Benign Breast Conditions Flashcards
Medical terms for breast pain (2)
mastodynia, mastalgia
CONDITION: A benign breast finding of dull, heavy ache, most likely bilateral, common in women ages 30-50. Begins a few days prior to menses and will resolve at the completion of menses
Cyclic mastodynia
CONDITION: Breast condition characterized by tightness, burning sensations, and stabbing sensations described as “zingers”. There is no correlation to the menstrual cycle, and the pain is more likely to be unilateral and localized.
Noncyclic mastodynia
(3) types of mastodynia
cyclic, non-cyclic, extra-mammary
Noncyclic mastodynia is more common in this population of patients
prior breast surgery
CONDITION: Breast pain characterized by very localized pain originating outside of the breast (i.e., trauma to breast or chest wall, pulled muscle, shingles)
Extramammary mastodynia
Priority treatment with mastodynia
reassurance
Lifestyle recommendations for mastodynia
warm or cool compresses, supportive bra, caffeine abstinence, vitamin E
______ is rarely the presenting symptom of breast cancer
breast pain
Medical management options for mastodynia
NSAIDs or acetaminophen, consider changing any hormonal medications (HRT, contraception). Topical NSAID (diclofenac gel) may be useful for localized pain. Breast imaging may be useful to provide reassurance.
Biggest risk to using evening primrose oil as alternative therapy for mastodynia
increased bleeding
CONDITION: Includes the spectrum of changes in the breasts, including all benign breast masses. Characterized by nodularity and mastodynia (mastalgia). The exact cause is unknown but likely r/t hormones circulating throughout the menstrual cycle
fibrocystic breast disease
(2) types of fibroepithelial lesions
fibroadenoma, phyllodes tumor
Characteristics of a fibroadenoma
round-oval, non-tender, firm, well-circumscribed. They are always benign
Which fibroepithelial lesion is ALWAYS benign
fibroadenoma (phyllodes are rarely malignant)
Characteristics of a phyllodes tumor
similar to a fibroadenoma but grows rapidly. Most often benign, but rarely may be malignant.
Which fibroepithelial adenoma will you ALWAYS biopsy?
Phyllodes tumor (r/t rapid growth, and ~10% become malignant. Fibroadenomas you would only biopsy if painful to pt, growing, or >2cm)
Characteristics of a breast cyst
often very tender, round, smooth, soft, and mobile
Characteristics of a lipoma
Soft, non-tender, not usually visualized on mammography
Management of cysts
If asymptomatic, can leave it. If painful, can aspirate the fluid (outpatient or under US guidance with specialist)
Lipomas are commonly in the ____ area
axillary
A milk filled cyst, generally during or just after lactation
galactocele
Characteristics of a hamartoma
firm, non-tender, collection of fibrous glandular and adipose tissue. May be an incidental finding, requires biopsy to confirm
Characteristics of fat necrosis
firm, ill-defined, non-tender, non-mobile. Most common after breast surgery
Characteristics of intraductal papilloma
Small growths that occur in the ducts leading up to the nipple, often associated with nipple discharge, near the areola.
How do you diagnose an intraductal papilloma (3)
ultrasound guided biopsy, ductogram, and excisional biopsy
Management of a galactocele
should be left alone unless they get infected
Priority risk of proliferative lesions with atypia
increased risk for breast cancer
(4) types of proliferative lesions with atypia
flat epithelial atypia, atypical lobular hyperplasia, atypical ductal hyperplasia, LCIS
Type of nipple discharge that would be a red flag
bloody
Bilateral milky discharge is called…
galactorrhea
Galactorrhea can be normal for ________ after stopping breastfeeding
6 months - 1 year
Does breast augmentation increase your risk of breast cancer?
No!
Does breast augmentation affect breast feeding?
No!
Does breast reduction increase your risk of breast cancer?
No!
Younger than age ____ it may be hard to see anything on mammo r/t density of breast tissue
<30 yo
Gold standard screening tool for breast imaging
Mammography
Medical term for “3D mammography”
tomosynthesis
US is most helpful for differentiating…..
cysts vs. solid masses
MRI in terms of specificity and sensitivity….
High sensitivity (picks up lots of little, early changes) but low specificity (most are probably not a breast cancer)
You are fairly certain you are feeling a cyst, but want to rule out a solid mass. What type of imaging might you order?
Breast US
Which breast densities have slightly higher risk of breast cancer
C,D (more dense)
(4) causes of denser breast tissue
HRT, hormonal contraceptives, younger age, lower BMI
INTERPRET: The breasts are almost entirely fatty
Breast density A
INTERPRET: There are scattered areas of fibroglandular density
Breast density B
INTERPRET: The breasts are hetergeneoously dense, which may obscure small masses
Breast density C
INTERPRET: The breasts are extremely dense, which lowers the sensitivity of mammography
Breast density D
BI-RADs categories ___ through ___
0-6
BIRADS 0
Additional imaging needed (they came in for screening mammo and they found something. Need additional imaging to make a determination. Maybe US, maybe a clinical exam)
BIRADS 1
negative, benign with no findings (totally normal exam)
BIRADS 2
Negative, changes found that are benign (i.e., cysts or calcifications that are normal)
BIRADS 3
Probably benign, changes were found that are not highly suspicious, short term follow-up imaging is recommended (i.e., 6 months)
BIRADS 4
Suspicious abnormality seen, biopsy should be considered (4A,B, or C)
BIRADS 5
highly suspicious abnormality seen, biopsy should be performed
BIRADS 6
known biopsy-proven cancer is present
Mammograms begin annually for normal risk woman at age….
40yo
Lifestyle recommendations for reducing risk of breast cancer generally
Get physical, limit HRT, weight control, no smoking, limit alcohol consumption
HRT is contraindicated with a history of….
breast cancer
Do microwaves, cell phones, deodorant, and caffeine cause breast cancer?
No!
