Breast Exam

Question 1

Incidence and mortality of breast cancer in women?

Answer 1

Highest incidence and second highest mortality for females

Question 2

Breast cancer risk by ethnicity?

Answer 2

White > African Americans > Latinas and American Indians > Asian Americans

Question 3

Recommendations for mammography screening?

Answer 3

■ Women 40-49: grade C (do not screen routinely)
■ Women 50-74: grade B (every 2 years)
■ Women > 75: grade I (insufficient)

Question 4

Is breast self exam recommended?

Answer 4

○ Breast self-exam for women >40 is grade D - adequate evidence that BSEs do not reduce mortality

Question 5

What can detect cysts?

Answer 5

○ Ultrasound detects cysts, mammograms do not

Question 6

When are biopsies required?

Answer 6

○ Biopsies are required for all lumps, EXCEPT:
■ Simple cyst
■ Young woman with fibroadenoma
■ Mass is clinically stable for over 2 years

Question 7

What is most common breast complaint?

Answer 7

Mastalgia = breast pain. There 2 two types:

1. Cyclical breast often associated with menstrual cycle
   - 20s - 30s non focal
2. Noncyclical breast pain not related to menstrual cycle.
   - 30s-40s localized

Question 8

What is Diffuse cystic mastopathy?

Answer 8

– lumpiness of breast tissue. Normal in many women
■ Fibrous tissue, lumpy cobblestone texture
■ May radiate to axilla, may be related to menstrual cycle
■ Also known as… fibrocystic disease, fibrocystic condition, and cystic mastitis (but no inflammation)

Question 9

What is Ectasia?

Answer 9

Ectasia – dilated or stretched
■ In breast – dilation of terminal ducts
■ Asymptomatic
■ Crushing or non-bloody nipple discharge

Question 10

What is Fibroadenoma?

Answer 10

– most frequent benign tumor of breast

Question 11

Characteristic of cancerous breast mass?

Answer 11

Fixed, irregular shape, hard, not clearly delineated, rectraction

Question 12

What are fibrocystic changes?

Answer 12

• Palpable as nodular, rope-like densities in women 25-50.

■ Can be tender/painful, but not risk factor cancer

Question 13

Characteristics of cysts?

Answer 13

Soft, well delineated, round, mobile, tender

Question 14

What are signs of retraction?

Answer 14

○ Dimpling
○ Changes in contour
○ Retraction or deviation of nipple, can feel thickened
○ Papilledema
○ Paget’s disease
■ Scaly, eczema-like lesion that may weep, crust, or erode
■ Suspect if any persisting dermatitis in the nipple and areola
■ Associated with invasive breast cancer or ductal carcinoma in situ

Question 15

Path of lymph drainage from breast?

Answer 15

■ Pectoral (anterior), subcapsular (posterior), and lateral → central nodes → infraclavicular and supraclavicular

Question 16

Which nodes most frequently palpable?

Answer 16

Central

Question 17

What is high bone density post menopause a risk factor for?

Answer 17

Breast cancer

Question 18

Modifiable risk factors for breast cancer?

Answer 18

● Postmenopausal obesity
● Use of HRT (hormone replacement therapy)
● Alcohol ingestion
● Physical inactivity
● Choices about breast-feeding: lack of
● Type of contraception

Question 19

Non modifiable risk factors for breast cancer?

Answer 19

● AGE – most important (65+, but risk increases across all ages until age 80)
● Family history
● Breast tissue density
● Proliferative lesions with atypia on breast biopsy
● Duration of unopposed estrogen exposure
○ Early menarche ( 50 or 55)
○ No children
● History of radiation – high risk

Question 20

Characteristics of pathologic discharge?

Answer 20

■ Unilateral
■ Comes from a single duct
■ Any non-milky color
■ Spontaneous

Question 21

Causes of pathologic discharge?

Answer 21

● Papillomas
● Duct ectasia
● Non-lactational infections
● Fibrocystic breast changes
● Ductal carcinoma in-situ/invasive carcinoma

Question 22

What is Nonpuerperal galactorrhea?

Answer 22

• Milky discharge unrelated to prior pregnancy / lactation

● Can be caused by hypothyroidism, pituitary prolactinoma, dopamine agonists

Question 23

What does spontaneous unilateral bloody discharge from one or two ducts indicate?

Answer 23

● Intraductal papilloma
● Ductal carcinoma in situ
● Paget’s disease

Question 24

1. A 45 year old female presents for routine yearly exams. Which of the following most increases her risk for breast cancer.
   a. menarche age 14
   b. three pregnancies, first at age 23
   c. distant cousin with pre-menopausal breast cancer
   d. high breast tissue density
   e. being of Asian-American descent

Answer 24

D

Question 25

2. A 65 year old female presents with scaly itchy skin in the nipple and areola of the right breast. This is most consistent
with:
a. invasive ductal carcinoma
b. inflammatory carcinoma
c. Paget's disease
d. local skin allergy or inflammation
e. fibrocystic disease of the breast

Answer 25

C

Question 26

3. A 22 year old female had delivered a healthy baby 2 weeks ago. She is breast feeding without difficulty. She develops a
   fever and has redness on the outer mid portion of her left breast.
   This is most consistent with:
   a. intraductal papilloma
   b. trauma, ecchymosis from the baby latching on the the mother’s breast
   c. fibrocystic disease of the breast
   d. staph aureus acute mastitis

Answer 26

D

Question 27

4. In the mastectomy patient, follow up exams:
   a. once the patient is a year post-operative, she no longer needs breast exams
   b. the exam should be firmer than usual to detect new lesions in thicker skin from surgery
   c. continued special attention to the scar and upper outer quadrant of the breast and axilla should be given
   d. the remaining breast should receive more attention than the operative side.

Answer 27

D

Question 28

5. A 45 yr old woman is found to have adenocarcinoma of the left breast. Resection of the tumor is scheduled, and the
   physician also plans to obtain samples of the draining nodes. To find these nodes, a radiotracer is injected adjacent to the
   tumor and images are obtained. The first draining sentinel node in this pt is most likely found at which of the following
   locations?
   a. Contralateral neck
   b. Ipsilateral axilla
   c. Ipsilateral mediastinum
   d. Ipsilateral supraclavicle
   e. Medial contralateral breast

Answer 28

B