Bates Chapter 10 - The Breast & Axillae

Question 1

The anatomical landmarks for the breast are:

Answer 1

Clavicle and 2nd rib down to 6th rib and sternum to midaxillary line

Question 2

The axillary tail of breast tissue is called the:

Answer 2

Tail of Spence

Question 3

The three different types of tissue in the breast that vary with age are:

Answer 3

1) Glandular tissue
2) Fibrous connective tissue
3) Adipose tissue

Question 4

What do you call tissue, often mistaken for a mole, that grows along the “milk line” and has no pathological significance?

Answer 4

A supernumerary nipple

Question 5

Lymphatics from most of the breast drain toward the:

Answer 5

Axilla

Question 6

What are 4 groups of lymphatics that drain the arm and breast?

Answer 6

1) Central (palpable most frequently)
2) Lateral
3) Subscapular
4) Pectoral

Question 7

What are the 3 common or concerning symptoms in the breast?

Answer 7

1) Breast lump or mass
2) Breast pain or discomfort
3) Nipple discharge

Question 8

When is the best time to do a breast self exam?

Answer 8

5-7 days after onset of menses, when estrogen stimulation is at it lowest

Question 9

What do you need to know if your patient reports a breast lump?

Answer 9

1) Location
2) How long has it been present
3) Has there been any change in size
4) Does it vary with cycle
5) Is there change in contour (dimpling, swelling, puckering)
6) Is there discharge (describe) if yes, is it unilateral or bilateral

Question 10

What do you call the inappropriate discharge of milk-containing fluid in males or females?

Answer 10

Galactorrhea

Question 11

Of the 3 common concerning symptoms in the breast, which one results in a cancer diagnosis most frequently?

Answer 11

Breast cancer occurs in 11% of women with a breast lump or mass

Question 12

What is a breast lesion likely to be that presents as a smooth, rubbery, round, mobile and non-tender character?

Answer 12

Fibroadenoma

Question 13

What is a breast lesion likely to be that presents as a soft to firm, round, mobile character? These may be tender.

Answer 13

Cyst

Question 14

What is a breast lesion likely to be that presents as a nodular, rope-like texture?

Answer 14

Fibrocystic changes

Question 15

What is a breast lesion likely to be that presents as irregular, firm, mobile or fixed to surrounding tissue?

Answer 15

Cancer (until proven otherwise)

Question 16

Which breast lesions are more common in the 15-25 year old age group?

Answer 16

Fibroadenoma

Question 17

Which breast lesions are more common in the 25-50 year old age group?

Answer 17

Cysts, fibrocystic changes and cancer

Question 18

What are common breast lesions in the pregnant or lactating female?

Answer 18

Lactating adenomas, cysts, mastitis and cancer

Question 19

What is the lifetime risk of developing breast cancer in a female born in the US today?

Answer 19

1 in 8 (12%)

Question 20

What ethnic group has a higher incidence of breast cancer before age 45?

Answer 20

African American

Question 21

What is the most important risk factor for breast cancer?

Answer 21

Age

Question 22

List some modifiable risk factors for breast cancer:

Answer 22

1) Postmenopausal obesity
2) Use of HRT
3) Alcohol ingestion
4) Physical inactivity
5) Choosing not to breast-feed
6) Type of contraception

Question 23

List some non-modifiable risk factors for breast cancer:

Answer 23

1) Family history
2) Breast tissue density
3) Proliferative lesions with atypia on biopsy
4) Duration of unopposed estrogen exposure related to early menarche
5) Age of first full-term pregnancy
6) Late menopause
7) History of radiation to the chest

Question 24

What percentage of breast cancer occurs in males?

Answer 24

1%

Question 25

What are risk factors for male breast cancer?

Answer 25

1) BRCA2 mutations
2) Obesity
3) Family history of male or female breast cancer
4) Testicular disorders
5) Work exposure to high temperatures and exhaust emission

Question 26

What are factors that increase the relative risk for breast cancer in women?

Answer 26

1) Female
2) Age
3) BRCA1 and/or BRCA2
4) Two or more first degree relatives with breast cancer (diagnosed at early age)
5) Personal history of breast cancer
6) High breast tissue density
7) Biopsy-confirmed atypical hyperplasia

Question 27

What are three well-used breast cancer risk assessment tools?

Answer 27

Gail risk model - >50 and doing mammograms
Claus risk model - for high risk women
BRCAPRO - for high risk women

Question 28

The risk of breast cancer in those who have BRCA1 mutations is:
The risk of breast cancer in those who have BRCA2 mutations is:

Answer 28

57%

49%

Question 29

What is DCIS? LCIS?

Answer 29

Ductal carcinoma in situ

Lobular carcinoma in situ

Question 30

What are the two common selective estrogen receptor modulators (SERMs) used in breast cancer?

Answer 30

Tamoxifen and raloxifene

Question 31

What is the name of the disease that can cause rashes or ulcerations on the breast?

Answer 31

Paget’s disease

Question 32

What to assess and record in a breast nodule:

Answer 32

1) Location (by quadrant or clock and cm from nipple)
2) Size (in cm)
3) Shape
4) Consistency
5) Delimitation (well circumscribed or not)
6) Tenderness
7) Mobility (in relation to structures)

Question 33

What is a sweat gland infection called?

Answer 33

Hydradentitis suppurativa

Question 34

What do you call a deeply pigmented, velvety, axilla that may or may not be malignant?

Answer 34

Acanthosis nigricans