Breast examination

Question 1

Risk factors for breast cancer - ask about in the history

Answer 1

Previous breast cancer

FHx of breast or ovarian cancer and age affected

use of HRT

prev mantle radiotherapy for Hodgkin’s lymphoma

Question 2

Causes of Gynaecomastia

Answer 2

Drugs: Cannabis, methadone, oestrogen and other hormone-manipulating drugs used in tx prostate cancer, spironolactone, digoxin

Klinefelter’s - decreased androgen syndrome

increased oestrogen levels - chronic liver disease, thyrotoxicosis, some adrenal tumours

Question 3

When should USS be used in a breast examiniation

Answer 3

If a lump is found

Question 4

When should/shouldn’t mammography be used?

Answer 4

Shouldn’t be used in women under 40 unless strong suspicion of cancer

Question 5

When is MRI useful ?

Answer 5

the extent of cancer in Dense breast

suspected ruptured implant

screening those with BRCA1/BRCA2 gene mutations

Question 6

Indication for fine bore needle aspiration?

Answer 6

shouldn’t be used to diagnose primary cancer but useful for assessing axillary lymph nodes

Question 7

Why is a core biopsy used?

Answer 7

To differentiate invasive or insitu cancer

Question 8

When is a large-core vacuum-assisted core biopsy used

Answer 8

Useful for large areas of diffuse change

Question 9

When is open surgical biopsy used?

Answer 9

Used as last resort when multiple core biopsies have not provided a definite diagnosis