Breast Disease

Question 1

What are the risk factors for fibrocystic breast disease. What is likely to be found on history/examination?

Answer 1

• Increased oestrogen exposure (nulliparity, late menopause, HRT, obesity etc.)
• Lumpy breasts (diffuse, symmetrical)
• Pain and tenderness that fluctuate with menstrual cycle

Question 2

What should be the investigative process in a patient with suspected breast disease?

Answer 2

• Triple assessment
  
  • Clinical examination
  • Mammography/ultrasound
  • Biopsy

Question 3

How should fibrocystic breast disease be managed?

Answer 3

• Pain management
• Hormonal therapy if pain resistant
  
  • Tamoxifen
• Cyst aspiration if cystic
• Lesion removal if high-grade DCIS

Question 4

What is the pathophysiology of fat necrosis of the breast?

Answer 4

Fibrosis and calcification after injury to breast tissue

Question 5

In fat necrosis of the breast, what are the likely history/exam findings?

Answer 5

• Breast trauma
• Surgical reduction/augmentation
• Firm mass, irregular border

Question 6

How is fat necrosis of the breast managed?

Answer 6

Reassurance

Question 7

Where would you generally find a fibroadenoma of the breast?

Answer 7

Confined to one breast lobule (TLDU)

Question 8

What are the history/examination characteristics of fibroadenomas of the breast?

Answer 8

• Solitary lump in one breast
  
  • Asymptomatic
  • Painless
  • Firm
  • Mobile “breast mouse”

Question 9

How are breast fibroadenomas generally treated?

Answer 9

• Reassurance and monitoring
• Surgical excision if large

Question 10

What are the risk factors for the development of breast cancer?

Answer 10

• FHx
• Increasing age
• Increased oestrogen exposure (nulliparity, late menopause, obesity, EtOH)
• Genes (BRCA, p53)

Question 11

What are the likely history/exam findings in a patient with breast cancer?

Answer 11

• Breast mass (less mobile, may be irregular)
• Nipple discharge (serous/bloody)
• Skin changes (peau d’orange)
• Axillary lymphadenopathy

Question 12

What are the management principles in a patient with known breast cancer?

Answer 12

• Surgical intervention
  
  • WLE or mastectomy with sentinel node biopsy
• Hormone therapy/herceptin
  
  • Depending on ER/PR/HER2 status
• Chemotherapy/radiotherapy
  
  • Neoadjuvant/adjuvant depending on size/extent
• Support
  
  • Breast care nurse

Question 13

What symptoms might be present in a patient with Paget’s disease of the breast?

Answer 13

• Eczema-like rash, scaling
• Discharge (serous/bloody)
• Nipple inversion
• +/- lump

Question 14

What are the common causes of gynaecomastia?

Answer 14

• Decreased androgen and increased oestrogen production
• D rugs (EtOH, oestrogen agonists, cimetidine)
• O ther
• C ongenital (Klinefelter’s, androgen insensitivity)
• T umours
• E ndocrine (hypogonadism, hyperthyroidism)
• Ch ronic disease (cirrhosis)

Question 15

What would be some important tests to do in someone with gynaecomastia?

Answer 15

• TFTs (exclude hyperthyroidism)
• LFTs (exclude liver disease)
• UECs (exclude renal impairment)
• Hormone studies

Question 16

What are the maangement principles of gynaecomastia?

Answer 16

• Reassurance
• Reduction in oestrogen exposure
  
  • Tamoxifen > danazol
• Surgical reduction

Question 17

What are generally important questions to cover when taking a history from someone with a breast mass?

Answer 17

• Oestrogen exposure
• Size and change of mass (with menstrual cycle)
• Pain/tenderness
• Discharge
• Previous breast cancer
• FHx

Question 18

What is the most common kind of breast cancer?

Answer 18

Ductal

Question 19

What would normally be prescribed fro a patient with ER/PR positive breast cancer? For how long?

Answer 19

Tamoxifen - 5y