Breast and Regional Lymphatics Flashcards
Structure and Function: Surface Anatomy
Surface anatomy
Location of breasts on chest wall: 2nd-6th rib
Most breast cancers occur in the upper outer quadrant.
Axillary tail of Spence-where most breast cancers are found
Nipple and areola
cupers ligament can pit or dimple skin
montgomery glands secrete lubricant during lactation
Adolescent changes Tanner staging
Tanner stage 1- Only small elevated nipple
Tanner stage 2- A small mound of breast and nipple develops; the areola widens
Tanner stage 3- Breast and areola enlarge; nipple flush with breast surface
Tanner stage 4- Areola and nipple form secondary mound over breast
Tanner stage 5- Mature breast- Only nipple protrudes; the areola is flush with breast contour (areola may continue as secondary mound in some normal women)
When do young girls first begin to develop?
Whites-10y/o
Blaks-8-9y/o
1 breast can grow faster than the other
Pregnancy Changes
Expansion of ductal system and hypertrophy of secretory aveoli
Breast enlarge, often feeling nodular as mammary alveoli hypertrophy
Nipples larger, darker, and more erect.
Areola increase in size, darker,montgomery tubercles more prominent
Bluish venous pattern often evident due to increased blood flow.
May produce colostrum (milk precursor, low in fat) during 4th month
Few days after childbirth breast produce breast milk
Older adult changes
With age glandular, alveolar, and lobular tissues in breast decrease
After menopause, fat deposits replace glandular tissue that continues to atrophy as a result of decreasing estrogen and progesterone
Suspensory ligaments relax causing breasts to sag
Breasts decrease in size and lose elasticity
Nipples flatter, smaller, and less erectile
Axillary hair may stop growing
Breast Cancer
2nd leading cause of cancer death in females, 2nd to lung cancer
Approx 1% of males develop disease
NCI-Lifetime risk for a women to develop breast cancer 12%
The 10-year risk for breast cancer:
at age 40: 1 and 69
at age 50: 1 and 42
at age 60: 1 and 29
Breast Cancer Risk Factors
Increased age (>40) Personal or family history of breast cancer or disease Early onset menarche (before age 13) Late-age menopause (after age 50) Nulliparous (never having borne a child) Late first pregnancy (after age 30) Recent use of oral contraceptives
Inherited Risk Factors BRCA1 or BRCA2 Mutation
Diagnosed with breast cancer before age 50 and/or ovarian cancer at any age
Have close family member (on mother’s or father’s side) diagnosed with breast cancer before age 50, ovarian cancer at any age, or male breast cancer at any age.
Half of all women with hereditary risk inherited it from father’s side.
BRCA1 BRCA2 Mutation statistics
Women with BRCA mutation have:
33%-50% risk of developing breast cancer by age 50
56%-87% risk by age 70
27%-44% chance of developing ovarian cancer by age 70
Men with BRCA mutation have:
-6% risk of developing breast cancer
If women have the BRCA1 or BRCA2 gene what are the age markers for certain tests?
18- Breast Self Exam
25-MRI & Annual Clinician Breast Exam & ovaries CA125
preventative therapy Tamoxifen
Removal of Breasts or ovaries
Screening for Breast Cancer for Average Risk Female
American Cancer Society (2003)
Film Mammogram-at 35 insurance will pay for a baseline mammogram
Annually after 40 years old
Clinical Breast Examination (CBE)
Every 3 years for age 20-40
Annually after 40 years old
Breast Self-Examination (BSE)
Option for women starting at age 20
Women 20 years of age or older need to report any breast changes to a health care provider immediately
“It is acceptable for women to choose not to do BSE or to do BSE irregularly.”
According to the US Preventive Service Task Force (2009) what are there recommendations?
Film Mammogram Not recommended in women 40-49 years old Biennial for women 50-74 years old Insufficient evidence for recommendation in women ≥75 Clinical Breast Examination (CBE) Insufficient evidence for recommendation Breast Self-Examination (BSE) Not recommended This is crap avoid following these
US Preventive Service Task Force (USPSTF)
Recommendations in 2009 have had little impact on number of women receiving annual mammograms.
Women not concerned about false positives and unnecessary biopsies. They know mammograms save lives.
Question…Will insurance continue to cover annual mammograms?
Health History
Assess patient’s risk factors
Assess socioeconomic status
Fixed or low-income may be less likely to pursue CBE and mammography
Consider importance of teaching SBE
Provide with resources for free/low cost screening
If already performs self breast exam:
Assess methods and times performs in relations to menstrual cycle
Health History-OLDCART
Pain or tenderness Discharge Distortion or retraction Rash or scaling of nipple Change in size of breast or swelling Lump Onset- When first noticed? Duration- Always present or come and go? Characteristics- Changed in size, shape, or with menstrual cycle? Associated Symptoms?
