Breast Disease

Question 1

What are the clinical presenting features of breast disease?

Answer 1

1. Physiological swelling and tenderness.
2. Nodularity.
3. Breast pain.
4. Breast pain (not usually associated with malignancy).
5. Palpable breast lumps.
6. Nipple discharge including galactorrhoea.
7. Breast infection and inflammation- usually associated with lactation.

Question 2

How can you divide breast disease histologically?

Answer 2

1. Non-proliferative disorders: no increased risk.
2. Proliferative disorders without atypical: mild to moderate increase in risk.
3. Atypical hyperplasias: substantial increase in risk (relative risk in the order).

Question 3

Describe physiological swelling and tenderness.

Answer 3

Puberty (breast enlargement, can be unilateral).

Can occur in pregnancy.

Question 4

What is benign breast disease?

Answer 4

Most common benign breast disorders.

Usually aged 20-50 years, with hormonal in aetiology. Most often with pain and nodularity.

Question 5

How does nodularity present?

Answer 5

Symptoms are greatest about one week before menstruation and decrease when it starts.
Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper outer quadrant of breast. If changes are bilateral usually occur.

Question 6

How would you manage someone with nodular breasts?

Answer 6

Review patient after one of two menstrual cycles, seeing her mid-cycle.

Question 7

How do you treat nodularity?

Answer 7

Treatment is with analgesia and a good, well-fitting bra.

Question 8

What is cyclical mastalgia?

Answer 8

Breasts and active organs that change throughout the menstrual cycle, with tenderness and nodularity in premenstrual phase.

Question 9

How do benign mass feel?

Answer 9

3D, mobile and smooth, have regular borders and is solid/cyclic in consistency.

Question 10

What are breast cysts?

Answer 10

Palpable, discrete lumps that are recurrent. Hard to distinguish from solid tumours on clinical exam.

Question 11

When do cysts commonly occur?

Answer 11

Ages 35-50.

Question 12

What are fibroadenomas?

Answer 12

Benign tumours that commonly affect young women (20-24). They are the most common type of breast lesion.
Fibroadenomas arise in breast lobules (fibrous and epithelial tissue). Present as form, non-tender, highly mobile palpable lumps. Hormones are involved in cause.
HRT increases the risk.

Question 13

What is intraductal papilloma?

Answer 13

Benign growth in single milk duct.

Present with spontaneous discharge from one nipple.

Question 14

What is mammary duct ectasia?

Answer 14

Unknown cause. Dilation of major ducts, filled with creamy secretion with periductal inflammation.
May be asymptomatic, or nipple discharge (bloody, serous, creamy white or yellow), retracted nipple, acute inflammation, recurrent chronic inflammation with abscess formation.

Question 15

How do you treat mammary duct ectasia?

Answer 15

Surgical excision of the major duct. Correction of nipple retraction.

Question 16

What is mastitis?

Answer 16

Generalise cellulitis of the breast.

Question 17

What are breast abscesses?

Answer 17

Present with point tenderness, erythema and fever.
Related to lactation.
Non-lactational abscesses moe frequent in smokers.
Caused by staph or strep.

Question 18

What do you refer someone to the specialist breast clinic (2 weeks within)?

Answer 18

Over 30 with an unexplained breast lump (+/- pain).
Aged >50 with any of the following symptoms in one nipple: discharge, retraction, other concerns.
Skin changes that suggest breast cancer.
Aged 30 and over with unexplained lump in axilla.
Consider non-urgent referral in people aged under 30.