Breast disease

Question 1

Triple -ve means

Answer 1

-ve for
HER
ER
PR

Question 2

Indications for mastectomy (3)

Answer 2

multifocality
local recurrence
DCIS / invasion >4cm

Question 3

Referral guidelines in breast cancer

Answer 3

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if:
- They are aged 30 and over and have an unexplained breast lump with or without pain or
- They are aged 50 and over with any of the following symptoms in one nipple only:
Discharge
Retraction
Other changes of concern (new NICE recommendation for 2015)

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) people:
With skin changes that suggest breast cancer or
Aged 30 and over with an unexplained lump in the axilla (new NICE recommendation for 2015).

Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain (new NICE recommendation for 2015).

Question 4

Benefits and harms of breast screening

Answer 4

The benefits include:

• Reduction in mortality. Breast screening detects breast cancers and saves lives, with the greatest reduction in mortality seen in women 50–70 years of age.
• More breast-conserving treatment due to an increase in the early detection of breast cancer.
• The harms include:
  Over-diagnosis leading to unnecessary treatment. (Over-diagnosis refers to the detection of breast cancers through screening that would not have been diagnosed without screening and would not have threatened the lives of the women concerned.)
• False-positive mammograms leading to unnecessary further investigations.
• False reassurance due to missed cancer and incorrect diagnosis.
• Pain and discomfort due to mammography.
• Psychological distress.
• Radiation exposure, which may increase the risk of breast cancer.

Question 5

Who is eligable for routine breast screen

Answer 5

47 to 73 y/0

Question 6

Managing breast pain

Answer 6

well fitting bar
topical NSAIDS
change OC if pain linked

consider hormone suppressing drugs if severe and prolonged

diet and exercise is important

Question 7

common organism in infective mastitis

Answer 7

s.areus

Question 8

how to treat an abscess

Answer 8

USS guided drainage

or surgical drainage

Question 9

Treatment of mastitis

Answer 9

flucloxacillin

Question 10

important serious differential in breast inflammation

Answer 10

inflammatory breast cancer

Question 11

Treatment options for DCIS

Answer 11

Low risk - excise (1cm margins) and radio

Intermediate and high / multifocality - mastectomy

Low recurrence - mastectomy