Bates/Lecture Flashcards
What breast mass is common between ages 15-25 during puberty and young adulthood?
Fibroadenoma
How does a fibroadenoma present?
Round, disc-like, or lobular usually single, but may be multiple mass that may be soft, but usually firm that is well delineated and very mobile, non-tender without retraction sign
What breast mass is common between ages 30-50 that repress after menopause except with estrogen therapy?
Cyst
How does a cyst present?
Single or multiple round mass that is soft to firm, usually elastic, well delineated, mobile, often tender, without retraction sign
What breast mass is seen between the ages of 30-90, but most common over the age of 50?
Breast cancer
How does breast cancer present?
Usually single mass with an irregular or stellate shape that is firm or hard, not clearly delineated from surrounding tissues, fixed to skin or underlying tissue, usually non-tender, retraction sign may be present
Fibrosis that is caused by shortening of the tissue that produces dimpling, changes in contour, and retraction deviation of the nipple on the breast
Retraction signs
What are some causes of retraction signs?
Breast cancer, fat necrosis, and memory duct ectasia
What position should the patient be in to look for skin dimpling?
Arms at rest, during special positioning, and on moving or compressing the breast
What are the retraction signs?
- Skin dimpling
- Abnormal contouring
- Nipple retraction/deviation
- Edema of the skin
- Pagets disease of the nipple
What produces edema of the skin?
lymphatic blockage
What sign is seen with edema of the skin?
peau d’orange sign: thickened skin with enlarged pores usually seen first in the lower portion of the breast or areola
What is seen with abnormal contours?
Any variation in the normal convexity of each breast compared one side with the other. Special positioning may be useful
What is a retracted nipple?
Flattened or pulled inward that may also be broadened and feels thickened
What can happen if nipple involvement is radially asymmetric?
It may deviate in a different direction from its normal counterpart, typically toward the underlying cancer
Uncommon form of breast cancer that starts as a scaly, eczema like lesion that may weep, crust, or erode with possible breast mass
Paget’s disease of the nipple
What can Paget’s disease present with?
invasive breast cancer or ductal carcinoma in situ
When to suspect Paget’s disease?
persisting dermatitis of the nipple and areola
What is the lifetime risk of breast cancer?
1 in 8!
What is the most important risk factor with breast cancer/
AGE!
Other risk factors for breast cancer?
- family history
- breast tissue density
- biopsy showing atypical hyperplasia
- Unopposed estrogen exposure (e.g. early menarche, late menopause, no pregnancies)
- radiation to chest wall
What percentage of women with breast cancer have no identifiable risk factors?
> 50%
What is important to know with a family history of breast CA?
Age of diagnosis
What screening is done for a young patient with increased risk factors for breast cancer?
Start screening early - usually 10 years prior to the age that the family member was diagnosed - MRI every other year with mammograms in off years
Diagnostic testing for a patient below 30 years old with nipple discharge/breast mass
Start with ultrasound only because younger breast tissue is more dense and harder to see things on mammogram
Diagnostic testing for a patient over 30 years old with nipple discharge/breast mass
Ultrasound and mammogram usually ordered
What age range do you start mammography?
40-50 years old - usually annually
Risks of mammograms
False positives, over diagnosis
When can you chose to stop giving patients mammograms for screening?
If life expectancy is less than 10 years
What gene mutations can you suspect with breast cancer?
BRCA1 & BRCA2
What can a positive family history for BRCA1 & BRCA2 include?
- 1st degree relative w/ breast CA BEFORE age 50
- ≥2 individuals in same lineage w/ breast CA
- 1st degree relative w/ ovarian CA
Recommendations for CBE
20-40 years old, every 2-3 years
>40, annually
What are you looking for in CBE?
- Lump
- Pulled in nipple
- Dimpling
- Dripping
- Redness/rash
- Skin changes
What lymphatics should be palpated during CBE?
Infraclavicular, supraclavicular, and central deep axilla
How should the patient be positioned on the table for inspection of the breasts?
Patient seated
4 positions that the patient needs to be in during breast inspection
- Arms at sides
- Arms over head
- Hands pressed against hips
- Leaning forward
What position on the table should the patient be in during palpation?
Patient supine
Where are 60% of breast cancers found?
Upper outer quadrant
What characteristics do you need to describe if you find a breast mass/lump?
- location (by quadrant or clock, w/ centimeters from nipple)
- size
- shape
- consistency
- tenderness
- mobility
