545 years for all tumor types\n2) All invasive subtypes or DCIS\n3) Total tumor size (invasive and DCIS) \u2264 3 cm\n4) T stage Tis, T1, T2 (\u2264 3 cm) \n5) Margins; No tumor on ink for invasive tumors or tumors involved with DCIS;  \u22652 mm for DCIS \n6) Node negative \n7) Multifocal acceptable if total span of tumors is \u22643 cm\n8) Estrogen receptor positive or negative\n9) Focal lymphovascular invasion\n10) No genetic mutationsFor more information https://www.medscape.com/answers/1947145-155348/what-are-the-asbrs-selection-criteria-for-treatment-of-breast-cancer-with-accelerated-partial-breast-irradiation-pbi"}, {"tags": "partial breast irradiation", "patterns": ["what are the potential complications of partial breast irradiation (pbi) in the treatment of breast cancer", "potential complications of partial breast irradiation (pbi) in the treatment of breast cancer", "potential complications of partial breast irradiation in the treatment of breast cancer"], "responses": "Potential complications of PBI are catheter placement followed by removal secondary to any of the following:\r\n\r\n1) Inadequate skin spacing\r\n2) Infection\r\n3) Seroma\r\n4) Fibrosis\r\n5) Chronic pain\r\n6) Disease recurrenceFor more information https://www.medscape.com/answers/1947145-155349/what-are-the-potential-complications-of-partial-breast-irradiation-pbi-in-the-treatment-of-breast-cancer"}, {"tags": "external-beam radiotherapy efficacy (EBRT)", "patterns": ["what is the efficacy of external-beam radiotherapy (ebrt) in the treatment of breast cancer", "efficacy of external-beam radiotherapy (ebrt) in the treatment of breast cancer", "efficacy of ebrt in the treatment of breast cancer", "efficacy of external-beam radiotherapy in the treatment of breast cancer"], "responses": "The most common type of radiation therapy for breast cancer, EBRT is generally given after other treatments are complete.\r\n\r\nIn EBRT, a beam of radiation, a high-energy X-ray, is focused on the spot where the cancer was removed. If a lumpectomy was performed, a patient may receive EBRT to the entire breast, a technique called whole-breast radiation. EBRT may also be delivered to nearby lymph nodes. Some advantages of EBRT for breast cancer patients may include:\r\n\r\n1) It is fast, painless and performed as an outpatient procedure.\r\n2) Unlike chemotherapy, which circulates throughout the body, EBRT is targeted to the treatment area.\r\n3) At no point during radiation therapy is a patient radioactive, and there\u2019s no risk of radioactivity to your friends and family.For more information https://www.cancercenter.com/cancer-types/breast-cancer/treatments/radiation-therapy"}, {"tags": "single-dose radiotherapy role", "patterns": ["what is the role of single-dose radiotherapy in the treatment of breast cancer", "role of single-dose radiotherapy in the treatment of breast cancer"], "responses": "According to 2 major studies, single-dose radiotherapy delivered during or soon after surgery for breast cancer is a viable alternative to conventional EBRT in selected patients who are at low risk for local recurrence.For more information https://www.medscape.com/answers/1947145-155351/what-is-the-role-of-single-dose-radiotherapy-in-the-treatment-of-breast-cancer"}, {"tags": "postmastectomy radiation therapy ASCO criteria", "patterns": ["what are the asco criteria for postmastectomy radiation therapy in the treatment of breast cancer", "asco criteria for postmastectomy radiation therapy in the treatment of breast cancer", "postmastectomy radiation therapy criteria in the treatment of breast cancer by asco"], "responses": "Clinical practice guidelines developed by the American Society of Clinical Oncology (ASCO), along with several prospective, randomized clinical trials, recommend that postmastectomy radiation therapy be performed according to the following criteria :\n\n1) Positive postmastectomy margins\n2) Primary tumors >5 cm\n3) Involvement of \u22654 lymph nodesFor more information https://www.medscape.com/answers/1947145-155352/what-are-the-asco-criteria-for-postmastectomy-radiation-therapy-in-the-treatment-of-breast-cancer"}, {"tags": "radiation therapy efficacy invasive", "patterns": ["what is the efficacy of radiation therapy for the treatment of invasive breast cancer", "efficacy of radiation therapy for the treatment of invasive breast cancer"], "responses": "If early-stage breast cancer hasn\u2019t spread, radiation therapy after a lumpectomy significantly reduces the risk of cancer coming back by approximately 50%. Studies show that a lumpectomy followed by radiation therapy is as effective as a mastectomy without radiation therapy.For more information https://my.clevelandclinic.org/health/treatments/9191-radiation-therapy-for-breast-cancer#:~:text=How%20effective%20is%20radiation%20therapy,a%20mastectomy%20without%20radiation%20therapy."}, {"tags": "systemic adjuvant therapy role", "patterns": ["what is the role of systemic adjuvant therapy in the treatment of breast cancer"], "responses": "Adjuvant treatment of breast cancer is designed to treat micrometastatic disease (ie, breast cancer cells that have escaped the breast and regional lymph nodes but which have not yet had an established identifiable metastasis). Treatment is aimed at reducing the risk of future recurrence, thereby reducing breast cancer-related morbidity and mortality. Depending on the model of risk reduction, adjuvant therapy has been estimated to be responsible for 35-72% of the reduction in mortality.For more information https://www.medscape.com/answers/1947145-155354/what-is-the-role-of-systemic-adjuvant-therapy-in-the-treatment-of-breast-cancer"}, {"tags": "DCIS treatment", "patterns": ["how is dcis breast cancer treated", "how does dcis breast cancer treatment go"], "responses": "Currently, the standard treatment of DCIS is surgical resection with or without radiation. Adjuvant radiation and hormonal therapies are often reserved for younger women, patients undergoing lumpectomy, or those with the comedo subtype. Local treatment for DCIS usually involves breast-conserving therapy (BCT), which consists of lumpectomy (also called wide excision or partial mastectomy) followed in most cases by adjuvant radiation therapy (RT). Alternatively, mastectomy may be consideredFor more information \r\nhttps://www.medscape.com/answers/1947145-155355/how-is-dcis-breast-cancer-treated\r\n\r\nhttps://www.uptodate.com/contents/ductal-carcinoma-in-situ-treatment-and-prognosis#:~:text=Local%20treatment%20for%20DCIS%20usually,Alternatively%2C%20mastectomy%20may%20be%20considered.\r\n"}, {"tags": "WBRT DCIS treatment", "patterns": ["what is the role of wbrt in the treatment of dcis breast cancer", "role of wbrt in the treatment of dcis breast cancer"], "responses": "In DCIS, WBRT is delivered over 5-6 weeks after surgery, reducing the local recurrence rate by approximately 60%. Roughly 50% of local recurrences are invasive breast cancer. Meta-analyses of randomized controlled trials have demonstrated slightly higher rates of contralateral breast cancer with radiation therapy than with observation (3.85% vs 2.5%) after surgery for DCIS. Studies comparing accelerated PBI given over 5 days to standard WBRT are currently under way.For more information https://www.medscape.com/answers/1947145-155356/what-is-the-role-of-wbrt-in-the-treatment-of-dcis-breast-cancer"}, {"tags": "tamoxifen role DCIS treatment", "patterns": ["what is the role of tamoxifen in the treatment of dcis breast cancer", "role of tamoxifen in the treatment of dcis breast cancer"], "responses": "Tamoxifen is the only hormonal therapy currently approved for adjuvant therapy in patients treated with breast-conserving surgery and radiation for DCIS. A retrospective study found that patients with ER-positive DCIS who were treated with tamoxifen showed significant decreases in subsequent breast cancer at 10 years. Adjuvant tamoxifen also reduces the risk of contralateral breast cancer.For more information https://www.medscape.com/answers/1947145-155357/what-is-the-role-of-tamoxifen-in-the-treatment-of-dcis-breast-cancer"}, {"tags": "LCIS Treatment ", "patterns": ["how is lcis breast cancer treated", "how does lcis breast cancer treatment go"], "responses": "Overall, treatment options for lobular carcinoma in situ (LCIS) include observation and close follow-up care with or without tamoxifen and bilateral mastectomy with or without reconstruction. There is no evidence of therapeutic benefit from local excision, axillary dissection, radiotherapy, or chemotherapy. LCIS in the breast of a woman with ductal or lobular cancer does not require further immediate surgery on the opposite breast. Mirror biopsy of the contralateral breast, once advocated for treatment of LCIS, is now mainly of historic interest.For more information https://www.medscape.com/answers/1947145-155358/how-is-lcis-breast-cancer-treated"}, {"tags": "inflammatory breast cancer", "patterns": ["how is locally advanced breast cancer (labc) and inflammatory breast cancer (ibc) treated", "how does locally advanced breast cancer and inflammatory breast cancer treatment go"], "responses": "LABC is often treated with a combination of chemotherapy, surgery, and radiation therapy.\r\n\r\n NOTE: Chemotherapy is not given every day but instead is given in cycles. A cycle of chemotherapy refers to the time it takes to give the chemotherapy and then allow the body to recover. A cycle of chemotherapy typically ranges from two to four weeks.\r\n\r\nThe treatment of inflammatory breast cancer is similar to that of other types of locally advanced breast cancer (LABC). Treatment usually includes neoadjuvant chemotherapy, surgery, and radiation therapy. As with other forms of LABC, two types of chemotherapy agents (anthracyclines and a taxane) are usually used. Once the diagnosis of inflammatory breast cancer (IBC) is established, it is important to proceed rapidly to treatment, as this is considered a rapidly spreading cancer.