Breast Clinical- Onello Flashcards
What breast imaging modality is most sensitive in women under 30?
Ultrasound
What classifies nipple discharge as “pathologic”
- Spontaneous
- Bloody, Serous, Clear
- Unilateral
- Associated w/ breast mass
What 3 major things have contributed to lower rates of breast feeding in black communities?
- Slavery
- Wet nursing
- Formula company advertising
What is the most common cause of physiologic nipple discharge?
Galactorrhea = bilateral milky white discharge in persons whoa re not pregnant or lactating
What labs should you check in a patient with galactorrhea?
Prolactin
TSH
Most commonly diagnosed cancer?
Breast Cancer
Where does breast cancer fall in causes of cancer death?
Second! (Lung cancer is leading killer)
What is the most common presenting symptom in patients diagnosed with breast cancer?
Breast mass
Describe a benign breast mass
Discrete margins Do NOT cause skin changes Smooth Soft to firm MOBILE
Describe a malignant breast mass
Generally hard
IMMOBILE
Fixed to surrounding tissue
Poorly defined margins
What should you use to evaluate a breast mass when there is low pre-test probability of cancer?
Fine-needle aspiration
What are some demographic risk factors for breast cancer?
Advanced age
Overweight
White or Ashkenazi Jew
What would increase risk for breast cancer in a reproductive history?
Menarche before age 12
Menopause after 55
Nulliparity
Older than 35 years at first delivery
What medical history is considered an increased risk factor for breast cancer?
BRCA1 or BRCA2 mutations First degree relative w/ breast or ovarian cancer Hx of atypical hyperplasia Prior breast biopsy Personal hx of cancer
Can alcohol increase you risk for breast cancer?
Yup! More than 1 drink per day
What percent of clinically palpable breast cancers get missed by mammography?
10-15%
Is mastalgia a risk factor for breast cancer?
Nope!
When should you consider imaging a pt with breast pain?
- Mass palpated
- Focal pain
- Diffuse pain but has risk factors
**if diffuse pain, and no risk factors then can just reassure
How should you treat breast pain?
NSAIDS
If persistent pain:
Danazol
Tamoxifen
Only treatment approved by FDA for treatment of mastalgia?
Danazol
Most common causes of pathologic nipple discharge?
Intraductal papilloma
Duct extasia
Carcinoma
Infection
How should you evaluate pathologic nipple dishcarge?
Mammography or subareolar ultrasonography
Where might you find abnormal breast tissue?
Anywhere along the milk line
Describe the 5 Tanner stages of development
1: prepubertal/ Childhood
2: Breast buds form = thelarche
3: Breasts enlarge
4: Development of glands, raised areolae
5: Adult, areolae are no longer raised
