Non-BRCA Early-Onset Breast Cancer in Young Women

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 1.75
Procedures: 1.75
Anatomy and Physiology: 1.00
Pathology: 0.75

Mammography: 1.75
Procedures: 1.75
Anatomy, Physiology, and Pathology: 1.75

Magnetic Resonance Imaging: 1.75
Procedures: 1.75
Body: 1.75

Nuclear Medicine Technology: 1.75
Procedures: 1.75
Endocrine and Oncology Procedures: 1.75

Registered Radiologist Assistant: 2.75
Patient Care: 1.00
Patient Management: 1.00
Procedures: 1.75
Thoracic Section: 1.75

Sonography: 1.75
Procedures: 1.75
Superficial Structures and Other Sonographic Procedures: 1.75

Radiation Therapy: 2.75
Patient Care: 2.75
Patient and Medical Record Management: 2.75

Outline

1. Introduction
2. Age and Molecular Subtype
   1. Age as an Independent Risk Factor
   2. Triple-Negative Cancers
   3. HER2-Enriched Tumors
   4. Stage I-III Luminal Cancers
3. Notable Trends
   1. Increase in Incidence of HR-Positive Luminal Subtypes
   2. Increase in De Novo Stage IV Disease
4. Special Considerations
   1. BRCA Carriers
   2. BRCA Noncarriers
   3. Pregnancy-Associated Breast Cancer
5. Challenges and Barriers
   1. Socioeconomic Disparity
   2. Race and Ethnicity
   3. Survival in Young Women
6. Guidelines and Strategies
   1. Education and Awareness
   2. Future Directions
7. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the incidence of breast cancer involving women aged 25 – 39 years within the timeframe of 1976 through 2009
2. understand the facts about early-onset breast cancer diagnosis
3. know what breast cancer type(s) disproportionately affect(s) younger wom
4. en, worsening prognosis and survival
5. know the comparative disease recurrence rates for women under 40 years with surgically treatable breast cancers in comparison with those of older women
6. be familiar with the breast cancer diagnosis rates from the large population-based study with long-term data from Norway
7. know the subtypes of basal-like TN breast cancer
8. understand why TN tumors have overall worse clinical outcomes
9. know the typical appearance of TN tumors
10. know why ultrasound is helpful in differentiating small TN cancers from fibroadenomas
11. know the imaging modality that has the highest sensitivity for detection of cancer in young women at high risk for breast cancer
12. know the peak time after treatment for local and distant TN breast cancer recurrence
13. know what therapy has been shown to have higher response rates for TN breast cancer patients than for non-TN breast cancer patients
14. be familiar with the disease processes associated with HER2-enriched tumors
15. know the breast cancer subtype that is significantly more likely to harbor extensive and high-grade DCIS and is frequently associated with suspicious mammographic calcifications
16. know the benefits of MRI for younger women with breast cancer
17. understand both the aggressiveness and therapeutic responsiveness of HER2-enriched tumors
18. know the current standard of care for treating HER2-enriched tumors
19. be familiar with the breast cancer subtypes that are significantly associated with worse five-year breast cancer-specific and disease-free survival rates when diagnosed in young women 40 years and under
20. know the tumor-associated factors that explain a large part of the survival disadvantage for younger women diagnosed with stage I – III luminal cancers
21. know what is driving the current increase in breast cancer incidence in younger women
22. know why the survival disadvantage in younger women with stage I – III luminal cancers is clinically important
23. understand the suggested evidence for the worse survival rate for luminal cancers in younger women in comparison with older women
24. know the breast locale for which 25 – 39 year old women who had statistically significant increases in cancer diagnosis from 1976 – 2009
25. be familiar with the survival rates for patients with stage IV breast cancers
26. know the locations where breast metastases portend better survival rates
27. know the screening imaging technique that is best for patients with BRCA1 and BRCA2 mutations
28. know which segment of BRCA mutation carriers has the highest ten-year incidence of a second breast cancer after initial diagnosis
29. be familiar with the comparative survival rate of BRCA carriers under 40 years with early onset breast cancer in both the near term and the longer term
30. understand the significance of women under 40 years being carriers of the BRCA1 or BRCA2 mutation in their first breast cancer diagnosis
31. be familiar with the differences in early-onset breast cancers for BRCA carriers versus BRCA non-carriers
32. know when pregnancy-associated breast cancer can be diagnosed
33. know the aggressiveness and the counterintuitive typical subtype of PABC’s
34. know the breast cancer screening method that is recommended by the ACR
35. for use during pregnancy
36. understand the incidence rate of breast cancer for young women in developing countries
37. understand the differences between the cancer incidence rates and cancer mortality rates in both high-HDI and low-HDI countries
38. understand how the combination of race and age affects the prevalence of breast cancer for a particular group
39. be familiar with the likely reasons for the higher incidence of breast cancer in 15 – 39 year old, non-White women in California
40. know the factor from the Military Health System Repository data that suggests, when equalized, it may help to mitigate disparities in outcomes
41. know what, according to the American Society of Clinical Oncology guidelines, is a mandatory subject of discussion with younger women undergoing breast cancer treatment
42. know the major concerns cited by young breast cancer survivors
43. know the age at which the current NCCN guidelines for BRCA1 and BRCA2 carriers endorse an emphasis on breast awareness to begin
44. understand why breast self-examination is usually not recommended on a regular basis
45. know the potential uses of liquid biopsy for patients with early-onset breast cancer