\r\n\r\nThere are some important differences in the treatment of IBC compared with LABC. In IBC, a mastectomy is usually recommended, even if the cancer responded well to neoadjuvant chemotherapy. After mastectomy, radiation therapy to the chest wall and lymph nodes is strongly recommended. Immediate reconstruction is NOT recommended in IBC.\r\n\rFor more information https://www.uptodate.com/contents/locally-advanced-and-inflammatory-breast-cancer-beyond-the-basics"}, {"tags": "LABC", "patterns": ["what is the prognosis of locally advanced breast cancer (labc) and inflammatory breast cancer (ibc) following treatment", "prognosis of labc and ibc following treatment", "prognosis of  locally advanced breast cancer and inflammatory breast cancer following treatment"], "responses": "Overall, the prognosis is better for women with T3N0 (stage IIB) and T3N1 (stage IIIA) breast cancer than it is for those with classically defined LABC (IIIB, IIIC) or IBC (IIIB, T4d). Disease-free survival (DFS) and overall survival are typically better for stage IIB and IIIA patients; however, the likelihood of achieving a pathologic complete response (pCR) from neoadjuvant treatment, a well-recognized surrogate for long-term outcome, is inversely related to tumor size. Thus, the relative proportions of patients in each category are important.For more information https://www.medscape.com/answers/1947145-155360/what-is-the-prognosis-of-locally-advanced-breast-cancer-labc-and-inflammatory-breast-cancer-ibc-following-treatment"}, {"tags": "IBC", "patterns": ["what is inflammatory breast cancer (ibc)", "explain ibc", "explain inflammatory breast cancer", "define inflammatory breast cancer", "inflammatory breast cancer"], "responses": "IBC is a clinical diagnosis that implies presentation with the cardinal signs of inflammation (calor [warmth], rubor [redness], tumor [mass]) involving the breast, although the warmth may be subtle and the mass may not be appreciated as something discrete. Indeed, even when a localized mass is apparent in IBC, the true extent of the disease (as shown by performing skin biopsies from the surrounding normal-appearing skin) is usually greater than is apparent on physical examination.For more information https://www.medscape.com/answers/1947145-155361/what-is-inflammatory-breast-cancer-ibc"}, {"tags": "locally advanced breast cancer", "patterns": ["what is locally advanced breast cancer (labc)", "explain labc", "explain locally advanced breast cancer", "define locally advanced breast cancer", "locally advanced breast cancer"], "responses": "LABC is more common in the US than IBC is; by the definition used here, it may account for 10-15% of patients (this drops to about 5% if one uses the older, stricter definition that includes inoperability). Epidemiologically, LABC is associated with lower socioeconomic class and, probably for that reason, with black race in the United States.\r\n\r\nLABC encompasses both relatively indolent neglected tumors and those that have grown rapidly as a result of their inherent biology. In most case series, LABC has a better long-term outcome than IBC does, even when only inoperable cases are considered.For more information https://www.medscape.com/answers/1947145-155362/what-is-locally-advanced-breast-cancer-labc"}, {"tags": "locally advanced breast cancer and inflammatory breast cancer lymph nodes evaluation", "patterns": ["how are lymph nodes evaluated in locally advanced breast cancer (labc) and inflammatory breast cancer (ibc)", "lymph nodes evaluation in locally advanced breast cancer and inflammatory breast cancer", "lymph nodes evaluation in labc and ibc", "evaluation of lymph nodes in labc and ibc"], "responses": "Patients with LABC or IBC with clinically positive nodes should undergo a core biopsy before initiating chemotherapy. Those with clinically negative nodes may undergo sentinel lymph node biopsy before they start treatment, or else sentinel node determination may be delayed until after treatment is completed. In general, the best single test for evaluating the status of measurable tumor is ultrasonography (preferably done by the same operator). The mass often appears larger on physical examination than on ultrasonography, which can more effectively discriminate hypoechoic masses from surrounding stroma or hematoma. In IBC, magnetic resonance imaging (MRI) may be an important adjunct to response assessment. The role of positron emission tomography (PET) in routine assessment of response must be determined on a case-by-case basis.For more information https://www.medscape.com/answers/1947145-155363/how-are-lymph-nodes-evaluated-in-locally-advanced-breast-cancer-labc-and-inflammatory-breast-cancer-ibc"}, {"tags": "metastatic systemic", "patterns": ["what are the systemic treatments for metastatic breast cancer", "systemic treatments for metastatic breast cancer", "what systemic treatments are available for metastatic breast cancer"], "responses": "Although treatments for metastatic breast cancer continue to improve, there remains no cure once distant metastases develop.\r\nFurthermore, although occasional patients with metastatic breast cancer benefit from surgical resection for an isolated recurrence and many require radiation therapy for palliation at a specific site (or definitive treatment of brain metastasis), in general, recurrent or metastatic breast cancer must be approached systemically so that the therapeutic effect reaches all sites of disease. There are two main interventions: hormone therapy and chemotherapy.For more information https://www.medscape.com/answers/1947145-155364/what-are-the-systemic-treatments-for-metastatic-breast-cancer"}, {"tags": "hormone therapy metastatic ", "patterns": ["what is the role of hormone therapy in the treatment of metastatic breast cancer", "role of hormone therapy in the treatment of metastatic breast cancer", "how can hormone therapy help in the treatment of metastatic breast cancer"], "responses": "Hormone therapy (also called hormonal therapy, hormone treatment, or endocrine therapy) slows or stops the growth of hormone-sensitive tumors by blocking the body\u2019s ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.For more information https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet#:~:text=Hormone%20therapy%20(also%20called%20hormonal,hormones%20on%20breast%20cancer%20cells."}, {"tags": "chemotherapy metastatic", "patterns": ["what is the role of chemotherapy in the treatment of metastatic breast cancer", "role of chemotherapy in the treatment of metastatic breast cancer", "how can chemotherapy help in the treatment of metastatic breast cancer"], "responses": "Chemotherapy is used as a treatment for most people who have metastatic breast cancer. Whether it is used first-line or not depends on your receptor status, previous treatments, and other factors Chemotherapy can work very well for metastatic breast cancer, although tumors almost always become resistant to any given drug or combination of drugs over time. It is not uncommon for people to undergo at least three different chemotherapy regimens during treatment.. Chemotherapy for metastatic breast cancer is not expected to cure the disease, but instead to control the disease for as long as possible. Chemotherapy for metastatic breast cancer, however, is used with different goals.\r\n\r\nThese goals are:\r\n\r\nTo extend your life\r\nTo improve your quality of life\r\nTo ease your symptomsFor more information https://www.verywellhealth.com/is-chemotherapy-used-to-treat-metastatic-breast-cancer-4154715"}, {"tags": "chemotherapy agents breast cancer treatment", "patterns": ["which chemotherapy agents are used in the treatment of metastatic breast cancer", "chemotherapy agents used in the treatment of metastatic breast cancer", "what chemotherapy agents are used in the treatment of metastatic breast cancer"], "responses": "Check out the agents: https://www.medscape.com/answers/1947145-155366/what-is-the-role-of-chemotherapy-in-the-treatment-of-metastatic-breast-cancerFor more information https://www.medscape.com/answers/1947145-155367/which-chemotherapy-agents-are-used-in-the-treatment-of-metastatic-breast-cancer"}, {"tags": "PARP inhibitors", "patterns": ["what is the role of poly (adp-ribose) polymerase (parp) inhibitors in the treatment of metastatic breast cancer", "role of poly (adp-ribose) polymerase (parp) inhibitors in the treatment of metastatic breast cancer", "role of parp inhibitors in the treatment of metastatic breast cancer"], "responses": "PARP inhibitors are a type of targeted (biological) therapy.\r\n\r\nPARP stands for poly-ADP ribose polymerase. It\u2019s a protein that helps cells repair themselves if they become damaged. PARP inhibitors stop the PARP from repairing cancer cells.\r\n\r\nTwo inherited altered genes that increase the risk of breast cancer developing are called BRCA1 and BRCA2. Cancer cells with faulty BRCA genes are already less able to repair themselves if they become damaged. Adding PARP inhibitors blocks another way cancer cells can repair themselves and causes them to become too damaged to survive.For more information https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/parp-inhibitors-in-breast-cancer-treatment#:~:text=PARP%20stands%20for%20poly%2DADP,are%20called%20BRCA1%20and%20BRCA2."}, {"tags": "triple-negative breast cancer treatment ", "patterns": ["what is the efficacy of combination therapy in the treatment of triple-negative breast cancer", "efficacy of combination therapy in the treatment of triple-negative breast cancer", "how much effective is combination therapy in the treatment of triple-negative breast cancer"], "responses": "Unresectable metastatic triple-negative breast cancer (ie, estrogen receptor\u2013negative, progesterone receptor\u2013negative, and HER2 receptor\u2013negative) is aggressive and carries a poor prognosis. However, combination therapy with the programmed cell death ligand\u20131 (PDL1) inhibitor atezolizumab plus nanoparticle albumin-bound (nab)\u2013paclitaxel has been shown to prolong PFS in these patients.  