Breast Disease & Breast Cancer Flashcards
Nerves around the breast / injuries
Intercostobrachial nerve → through axilla; sensory to upper medial arm
Long thoracic nerve (C5-7) → serratus anterior (“winged scapula”)
Thoracodorsal nerve → latissimus dorsi
Timing of breast exams
SBE: monthly 5d after menses
CBE: yearly
Mammograms:
Should have yearly mammogram starting at age 40; continue as long as the woman is in good health
No upper age limit!
If strong FHx breast cancer (mother or sister), mammogram screening 5 yrs earlier than youngest family member’s diagnosis or 10 years if family member was premenopausal.
Breast pain (mastalgia / mastdynia)
If cyclic, can be 2/2 PMS, normal hormonal fluctuations, fibrocystic change
If no signs of malignancy and really low risk, reassure → NSAIDs, support bra, warm compresses
Consider U/S if hx trauma or mammogram if higher risk for cancer
Nipple discharge:
Mostly normal physiologic
Worrisome: spontaneous, bloody / SS, unilateral, persistent, from single duct, a/w mass
Bloody Nipple discharge:
Think intraductal papilloma / invasive papillary cancer
Galactorrhea:
Think pregnancy, pituitary adenomas, hypothyorid, stress, OCPs/antiHTN/antipsychotics
Serous nipple discharge
Think normal menses, OCPs, fibrocystic change, early pregnancy
Yellow-tinged nipple discharge
Think fibrocystic change, galactocele
Green, sticky nipple discharge
Think duct ectasia
Purulent nipple discharge
Think breast abscess
Breast masses
Never dismiss a mass just because mammogram is negative
Think malignant if firm, nontender, poorly circumscribed, immobile
Breast mass work up
Get U/S for women < 30, mammogram for women >30
If concerning on imaging or exam, get tissue
Cystic → aspirate ; excise cyst if bloody fluid or persistent
Solid → fine needle aspiration if < 30 → excisional bx if FNA fails, or nondiagnostic
Core needle biopsy if > 30
Nonpalpable → excisional bx under needle / wire guidance
Benign breast disease: Fibrocystic change
Painful breast masses that are multiple / bilateral, hormonal response, fluctuates in cycle
Peak incidence in women 30-40 years old
Treat with less caffeine, tea, chocolate (controversial), avoiding trauma, using support bra
Not associated with increased cancer risk
Benign breast disease: Fibroadenoma
Benign tumor with glandular / stromal component
Usually solitary but can be bilateral; rubbery / nontender, can change during cycle
Peak incidence in women 20-35 years old
Classic fibroadenoma in a woman < 30 may be only solid breast mass not requiring tissue dx
Follow clinically if stable!
If concerned, get FNA for cytology to r/o cancer or phyllodes tumor, or excise if large/bothersome