Breast diseases

Question 1

What are 5 important parts to cover in a breast history?

Answer 1

Lumps
Skin changes/distortion
Nipple discharge
Nipple inversion
Ulceration
Axillary lymphadenopathy

Question 2

Why is mammography not useful in women under the age of 40?

Answer 2

In younger women the breasts are so dense and glandular that it can be difficult to see anything on mammography. Over the age of 40 the breasts become more fatty, and darker on mammography therefore it is easier to see any abnormalities.

Question 3

What are the indications for mammography?

Answer 3

Breast screening programme between 47 and 73
Clinically suspicious lump in over 40 years
Residual lump after cyst aspiration
Single duct blood stained nipple discharge
Nipple skin change

Question 4

What are the 4 contraindications to mammography?

Answer 4

Breast pain without a lump
Symmetrical thickening
Before commencing HRT
Women under 40 unless previous diagnosis of breast cancer.

Question 5

What assessment should be done in women under the age of 24 with a breast lump?

Answer 5

USS
Biopsy may not always be needed

Question 6

What assessment should be done in women between 25 - 39 with a breast lump?

Answer 6

Breast USS plus histology or cytology.

Question 7

What assessment should be done in women over the age of 40 with a breast lump?

Answer 7

Mammography and USS and either histology or cytology.

Question 8

What screening is offered and when for BRCA gene carriers?

Answer 8

Annual MRI between the ages of 25 - 60

Question 9

What investigations would you do to look for implant rupture?

Answer 9

MRI will show silicone leakage

Question 10

What type of biopsy is most commonly performed for breast lumps?

Answer 10

Core biopsy

Question 11

What are the advantages of core biopsy over fine needle aspiration?

Answer 11

Core biopsy can give a histological diagnosis.
Accurate diagnosis of benign lesions
Differentiate between invasive cancer and DCIS
Tumour typing

Question 12

What is a triple assessment in breast disease?

Answer 12

Clinical assessment
Radiological assessment
Pathological assessment
The aim is to show concordance across the assessment.

Question 13

What is the median age of occurrence for breast cancer?

Answer 13

62

Question 14

What are the main risk factors for breast cancer?

Answer 14

FHx
Nulliparous women
Early age of menarche
HRT use for 5 years or more

Question 15

What ages are women invited for breast screening in the UK?

Answer 15

47 - 73 years every 3 years

Question 16

How much has the screening programme reduced the mortality from breast cancer?

Answer 16

16%-29%

Question 17

What is pre-invasive breast cancer?

Answer 17

An example of this is DCIS. This is where the cells lining the ducts have become cancerous but it has not spread beyond that. This is known as stage 0 cancer.

Question 18

What are the 2 common histological subtypes of breast cancer?

Answer 18

Ductal and lobular

Question 19

Which histological subtypes of breast cancer are typically high grade?

Answer 19

Medullary

Question 20

What are the cells like in grade 1 tumours?

Answer 20

Well differentiated and low mitotic rate

Question 21

What are the cells like in grade 3 tumours?

Answer 21

They look very abnormal and may have many more mutations in the genes.

Question 22

Which receptors expressed on tumour cells are a poor prognostic marker of disease?

Answer 22

HER-2 receptor

Question 23

What does it mean for treatment if a cancer is oestrogen receptor positive?

Answer 23

It will respond well to anti-oestrogen therapy, and the cancers themselves tend to be less biologically aggressive.

Question 24

What is a triple negative cancer subtype?

Answer 24

They do not express any of the hormone receptors, and is a very aggressive cancer subtype.

Question 25

What are the 2 types of surgery for breast cancer?

Answer 25

Mastectomy or lumpectomy

Question 26

What are the indications for mastectomy over lumpectomy?

Answer 26

Large tumour relative to breast size
Patient choice
Multi focal disease
BRCA gene

Question 27

When is axillary node clearance indicated?

Answer 27

The standard surgery when the disease has spread to the axillary nodes

Question 28

What is a sentinel node biopsy?

Answer 28

Looks at whether the first node in the drainage chain has been affected.

Question 29

When is radiotherapy used to treat breast cancer?

Answer 29

Given to the remaining breast after a wide local excision
Palliation for a large inoperable tumour
To treat the axilla
Reduce local recurrence rates

Question 30

Which hormonal therapy is given in premenopausal women?

Answer 30

Tamoxifen

Question 31

Which hormonal therapies are used in post menopausal women?

Answer 31

Aromatase inhibitors such as letrozole and anastrozole

Question 32

How long should patients be treated with hormonal therapy?

Answer 32

10 years

Question 33

When is trastuzumab used in breast cancer treatment?

Answer 33

In HER-2 expressing cancers.

Question 34

What is paget’s disease of the nipple?

Answer 34

An eczematous change on the nipple due to underlying malignancy

Question 35

Where is the most common site for metastases in breast cancer?

Answer 35

Bones, then lungs, then liver.

Question 36

What is the cause of cyclical breast pain?

Answer 36

Worse prior to and better after a period

Question 37

What is a fibroadenoma?

Answer 37

A common benign breast lump in women under 35
Most are less than 3cm and are mobile on examination.

Question 38

When are breast cysts most commonly seen?

Answer 38

Women aged 40-60 years

Question 39

What criteria ensure a breast cyst is benign?

Answer 39

The fluid is not blood stained
No residual lump
The same cyst does not continually refill

Question 40

What is the most common organism to cause breast infection?

Answer 40

S.aureus