In 2019, FDA approved atezolizumab in combination with nab-paclitaxel for triple-negative breast cancer. The combination therapy attacked the tumor on two fronts. On one side, the chemotherapy drug cyclophosphamide eliminated tumor cells, while on the other front, another drug inhibited tumor-associated cells called macrophages, which block the body\u2019s immune response against the tumor. This two-front strategy effectively treated several highly aggressive TNBC primary tumors and metastasisFor more information https://www.medscape.com/answers/1947145-155369/what-is-the-efficacy-of-combination-therapy-in-the-treatment-of-triple-negative-breast-cancer\r\n\r\nhttps://www.bcm.edu/news/a-promising-combination-therapy-for-triple-negative-breast-cancer"}, {"tags": "surgery role", "patterns": ["what is the role of surgery for the treatment of metastatic breast cancer", "role of surgery in the treatment of metastatic breast cancer", "what role does surgery play in the treatment of metastatic breast cancer"], "responses": "There is increasing interest in the role of surgical intervention for the intact primary tumor of these metastatic breast cancer patients. Several single-institution cohort and retrospective studies have concluded that surgical resection of the intact primary tumor may provide a survival advantage.\r\n\r\nIt is still unknown whether a selection bias affects the findings of a survival advantage in favor of surgery. However, the dogmatic belief that one should never operate in the setting of metastatic disease has certainly been dispelled in favor of critical evaluation of whether surgically achieved local control can lead to improved survival as a part of multimodal treatment. An ongoing prospective randomized clinical trial, E2108, is addressing the role of surgery for the primary tumor in metastatic setting.For more information https://www.medscape.com/answers/1947145-155371/what-is-the-role-of-surgery-for-the-treatment-of-metastatic-breast-cancer"}, {"tags": "tamoxifen raloxifene", "patterns": ["what is the role of tamoxifen and raloxifene for the reduction of breast cancer risk", "role of tamoxifen and raloxifene for the reduction of breast cancer risk", "what role does tamoxifen and raloxifene play for the reduction of breast cancer risk"], "responses": "\r\nTwo selective estrogen receptor modulators (SERMs), tamoxifen and raloxifene, are approved for reduction of breast cancer risk in high-risk women. Two NSABP trials (P1 and P2) showed that tamoxifen reduced the risk of DCIS and invasive breast cancer by 30-50%. In the NSABP P2 prevention trial, raloxifene was as effective as tamoxifen in reducing the risk of invasive breast cancer but was 30% less effective than tamoxifen in reducing the risk of DCIS. Tamoxifen and raloxifene are equally effective in reducing the risk of ER-positive breast cancer in postmenopausal women. Raloxifene is associated with lower rates of thromboembolic disease, benign uterine conditions, and cataracts than tamoxifen is. The evidence does not allow determination of whether either agent decreases mortality from breast cancer.For more information https://www.medscape.com/answers/1947145-155372/what-is-the-role-of-tamoxifen-and-raloxifene-for-the-reduction-of-breast-cancer-risk"}, {"tags": "pharmacologic ASCO", "patterns": ["what are the asco guidelines for the pharmacologic reduction of breast cancer risk", "asco guidelines for the pharmacologic reduction of breast cancer risk", "pharmacologic reduction of breast cancer risk guidelines by asco"], "responses": "ASCO guidelines on endocrine therapy to reduce breast cancer risk recommend the following :\r\n\r\n1) In premenopausal women who are at least 35 years old and have completed childbearing, tamoxifen (20 mg/day for 5 years) remains the standard of care for risk reduction. Low-dose tamoxifen (5 mg/day) may be an alternative in women with intraepithelial neoplasia.\r\n\r\n2) Anastrozole, exemestane, or raloxifene should not be prescribed for breast cancer risk reduction in premenopausal women.\r\n\r\n3) In postmenopausal women, the choice of endocrine therapy includes anastrozole (1 mg/day) in addition to exemestane (25 mg/day), raloxifene (60 mg/day), or tamoxifen (20 mg/day).\r\n\r\nThe ASCO guidelines delineate the risk thresholds for use of individual agents, along with the benefits and risks that clinician and patient should discuss when considering endocrine therapy for primary breast cancer preventionFor more information https://www.medscape.com/answers/1947145-155373/what-are-the-asco-guidelines-for-the-pharmacologic-reduction-of-breast-cancer-risk"}, {"tags": "mastecomy", "patterns": ["what is the role of mastectomy in the prevention of breast cancer", "role of mastecomy in the prevention of breast cancer", "what role does mastecomy play in the prevention of breast cancer"], "responses": "In retrospective studies with median follow-up periods of 13-14 years, bilateral risk-reduction mastectomy decreased the risk of developing breast cancer by at least 90% in women at moderate to high risk and in those with known BRCA1/2 mutations. In women with deleterious mutations in other genes that are associated with a 2-fold or greater risk for breast cancer but without a compelling family history of breast cancer, the value of risk-reducing mastectomy is unknown.\r\nNOTE: Woman who are considering prophylactic mastectomy should meet with a range of specialists to discuss the risks and benefits of surgery, including its potential psychosocial effects, as well as the nonsurgical options for reducing risk of breast cancer.These may include a breast health specialist, medical social worker, or cancer clinical psychologist or psychiatrist. For more information https://www.medscape.com/answers/1947145-155374/what-is-the-role-of-mastectomy-in-the-prevention-of-breast-cancer"}, {"tags": "contralateral prophylactic mastectomy ASBrS", "patterns": ["what are the asbrs recommendations for contralateral prophylactic mastectomy (cpm) in the treatment of breast cancer", "asbrs recommendations for contralateral prophylactic mastectomy in the treatment of breast cancer", "cpm mastectomy in the treatment of breast cancer recommendations by asbrs", "contralateral prophylactic mastectomy in the treatment of breast cancer recommendations"], "responses": "A consensus statement from the American Society of Breast Surgeons (ASBrS) recommends that women with unilateral breast cancer who are at average risk should be discouraged from undergoing a contralateral prophylactic mastectomy (CPM), because most of those women, with the possible exception of BRCA carriers, will not obtain a survival benefit, and CPM doubles the risk of surgical complications. However, the ASBrS advises that the final decision whether or not to proceed with contralateral prophylactic mastectomy  is a result of the balance between benefits and risks of CPM and patient preference.For more information https://www.medscape.com/answers/1947145-155375/what-are-the-asbrs-recommendations-for-contralateral-prophylactic-mastectomy-cpm-in-the-treatment-of-breast-cancer"}, {"tags": "NCCN ASCO", "patterns": ["what are the differences between the nccn and asco guidelines for the long-term monitoring of breast cancer survivors", "differences between nccn and asco guidelines for the long-term monitoring of breast cancer survivors", "how nccn and asco differ from eachother in guidelines for the long-term monitoring of breast cancer survivors"], "responses": "Check out the table to know the difference between NCCN and ASCO guidelines : https://emedicine.medscape.com/article/1947145-treatment#d16For more information https://www.medscape.com/answers/1947145-155376/what-are-the-differences-between-the-nccn-and-asco-guidelines-for-the-long-term-monitoring-of-breast-cancer-survivors"}, {"tags": "monitoring bone density ASCO guidelines", "patterns": ["what are asco guidelines for monitoring bone density following the treatment for breast cancer", "asco guidelines for monitoring bone density following the treatment for breast cancer", "guidelines by asco for monitoring bone density following the treatment for breast cancer"], "responses": "Women aged \u226565 years\r\n-----------------------------------------------------------------------\r\nWoman aged 60-64 years with \u22651 of the following:\r\n\r\n1. Family history of osteoporosis\r\n\r\n2. Low body weight\r\n\r\n3. Prior nontraumatic fracture\r\n\r\n4. Other risk factors (eg, smoking, sedentary lifestyle)\r\n\r\n-----------------------------------------------------------------------\r\nPostmenopausal women on aromatase inhibitors\r\n\r\n-----------------------------------------------------------------------\r\nPremenopausal women who develop treatment related premature menopause\r\n\r\n-----------------------------------------------------------------------For more information https://www.medscape.com/answers/1947145-155377/what-are-asco-guidelines-for-monitoring-bone-density-following-the-treatment-for-breast-cancer"}, {"tags": "long-term monitoring", "patterns": ["what is the role of postoperative imaging in the long-term monitoring of breast cancer", "role of postoperative imaging in the long-term monitoring of breast cancer", "what role does postoperative imaging play in the long-term monitoring of breast cancer"], "responses": "Women who have had surgery for breast cancer may still require breast cancer screening with mammography. If a woman had a total mastectomy, then the other breast requires yearly follow-up, because there is still a higher risk that cancer will develop in the remaining breast. If the woman had a subcutaneous mastectomy, partial mastectomy, or lumpectomy, then that breast itself requires follow-up mammography.