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
