Breast Flashcards
What are the features of mammary duct ectasia?
dilatation of the large breast ducts
most common around the menopause
may present with a tender lump around the areola +/- green nipple discharge
If it ruptures it may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
How does fat necrosis of the breast present?
most common in obese women with large breasts
may follow trivial or unnoticed trauma
initial inflammatory response, the lesion is typically firm and round but may develop into a hard, irregular breast lump
Rare but may mimic breast cancer so further investigation is always warranted
What is tamoxifen used for?
management of oestrogen receptor positive breast cancer
used in pre- and post- menopausal women
what is anastrazole and what is it used for?
aromatase inhibitor - reduced peripheral oestrogen synthesis
important as aromatisation accounts for the majority of oestrogen production in post-menopausal women and therefore anastrozole is used for ER +ve breast cancer in this group
What are the adverse effects of aromatase inhibitors?
osteoporosis - NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
What are the risk factors for breast cancer?
- increased hormone exposure - early menarche/late menopause, nulliparity, contraceptive/hrt
- advacing age
- caucasian ethnicity
- obesity and lack of physical activity
- alcohol and tobacco use
- history of breast cancer
- previous radiotherapy treatment
What are the indications for urgent referral to breast assessment clinic
> /= 30 with unexplained breast mass (regardless of whether there is pain present or not)
/= 50 or older presenting with nipple discharge, retracting or other concerning symptoms
consider referral if there are skin changes suggestive of breast cancer or if the patient is 30 years or older with an unexplained mass in the axilla
non-urgent referral should be carried out for patients under 30 with an unexplained breast mass
what is included in an urgent referral for triple assessment?
history and clinical exam
imaging - mammorgram - USS
fine needle aspiration and core biopsy
what investigations would be useful when investigating breast cancer?
bloods - LFT (liver mets), bone profile (serum calcium and phosphate)
imaging - e.g. cxr, MRI, isotope bone scan
what are the treatment options for breast cancer?
surgery - breast-conservative - wide local excision or lumpectomy folowed by adjuvant radio/chemo OR mastectomy (simple, modified, radical) usually involving removal of sentinel lymph nodes for biopsy
chemo
radio
hormonal therapy
targeted therapy
risk factors for breast cancer?
female
increased oestrogen exposure
more dense breast tissue
obesity
smoking
family history
cocp gives small increase in risk but the risk returns to normal 10 years after stopping the pill
what is the breast cancer screening regime in the UK?
mammogram every 3 years to women aged 48/50-70/early 70s
what family history puts a patients at high risk of breast cancer?
first degree relative with breast cancer under 40
first degree male with breast cancer
first degree relative with bilateral breast cancer, first diagnosed under 50
two first-degree relatives with breast cancer
what can be done for high risk patients with strong family history of breast cancer?
annual mammogram screening which can start from 30
chemoprevention may be offered for women at high risk:
tamoxifen is premenopausal
anastrazole is postmenopausall except with severe osteoporosis
