43. Breast lumb (bosse au sein) Flashcards
high-risk patients modifiable risk factors
smoking
ROH
Hormone replacement therapy (prolonged >5 years)
obesité après la menopause
high-risk patients non-modifiable risk factors
Female
Age >70 (RR 18)
Prior hx of breast CA
BRCA1/2 (RR 3-7)
Prior hx of biopsy (RR 1.7-3.7)
1st degree relative with breast CA (RR 2.6)
Menarche<12 (RR 1.5)
Menopause >55yo (RR 2)
woman’s role in preventing or detecting breast disease (breast self-examination, lifestyle changes).
screening (mammography, breast self- examination) and its limitations
facteurs protecteurs
breastfeeding
exercice
BMI <22.9 après la menopause
pas de ROH…
Hx elements clés (6)
Change in breast mass (increase/decrease in size, change in symmetry)
Changes with menstrual cycle (benign if prominent premenstrual and regress during follicular phase)
Skin changes
Nipple discharge
nipple inversion
areola changes
ddx lump (7)
- Normal glandular tissue (upper/outer quadrant)
- Fibrocystic changes (25%)
Nodular nondiscrete tender mass, changes with menses, cyclical or constant pain - Cancer (10%)
- Gross Cyst
- Galactocele - milk retention cyst in breasfeeding women
- Fibroadenoma
- Fat necrosis
mgnt (4)
Mammography,
U/S,
core biopsy,
breast surgeon referral
tests <35yo or Pregnancy/Lactation
Ultrasound*
Mammography in all age groups if suspicious findings
tests 35-50yo
Mammography + Ultrasound
mets location
Clinique : os > poumons > foie > cerveau
- Poumon : toux, dyspnée, hémoptysie
- Os : dlr osseuse – surtout colonne, côtes, jambes
- Cérébrale : diplopie, céphalée, ataxie, vertige
- Hépatique : No, perte d’appétit ictère
breast cancer screening
Women 50-74yo routine mammography q2-3y
risks of breast cancer screening
false positives - 20 à 25%
nipple discharge - when to worry (6)
unilateral, uniductal, spontaneous, bloody, breast mass, >40yo
ddx niple discharge
1) Galactorrhea aka milk production
Hyperprolactinemia
- Medications/drugs - eg. antipsychotics, antidepressants, antiemetics, antihypertensive, estrogen, verapamil, opioids, cocaine
- Pathologic - pituitary adenoma, chronic renal failure, cirrhosis, hypothyroid, Cushing disease, acromegaly
- Physiological
galactorrhea
Hyperprolactinemia drugs that could cause
antipsychotics, antidepressants, antiemetics, antihypertensive, estrogen, verapamil, opioids, cocaine
galactorrhea Pathologic causes
pituitary adenoma, chronic renal failure, cirrhosis, hypothyroid, Cushing disease, acromegaly
galactorrhea physiologic causes
nipple discharge (écoulement du mamelon) Serosanguineous cause
malin
investigations nipple discharge
b-hCG (r/o pregnancy), Prolactin, TSH, Creat/eGFR, ALT, Bilirubin, INR, platelets
what are you looking for with pituitary MRI
Pituitary adenoma
pituitary = hypophyse
quand demander IRM
If prolactin elevated and work-up negative (no other cause identified)
physical exam - nipple discharge
visual fields - Bitemporal hemianopsia r/o
nipple discharge bilat
hx (6)
Discharge
Unilateral vs Bilateral
Timing/Frequency/Spontaneity
Colour
Medication
other Hyperprolactinemia sx (amenorrhea, hot flashes, vaginal dryness)
other other Hyperprolactinemia sx
(amenorrhea, hot flashes, vaginal dryness)