\r\n\r\nThe first mammogram is best performed 6 months postoperatively to provide a baseline for the new postoperative and postirradiation changes. Thereafter, mammography may be performed every 6-12 months for screening and follow-upFor more information https://www.medscape.com/answers/1947145-155378/what-is-the-role-of-postoperative-imaging-in-the-long-term-monitoring-of-breast-cancer"}, {"tags": "postoperative imaging", "patterns": ["what is the role of postoperative imaging in the monitoring of metastatic breast cancer", "role of postoperative imaging in the monitoring of metastatic breast cancer", "what role does postoperative imaging play in the monitoring of  metastatic breast cancer"], "responses": "Recommendations for monitoring disease response in the metastatic setting vary. In general, monthly evaluations consisting of a history and physical examination to evaluate progression of disease and toxicities are reasonable.\r\n\r\nMeasurement of tumor markers, such as CEA, CA15.3, and CA27.29, can be used in conjunction with diagnostic imaging, history, and physical examination for monitoring patients on active therapy. CA15.3 and CA27.29 levels correlate with the course of disease in 60-70% of patients, whereas CEA levels correlate in 40% of patients.\r\n\r\nHowever, data are insufficient to recommend the use of CEA, CA15.3, or CA27.29 alone for monitoring response to treatment. Caution should be used in the interpretation of rising CEA, CA15.3, or CA27.29 levels during the first 4-6 weeks of a new therapy; spurious early rises may occur.For more information https://www.medscape.com/answers/1947145-155379/what-is-the-role-of-postoperative-imaging-in-the-monitoring-of-metastatic-breast-cancer"}, {"tags": "heart disease", "patterns": ["how is radiation-induced heart disease monitored in patients with breast cancer", "how is radiation-induced heart disease in breast cancer patients monitored", "monitoring of radiation-induced heart disease in breast cancer patients"], "responses": "According to a consensus statement from the European Association of Cardiovascular Imaging and the American Society of Echocardiography, patients treated with radiotherapy to the chest for Hodgkin's disease, or breast, lung, or esophageal cancer, should have an echocardiogram every 5 to 10 years to detect radiation-induced heart disease (RIHD). The relative risk of RIHD is 2- to 5.9 times higher in patients treated with radiation for breast cancer.For more information https://www.medscape.com/answers/1947145-155380/how-is-radiation-induced-heart-disease-monitored-in-patients-with-breast-cancer"}, {"tags": "Integrative Oncology", "patterns": ["what are society for integrative oncology guidelines for use of integrative therapy in breast cancer", "society for integrative oncology guidelines for use of integrative therapy in breast cancer, guidelines for use of integrative therapy in breast cancer by society of integrative oncology"], "responses": "The Society for Integrative Oncology has released clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. Recommendations include the following  :\r\n\r\n1) Meditation, yoga, and relaxation with imagery may be useful for alleviating anxiety and mood disorders (grade A evidence)\r\n\r\n2) Stress management, yoga, massage, music therapy, energy conservation, and meditation may reduce stress, improve mood, decrease fatigue, and improve quality of life (grade B evidence)\r\n\r\n3) Acetyl-L-carnitine for the prevention of taxane-induced neuropathy may increase neuropathy and should not be used (grade H [likely harmful])\r\n\r\n4) Evidence of benefit is weak or lacking for many interventionsFor more information https://www.medscape.com/answers/1947145-155381/what-are-society-for-integrative-oncology-guidelines-for-use-of-integrative-therapy-in-breast-cancer"}, {"tags": "cancer screening", "patterns": ["which organizations have issued guidelines on breast cancer screening", "which organizations have released recommendations for breast cancer screening", "organizations that have issued guidelines on breast cancer screening"], "responses": "Guidelines on breast cancer screening have been issued by the following organizations:\r\n\r\n1) American Cancer Society (ACS)\r\n2) U.S. Preventive Services Task Force (USPSTF)\r\n3) American College of Obstetricians and Gynecologists (ACOG)\r\n4) European Commission Initiative on Breast Cancer (ECIBC)For more information https://www.medscape.com/answers/1947145-155382/which-organizations-have-issued-guidelines-on-breast-cancer-screening"}, {"tags": "breast ACS", "patterns": ["what are the acs guidelines for breast self-exam (bse)", "acs guidelines for breast self-exam", "acs guidelines for bse", "bse guidelines by asc"], "responses": "ACS recommendations for BSE are as follows :\r\n\r\n1) Women should begin regular screening mammography at age 45 years (strong recommendation)\r\n2) Women aged 45-54 years should be screened annually (qualified recommendation)\r\n3) Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation)\r\n4) Women should have the opportunity to begin annual screening at 40-44 years  of age (qualified recommendation)\r\n5) Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation)For more information https://www.medscape.com/answers/1947145-155383/what-are-the-acs-guidelines-for-breast-self-exam-bse"}, {"tags": "MRI screening", "patterns": ["what are acs guidelines for the use of mri in breast cancer screening", "can we use mri for breast cancer screening", "use of mri in breast cancer screening"], "responses": "The ACS considers a woman to be at average risk for breast cancer in the absence of all of the following:\n\nA personal history of breast cancer\nA strong family history of breast cancer\nA genetic mutation known to increase risk of breast cancer (eg, in BRCA)\nA history of chest radiation therapy before the age of 30\nFor average-risk women, the ACS screening recommendations are as follows:\n\nAge 40-44 - Starting screening with annual mammography is an option.\nAge 45-54 - Annual mammography is recommended.\nAge 55 and older - Transition to biennial screening or have the opportunity to continue screening annually. Continue screening as long as the woman is in good health and has a life expectancy of at least 10 years.\nClinical breast exams are not recommended for breast cancer screening in average-risk women at any age.For more information https://www.medscape.com/answers/1947145-155385/what-are-acs-guidelines-for-the-use-of-mri-in-breast-cancer-screening"}, {"tags": "breast self-exam", "patterns": ["what are the uspstf guidelines for breast self-exam (bse)", "what are the guidelines for breast self-exam"], "responses": "In 2016, the USPSTF released updated recommendations on breast cancer screening, but did not update its 2009 recommendations for breast examination. In its 2016 statement, the USPSTF encouraged patients to be aware of changes in their bodies and discussing these changes with clinicians.\n\nThe 2009 breast examination recommendations are as follows  :\n\nNo requirement for clinicians to teach women how to perform BSE (Grade D recommendation)\n\nInsufficient current evidence to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or olderFor more information https://www.medscape.com/answers/1947145-155386/what-are-the-uspstf-guidelines-for-breast-self-exam-bse"}, {"tags": "breast cancer screening guidelines", "patterns": ["what are the uspstf guidelines for breast cancer screening", "what are the guidelines for breast cancer screening"], "responses": "Since 2009 the USPSTF has recommended biennial screening mammography for women aged 50-74 years (grade B recommendation). The USPSTF recommends against routine screening mammography in women aged 40-49 years because of high rates of false-negative findings, perceived harm of unnecessary biopsy, and concern for the harm associated with overdiagnosis and overtreatment (grade C recommendation). [97]\r\n\r\nInstead of routine screening for women 40-49 years old, the USPSTF recommends that clinicians provide screening to selected patients in this age range, depending on individual circumstances and patient preferences. The USPSTF further concluded that for most individuals without signs or symptoms, there is likely to be only a small benefit from screening.