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  #1  
Old 05-05-2016
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Default Preventive med q

Which of the following is most likely to benefit an asymptomatic women with multiple first-degree relatives with breast cancer?
1. Dietary modification
2. BRCA testing
3. Tamoxifen or raloxifene
4. ER/PR testing
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Old 05-05-2016
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Quote:
Originally Posted by saxo View Post
Which of the following is most likely to benefit an asymptomatic women with multiple first-degree relatives with breast cancer?
1. Dietary modification
2. BRCA testing
3. Tamoxifen or raloxifene
4. ER/PR testing
confused btween : 2 & 3
but my answer is tamoxifen
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Its given as SERMs in MTB2. But that is wrong.

Its clearly given in UptoDate that in women who have strong family hx of breast cancer (numerous relatives with breast cancer) or in women having a daughter/sister/mother(first degree relative) with breast cancer before 50 yrs is at a high risk and needs BRCA testing and genetic counseling.

Also if there is BRCA positivity, bilateral mastectomy and BSO (if child bearing is completed) is recommended (risk reduction surgery). If not favourable, do medical chemoprevention with either SERMs or aromatase inhibitors and/or annual mammography AND MRI (unlike routine mammography only every 2 years for women above 50 years)
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Cancer screening preventive med
Attached Thumbnails
Preventive med q-cancer-screening.pdf  
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Thanks saxo!

are you studying from Uptodate? I am thinking of getting a 30 day subscription for $19.00. Is it a good source?
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Thanks saxo!

are you studying from Uptodate? I am thinking of getting a 30 day subscription for $19.00. Is it a good source?
Its not mandatory but its very good. I am only using it for peds and medicine as they are important and MTB has a fair share of mistakes. The summary and recommendations section is great and a lot of UW is based on information directly taken from UptoDate. You can directly read UW and it will cover most of the important stuff that will be tested. If u want to get it, use it as a reference especially when reading MTB.
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Quote:
Originally Posted by saxo View Post
Its not mandatory but its very good. I am only using it for peds and medicine as they are important and MTB has a fair share of mistakes. The summary and recommendations section is great and a lot of UW is based on information directly taken from UptoDate. You can directly read UW and it will cover most of the important stuff that will be tested. If u want to get it, use it as a reference especially when reading MTB.
thanks I was planning on only using it for IM because of the time limitation.


I don't check MTB answers, I just accept them as they are lol. So thank-you for the heads up.
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Originally Posted by maymed View Post
Thanks saxo!

are you studying from Uptodate? I am thinking of getting a 30 day subscription for $19.00. Is it a good source?
could u pls send me its website,
i have found this site:
http://www.uptodate.com/contents/man...tedTitle=3~150
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Originally Posted by krishna_3228 View Post
could u pls send me its website,
i have found this site:
http://www.uptodate.com/contents/man...tedTitle=3~150
That's the website krishna_3228. You found it If you don't have a subscription you will have limited access...
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Yea u need subscription for full access. Here are the summary and recommendations for that topic

SUMMARY AND RECOMMENDATIONS

●Women with inherited mutations in breast cancer type 1 and 2 susceptibility genes (BRCA1 and BRCA2) have markedly elevated risks of breast cancer and ovarian cancer. Men with BRCA mutations have increased risk for breast and prostate cancer. (See 'Introduction' above.)
●For women with a known BRCA mutation, risk-reducing mastectomy is a highly effective strategy for breast cancer risk reduction. For BRCA carriers diagnosed with advanced ovarian cancer, we prefer not proceeding with risk-reducing mastectomies until at least five years after the ovarian cancer diagnosis, as survival is dominated by the mortality rate of ovarian cancer. (See 'Mastectomy' above.)
●For women with a BRCA mutation, risk-reducing salpingo-oophorectomy (BSO) is indicated by age 35 to 40 and when childbearing is completed. BSO is also indicated for carriers who are diagnosed with early-stage breast cancer. (See 'Bilateral salpingo-oophorectomy' above.)
●Women with a BRCA mutation who do not opt for bilateral mastectomy should undergo breast cancer surveillance with annual mammography and magnetic resonance imaging (MRI). (See 'Cancer surveillance' above.)
●For women with a BRCA mutation who do not opt for risk-reducing mastectomy, chemoprevention with tamoxifen, raloxifene, or an aromatase inhibitor is appropriate. (See 'Chemoprevention' above.)
●For women who carry mutations in genes other than BRCA that confer moderate risk for breast cancer (eg, PALB2, CHEK2, and ATM gene mutations), the options for breast cancer prevention are similar. (See 'Patients with mutations in moderate-risk/newer genes' above.)
●For men with BRCA mutations, cancer surveillance options are limited but include clinical breast examination and prostate cancer screening at an earlier age. Men with evidence of gynecomastia may consider the role of mammography. (see 'Cancer surveillance' above).
●Oral contraceptive use in BRCA mutation carriers decreases the risk of ovarian cancer and does not appear to increase risk of breast cancer. (See 'Oral contraceptives' above.)
●For women with negative or uninformative test results, quantitative models can help identify women with a high lifetime risk of breast cancer of at least 20 percent. These women are candidates for breast cancer screening with MRI in addition to mammography. (See 'Women at high risk' above.)
●Women with uninformative negative BRCA results without a family history of ovarian cancer do not appear to be at increased risk of developing ovarian cancer. Thus, BSO is not indicated for ovarian cancer risk reduction. (See 'Ovarian cancer risk management' above.)
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