Breast disorders Flashcards
What are the 2 types of breast tissue?
- epithelial elements
- stromal elements
When is the best time to perform a breast exam?
7-9 days after onset of menses
What kind of abnormalities are you looking for on the visual breast exam?
- asymmetry
- skin changes
- nipple asymmetry
- nipple inversion or retraction
- nipple discharge or crusting
What is the initial study performed for a new palpable breast mass?
Mammogram
What is the Mammogram looking at?
- shape
- margin
- orientation
- echogenicity
- homogeneity
- attenuation
In the 0-6 scale, what is a suspicious mass (f/u= coordination w/ surgeon)?
4= Suspicious
5= highly suggestive of malignancy
6= known biopsy-proven malignancy
if a pt has a BI-RADS score of 3, when do they f/u?
probably benign- short f/u in 6 mo
What is the initial test done for young, low-risk women w/ suspected fibroadenoma?
US
Describe the classic pt w/ a fibroadenoma and how does it present?
-young -more frequent in black women -usually solitary mass -round 1-5 cm -rubbery -discrete -movable -non-tender
How do you dx and tx a fibroadenoma?
Dx= core needle biopsy Tx= -excision -conservative tx w/ monitoring
What is a Phyllodes tumor and how is it treated?
Large fibroadenoma that grows rapidly -benign, borderline, or malignancy -Excision required!
MC breast lesion
fibrocystic changes
What age group, what hormone a/w, and what risk factor a/w Fibrocystic changes?
-age 30-50 -estrogen dependent -increased risk w/ alcohol use
Clinical presentation of fibrocystic changes
-painful -multiple -usu. b/l -rapid change in size and appearance -nodular breast tissue -mobile -tender
Dx for fibrocystic changes?
-mammogram and/or US -fine needle aspiration (for single cyst) -core needle biopsy if “cord-like”, nodular
Tx options for fibrocystic changes
-breast support -evening primrose oil? -low fat diet? -avoid caffeine? -vitamin E? (will subside w/ menopause)
Top 3 risk factors for breast CA?
- BRCA1/BRCA2 genes
- personal and/or fam hx ovarian, peritoneal, or breast CA
- radiotherapy to chest b/t age 10-30
Other RFs for breast CA?
-age -white race -postmenopausal obesity -tall stature -high estrogen -dense breast tissue -higher bone density -DES exposure in utero HRT/contracetives -early menarche or late menopause -nulliparity -first pregnancy > age 35 -alcohol -smoking
What are protective factors against breast CA? (5)
-breastfeeding -higher parity -physical activity -oophorectomy < 35 yo -aspirin use
What is the name of the risk calculator used for breast CA in average risk women?
Gail model
What are the USPSTF guidelines for mammogram screening?
- age 40-49, individualize
- every 2 yrs, age 50-74
What are the ACOG guidelines for mammogram screening?
-age 40-49, shared decision making -recommend age 50-74 -every 1-2 yrs - >75, shared decision making
What are the general guidelines for mammograms in high risk women?
- annual screening starting at age 25 (or 5-10 yrs before dx of affected relative)
- supplemental screening breast MRI
- scheduled 6 months apart
What are some things that would make you think that a pt would be good for genetic testing?
-any relative w/ BRCA 1 or 2 -breast CA before age 50 -b/l breast CA -breast and ovarian CA in same woman or family -multiple breast CAs in fam -male breast CA -Ashkenazi Jewish ethnicity