\r\n\r\nFinally, the USPSTF recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination in women aged 40 years or older or the benefits and harms of screening mammography in women aged 75 years or older.For more information https://www.medscape.com/answers/1947145-155387/what-are-the-uspstf-guidelines-for-breast-cancer-screening"}, {"tags": "breast cancer screening guidelines", "patterns": ["what are the uspstf guidelines for brca-related breast cancer screening", "what are the brca-related guidelines for breast cancer screening"], "responses": "In 2013, the USPSTF issued updated guidelines on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women. The current USPSTF recommendations are as follows:\n\nWomen who have family members with breast, ovarian, tubal, or peritoneal cancer should be screened to identify a family history that may be associated with an increased risk for mutations in the breast cancer susceptibility genes BRCA1 or BRCA2\n\nWomen who have positive screening results should receive genetic counseling and then BRCA testing if warranted\n\nWomen without a family history associated with an increased risk for mutations should not receive routine genetic counseling or BRCA testingFor more information https://www.medscape.com/answers/1947145-155388/what-are-the-uspstf-guidelines-for-brca-related-breast-cancer-screening"}, {"tags": "breast cancer screening guidelines", "patterns": ["how are the acog guidelines for breast cancer screening categorized", "what are the categories for breast cancer screening"], "responses": "The ACOG released guidelines for breast cancer risk assessment and screening in average-risk women in 2017. [184] For women at average risk, ACOG categorizes its recommendations as follows:\n\nLevel A \u2013 Based on good and consistent scientific evidence\nLevel B \u2013 Based on limited or inconsistent scientific evidence\nLevel C \u2013 Based primarily on consensus and expert opinion\nACOG recommends that health care providers periodically assess patients' breast cancer risk by reviewing the history (level B). Breast cancer risk factors include a long list. Visit the provided link for more information.For more information https://www.medscape.com/answers/1947145-155389/how-are-the-acog-guidelines-for-breast-cancer-screening-categorized"}, {"tags": "Risk factor guidelines", "patterns": ["according to acog guidelines, which breast cancer risk factors should be periodically assessed in women", "breast cancer risk factors", "what are breast cancer risk factors which need to be assessed periodically"], "responses": "ACOG recommends that health care providers periodically assess patients' breast cancer risk by reviewing the history (level B). Breast cancer risk factors include the following:\n\nFamily history of breast cancer, ovarian cancer, or other hereditary breast and ovatrians syndrome-associated cancer (eg, prostate cancer, pancreatic cancer)\nKnown deleterious gene mutation\nPrior breast biopsy with atypical hyperplasia (lobular or ductal) or lobular carcinoma in situ\nEarly menarche\nLate menopause\nNulliparity\nProlonged interval between menarche and first pregnancy\nMenopausal hormone therapy with estrogen and progestin (decreased risk with progestin alone)\nNot breastfeeding\nIncreasing age\nCertain ethnicities (eg, higher likelihood of BRCA mutation in Ashkenazi Jewish women)\nHigher body mass index\nAlcohol consumption\nSmoking\nDense breasts on mammography\nPrior exposure to high-dose therapeutic chest irradiation at age 10-30 yearsFor more information https://www.medscape.com/answers/1947145-155390/according-to-acog-guidelines-which-breast-cancer-risk-factors-should-be-periodically-assessed-in-women"}, {"tags": "Clinical breast exam", "patterns": ["what are the acog guidelines for clinical breast exam to screen for breast cancer", "clinical breast cancer exam guidelines"], "responses": "Women should be counseled about breast self-awareness (ie, awareness of the normal appearance and feel of their breasts) and encouraged to notify their health care provider if they experience a change (level C). However, breast self-examination is not recommended (level B).\r\n\r\nClinical breast examination remains a recommended part of the evaluation of women who are at high risk or have symptoms. Screening clinical breast examination may be offered to asymptomatic, average-risk women on the following schedules, in the context of an informed, shared decision-making approach that recognizes the uncertainty of its benefits and the possibility of adverse consequences (level C):\r\n\r\nFor women aged 25\u201339 years, clinical breast examinations may be offered every 1\u20133 years.\r\nFor women aged 40 years and older, clinical breast examination may be offered annuallyFor more information https://www.medscape.com/answers/1947145-155391/what-are-the-acog-guidelines-for-clinical-breast-exam-to-screen-for-breast-cancer"}, {"tags": "mammography recommendations", "patterns": ["what are the acog recommendations for breast cancer screening mammography", "breast cancer screening mammography", "mammography screening recommendations"], "responses": "The decision about the age to begin mammography screening should be made through a shared decision-making process that includes information about the potential benefits and harms. Recommendations (level A) for average-risk women are as follows:\n\nScreening mammography should be offered starting at age 40 years.\n\nIf patient desires, after counseling, initiate mammography at age 40-49 years.\n\nWomen should begin screening mammography by no later than age 50 years.\nFor more information https://www.medscape.com/answers/1947145-155392/what-are-the-acog-recommendations-for-breast-cancer-screening-mammography"}, {"tags": "breast cancer screening guidelines", "patterns": ["what are european commission initiative on breast cancer (ecibc) screening guidelines", "ecibc guidelines"], "responses": "The European Commission Initiative on Breast Cancer (ECIBC) screening guidelines include the following recommendations for women age 40-74 years who are at average risk of breast cancer [185] :\r\n\r\nAge 40-44: no screening \r\nAge 45-49: screening every 2 or 3 years\r\nAge 50-69: screening every 2 years\r\nAge 70-74: screening every 3 yearsFor more information https://www.medscape.com/answers/1947145-155384/what-are-european-commission-initiative-on-breast-cancer-ecibc-screening-guidelines"}, {"tags": "risk reduction organizations", "patterns": ["which organizations have issued guidelines for pharmacologic intervention for breast cancer risk reduction", "which organization issued guidelines for breast cancer risk reduction"], "responses": "Guidelines for pharmacologic intervention in women who are at increased risk for breast cancer, but do not have a personal history of breast cancer, have been issued by the American Society of Clinical Oncology (ASCO) and the U.S. Preventive Services Task Force (USPSTF). The guidelines differ in their classification of increased risk and in their inclusion of women with lobular carcinoma in situ (LCIS).For more information https://www.medscape.com/answers/1947145-155393/which-organizations-have-issued-guidelines-for-pharmacologic-intervention-for-breast-cancer-risk-reduction"}, {"tags": "risk reduction guidelines", "patterns": ["what are the asco guidelines on pharmacologic interventions for breast cancer risk reduction", "guidelines on medical interventions for risk reduction"], "responses": "ASCO guidelines recommend the following [186] :\n\nFor premenopausal or postmenopausal women with increased risk for breast cancer, offer tamoxifen (20 mg/day for 5 years) to reduce the risk of invasive ER-positive breast cancer\n\nIn postmenopausal women, raloxifene (60 mg/day for 5 years) may also be considered\n\nOff-label use of exemestane (25 mg/day for 5 years) should be discussed as an alternative to reduce the risk in postmenopausal women\n\nAll three agents should be discussed (including risks and benefits) with women aged 35 years or older without a personal history of breast cancer who are at increased risk of developing invasive breast cancerFor more information https://www.medscape.com/answers/1947145-155394/what-are-the-asco-guidelines-on-pharmacologic-interventions-for-breast-cancer-risk-reduction"}, {"tags": "tamoxifen", "patterns": ["what are the asco recommendations for use of tamoxifen in breast cancer risk reduction", "use of tamoxifen in risk reduction", "can i use tamoxifen", "shall i use tamoxifen", "how to use tamoxifen"], "responses": "ASCO guidelines recommend that use of tamoxifen, 20 mg per day orally for 5 years, should be discussed as an option to reduce the risk of invasive breast cancer (BC), specifically ER-positive BC, in women 35 years of age or older who are premenopausal or postmenopausal and have a 5-year projected absolute breast cancer risk \u2265 1.66% or with LCIS. Risk reduction benefit continues for at least 10 years. \n\nASCO guidelines advise that tamoxifen not be used in the following cases:\n\nIn women with a history of deep vein thrombosis, pulmonary embolus, stroke, or transient ischemic attack or during prolonged immobilization\n\nIn combination with hormone therapy\n\nIn women who are pregnant, may become pregnant, or are nursing mothersFor more information https://www.medscape.com/answers/1947145-155395/what-are-the-asco-recommendations-for-use-of-tamoxifen-in-breast-cancer-risk-reduction"}, {"tags": "raloxifene", "patterns": ["what are the asco recommendations for use of raloxifene in breast cancer risk reduction", "use of raloxifene in risk reduction", "can i use raloxifene", "shall i use raloxifene", "how to use raloxifene"], "responses": "ASCO guidelines recommend that raloxifene should be discussed as an option to reduce the risk of invasive BC, specifically ER-positive BC, in postmenopausal women who are age \u2265 35 years with a 5-year projected absolute BC risk \u2265 1.66% or with LCIS. Raloxifene is given in a dosage of 60 mg/ day orally for 5 years; it can be used for longer than 5 years in women with osteoporosis, in whom BC risk reduction is a secondary benefit.