Breast Cancer Flashcards

1
Q

Trends in the Picture

A

African American women tend to have more aggressive form of breast CA and not responsive to treatment

Issue of self-exam: done same time each month at end of period (when hormones are most neutral)

Breast feeding is protective for breast cancer

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2
Q

Obectives ​

A
  1. Review normal breast anatomy
  2. Discuss Breast Cancer Screening Guidelines for Average Risk Women (ACOG, ACS, USPSTF, NCCN)
  3. Review Breast Health History for risk assessment
  4. Describe Clinical Breast Exam (CBE) competencies and mass documentation
  5. Understand the BIRADS reporting system for mammograms and sonograms
  6. Review assessment, diagnosis, management and follow up of common breast conditions: Breast Masses and Nipple Discharge
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3
Q

Breast Cancer Incidence

___ leading cause of Cancer deaths

___ leading cause of Cancer Sites

A

2nd

1st

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4
Q

Breast Cancer Incidence vs. Mortality Rate

Overall what is the takeaway?

A

Although incidence is higher in white women, mortality rate is higher in AA women

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5
Q

Breast Anatomy

  1. Marks the upper boundary of the breast tissue
  2. (breastbone) can be felt beneath the skin
  3. Is a dark circle of skin that surrounds nipple
  4. Is the outlet for milk during breastfeeding
  5. Tissue that supports breasts, making them feel firm
  6. Helps move your arm
  7. Can be felt beneath skin (bones)
  8. Makes up the Axillary Lymph nodes
  9. Tissue that fills spaces around the ducts and lobules
  10. Mamary glands that produce milk during pregnancy and breastfeeding
  11. Carry milk from lobules during breastfeeding
A
  1. Clavicle
  2. Sternum
  3. Areola
  4. Nipple
  5. Fibrous Tissue
  6. Chest muscles
  7. Ribs
  8. Tail of Spence
  9. Fatty tissue
  10. Lobules
  11. Ducts
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6
Q

Normal Nipples

  • ____ Range of what’s normal
    • Nipple ____ vs ____
    • Areola is ____ vs. ____
    • ____ follicles
A
  • Wide
    • inverted, exverted
    • wide, narrow
    • Hair
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7
Q

Montgomery Glands

=

A

Glands that provide lubrication during lactation, immunoglobulin, and scent attracts infant to breast

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8
Q

More Variations of Normal

Left and Middle Pic =

Right Pic =

A

Scar for breast implants

Breast reduction scar

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9
Q

Breast Anatomy Cont.

Coopers Ligaments =

Inframmamary Ridge =

A

holds the breast up (weaker as we age)

Feels a little thick on palpation

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10
Q

Breast Physiology

  1. Follicular Phase: (2): proliferation of _____ tissue
  2. Luteal Phase: (1): duct ____, s____, interlobular _____
  3. Menstrual Phase: _______ of follicular/luteal changes
  4. Pregnancy/Lactation: Increase in (3): proliferation of d____, l____, al____; (1) -> contraction/milk ejection
  5. Menopause: _____ in E and P -> (1) < (1)
A
  1. FSH, E: glandular
  2. P: duct dilation, secretion, edema
  3. Regression
  4. E, P, Prolactin: ducts, lobes, alveoli/ Oxytocin
  5. Decrease -> connective/glandular tissue < fatty tissue
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11
Q

Breast Physiology Notes

  • Natural aging process -> less what overtime? which is why we choose to do a ___ to look for abnormalities in younger women
  • Mammography is better for women age?
  • Screening technique is better with what type of breasts?
A
  • less glandular/connective tissue overtime -> US for younger women
  • Mammography 30 and older
  • Less dense breasts (why we start >40)
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12
Q

Average Lifetime Risk of Being Dx’d with Breast Cancer

If you DO NOT have (3)

A

Personal History of breast, ovarian, tubal, or peritoneal cancer

Radiotherapy to chest 10-30y

BRCA1/2 Known carrier of pathogenic mutation for hereditary breast and ovarian CA

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13
Q

Average Lifetime Risk of Being Dx’d with Breast Cancer

If you do not have

  • Mammographic breast _____
  • Previous breast biopsy indicating ___-risk _____ (atypical hyperplasia)
  • _____ history of breast, ovarian, tubual, or peritoneal CA
  • _____ (1) associated with BRCA1 or 2 mutations
A
  • density
  • high risk lesion
  • Fam hx
  • Ancestry (Ashkenazi Jewish)
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14
Q

