Breast Flashcards
What percentage of females will present with mastalgia in their lifetime
70% with mastalgia
10-20% with cyclical mastalgia
What causes nodularity in the lobe of the breast?
Benign cytic change/ Fibrocystic change
What are the specificity of ultrasound, two view mammography and core biopsy for benign breast disease?
Ultrasound (92%)
Mammography (90%)
Core biopsy (95%)
Which 3 drug treatments can be used for breast pain (mastalgia)?
How long do you give them for?
Danazol (37% at 1 year)
Tamoxifen (53% at 1 year)
-less side effects
Bromocryptine (44% at 1 year)
6 months
-72% respond
What percentage of females presenting with breast pain actually have breast cancer?
5%
What features on clinical examination would suggest breast malignancy?
Lump: irregular surface, indistinct borders, hard consistency, not mobile, fixed or tethered to skin or underlying muscle
Axillary lymphadenopathy
Skin changes: peau d’orange, ulceration
Nipple changes: inversion of the nipple
Discharge: bloody, unilateral
What is the sensitivity of each of the triple assessment investigations for breast cancer?
Examination (88%)
Ultrasound (88%)
Mammography (93%)
Core biopsy (98%) FNA (94%)
What are the risk factors for breast cancer?
Age
Previous breast cancer
Family history
BRCA1, BRCA2
Early menarche Late menopause Nulliparous HRT COCP Obesity
Irradiation to the chest wall (Hodgekin’s lymphoma)
List 3 pathological features of breast cancer that are prognostic indicators
Tumour stage (TNM) -Nodal involvement is single most important factor
Tumour grade (reflects loss of differentiation)
Hormone receptor status (oestrogen, progestogen, human epidermal growth factor (HER-2) status)
What are the 4 most common causes of breast lump in a 48 year old
Benign cystic change/ Fibroadenosis
Cyst
Carcinoma
Abscess
Others: duct ectasia, fat necrosis
What are the most common causes of nipple discharge?
Mammary duct ectasia
Intraductal papilloma
Breast abscess
What is mammary duct ectasia?
Benign
Smoking is a major risk factor
Nipple discharge, often blood stained
Mastalgia (non-cyclical)
Nipple inversion/retraction
Occasional associated with a palpable subareolar mass.
Treat conservatively and it often settles spontaneously.
If persists surgical excision is an option.
What are the features of Intraductal papilloma?
Usually present around the post menopause
Can present with a serous or bloody discharge from the nipple
Small (2-3mm) wart like lesion within a breast duct
They can obstruct the duct causing cysts or twist and become necrotic causing bleeding
Investigate with breast ductography (injection of contrast to visualise the breast ductal system).
Benign but can represent and increase risk of cancer
Treated mostly with surgical excision and vigilant breast screening
What is the TNM staging for breast cancer?
T0= no tumour Tis= DCIS T1 = 2cm T2 = 2-5cm T3 = >5cm T4 = growing into chest wall or skin
N0 = no spread to nodes N1 = 1-3 nodes N2 = 4-9 nodes N3 = >10 nodes
M0 = no distant spread M1 = spread to distant organs (bone, lung, brain, liver)
Which patients get screened for breast cancer?
Every 3 years aged 50-70
High risk patients:
- Patients should be offered genetic counselling and pre-test counselling prior to testing
- Tests available for BRCA1, BRCA2, TP53 and PTEN genes
- Screening for breast cancer in high risk patients consists of annual mammograms
- —Aged 40-49 if moderate risk
- —Aged 40-59 if high risk
- —Aged 40-69 if known BRCA positive
- —Consider offering aged 30-59 if high risk
