Breast disease Flashcards
What is a woman’s lifetime risk of developing breast cancer?
12%
What are the risks factors for breast cancer?
Main risk are = female sex and age
Female sex
advancing age
Early menarche
late menopause
Nullipiarty
Family history of breast cancer, ovarian cancer
Prior biopsy showing atypical ductal or lobular hyperplasia
Higher BMI
Smoking
Menopausal hormonal therapy with estrogen
Chest radiation between age 10-30
Dense breast
What factors can decrease risk of hormone receptor positive breast cancer?
Parity
Breastfeeding
What are risks/benefits of breast screening test?
Risks= false positive, cost, anxiety, over diagnosis, over treatment
Benefits= improves health outcomes
What is ACOG recommendation for clinical breast exams?
May be OFFERED every 1-3 years from age 25-39, annually at age 40
What is ACOG recommendation for mammogram screening?
OFFER starting at age 40
Can initiate between 40-49 after counseling if patient desires
Recommend by age 50
What is ACOG recommendation for mammogram screening interval and discontinuation?
Annually or biennial
Stop at age 75
Beyond age 75 it should be a shared decision making process
What is breast cancer risk assessment based on?
Patient history
Family history
Reproductive risk factors
prior biopsies
radiation exposure
How do you determine breast cancer risk?
breast cancer risk assessment
Using risk assessment tool like GAIL or CLAUS
Why is breast cancer risk assessment important?
To help determine proper surveillance, genetic testing, risk reduction
Which women would GAIL model not be appropriate for?
- Age <35
- Family history of cancer in dad or distant relatives
- Family history of germline mutations
- Previous biopsy of lobular carcinoma in situ
What is the recommendation regarding self breast exams?
Self breast exams are not recommended in average risk women due to risk of harm from false positives and no proven benefit
Women should instead be counseled about breast self awareness and come for evaluation if there is a change
How do you counsel a patient regarding breast awareness?
Awareness of appearance and feel of her breast
What are symptoms of potential breast cancer you should counsel patients about?
New onset pain
New mass
Nipple discharge
Redness of breast
When is a clinical breast exam recommended?
High risk women for breast cancer
Symptomatic women
What benign breast lesion has a significant risk of future breast cancer?
Lobular carcinoma in situ
What is a fibroadenoma?
Benign proliferative mass composed of epithelial and stromal elements
What is diagnosis of atypical hyperplasia associated with?
Future risk of invasive cancer of the same or contralateral breast
How do you diagnose a tubular adenoma?
Tissue biopsy
Single enlarging breast mass what should you think of?
Phyllodes tumor
What other breast mass can phyllodes tumor present like?
Fibroadenoma
How do you diagnose phyllodes tumor?
Excision biopsy
What is the risk of developing invasive cancer after diagnoses of lobular carcinoma in situ?
1-20%
What are characteristics of benign nipple discharge?
Green or milky in color
Bilateral
Only present when expressed
What are causes of galactorrhea outside of pregnancy or postpartum period?
Chronic nipple stimulation
Thyroid disease
Prolactin secreting tumor
Medications that inhibit dopamine
Causes of mastitis?
Cyclical (hormonal)
Noncyclical ( tumor, cancer, cyst mastitis, trauma, thrombophlebitis)
Extramammary (costochondirits, rib fracture, medications)
Treatment for mastitis?
Dicloxacillin 500mg QID for 7-10 days
Alternative treatment for mastitis?
Cephalexin
Ulcerated crusted scaling lesion on the nipple what should you think of?
Paget disease of the breast
What is the initial evaluation for a women presenting with breast related problem?
History including characterization of symptoms and assessment of risk factors for breast cancer + clinical breast exam
What are the BIRADS categories?
BIRAD 1= negative 0% chance of malignancy
BIRAD 2= benign 0% chance of malignancy
BIRAD 3= probably benign 0-2% chance of malignancy
BIRAD 4= suspicious 3-94% chance of malignancy
BIRAD 5= highly suggestive= >95% chance of malignancy
BIRAD category 6= Known biopsy proven malignancy= excision biopsy
What are next steps after a palpable mass at age <30?
- Consider if low risk or high risk
- If low risk consider observing over 1-2 menstrual cycles
- If high risk offer ultrasound
- Base further management on BIRAD score
What are next steps after a palpable mass at age 30 or older?
- Offer Diagnostic mammogram
- Based on BIRAD score either do tissue biopsy or ultrasound
- Based on ultrasound BIRAD score either do tissue biopsy or clinical exam with imaging yearly for 1-2 years. If BIRAD 1 or 2 consider clinical suspicious and either biopsy or observe
What medication is FDA approved for mastalgia?
Danazol
What is the next step after bilateral milky discharge is noted on clinical exam?
Pregnancy test
If negative order galactorrhea workup
What does a galactorrhea workup entail?
Review medications
TSH level
Prolactin level
