Breast Flashcards
Women’s lifetime risk of developing caner?
12%
1 in 8 women
Recommend imaging for a breast mass in woman < 30?
Ultrasound
Imaging for breast mass in woman > 30?
Mammogram
BI RADS 0
No enough info
Get additional info
BI RADS 1
Negative
BI RADS 2
Benign (simple cyst)
Continue routine screening
BI RADS 3
Probably benign
CBE and US +/- mammogram for stability (if low suspicion) OR tissue biopsy (if high suspicion)
BI RADS 4
Suspicious
GET BIOPSY
BI RADS 5
Highly suggestive of malignancy
GET BIOPSY
When should women get screening mammograms?
Annually starting at age 40
Blood, serous or clear discharge is concerning for what?
Intraductal papillomas
If atypia present on core biopsy, need surgical excision since invasive or in situ carcinoma found in 15-20%
Most common cause of bloody nipple discharge?
Intraductal papillomas
If atypia present on core biopsy, need surgical excision since invasive or in situ carcinoma found in 15-20%
Most common benign tumor in the breast that accounts for half of all breast biopsies?
Fibroadenoma
Well defined, 1-2 cm, mobile mass on exam is likely what?
Fibroadenoma
Two most common pathogens in mastitis
Staph aureus
Strep Viridans
Treatment of breast abscess
I&D
If tissue is fluctuant OR if patient’s symptoms do not improve after 2-3 days of treatment
Send fluid for culture
Give IV antibiotics w/ Vanc until surgical I&D, then Bactrim DS BID for 10-14 days
What hormone stimulates glandular growth in the breast?
Progesterone secreted by the theca EXTERNA
*overstimulation of these glands can lead to cyst formation, which in turns lead to fibrocystic change of the breast
What is the risk of an underlying carcinoma in the surrounding areas of atypical ductal hyperplasia?
30%
Relative risk = 5.0
Lifetime risk of ovarian cancer w/ BRCA1?
40%
BRCA1 is found on what chromosome?
17
BRAC2 is found on what chromsome?
13
Performing elective oophorectomy at time of hysterectomy in premenopausal pt w/ no family or personal hx of cancer will increase her risk for???
All cause mortality
Most likely clinical symptom of Paget’s disease of the breast?
Scaly rash arising from the nipple
When is a breast MRI indicated for screening?
A high lifetime risk of breast cancer (>20-25%) = BRCA mutation carriers, strong family hx, or hx of chest radiation
Treatment of DCIS?
Lumpectomy/WLE w/ or w/out radiation therapy
When would you do a total mastectomy for treatment of DCIS?
- Persistent positive margins
- Multicentric disease involving more than one quadrant
- Cosmetically unacceptable breast conservation surgery due to a large DCIS process
Li Fraumeni Syndrome
Cowden Syndrome
Peutz-Jeghers Syndrome
What treatment is appropriate for a patient with a history of breast cancer and vasomotor symptoms of menopause?
Paroxetine
FDA APPROVED!
Describe benign nipple discharge
Multiductal
Bilateral
Expressed
Green/Milky/Clear
Descrbie malignant nipple discharge
Uniductal
Unilateral
Sponatneous
Serous/Clear/Bloody
Nipple discharge w/ age > 40?
Requires US AND MAMMO regardless if benign or malignant features
Endocrine therapy for pre menopausal breast ca?
Tamoxifen for 5 years
Tamoxifen will decrease annual risk of breast cancer recurrence by how much?
40%!!
And reduces annual mortality by 35%!
Endocrine therapy for post menopausal breast ca?
Tamoxifen OR Aromatse Inhibitor
*Aromatse inhibitors are more effective, and have a better SE profile
Benefits of Aromatse inhibitors over tamoxifen?
- reduced risk of thrombus
- reduced em ca
- reduced vaginal bleeding
