Approach to breast abnormalities

Question 1

red flag features of breast masses?

Answer 1

• firm
• tender
• irregular borders
• fixed to skin or chest wall
• skin changes: peau d’orange, rashes, eczema-like lesions
• bloody/spon nipple discharge or nipple changes/inversions
• matted or fixed axillary LN

Question 2

what are some physiologic causes for breast masses?

Answer 2

• menstruation
• approaching and after menopause
• taking hormonal supplement (hormone replacement therapy or OCP)
• pregnancy

Question 3

differentials for benign breast masses?

Answer 3

• cysts
• abscess
• lipoma
• fat necrosis from radiation
• fibroadenomas
• mastitis
• hematoma

Question 4

what are some precancerous lesions for breast ca?

Answer 4

ductal carcinoma in situ
lobular carcinoma in situ

atypical ductal/lobular hyperplasia

Question 5

what are some RF for your breast mass being a malignancy?

Answer 5

• female
• increased age
• Ashkenazi Jewish
• increase hormone exposure (high parity, OCP, hormone replacement therapy)
• personal hx of DCIS or LCIS or other cancer
• fhx ➔ familial syndromes or BRCA1/BRCA2
• dense breasts
• smoking and alcohol