Breast Ca Risk Reduction Tools

  • Calculate Lifetime or __-__yr risk for Breast Ca
  • Multiple Tools: ____ Model https://bcrisktool.cancer.gov/Others: BCRAT, IBIS
  • Variables include?
  • Lifetime risk: average %? moderate %?
A
  • 5-10
  • Gail
  • Age, race, relatives w br ca, PMHx of br bx, breast density, age at menarche, age at first birth, abnl bx, chest irradiation, known BRCA 1 or 2 mutation
  • <15%, _>_15-20% (>15% requires enhanced screening)
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15
Q

Refer for Genetic Counseling

__ positive response needs referral

  1. Did any of your ___-degree relatives have breast or ovarian ca?
  2. Did any of your relatives have _____ breast ca?
  3. Did any ___ in your family have breast ca?
  4. Did any _____ in your family have breast ca before age __?
  5. Do you have 2 or more relatives with breast and/or _____ ca?
  6. Do you have 2 or more relatives with breast and/or ____ ca?
A

1 (any positive response)

  1. First
  2. bilateral
  3. man
  4. woman, <50
  5. ovarian
  6. bowel
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16
Q

Breast Cancer Screening Guidelines for Ave Risk (Female sex at birth)

***Diagnostic CBE important part of assessment of women with breast _____ or _____***

Guidelines apply to those with _____ for benign reasons

Note: Overall different guidelines have different age ranges: all depends on?

We don’t really use CBE to screen but important to use when woman presents with _____, on the other hand ______ definitely decreases mortality its just a question of when to start

A

Complaints or Abnormalities

Implants

Diff conclusions dt variation in weighing risks and benefits - if you start earlier and do it more often your going to find more cancers AND non-cancers (false positives) -> unecessary intervetion

17
Q

Professional Societies Breast Cancer Screening Recommendations

Just a diff look at screening guidelines

Mast majority about __-__ yo recommend ______ screening

A

55-70 - Biennial

18
Q

Modifiable Behavioral Risks List

(4)

A

Postmenopausal weight gain

Alcohol consumption

Smoking

Physical Inactivity

19
Q

Risk Based Screening

Folks at increased Risk

Don’t need to memorize just understand we approach screending differently in those at high risk: we screen ____ and more ____: sometimes even using other mechanisms like ____

A

Earlier, More often (Annually), MRI

20
Q

Imaging Tests

(5)

What is the difference between Mammography and DBT?

DBT is best for? Significant of DBT?

A
  1. Mammogram
  2. Digital Breast Tomosynthesis (DBT)* 3D mammography
  3. Ultrasound
  4. MRI
  5. Thermography

DBT is a 3D mammogram (we get more info) - both are mammography but DBT is more detailed***

Best for detecting lesions in dense breasts, we’re moving towards that being the norm

21
Q

Mammography V Tomosynthesis (DBT)

Which is which?

A
22
Q

What Tests are these Pictures?

A

Mammogram (Left), Sonogram (Right)

23
Q

BI-RADS mammographic assessment categories

Breast Imaging Rating and Data System

  • Is a _____ classification from __-__
  • Recommendations for further evaluation _____vs. _____
  • Probability of _______

Generally a __ or __ = normal interval follow up

A
  • numeric 0-6
  • further eval biopsy v. surgery
  • malignancy

​​1 or 2 = normal

24
Q

Results of Screening Mammography

  • BI-RADS 0 =
  • BI-RADS 1, 2 =
  • BI-RADS 3 =
  • BI-RADS 4,5 =
A
  • Additional Imaging required
  • Routine Follow up
  • CBE
    • Negative CBE: follow recommended short interval follow up in radiology report
    • Positive CBE: refer to outside specialist
  • Refer to outside specialist
25
Q

Breast Density

Another part of the mammography report (certain states require) to include Breast Density

A
26
Q

Common Mammographyic Finding: Calcifications

  • Macrocalcifications**
    • _____ distribution
    • _____ after age 50 (>50%)
    • _____ with cancer
    • Require _____
  • Microcalcifications**
    • _____ distribution
    • _____ with cancer
    • Require further ____
A
  • Macro
    • random
    • common >50
    • unrelated
    • consult
  • Micro
    • Clustered
    • Correlated
    • eval
  • Not from dietary calcium
  • Calcifications: know the macrocalcifications are extremely common and normal >50yo
  • MICROcalcifications we need to worry about
27
Q

Breast Health: At each visit

  • Breast Health ___
    • Periodic Assessment of Breast Cancer ____
      • ____ and ___ cancers
      • _____? pain, nipple discharge, masses, skin changes, redness
      • _____? Encourage Breast Self ______
  • Pt education regarding ______ risk factors
  • Review ____ Based Breast Cancer Screening Recommendations for Average Risk Women or Enhances screening for higher risk
  • Perform ___ prn
A
  • Hx
    • ​Risk
      • Personal, Hx
      • Symptoms
      • Changes: Self Awareness
  • Modifiable
  • Age Screening Recommendations
  • CBE
28
Q

Pt Education: Breast Self Awareness

Symptoms of Breast Cancer

(6)

A

Lump

Pulled in Nipples

Dimpling

Dripping

Redness/Rash

Skin Changes

29
Q

When is Nipple Discharge Concerning?