\nASCO guidelines advise that raloxifene not be used in the following cases:\n\nFor BC risk reduction in premenopausal women\n\nIn women with a history of deep vein thrombosis, pulmonary embolus, stroke, or transient ischemic attack or during prolonged immobilizationFor more information https://www.medscape.com/answers/1947145-155396/what-are-the-asco-recommendations-for-use-of-raloxifene-in-breast-cancer-risk-reduction"}, {"tags": "exemestane", "patterns": ["what are the asco recommendations for use of exemestane in breast cancer risk reduction", "use of exemestane in risk reduction", "can i use exemestane", "shall i use exemestane", "how to use exemestane"], "responses": "Exemestane is not FDA approved for breast cancer risk reduction. However, ASCO guidelines recommend that it should be discussed as an alternative to tamoxifen and/or raloxifene to reduce the risk of invasive BC, specifically ER-positive BC, in postmenopausal women age \u2265 35 years with a 5-year projected absolute BC risk \u2265 1.66% or with LCIS or atypical hyperplasia. It should not be used for BC risk reduction in premenopausal women. Exemestane is given in a dosage of 25 mg per day orally for 5 years.For more information https://www.medscape.com/answers/1947145-155397/what-are-the-asco-recommendations-for-use-of-exemestane-in-breast-cancer-risk-reduction"}, {"tags": "risk reduction guidelines", "patterns": ["what are the uspstf guidelines on pharmacologic interventions for breast cancer risk reduction", "guidelines on medical interventions for risk reduction"], "responses": "The USPSTF updated its guidelines for primary breast cancer risk reduction in 2019. [178]  The USPSTF recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors.For more information https://www.medscape.com/answers/1947145-155398/what-are-the-uspstf-guidelines-on-pharmacologic-interventions-for-breast-cancer-risk-reduction"}, {"tags": "sentinel lymph node biopsy. axillary lymph node dissection.", "patterns": ["which organizations have issued guidelines for sentinel lymph node biopsy (slnb) and axillary lymph node dissection (alnd) in the treatment of breast cancer", "who issues guidelines for sentinel lymph node biopsy", "which organization issues guidelines for axillary lymph node dissection"], "responses": "Guidelines for sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) have been issued by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).For more information https://www.medscape.com/answers/1947145-155399/which-organizations-have-issued-guidelines-for-sentinel-lymph-node-biopsy-slnb-and-axillary-lymph-node-dissection-alnd-in-the-treatment-of-breast-cancer"}, {"tags": "sentinel lymph node biopsy. axillary lymph node dissection.", "patterns": ["what are the asco guidelines for the use of sentinel lymph node biopsy (slnb) in the treatment of breast cancer", "guidelines for sentinel lymph node biopsy", "guidelines for axillary lymph node dissection"], "responses": "A 2016 update on SLNB for patients with operable early-stage breast cancer by ASCO advises that SLNB may be offered to the following patients:\n\nWomen with multicentric tumors\nWomen with DCIS who will be undergoing mastectomy\nWomen who previously underwent breast and/or axillary surgery\nWomen who received preoperative/neoadjuvant systemic therapy\nAccording to the ASCO guidelines, SLNB should not be performed in patients with any of the following:\n\nLarge or locally advanced invasive breast cancer (tumor size T3/T4)\nInflammatory breast cancer\nDCIS (when breast-conserving surgery is planned)\nPregnancyFor more information https://www.medscape.com/answers/1947145-155400/what-are-the-asco-guidelines-for-the-use-of-sentinel-lymph-node-biopsy-slnb-in-the-treatment-of-breast-cancer"}, {"tags": "sentinel lymph node biopsy. axillary lymph node dissection.", "patterns": ["what are the asco guidelines for the use of axillary lymph node dissection (alnd) in the treatment of breast cancer", "guidelines for sentinel lymph node biopsy", "guidelines for axillary lymph node dissection"], "responses": "A 2016 update on SLNB for patients with operable early-stage breast cancer by ASCO advises that SLNB may be offered to the following patients [188] :\r\n\r\nWomen with multicentric tumors\r\nWomen with DCIS who will be undergoing mastectomy\r\nWomen who previously underwent breast and/or axillary surgery\r\nWomen who received preoperative/neoadjuvant systemic therapyFor more information https://www.medscape.com/answers/1947145-155401/what-are-the-asco-guidelines-for-the-use-of-axillary-lymph-node-dissection-alnd-in-the-treatment-of-breast-cancer"}, {"tags": "sentinel lymph node biopsy. axillary lymph node dissection.", "patterns": ["what are the nccn guidelines on the use of sentinel lymph node biopsy (slnb) for the treatment of breast cancer", "guidelines for sentinel lymph node biopsy", "guidelines for axillary lymph node dissection"], "responses": "The NCCN guidelines recommend that SLNB should be performed and is the preferred method of axillary lymph node staging if the patient is an appropriate candidate for SLNB. [72] Candidates include patients who are clinically node negative at the time of breast cancer diagnosis, with or without 1\u20132 suspicious nodes on imaging, and for whom no preoperative systemic therapy is planned.\r\n\r\nIf the sentinel lymph node is negative, no further axillary surgery is a category 1 recommendation. The NCCN recommends axillary dissection level I/II if the sentinel node is not identified or if the sentinel node is positive but the patient fails to meet all the following criteria:\r\n\r\nT1 or T2 tumor\r\nOnly one or two positive sentinel lymph nodes\r\nBreast-conserving surgery\r\nWhole-breast radiation therapy planned\r\nNo preoperative chemotherapyFor more information https://www.medscape.com/answers/1947145-155402/what-are-the-nccn-guidelines-on-the-use-of-sentinel-lymph-node-biopsy-slnb-for-the-treatment-of-breast-cancer"}, {"tags": "fine needle aspiration. core biopsy", "patterns": ["what are the nccn guidelines for fine needle aspiration (fna) and core biopsy in the treatment of breast cancer", "guidelines for fine needle aspiration"], "responses": "The NCCN recommends fine needle aspiration (FNA) or core biopsy for patients with any of the following characteristics:\r\n\r\nClinically node positive (3 or more positive nodes on physical exam and/or imaging) at time of diagnosis  or\r\n\u2265T2 or \u2265N1 and with preoperative systemic therapy planned  or\r\nT2\u20134,N1\u20133,M0\r\nIf FNA or core biopsy results are negative, the NCCN recommends SLNB. For those with positive results, the NCCN recommends axillary dissection I/II, although SLNB may be considered in selected cases (eg, patients with clinically negative nodes after neoadjuvant therapy).For more information https://www.medscape.com/answers/1947145-155403/what-are-the-nccn-guidelines-for-fine-needle-aspiration-fna-and-core-biopsy-in-the-treatment-of-breast-cancer"}, {"tags": "sentinel lymph node biopsy during pregnancy", "patterns": ["what are the nccn guidelines for use of sentinel lymph node biopsy (slnb) in the treatment of breast cancer during pregnancy", "guidelines for sentinel lymph node biopsy during pregnancy"], "responses": "In contrast with ASCO, the NCCN concluded that insufficient data exist on which to base recommendations regarding the use of SLNB in pregnant women. The NCCN advises that whether to use SLNB in pregnancy should be an individualized decision, but cites a review recommending that SLNB should not be offered to pregnant women under 30 weeks' gestation. If SLNB is used, the NCCN advises that isosulfan blue or methylene blue dye is discouraged for SLNB in pregnancy, and that the use of radioactive tracer (eg, technetium 99m sulfur colloid) is supported by limited data, with only case reports and estimations of fetal radiation dose.For more information https://www.medscape.com/answers/1947145-155404/what-are-the-nccn-guidelines-for-use-of-sentinel-lymph-node-biopsy-slnb-in-the-treatment-of-breast-cancer-during-pregnancy"}, {"tags": "hormone receptor testing", "patterns": ["what were the asco/cap guidelines for hormone receptor testing in patients with breast cancer", "guidelines for hormone receptor testing"], "responses": "ER testing of invasive breast cancers by validated immunohistochemistry remains the standard for predicting which patients may benefit from endocrine therapy; no other assays are recommended for this purpose.\r\nBreast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, data on the benefit of endocrine therapy for cancers with 1-10% of cells staining ER positive are limited. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment.\r\nA sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive.For more information https://www.medscape.com/answers/1947145-197610/what-were-the-ascocap-guidelines-for-hormone-receptor-testing-in-patients-with-breast-cancer"}, {"tags": "whole breast radiation therapy", "patterns": ["what are the guidelines for breast-conserving surgery with whole-breast radiation therapy (wbrt) in ductal carcinoma in situ (dcis) breast cancer", "guidelines for whole-breast radiation therapy"], "responses": "A positive margin is associated with a significant increase in ipsilateral breast tumor recurrence (IBTR); this increased risk is not nullified by the use of WBRT\r\nNegative margins halve the risk of IBTR  and a 2 mm margin minimizes the risk of IBTR compared with smaller negative margins.\r\nMore widely clear margins do not significantly decrease IBTR compared with 2 mm margins.