Breast Path Question

[MudPhud20XX]

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A 22 yr old woman presents with a painless nodule in the lower outer aspect of her right breast that she has had for 2 months. the nodule appears to freely movable, sharply demarcated fro the surrounding parenchyma, and firm. A mammogram demonstrates a circumscribed, homogeneous density. Which of the following best estimates the risk of subsequent invasive breast cancer developing in this patient?

A. Greater than 90% lifetime risk
B. Greater than 50% lifetime risk
C. Risk is doubled
D. Risk is halved
E. No risk at all

So let me hear your thoughts first and I will post the answer.

 

[SBR249]

Sounds like a fibroadenoma which is usually hormone-sensitive and regresses with menopause. So no increased risk would be my guess

 

[MudPhud20XX]

Sounds like a fibroadenoma which is usually hormone-sensitive and regresses with menopause. So no increased risk would be my guess

That's exactly what I thought, but the answer is E. The explanation just says "the risk of subsequent invasive cancer in a breast from which a fibroadenoma has been removed is doubled." Probably not a good question, but just wanted to see if there is anyone who had a similar thought. Thank you!

 

[SBR249]

Wait, the answer is E? But the explanation would suggest the correct answer is C...

Edit: I guess according to the American Cancer Society, there is a 1.5x to 2x increase in risk.

Source: http://www.cancer.org/healthy/findc...non-cancerous-breast-conditions-fibroadenomas

 

[Macaroon_Berry]

I would've also guessed E because in med school we were taught that fibroadenomas do not increase the risk of developing breast cancer. So is the correct answer C (according to the explanation and the American Cancer Society)?

 

[thehundredthone]

That's exactly what I thought, but the answer is E. The explanation just says "the risk of subsequent invasive cancer in a breast from which a fibroadenoma has been removed is doubled." Probably not a good question, but just wanted to see if there is anyone who had a similar thought. Thank you!

Might want to edit the first line of your post to read that the answer is C. It is actually controversial whether there is an increased risk in women with fibroadenoma. There was a NEJM article back in 1994 that first stated that there was an increased risk, however there was a subsequent 1997 study that said that the reason might have been due to bias based on studying only cases where the fibroadenoma was surgically excised. A recent abstract also stated that after stratification, there seemed to be no increased risk simply based on the the diagnosis of a fibroadenoma. The American Cancer society doesn't seem to mention it's sources, unfortunately.

 

[MudPhud20XX]

Wait, the answer is E? But the explanation would suggest the correct answer is C...

Edit: I guess according to the American Cancer Society, there is a 1.5x to 2x increase in risk.

Source: http://www.cancer.org/healthy/findc...non-cancerous-breast-conditions-fibroadenomas

yup my bad, the answer is C.