Breast

Question 1

What 6 symptoms should you ask in a breast history?

Answer 1

Pain, Lumps, Discharge, Rashes, Inversion, Distortion

Question 2

What are the 2 views used in mammography?

Answer 2

Mediolateral oblique

Craniocaudal

Question 3

Each component of the triple assessment is scored on a scale of 1-5 - what do these numbers mean?

What does C1 mean?

Answer 3

1 - normal
2 - benign
3 - probably benign
4 - suspicious
5 - malignant

C1 - inadequate sample

Question 4

What are the disadvantages of FNAC? (3)

Answer 4

Cannot determine receptor status
Cannot determine if invasive or non-invasive cancer
Requires a highly trained pathologist

Question 5

When in primary care, when should you refer the following?

1. Discrete lump
2. Symmetrical nodularity
3. Asymmetrical nodularity

Answer 5

1. Refer
2. Reassurance
3. If >35 or <35 with family history, refer; if <35, reassess after next menstrual period; if persists, refer

Question 6

What are the benign causes of a lump in the breast? (5)

Which lumps cause discharge? What type of discharge do they produce?

Answer 6

Fibroadenoma, cysts, intraductal ductal papilloma, fat necrosis, nodularity

Intraductal papilloma - clear or blood-stained
Duct ectasia - green/brown/blody discharge

Question 7

What imaging is used to assess a breast lump and who are they used on?

Answer 7

USS for everyone

Mammography if >40 or <40 P4/P5

Question 8

What is determining grade and receptor status important in breast cancer?

Answer 8

Determines if chemotherapy or hormone treatment would be a suitable treatment option

Question 9

What age group is offered breast screening?
How often is screening?
What are the disadvantages of breast screening? (5)

Answer 9

50-70
Every 3 years
False positives cause anxiety, may miss a cancer, may treat a cancer that otherwise would not have caused problems, may develop cancer in between screenings, exposed to small amount of radiation

Question 10

What online decision making tool can help guide treatment of breast cancer?

Answer 10

PREDICT

Question 11

How is DCIS managed? (2)

Answer 11

Surgery - either wide local excision or mastectomy

Follow by radiotherapy or hormone therapy if receptor positive or decide not to have radiotherapy

Question 12

What are some causes of non-cyclical breast pain? (3)

Answer 12

• Breast: cancer, trauma, mastitis, large breasts
• Extramammary: costochondritis, shoulder pain, fibromylagia, thoracic outlet syndrome
• Medication e.g. SSRIs, spironolactone

Question 13

What are the management options for breast pain? (4)

Answer 13

Well-fitting bra
Low-fat diet, less caffeine
Topical NSAIDs
If severe, hormone suppressing drugs

Question 14

What is the most common cause of mastitis in non-lactating women?
What is a less common cause of mastitis in non-lactating women?

Answer 14

Periductal mastitis - central

Peripheral mastitis - occurs in rheumatoid arthritis, steroids, diabetics

Question 15

What is the management of mastitis? (3)

What is the management of a breast abscess?

Answer 15

Encourage breast-feeding and observe breast-feeding technique
Analgesia and warm compresses
Antibiotics if indicated (in all cases if non-lactating)

Refer to hospital for USS and aspiration

Question 16

If a first-degree relative was affected with breast cancer, at what age would this be suggestive of a family history?

What other factors would make you suspicious of a family history? (5)

Answer 16

<40 years

Male breast cancer, bilateral disease, other patterns of cancer within the family, ovarian cancer, Jewish ancestry

Question 17

What other gene is tested for in breast cancer apart from the BRCA genes?
What type of cancer does it cause? (4)

Answer 17

TP53 (causes sarcoma, leukaemia, adrenal cancer and breast cancer)

Question 18

What risk reduction strategies are available for women at high risk of breast cancer? (2)

Answer 18

Enhanced screening at 40 - every year, includes mammography and MRI
Surgery (mastectomy and oopherectomy) and medication e.g. tamoxifen