Breast Disorders

Question 1

What are some common RFs for breast cancer?

Answer 1

• BRCA1 & BRCA2
• Age > 65y/o
• Hormonal: increased # of menstrual cycles= nulliparity, 1st full term pregnancy > 35 years, early onset menarche, late menopause, prolonged unopposed estrogen, never having breast fed
• Post-menopausal HRT
• Obesity
• ETOH

Question 2

What is the MC type of breast cancer?

Answer 2

Infiltrative ductal carcinoma (75%)

Question 3

What are some characteristics of a breast lump that is suspicious for breast cancer?

Answer 3

Painless, hard, and fixed

• Most common in upper, outer quadrant
• Unilateral nipple discharge that is bloody, purulent, or green is also possible

Question 4

What is the recommended initial modality for evaluating breast masses in women <40y/o?

Answer 4

Ultrasound

Question 5

What is the TNM of staging?

Answer 5

T= size 
N= # of Nodes involved
M= Metastasis

Question 6

Staging breast cancer

Answer 6

0: Precancerous, DCIS, or LCIS
I-III: Within breast/regional lymph nodes
IV: Metastatic

Question 7

What medication is useful in post-menopausal women who are ER-positive with breast cancer?

Answer 7

Aromatase inhibitor- Letrozole or Anastrozole

*Reduce the production of estrogen

Question 8

Patients with HER2 positivity are good candidates for what medication?

Answer 8

Herceptin/Trastuzumab

Question 9

SERMs are useful for breast cancer prevention- can be used in post-menopausal or women >35 y/o w/ high risk. What are two examples?

Answer 9

Tamoxifen and Raloxifene

-Tamoxifen is preferred but has an increased risk of DVT and endometrial cancer compared to Raloxifene

Question 10

What is the MC cause of mastitis?

Answer 10

Staph Aureus- MC in lactating women

Question 11

If there is bilateral breast pain and swelling it is likely not infectious but ______.

Answer 11

Congestive

Question 12

What are some anti-staph abx given for mastitis?

Answer 12

Cephalosporin (Cephalexin), Augmentin

-Fluconazole if fungal

Question 13

Fluid-filled breast cysts due to exaggerated response to hormones is associated with what diagnosis?

*Hint: It is the MC breast disorder (esp. in 30-50y/os)

Answer 13

Fibrocystic Breast Disorder

Question 14

What are some clinical manifestations of fibrocystic breast disorder?

Answer 14

Multiple, mobile, well demarcated lumps in the breast tissue

• Often TENDER, bilateral
• Cysts may INCREASE OR DECREASE IN SIZE W/ MENSTRUAL HORMONAL CHANGES

Question 15

How is fibrocystic breast disorder diagnosed?

Answer 15

• US
• FNA–> reveals straw-colored fluid (no blood)

*Most spontaneously resolve. Can do FNA is symptomatic

Question 16

________ is a diagnosis of glandular & fibrous tissue. It is the 2nd MC benign breast disorder. Associated with NON-TENDER, freely mobile rubbery lumps in the breast.

Answer 16

Fibroadenoma of breast

-Gradually grows over time and DOES NOT USUALLY WAX AND WANE WITH MENSTRUATION