Breast Concerns Over the Lifespan

Question 1

treatment for redisual maternal hormones

Answer 1

Neonatal gynecomastia +/- witch’s milk lactation

Swollen genitals

Vaginal discharge: clear/white/ blood tinged

RMH in neonates basically give newborns a mini-puberty– it is normal and will resolve within days-weeks.

Treatment: reassurance.

Question 2

treament for mastitis

Answer 2

mastitis is a plugged duct. management; keep pumpking, consider nipple shield

treatment: cefazolin/vancomycin

Question 3

redflags to nipple discharge

Answer 3

unilateral

blood, green, pus

age >40

spontaneous (not pregnant, not on hormonal therapy)

Question 4

rust pipe syndrome

Answer 4

brown discharge in the first 10 days of breast feeding due to engorgement and vascularity

Question 5

T/f its normal to have breast buds during puberty for boys

Answer 5

true.

48-64% of boys going through puberty will have gynecomastia first appearing as early as 10 years of age, with a peak onset between ages 13-14.

At puberty, higher levels of estrogen, progesterone and prolactin

Question 6

T/f all breast lumps should be worked up

Answer 6

true.

Question 7

how does workup of breast lump differ between young and older patients

Answer 7

young under 30–> use ultrasounds cause they have more dense breast tissue

older–> diagsnotic mammogram

Question 8

cyclical mastalgia

Answer 8

Soreness and possible swelling/mass/transient cyst formation in breast dependent on cycle

Treatment; supportive bra, acetaminophen

Consider discontinuing caffeine. Try vitamin E, primrose oil and a lower fat diet with weight management.

Limit exogenosu estrogen (if on OCP, consider a low estrogen option)

Medication: danazol (androgenic, inhibitory effect on breast. Can cause acne, facial hair growth and lowered voice. Tamoxifen (SerM, blocks estrogen effect on breast → S/E= risk of DVT/PE)

Question 9

Pagets Disease of the Nipple

Answer 9

indication of breast cancer. nipple eczema that does not clear quickly with hydrocortisone cream

Question 10

Both Peau d’orange and Paget’s Disease may indicate ___ __ __→ a mastitis in a non-breast feeding woman (or man) should make you think of the possibility of an aggressive inflammatory breast cancer → treat with an appropriate antibiotics and simultaneously make an urgent referral to the breast clinic. This is an aggressive tumour and can metastasize quickly!

Answer 10

Both Peau d’orange and Paget’s Disease may indicate inflammatory breast cancer→ a mastitis in a non-breast feeding woman (or man) should make you think of the possibility of an aggressive inflammatory breast cancer → treat with an appropriate antibiotics and simultaneously make an urgent referral to the breast clinic. This is an aggressive tumour and can metastasize quickly!

Question 11

major signs on mammography that would indicate breast cancer.

Answer 11

Mammography findings: spiculated mass, anterior focal asymmetry

Major signs: stellate mass, microcalcification (clustered or branching), architectural distortions with no history previous surgery

Minor signs: skin thickening, lymphadenopathy

Question 12

t/f OCP can protect against endometrial and ovarian cancer

Answer 12

true

Question 13

T/F: • If you’re a trans guy aged 50 to 69, it’s important to get screened for cancer in the chest area. This means finding cancer before there are any symptoms by getting a mammogram every two years. Even if you’ve had top surgery, you still need to monitor the health of your chest tissue.

T/F: If you’re a trans woman who has never taken gender-affirming hormones (like estrogen), or if you’ve taken hormones for fewer than five years, then you do not need to be screened regularly for breast cancer.

Answer 13

Breast Cancer and Trans People–> BOTH ARE TRUE

• If you’re a trans guy aged 50 to 69, it’s important to get screened for cancer in the chest area. This means finding cancer before there are any symptoms by getting a mammogram every two years. Even if you’ve had top surgery, you still need to monitor the health of your chest tissue.

If you’re a trans woman who has never taken gender-affirming hormones (like estrogen), or if you’ve taken hormones for fewer than five years, then you do not need to be screened regularly for breast cancer.

Question 14

non modifiable risk factors for breast cancer

Answer 14

age, gender, genetics, personal history of invasive breast cancer, previous abnormal breast biopsy (hyperplasia with atypia, LICS, borderline ADH/DCIS), previous chest wall radiation, family history, dense breasts, more menstrual cycles (menarche <10 years, menopause >55)

There is a 4-6x increase of BC in women with dense breasts because there is an increased volume of fibroglandular tissue and there is an increased estrogenic effect.

Question 15

modifiable risk factors for breast cancer

Answer 15

Modifiable Risk Factors; post-menopausal obesity (BMI>30), sedentary, high fat diet, smoking, alcohol, reproduction (no children or first pregnancy >35 years), no breast feeding, HRT>10 years

Question 16

when should you referr to medical genetics?

Answer 16

• fam history of breast cancer and ovarian cacner
• BRCA1/2 gene
• atypical breast cancer patterns–males, young
• triple negative
• breast and ovarian cancer in same individuals
• ashkenazi jewish

Question 17

how does screening change in women with one or two first degree relative with invasive breast cancer?

Answer 17

• annual mammography starting 5 or 10 years younger to the youngest case in the family, but no earlier than 245.

annual breast exam starting at age 25.