Breast Disorders Flashcards
3 components of breast anatomy
Skin
Subcut. tissue
Breast tissue
What are the 2 components of breast tissue
Epithelial
Stromal
When performing the breast exam what body parts are examined
breast
neck
chest wall
axillae
What days are ideal to perform a breast exam
Ideally performed 7-9 days after onset of menses
What are the 2 components of performing breast exams
inspection
palpation
What are different positions to have women in during breast exam?
What are you examining
Upright
Hands above head
Hands on side
Leaning forward
Skin retractions
What are abnormalities during a breast exam
Asymmetry Skin changes Nipple asymmetry Nipple inversion or retraction Nipple discharge or crusting
What are the 2 positions to have women in on an exam table while doing breast exams
Sitting upright
Supine
What lymph nodes do you palpate on breast exam
axillary
supraclavicular
infraclavicular
cervical (anterior and posterior)
What screening is recommended for breast exams
mammogram
What is BI-RADS grading system criteria
0: incomplete (not a good enough review)
1: Negative (routine f/u)
2: Benign (routine f/u)
3: Probably benign (short-interval f/u)
4: Suspicious
4A: Low suspicion for malignancy
4B: Moderate suspicion for malignancy
4C: High suspicion for malignancy
5: Highly suggestive of malignancy
6: Known biopsy-proven malignancy
Who are ultrasounds reserved for during breast screenings?
Initial study young, low-risk woman with suspected fibroadenoma
Who are MRI with IV gadolinium dye reserved for during breast screenings?
What is a concern about using these
High risk women
***but high false positive rate
What population are fibroadenomas most seen in?
Which race is this most frequent in
Young women
More frequent in black women
Usually a solitary mass
How are fibroadenomas diagnosed
Core needle biopsy
Treatment for Fribroadenomas?
Excision
Conservative treatment with monitoring
What are Phyllodes tumor and where do they originate from?
Large fibroadenoma that grows rapidly
What is the ideal treatment for Phyllodes tumor?
Excision
What is the MC breast lesion
Fibrocystic conditions
What age group do fibrocystic conditions occur in?
Age 30-50
Clinical presentation of Fibroadenomas
Round or ovoid, 1-5 cm Rubbery Discrete Movable Non-tender
What hormone can cause fibrocystic conditions?
What can cause an increased risk of Fibrocystic conditions?
Estrogen dependent
Alcohol use
Clinical presentations of Fibrocystic changes?
PAINFUL Tender Multiple cysts Bilateral Rapid changes in size Nodular "rope" breast tissue Mobile
Diagnosis of Fibrocystic changes?
Mammogram and/or ultrasound
FNA
Treatment for Fibrocystic changes
Breast support
Will subside with menopause
Evening primrose oil?
Low fat diet?
Avoid caffeine?
Vitamin E?
MC female cancer in U.S?
Breast cancer
Which genes are associated with breast cancers?
BRCA1/BRCA2 genes
What are HIGH risk factors for Breast cancer
Personal/Family history of ovarian, peritoneal or breast cancer
BRCA 1/2 genes
Radiotherapy to chest between ages 10-30
Protective factors for breast cancer
Breastfeeding Higher parity Physical activity Oophorectomy ≤ 35 y/o Aspirin use
What screenings are recommended to det. risk of breast cancer in Average risk women?
Gail model calculator
General screening guidelines for high risk patients
Annual screening mammogram, starting at age 25 (or 5-10 years before age of diagnosis in affected relative)
Supplemental screening breast MRI
Scheduled 6 months apart
What percent likely does postivie BRCA1 indicate for breast cancers
65% risk of breast cancer by age 70
A positive BRCA2 indicates what percent likely of breast cancer
45% of breast cancer by age 70
USPSTF recommendations for breast cancer screenings
Age 40-49, individualize (grade C)
Every 2 years, age 50-74 (grade B)
ACOG recommendations for breast cancer
Age 40-49, shared decision making
Recommend at age 50-74
Every 1-2 years
≥ age 75, shared decision making
Which type of carcinomas are the MC type of breast cancer?
