Breast Cancer and benign breast disease

Question 1

What is the presentation of breast disease ?

Answer 1

lump, nipple discharge, abnormal imaging

Question 2

important aspects of the history

Answer 2

Duration, trauma, progression - rapid growth(cysts may appear overnight)

who found it?
how was it found?
Do you do regular breast exams?
How long ago was it found?
was there a hx of trauma? when?
has it gotten larger, smaller or does it fluctuate in size?
pain association?

Question 3

Breast lumps vs nipple discharge

Answer 3

LUMPS
benign vs suspicious vs malignant
Benign lumps have slow growth
Cysts - may appear overnight, have rapid growth, fluctuate in size, intermittent, may be tender

NIPPLE DISCHARGE
only one normal nipple discharge, milk from a woman who has recently delivered a child

what is the colour? (straw, white, red, brown, green?)
What is the volume?
Where is it coming from?
Has it changed in appearance?

scant straw colored is not worrisome

multiple ducts may indicate benign condition

Question 4

Why is it more difficult to see masses in mammogram of a younger woman?

Answer 4

There is dense fibroglandular tissue which appears white and opaque and obscures the view

Question 5

What are you looking for in a mammogram?

Answer 5

Abnormal lumps or abnormal calcifications

Question 6

Normal and abnormal mammograms. How are they reported and what is seen?

Answer 6

Relatively parallel calcifications that get smaller as they approach the nipple are not pathological. they are calcifications that normally occur due to age

Bilateral cranio-caudal mammogram showing bright hyperdense calcifications usually not pathological

A spiculated mass with band radiating towards the areolar area causing nipple retraction is USUALLY MALIGNANT - the only other thing that looks like this is traumatic -fat necrosis or inflammatory- granulomatous mastitis

scattered small branching microcalcifications typical of ductal carcinoma insitu