Breast disorders Flashcards
Breast tissue: epithelial
- Lobules
2. Ducts
Breast tissue: stromal
- Fat
2. Connective tissue
What is polythelia?
congenital suprenumerarary nipples (occur along milk lines)
When is the breast exam (including neck, chest wall, breasts and axillae) ideally performed?
7-9 days after the onset of menses
What is the initial study for new palpable breast mass?
diagnostic mammogram
What are the levels of findings for mammograms (0-6)?
0: incomplete
1: Negative
2: Benign
3: Probably benign (short interval follow up)
4: Suspicious
4A; low suspicion for malignancy
4B: moderate suspcion for malignancy
4C: High suspicion for malignancy
5**:Highly suggestive of malignancy
6: Known biopsy-proven malignancy
What is the initial test for young. low risk women who have a breast lump?
Ultrasound
What is a downside with MRI imaging of the breast?
high false positive rate (finds things that may not be cancer)
In what type of patient might a MRI with contrast be useful to image the breast?
high risk women
What is a benefit of core needle biopsy versus fine needle aspiration
Core biopsy can perform hormone receptor analysis from tissue
What type of patient is most likely to get fibroadenoma?
young women, more often black
What are the defining features of fibroadenoma of the breast?
- smooth
- nontender**
- mobile
- grows gradually over time
- DOES NOT wax and wane with menstruation**
What are the defining features of fibrocystic changes of the breast?
- tender**
- bilateral
- multiple, mobile, well demarcated
- change in size with menstrual hormonal changes** (estrogen dependent)
What is the name of the large fibroadenoma that grows very rapidly, and needs to be excised?
Phyllodes Tumor
What is the most common type of benign breast lesion?
Fibrocystic change
If you suspect fibrocystic change of the breast, what study would you use to diagnose this?
ultrasound, fine needle aspiration
Fibrocystic changes: Treatment
- Bra (breast support)
- Evening primrose oil
- Low fat diet
- Will subside with menopause
Breast cancer: epidemiology
- MC female reproductive cancer
- 2nd most common cause of cancer death in women (1st is lung cancer)
Breast cancer: Risk factors
- Age >65
- Caucasion
- Tall
- Obesity
- High estrogen levels*
- Dense breast tissue
- Higher bone density
- DES exposure in utero
- BRCA1/BRCA2
- Early menarche (<12) or late menopause
- Nullparity
- First pregnancy >35
- Personal or family history of ovarian, peritoneal or breast cancer
- Alcohol
- Smoking
- Radiotherapy to chest between ages 10-30
What are the USPSTF guidelines for breast cancer screening?
If 50-74: mammogram every 2 years
If 40-49: individualize
In high risk women, what is the screening recommendation for breast cancer?
25 and older: mammogram every year (or 5-10 years before age of dx in relative)
-refer to high risk center
American college of obsetrics and gynecology breast cancer screening recommendation
40-74: mammogram every year
75+: individualize
risk of breast cancer with BRCA1?
65% by age 70
Risk of breast cancer with BRCA2?
45% by age 70
What type of cancers is BRCA associated with?
Ovarian
Breast
Who needs to have genetic testing for BRCA?
- any relative with BRCA1 or 2 mutation
- 2 relatives with breast cancer before 50. One is 1st degree relative
- 3 relatives with breast cancer before 50
- 1 relative with ovarian cancer
- Multiple relatives with melanoma
What is the most common type of breast cancer?
Infiltrating ductal carcinoma
associated with lymphatic METS especially axillary
Breast cancer clinical manifestations
- painless, hard, non-mobile lump
- MC in upper outer quadrant
- Unilateral blood discharge**
Paget’s disease (breast)
- May first present as pain, burning and itching (before rash appears)
- chronic eczematous itchy, scaling rash on the nipple and areola**
Inflammatory breast cancer: PE
- red, swollen, warm, itchy breast
- Rapid growth
- nipple retraction, peau d’orange**
- 1/3 have distant METs
- poor prognosis
–>must do chemo + mastectomy w/ axillary node dissection + radiation
What are the key findings you would expect on mammogram of breast cancer?
microcalcifications and spiculated masses**
If a women is younger than 40 what is the initial imaging modality?
ultrasound (due to high density of the breast)
If a breast cancer patient would like to conserve breast tissue, what is a good option?
lumpectomy followed by radiation therapy
What treatment should you initiate if the patient has ER positive tumor?
Tamoxifen (anti-estrogen)
What treatment should you initiate if the patient has breast cancer and is postmenopausal?
Letrozole, Anastrozole (aromatase inhibitors)
-Prevent estrogen production
How long is Tamoxifen used to lower risk in high risk patients (either post menopausal or over 35yrs)?
5 years (preventative course)
What drug can be used for HER-2 cancers?
Trastuzumab
severe ADE: heart failure, respiratory problems
After a patient’s breast cancer is treated, how do you follow up?
- Visit every 3-6 months for 2 years. Then, annually
- Annual mamogram and CBE indefinitely
Most recurrences are within 5 years
What can a full-thickness skin punch biopsy for Inflammatory Breast Cancer show you?
dermal lymphatic invasion
If you think a patient has Paget Disease of the Breast, how would you diagnose this?
- Full thickness wedge or punch biopsy of nipple
2. Bilateral mammogram
BI-RADS score of 1,2
normal or benign: routine follow-up
BI-RADS score of 3
Probably benign: 6 month follow up mammogram
BI-RADS score of 4 or 5
Needs to see surgeon (these need biopsy!**)
Worrisome nipple discharge
- spontaneous
- bloody
- unilateral, uniductal
When are you most likely to see mastitis?
1st pregancy nursing (primiparous)
Mastitis: Tx
Continue breast feeding/pumping
Dicloxacillin
Cephalexin
Cephalosporin
(if fungal, Fluconazole)
Breast abcess: Tx
Incision and drainage
Stop breast feeding
Risk factors for breast abscess
- > 30
- First pregnancy
- Gestational age >41 weeks
- Tobacco use
Where is the most likely location for gynecomastia?
symmetrical, around areolar-nipple complex
-Tender for about 6 mo then gradually resolves