Infiltrating ductal carcinomas
MC subtype of breast carcinomas
Luminal A/Luminal B
***Estrogen-positive cancers
What are Ductual carcinoas in situ?
Neoplastic lesions confined to breast ducts and lobules
What are skin changes associated with breast cancers
Erythema
Thickening
Dimpling (pea d’orange)
What are signs and symptoms of a metastasized breast cancer
Back/leg pain Abdominal pain nausea jaundice SOB cough
How do breast cancers first present?
majority presents due to abnormal mamograms
What imaging is preferred to diagnose breast cancer?
What findings suggest BC?
Mammogram – soft tissue mass/density and clustered microcalcifications
***Spiculated soft tissue mass
What treatment is preferred for breast cancers
Lumpectomy + radiation therapy (“breast conservation therapy”)
What medications can you use for Estrogen postive breast cancers
Tamoxifen or Raloxifene
What is a side effect of taking Trastuzumab for HER-2 cancers?
heart failure, respiratory problems, life-threatening allergic reactions
Follow up recommendations for Breast cancer treatments
Every 3-6 months x 2 years, then annually
Annual mammogram and CBE indefinitely
What is the classic characterisitic of Inflammatory Breast cancer?
Diffuse erythema and edema (peau d’orange)
Clinical presentation for IBC?
Rapid presentation
breast pain
How are IBC diagnosed
Full-thickness skin punch biopsy
Dermal lymphatic invasion by tumor cells
Treatment for IBC
Chemotherapy followed by mastectomy with axillary node dissection and post-mastectomy radiation
How can Pagets Disease of the breast be characterized as?
scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola
Clinical presentation of Pagets disease of breast
Unilateral
Bloody disharge
Pain, burning, and pruritis***
Diagnosis of PDB?
Full thickness wedge or punch biopsy of the nipple
Bilateral mammogram
Treatment of PDB
Mastectomy or BCT followed by radiation
Causes of Nipple disharge
Usually benign Early endocrine dysfunction – hyperprolactinemia, hypothyroidism Medications – OCPs, tricyclics, antipsychotics Cancer – 5-15%
What would indicate nipple discharge from fibrocystic changes
Non-bloody
Bilateral
Green, yellow, or brown; sticky
What would indicate Milky, bilateral nipple discharge
Endocrine/Meds
What would indicate purulent nipple discharge
Infections
Bloody nipple discharge would indicate what?
breast cancer
labs needed to diagnose nipple disharge
HCG
Prolactin
Renal tests
Thyroid function tests
Treatment for nipple discharge
If medication related, reassurance
Terminal ductal excision
If malignancy, appropriate cancer surgery
What is the causative organism of mastitis
What is the main cause of Mastitis?
S. aureus
Can be hospital acquired infection
Disrupted flow of milk causing engorgement
Infection of the infant
Treatment for Mastitis?
Continue breastfeeding or use breast pump
Local heat
What antibiotics can be used to treat Mastitis?
Dicloxacillin 500 mg po QID
Cephalexin 500 mg po QID
BOTH CAN BE 1st Line
Alternatively, clindamycin 300 mg po TID
MC pathogen that causes abscess of the breast?
How else can it be caused?
S. aureus
Secondary to untreated or refractory to treatment mastitis or cellulitis
Diagnosis for beast abcess?
Clinical findings and ultrasound
Breast milk cultures
+/- blood cultures
Treatment for Breast abscess?
Drainage and antibiotics
Ultrasound guided needle aspiration or surgical drainage (I&D)
What are pathological reasons for Gynecomastia
Drugs (estrogens)
Hypogonadism
tumors
Treatment for Gynecomastia?
Regresses spontaneously in > 70% of patients after 1 year
Rare regression if
persists over 1 year or after age 17
Psychotherapy as needed
Consider surgery
