Breast Brief

Question 1

What is the next step after History & Examination for a young patient with a breast lump?

Answer 1

Ultrasound (US).

Question 2

What is the next step after History & Examination for older patients (>40 or 35) with a breast lump?

Answer 2

Mammography.

Question 3

What is the first investigation after imaging for a solid mass in the breast?

Answer 3

Core biopsy.

Question 4

What is the best investigation for a solid mass in the breast?

Answer 4

Excision.

Question 5

What is the first investigation for a cystic mass in the breast?

Answer 5

Fine-needle aspiration biopsy cytology (FNABC).

Question 6

Describe the presentation of a hypoechoic mass on ultrasound in a young female.

Answer 6

Fibroadenoma.

Question 7

What is the treatment for fibroadenoma in the breast?

Answer 7

Surgery.

The treatment for fibroadenoma in the breast can be managed either with surgical excision or ongoing clinical and imaging surveillance, depending on various factors such as age and patient preference. Here are the details:

1. Surgical Excision:
   
   • Women Over 40 Years: New palpable fibroadenomas should be considered for excision biopsy even if benign on triple testing, due to the increased likelihood of a new lump being cancer.
   • Fibroadenomas >3–4 cm: Regardless of age and triple testing results, these should be considered for excision biopsy.
   • Atypical Features: Any lesion showing atypical features on imaging or clinical assessment should be considered for excision biopsy.
2. Clinical and Imaging Surveillance:
   
   • Women Under 40 Years: If benign on triple testing, can be managed with regular clinical and ultrasound review until stable over time.
   • Impalpable Lesions: Lesions with benign features on imaging +/- biopsy can be managed with imaging surveillance.
   • Surveillance Interval: There is no consensus on the interval between surveillance ultrasound scans, but 6–12 months is reasonable.
3. Follow-Up:
   
   • Size Increase or Atypical Features: Any lesion that significantly increases in size or develops atypical features on imaging should undergo repeat biopsy or be considered for excision biopsy.

• Educating and reassuring the patient is important, as most fibroadenomas are benign and do not significantly increase the risk of breast cancer.

Reference: 200504brennan.pdf oai_citation:1,200504brennan.pdf.

Question 8

What is the diagnosis for a young patient with breast pain and swelling that fluctuates with menses?

Answer 8

Fibrocystic disease of the breast (fibroadenosis).

Question 9

What is the initial treatment for fibroadenosis?

Answer 9

Analgesics and a tight-fitting bra; if no response, oral contraceptive pills (OCPs).

Question 10

What is the treatment for severe fibroadenosis that does not respond to OCPs?

Answer 10

Danazol.

Question 11

What is the most common cause of bloody discharge from the breast?

Answer 11

Intraductal papilloma.

Question 12

What is the treatment for mastitis in a lactating female?

Answer 12

Continued breastfeeding.

Question 13

What is the initial approach for mastitis complicated by a breast abscess?

Answer 13

Continued breastfeeding from the affected side first.

Question 14

How do you manage gynecomastia in an infant?

Answer 14

Reassure, as it is due to the passage of maternal hormones.

Question 15

How do you manage gynecomastia in puberty with pain and induration?
less than 17 age

Answer 15

Reassure.

Question 16

What is a common cause of gynecomastia in a young athlete?

Answer 16

Steroid abuse.

Question 17

How do you manage senile gynecomastia?

Answer 17

Testosterone replacement.

Question 18

What is the likely diagnosis for a patient with viscid secretion (serous or creamy discharge) from the breast?

Answer 18

Mammary duct ectasia.

Question 19

Describe the most common cause of bleeding per nipple.

Answer 19

Duct papilloma.

Question 20

What is the increased risk associated with mutations in the BRCA1 and BRCA2 genes?

Answer 20

Increased risk of breast and ovarian cancer.

Question 21

How is breast cancer typically diagnosed in an older female with any changes in her breast, skin, nipple, or nipple discharge?

Answer 21

Breast cancer is the most probable diagnosis.

Question 22

Define the screening method for breast cancer that involves cancer appearing as micro-calcifications.

Answer 22

Mammography.

Question 23

When is mammography typically done for females starting from age 50?

Answer 23

Every 2 years.

Question 24

Why are Australian females often scared of mammography?

Answer 24

Due to the pain associated with the procedure.

Question 25

What is the current recommendation regarding routine self-breast examination?

Answer 25

No longer recommended.

Question 26

What should be done for a female with a strong positive family history of breast or ovarian cancer?

Answer 26

Gene assessment.

Question 27

What is the next step for a female with a relative who has a BRCA mutation?

Answer 27

Gene assessment.

Question 28

Before conducting BRCA1 and BRCA2 testing, what should be done first?

Answer 28

Counseling about the test.

Question 29

If a woman treated for breast cancer on one side develops cancer on the other side, what is the likely cause?

Answer 29

Primary cancer (not metastasis).

Question 30

What is the most important prognostic factor for breast cancer?

Answer 30

Lymph node involvement.

Question 31

What is the main approach to managing breast hematoma?

Answer 31

Excision.