\r\nNegative margins < 2 mm alone are not an indication for mastectomy; clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.For more information https://www.medscape.com/answers/1947145-155405/what-are-the-guidelines-for-breast-conserving-surgery-with-whole-breast-radiation-therapy-wbrt-in-ductal-carcinoma-in-situ-dcis-breast-cancer"}, {"tags": "whole breast radiation therapy in Stage 1 and Stage 2 cancer", "patterns": ["what are the guidelines for breast-conserving surgery with whole-breast radiation therapy (wbrt) in stages i and ii invasive breast cancer", "whole-breast radiation therapy in stage 1 and stage 2 cancer"], "responses": "The following consensus guideline, released in 2014 by the Society of Surgical Oncology and the American Society for Radiation Oncology, addresses margins for breast-conserving surgery with whole-breast irradiation (WBI) in stages I and II invasive breast cancer:\n\nPositive margins are associated with at least a two-fold increase in ipsilateral breast tumor recurrence (IBTR)\n\nNegative margins optimize IBTR; this risk is not significantly lowered by wider margin widths\n\nIBTR rates are reduced with the use of systemic therapy; in patients who do not receive adjuvant systemic therapy, margins wider than no ink on tumor are not needed\n\nBiologic subtypes do not indicate the need for margins wider than no ink on tumor\n\nMargin width should not determine the choice of WBI delivery technique, fractionation, and boost doseFor more information https://www.medscape.com/answers/1947145-155406/what-are-the-guidelines-for-breast-conserving-surgery-with-whole-breast-radiation-therapy-wbrt-in-stages-i-and-ii-invasive-breast-cancer"}, {"tags": "postmastectomy radiation therapy", "patterns": ["what are the asco guidelines for postmastectomy radiation therapy in the treatment of breast cancer", "guidelines for postmastectomy radiation therapy"], "responses": "Clinical practice guidelines developed by the American Society of Clinical Oncology (ASCO), recommend that postmastectomy radiation therapy be performed according to the following criteria :\n\nPositive postmastectomy margins\nPrimary tumors >5 cm\nInvolvement of \u22654 lymph nodes\nPatients with more than four positive lymph nodes should also undergo prophylactic nodal radiation therapy at doses of 45-50 Gy to the axillary and supraclavicular regions. For patients in whom ALND shows no node involvement, axillary radiation therapy is not recommended.For more information https://www.medscape.com/answers/1947145-155408/what-are-the-asco-guidelines-for-postmastectomy-radiation-therapy-in-the-treatment-of-breast-cancer"}, {"tags": "HER2 positive cancer", "patterns": ["what are the asco treatment guidelines for her2-positive breast cancer", "guidelines for her2 positive breast cancer"], "responses": "HER2-targeted therapy is recommended for patients with HER2-positive advanced breast cancer, except for those with clinical congestive heart failure or significantly compromised left ventricular ejection fraction, who should be evaluated on a case-by-case basis.\r\n\r\nThe combination of trastuzumab, pertuzumab, and a taxane is recommended for first-line treatment.\r\n\r\nTrastuzumab emtansine is recommended for second-line treatment.\r\n\r\nIn the third-line setting, clinicians should offer other HER2-targeted therapy combinations or trastuzumab emtansine (if not previously administered) and may offer pertuzumab if the patient has not previously received it.For more information https://www.medscape.com/answers/1947145-155409/what-are-the-asco-treatment-guidelines-for-her2-positive-breast-cancer"}, {"tags": "hormonal adjuvant therapy", "patterns": ["what are the asco guidelines for the use of hormonal adjuvant therapy in the treatment of premenopausal women with breast cancer"], "responses": "SCO recommends high-risk women receive adjuvant endocrine therapy with ovarian suppression but lower-risk patients should not.\n\nWomen with stage II or stage III breast cancers who would ordinarily be advised to receive adjuvant chemotherapy should receive ovarian suppression in addition to endocrine therapy\n\nWomen with stage I or II breast cancers at higher risk of recurrence, who might consider chemotherapy, may also be offered ovarian suppression in addition to endocrine therapy\n\nWomen with stage I breast cancers not warranting chemotherapy should receive endocrine therapy but not receive ovarian suppression\n\nWomen with node-negative cancers 1 cm or less (T1a, T1b) should receive endocrine therapy but not receive ovarian suppression\n\nOvarian suppression may be administered with either tamoxifen or an aromatase inhibitorFor more information https://www.medscape.com/answers/1947145-155410/what-are-the-asco-guidelines-for-the-use-of-hormonal-adjuvant-therapy-in-the-treatment-of-premenopausal-women-with-breast-cancer"}, {"tags": "adjuvant endocrine therapy", "patterns": ["what are the asco guidelines for adjuvant endocrine therapy in the treatment of postmenopausal women with breast cancer"], "responses": "Women with stage II or stage III breast cancers who would ordinarily be advised to receive adjuvant chemotherapy should receive ovarian suppression in addition to endocrine therapy\r\n\r\nWomen with stage I or II breast cancers at higher risk of recurrence, who might consider chemotherapy, may also be offered ovarian suppression in addition to endocrine therapy\r\n\r\nWomen with stage I breast cancers not warranting chemotherapy should receive endocrine therapy but not receive ovarian suppression\r\n\r\nWomen with node-negative cancers 1 cm or less (T1a, T1b) should receive endocrine therapy but not receive ovarian suppression\r\n\r\nOvarian suppression may be administered with either tamoxifen or an aromatase inhibitorFor more information https://www.medscape.com/answers/1947145-155411/what-are-the-asco-guidelines-for-adjuvant-endocrine-therapy-in-the-treatment-of-postmenopausal-women-with-breast-cancer"}, {"tags": "young women with breast cancer", "patterns": ["what are guidelines on the treatment of breast cancer in young women", "treatment of breast cancer in young women", "can young women with breast cancer be cured"], "responses": "There is no clear role for routine screening by any imaging technique for early breast cancer detection in healthy, average-risk young women. However, in young women with a cancer predisposition syndrome (germline mutation in a known cancer predisposition gene), significant family history, or prior personal history of ionizing radiation to the chest, consideration may be given to screening breast MRI.\nIn young women with the diagnosis of either invasive disease or preinvasive lesions who are not high-risk mutation carriers, there is no evidence that performing risk-reducing bilateral mastectomy leads to improved overall survival (OS). Visit the website for a lot more information.For more information https://www.medscape.com/answers/1947145-155412/what-are-guidelines-on-the-treatment-of-breast-cancer-in-young-women"}, {"tags": "breast cancer survivors", "patterns": ["which organizations issued guidelines on follow-up care for breast cancer survivors"], "responses": "The National Comprehensive Cancer Network (NCCN) and the American Cancer Society/American Society of Clinical Oncology (ACS/ASCO) have issued guidelines on followup care for breast cancer survivors. The guidelines differ principally in the timing of care. See the table in the website below.For more information https://www.medscape.com/answers/1947145-155413/which-organizations-issued-guidelines-on-follow-up-care-for-breast-cancer-survivors"}, {"tags": "biomarkers", "patterns": ["what are asco guidelines for use of biomarkers in the treatment of breast cancer", "use of biomarkers in treatment", "can we use biomarkers to treat breast cancer"], "responses": "A guideline from the American Society of Clinical Oncology (ASCO) advises that the only biomarkers that can guide choices of specific treatment regimens in breast cancer are as follows:\r\n\r\nEstrogen receptor (ER)\r\nProgesterone receptor (PR)\r\nHuman epidermal growth factor receptor 2 (HER2)For more information https://www.medscape.com/answers/1947145-155414/what-are-asco-guidelines-for-use-of-biomarkers-in-the-treatment-of-breast-cancer"}, {"tags": "radical mastectomy", "patterns": ["what are the nccn guidelines for radical mastectomy in the treatment of breast cancer", "guidelines for radical mastectomy", "can we use radical mastectomy for treatment"], "responses": "According to National Comprehensive Cancer Network (NCCN) guidelines, mastectomy with level I/II axillary lymph node dissection is the recommended procedure in patients who respond to neoadjuvant chemotherapy. Other NCCN indications include:\n\nPrior radiation therapy to the breast or chest wall\nRadiation therapy contraindicated by pregnancy (except patients in the third trimester who can receive radiation postpartum)\nInflammatory breast cancer\nDiffuse suspicious or malignant-appearing microcalcifications\nWidespread disease that is multicentric, located in more than one quadrant, and cannot be removed through a single incision with negative margins\nA positive pathologic margin after repeat re-excision and suboptimal cosmetic outcomeFor more information https://www.medscape.com/answers/1947145-155407/what-are-the-nccn-guidelines-for-radical-mastectomy-in-the-treatment-of-breast-cancer"}, {"tags": "adjuvent therapy", "patterns": ["what is the role of adjuvant therapies in the treatment of breast cancer", "role of adjuvent therapies", "do adjuvent therapies work", "does adjuvent therapy work"], "responses": "Adjuvant treatment for breast cancer involves radiation therapy and a variety of chemotherapeutic and biologic agents. It is designed to treat micrometastatic disease (or breast cancer cells that have escaped the breast and regional lymph nodes but which have not yet had an established identifiable metastasis). Treatment is aimed at reducing the risk of future recurrence, thereby reducing breast cancer\u2212related morbidity and mortality.\r\n\r\nIn patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation.For more information https://www.medscape.com/answers/1947145-155415/what-is-the-role-of-adjuvant-therapies-in-the-treatment-of-breast-cancer"}, {"tags": "adjuvent treatment medications", "patterns": ["which medications are used in the adjuvant treatment of breast cancer", "medications used in adjuvent treatment", "what does adjuvent treatment work", "which medication is used in adjuvent treatment"], "responses": "Medication Summary\r\nAdjuvant treatment for breast cancer involves radiation therapy and a variety of chemotherapeutic and biologic agents. It is designed to treat micrometastatic disease (or breast cancer cells that have escaped the breast and regional lymph nodes but which have not yet had an established identifiable metastasis). Treatment is aimed at reducing the risk of future recurrence, thereby reducing breast cancer\u2212related morbidity and mortality.