Breast

Question 1

RF for Breast ca

Answer 1

Age
Obesity

FmHx: - what degree relative, age of onset, bilateral or not.
Genes - BRCA2
PmHx - Breast Ca, increase breast density
Estrogen exposure: Age of puberty, Age of menopause, HRT, Post menopause, Obesity
Lifestyle: Alcohol, Smoking, Radiation
Use FRAC- BOC (calculator)

Question 2

Protective factors of breast ca

Answer 2

Regular physical activity
Child bearing
Breast feeding for 12 months or longer

Question 3

Benign breast disorder

Answer 3

 Developmental Abnormalities: ectopic breast tissue, supernumerary breast/nipple, hypoplasia
 Inflammatory & Related Lesions: mastitis, granulomatous mastitis, FB rxn, mammary duct ectasia, fat necrosis
 Fibrocystic Changes: cysts, adenosis, metaplasia, epithelial hyperplasia (ductal, lobular), radial scar/complex sclerosing lesions, intraduct papillomata
 Proliferative Stromal Lesions: diabetic fibrous mastopathy, pseudoangiomatous stromal hyperplasia (PASH)
 Neoplasms: fibroadenoma, lipoma, adenoma, hamartoma, granular cell tumour

Question 4

Causes of Mastalgia

Answer 4

• True Breast Pain (cyclical, non-cyclical, diffuse, focal)

* Non-Breast Causes (chest wall, lung, gallstones, other)

Question 5

Management of Mastalgia

Answer 5

 Assess origin of pain • True breast pain
• Chest wall pain
 Exclude cancer
• ‘Triple Assessment’
 Provide reassurance and information • +/- Non-specific & specific measures

Question 6

Tx of true mastalgia

Answer 6

Non-specific
• Reassurance, Supportive bra, lifestyle, gentle exercise
• Caffeine reduction (unproven benefit)
• Low-fat diet
• Evening Primrose Oil (no good study showing benefit)
Specific
- NSAIDS and compresses
- Tamoxifen
- Danazol
- Goseralin

Question 7

Pros and Cons of screening for breast Ca

Answer 7

Characteristics of screen-detected ca: smaller, DCIS, low grade, NOS, LN neg
 Psychological morbidity induced by BS
 Risk of MMG – radiation exposure
 Unnecessary biopsies
 Limitation of MMG in dense breasts
 MMG sensitivity 68%, specificity 75%