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Résidence - FM Learner > 11. Breast Lump > Flashcards

11. Breast Lump Flashcards

1
Q

Name DDX : Not a lump (4)

A
  • Prominent rib
  • Costochondral junction
  • Firm margin at edge of breast
  • Defect secondary to previous biopsy
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2
Q

Name DDX : Breast lump

A
  • Normal glandular tissue (upper/outer quadrant)
  • Fibrocystic changes (25%)
  • Cancer (10%)
  • Gross Cyst, Galactocele
  • Fibroadenoma
  • Fat necrosis
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3
Q

Describe : Fibrocystic changes (3)

A
  • Nodular nondiscrete tender mass
  • changes with menses
  • cyclical or constant pain
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4
Q

Name cancer breast lumps (2)

A
  • Infiltration canalaire (most common)
  • Le cancer du sein lobulaire et inflammatoire infiltrant se présente souvent sans masse discrète
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5
Q

Describe : Galactocele (1)

A

milk retention cyst in breasfeeding women

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6
Q

Describe : Fat necrosis

A

Trauma, associated with ecchymosis

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7
Q

Name Risk for Malignancy (10)

A
  • Female
  • Age >70
  • Prior hx of breast CA
  • BRCA1/2
  • Prior hx of biopsy
  • 1st degree relative with breast CA
  • Unopposed estrogen
  • Alcohol
  • Radiation (Mantle radiation in Hodgkin’s)
  • Benign breast disease
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8
Q

Name causes Unopposed estrogen (6)

A
  • Bone density - High (RR 2.7-3.5)
  • Nulliparity/Age at first birth* >30 (RR 1.9-3.5)
  • Menarche <12 (RR 1.5)
  • Menopause >55yo (RR 2)
  • HRT* (RR 1.2)
  • OCP* (RR 1.07-1.2)
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9
Q

Name protective factors breast cancer (6)

A
  • Oophorectomy <35yo
  • Postmenopause BMI* <22.9
  • Exercise
  • Parity* ≥5
  • Breastfeeding* ≥16mo
  • Aspirin* ≥weekly for ≥6 mo
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10
Q

Describe history taking for breast lump (4)

A
  • Change in breast mass (increase/decrease in size, change in symmetry)
  • Skin changes
  • Nipple discharge
  • New (acquired) nipple inversion (benign vs malignant)
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11
Q

Malign or benign if breast mass changes during menstrual cycle ?

A

Changes with menstrual cycle (benign if prominent premenstrual and regress during follicular phase)

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12
Q

Describe nipple inversion (benign vs malignant)

A
  • Benign (ectasia) : Central, symmetric, transverse slit with normal areola
  • Malignant : Asymmetrical, areola changes, flattened nipple, varied nipple position
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13
Q

Describe physical exam : Breast lump (5)

A
  • Inspection with arms by side, raised above head, pressing on hips leaning forward
  • Regional lymph nodes : Cervical, supraclavicular/infraclavicular, axillary, mammary chain
  • Skin changes
  • Nipple/Areolar changes
  • Breast mass
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14
Q

Describe skin changes in physical exam (4)

A
  • Ecchymosis/erythema
  • Peau d’orange
  • Ulceration
  • Dimpling/retraction
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15
Q

Describe nipple/areolar changes in physical exam (2)

A
  • Discharge/crusting
  • Inversion/retraction
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16
Q

Describe how to describe breast mass in physical exam (5)

A
  • Obvious/Subtle
  • Well-defined/Nondiscrete margins
  • Density - Soft/Firm/Hard
  • Mobile/Fixed to chest wall or skin
  • Tender/Non-Tender
17
Q

Describe management of breast mass

A
  • Feature of cancer (hard irregular fixed mass, palpable ipsilateral nodes, peau d’orange) = Mammography, U/S, core biopsy, breast surgeon referral
  • Benign = Ultrasound or initial aspiration to differentiate between cystic vs. solids lesions
18
Q

Describe triple test

A
  • Clinical exam
  • Imaging
  • Non-excision biopsy (FNAC/Core)
    Any abnormal result requires surgical referral +/- further investigation
19
Q

Describe First-line Imaging

A
  • <35yo or Pregnancy/Lactation - Ultrasound. Mammography in all age groups if suspicious findings
  • 35-50yo - Mammography + Ultrasound
  • > 50yo - Mammography
20
Q

Describe screening

A

Women 50-74yo routine mammography q2-3y (weak recommendation)

21
Q

Describe utility Clinical breast examination and Breast self-examination

A

has not been shown to provide benefit (no reduction in mortality) and good evidence of harm (RR1.5 for benign biopsy)

22
Q

When to consider genetics referral

A

If risk factors present
* Personal Hx Breast CA ≤ 40 or Ovarian CA at any age
* Fam Hx Breast CA ≤ 50

23
Q

Consider what tool for women ≥ 35yo with risk factors ?

A

Consider Gail Model for Breast Cancer risk

Résidence - FM Learner (26 decks)

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