\r\n\r\nIn patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation.For more information https://www.medscape.com/answers/1947145-155416/which-medications-are-used-in-the-adjuvant-treatment-of-breast-cancer"}, {"tags": "Estrogen Receptor Antagonist", "patterns": ["which medications in the drug class antineoplastics, estrogen receptor antagonist are used in the treatment of breast cancer", "antineoplastics estrogen receptor antagonist usage", "when to use antineoplastics estrogen receptor antagonist"], "responses": "Bevacizumab, a humanized monoclonal antibody that inhibits angiogenesis, had been approved for use in combination therapy for metastatic breast cancer. In November 2011, however, the US Food and Drug Administration (FDA) revoked its approval for this indication, after concluding that bevacizumab had not been shown to be safe and effective for that use. [72]  \n\nAnthracyclines work in multiple ways, including intercalation between DNA base pairs and inhibition of type II topoisomerase function, resulting in inhibition of cell replication and transcription. They also work by inhibition of DNA helicase, resulting in DNA cleavage.For more information https://www.medscape.com/answers/1947145-155960/which-medications-in-the-drug-class-antineoplastics-estrogen-receptor-antagonist-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "PARP inhibitors", "patterns": ["which medications in the drug class antineoplastics, parp inhibitors are used in the treatment of breast cancer", "antineoplastics parp inhibitors usage", "when to use antineoplastics parp inhibitors"], "responses": "This class of agents is thought to augment cytotoxic therapy without increasing side effects and to kill cancer cells with DNA repair defects as a single agent. The genomic instability of some tumor cells allows poly (ADP-ribose) polymerase (PARP) inhibitors to have selectivity for the tumor cells over normal cells.\n\nOlaparib was the first PARP inhibitor approved for breast cancer. Its approval was based on the first phase 3 randomized trial that demonstrated PARP inhibitors were superior to chemotherapy for patients with HER2-negative metastatic breast cancer with a BRCA mutation. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155961/which-medications-in-the-drug-class-antineoplastics-parp-inhibitors-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "CDK inhibitors", "patterns": ["which medications in the drug class cdk inhibitors are used in the treatment of breast cancer", "cdk inhibitors medication usage", "when to use cdk inhibitors"], "responses": "Palbociclib and ribociclib are cyclin-dependent kinases (CDK) 4, 6 inhibitors indicated in combination with an aromatase inhibitor as initial endocrine-based therapy for postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155962/which-medications-in-the-drug-class-cdk-inhibitors-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Aromatese inhibitors", "patterns": ["which medications in the drug class aromatase inhibitors are used in the treatment of breast cancer", "aromatese inhibitors medication usage", "when to use aromatese inhibitors"], "responses": "In patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155963/which-medications-in-the-drug-class-aromatase-inhibitors-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Antimicrotubular medications", "patterns": ["which medications in the drug class antineoplastics, antimicrotubular are used in the treatment of breast cancer", "antineoplastics antimicrotubular medication usage", "when to use antineoplastics antimicrotubular"], "responses": "Use of antimicrotubular therapy may be considered in patients who have received at least 2 chemotherapeutic regimens for metastatic disease. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155964/which-medications-in-the-drug-class-antineoplastics-antimicrotubular-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Tyrosine Kinase Inhibitors", "patterns": ["which medications in the drug class tyrosine kinase inhibitors are used in the treatment of breast cancer", "tyrosine kinase inhibitors medication usage", "when to use tyrosine kinase inhibitors"], "responses": "Tyrosine kinase inhibitors play an important role in the modulation of growth factor signaling. They are commonly combined with other forms of chemotherapy or radiation therapy. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155965/which-medications-in-the-drug-class-tyrosine-kinase-inhibitors-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Monoclonal antibodies", "patterns": ["which medications in the drug class monoclonal antibodies are used in the treatment of breast cancer", "monoclonal antibodies medication usage", "when to use monoclonal antibodies"], "responses": "Monoclonal antibodies have been engineered to react against specific antigens on cancer cells, thereby potentially helping to enhance the patient\u2019s immune response and prevent cancer cell growth. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155966/which-medications-in-the-drug-class-monoclonal-antibodies-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Vinca Alkaloid", "patterns": ["which medications in the drug class antineoplastics, vinca alkaloid are used in the treatment of breast cancer", "antineoplastics vinca alkaloid medication usage", "when to use antineoplastics vinca alkaloid"], "responses": "Antimetabolite therapy can stop cancer cell growth and cell division by interfering with DNA replication of these cells. These drugs are often first-line agents for breast cancer. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155967/which-medications-in-the-drug-class-antineoplastics-vinca-alkaloid-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Antimetabolite medications", "patterns": ["which medications in the drug class antineoplastics, antimetabolite are used in the treatment of breast cancer", "antineoplastics antimetabolite medication usage", "when to use antineoplastics antimetabolite"], "responses": "Antimetabolite therapy can stop cancer cell growth and cell division by interfering with DNA replication of these cells. These drugs are often first-line agents for breast cancer. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155968/which-medications-in-the-drug-class-antineoplastics-antimetabolite-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Calcium metabolism modifiers", "patterns": ["which medications in the drug class calcium metabolism modifiers are used in the treatment of breast cancer", "calcium metabolism modifiers medication usage", "when to use calcium metabolism modifiers"], "responses": "Bisphosphonates are complementary to chemotherapy and hormone therapy because they may lessen the damage to bone from metastatic disease. Bisphosphonates inhibit osteoclast function and reduce the resorption of bone. An intravenous bisphosphonate should be used in combination with oral calcium citrate and vitamin D supplementation in bone metastasis, according to the National Comprehensive Cancer Network (NCCN) guidelines. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155969/which-medications-in-the-drug-class-calcium-metabolism-modifiers-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Anthracycline medications", "patterns": ["which medications in the drug class antineoplastics, anthracycline are used in the treatment of breast cancer", "antineoplastics anthracycline medication usage", "when to use antineoplastics anthracycline modifiers"], "responses": "Anthracyclines work in multiple ways, including intercalation between DNA base pairs and inhibition of type II topoisomerase function, resulting in inhibition of cell replication and transcription. They also work by inhibition of DNA helicase, resulting in DNA cleavage. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155970/which-medications-in-the-drug-class-antineoplastics-anthracycline-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "Alkylating medications", "patterns": ["which medications in the drug class antineoplastics, alkylating are used in the treatment of breast cancer", "antioneplastics alkylating medication usage", "when to use antioneplastics alkylating"], "responses": "Alkylating agents constitute one of the earliest classes of antineoplastic agents used to treat cancer. They work by cross-linking DNA, which impedes cellular growth. They can be used alone or in combination with other chemotherapeutic agents. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-155971/which-medications-in-the-drug-class-antineoplastics-alkylating-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "PD-1/PD-L1 PD-1 PD-L1", "patterns": ["which medications in the drug class pd-1/pd-l1 inhibitors are used in the treatment of breast cancer", "pd 1 / pd l1 inhibitors usage", "pd-1/pd-l1 medication usage", "when to use pd-1/pd-l1"], "responses": "PD-L1 is expressed on the surface of activated T cells under normal conditions; binding PDL1 inhibits immune activation and reduces T-cell cytotoxic activity when bound. This negative feedback loop is essential for maintaining normal immune responses and limits T-cell activity to protect normal cells during chronic inflammation. Tumor cells may circumvent T-cell\u2013mediated cytotoxicity by expressing PDL1 on the tumor itself or on tumor-infiltrating immune cells, resulting in the inhibition of immune-mediated killing of tumor cells. See link for full list of medications.For more information https://www.medscape.com/answers/1947145-185453/which-medications-in-the-drug-class-pd-1pd-l1-inhibitors-are-used-in-the-treatment-of-breast-cancer"}, {"tags": "PI3K", "patterns": ["which medications in the drug class pi3k inhibitors are used in the treatment of breast cancer", "pi3k inhibitors usage", "when to use pi3k inhibitors"], "responses": "PI3K inhibitor indicated in combination with fulvestrant for treatment of men and postmenopausal women with HR+/HER2- PIK3CA-mutated advanced or metastatic breast cancer following progression on or after an endocrine-based regimen.For more information https://www.medscape.com/answers/1947145-185463/which-medications-in-the-drug-class-pi3k-inhibitors-are-used-in-the-treatment-of-breast-cancer"}]}