  1. When discharge is _______
  2. _____ or blood stained
  3. When it is completely ____ and _____
  4. When there is ____ of discharge
  5. When it is associated with a ____ _____
  6. When it is from only ____ ____, ____ _____
  7. When it is ____

Note: after _____, some women will continue to have discharge for many ____

A
  1. spontaneous
  2. Bloody
  3. Clear and Colorless
  4. Alot
  5. Breast Lump
  6. One Duct, One Breast
  7. New

childbirth, discharge for many years

30
Q

Clinical Breast Exam (CBE)

Includes assessment of ___

  • Patient Standing with Arms ___
  • Standing wiht Arms ____
  • Pushing on ___ to ___ pectoralis Muscles
A

LN

  • Down
  • Elevated
  • Hips, Tense
31
Q

Palpation Technique

(3)

  • Use _____ hand: pads of ____ fingers
  • ____ sized circles
  • _____ between palpations, without ____ fingers from breast
A

Superficial

Intermediate

Deep

  • dominant, three
  • dime
  • Slide, without lifting
32
Q

Breast Mass Documentation: Exam, Plan, F/U*

  • Location*
    • ​____ or ____ breast
    • ____ face location
    • _____ from ____ edge
    • Sz: __ dimensions
    • D______
  • (1) Fixed, mobile
  • (1) round, oval, smooth, lobulated
  • (1) Soft, Firm, Rubbery
  • (1) Pos or Neg
  • (1) Pos or Neg
A
  • Left or Right
  • Clock
  • Distance from areolar edge
  • 2
  • Drawing
  • Mobility
  • Shape/Margins
  • Tenderness
  • Consistency
  • Lymphadenopathy
  • Skin Changes

First 4 things to document is SUPER important -> allows you to know what/where to recheck/assess further

33
Q

Diagnostic Algorithm for Palpable Breast Abnormalities in Women Less than 30 years of Age

Most important thing to take away is if you palpate something in the breast for someone <30 - first you order a diagnostic ___ -> determines what?

A

US -> determines if mass is cyst, fluid filled, or mass

34
Q

Diagnostic Algorithm for palpable breast abnormabilites in women 30y and older

Key Takeaway =

A

>30 and postmenopausal start with diagnostic mammogram AND refer to breast specialist right away

35
Q

Discordance: Self Breast Exam v. Clinical Breast Exam

  • If SBE is positive but CBE is negative ->

After repeat

  • SBE is still positive and CBE is still negative ->
  • CBE is positive ->
  • SBE Neg/CBE Neg ->

What can you always do per pt request?

A
  • Repeat CBE in 2-3 months
  • Refer or Age appropriate diagnostic imaging; specilaist/sampling prn
  • Refer for Age appropriate diagnostic imaging; specialist/sampling prn
  • Routine f/u

Can always appropriate imaging per pt request

36
Q

Common Breast Conditions: Cysts/Fibrocystic Changes

=

  • Discrete, m_____, “_____”
  • Variable, c____ size/discomfort
  • Tx (2)
A

Benign, Fluid Filled Masses

  • mobile, “rubbery”
  • cyclic
  • Expectant or Aspiration
37
Q

Common Breast Conditions: Fibroadenomas

=

  • Etiology: ____, _____ effects
  • Round with distinct _____
  • M____, f___, r____
  • Painful?
  • Common in?
  • Tx:
A

Benign, dense, epithelial and fibrous tissue

  • unknown, estrogenic
  • borders
  • mobile, firm, rubbery
  • Painless*
  • Adolescents, young women
  • <3cm expectant mngmt, f/u imaging
38
Q

Best Practices for Breast Screening Cancer and Prevention

  • Risk assessment _____ via hx
  • Risk based ______ recommendations in accordance with guidelines; shared decision making
  • Pt _____ re modifiable risk factors
  • Referrals for ____ counseling prn
  • Knowledge of _____ breast problems: assessment, dx, mngmt
  • Follow established protocols for referring pts for ____/sampling/breast ____ rn
  • Always refer to _____:______ women w/breast masses OR any _____ or confusing results
  • Avoid ____ in Dx: follow up every breast mass or sx to conclusion and document exam, pt sx, referrals, results, pt education, and f/u
A
  • annually
  • screening
  • education
  • genetic
  • common
  • imaging, specialist
  • specialist: menopausal or discordant results
  • AVOID DELAYS