Breast Health

Question 1

What women are at risk for breast cancer?

Answer 1

Most common in women ages 30 to 50 years and postmenopausal women on hormonal replacement therapy (HRT)

Question 2

What are diagnostic tests for breast cancer?

Answer 2

Mammogram followed by ultrasound

Breast biopsy essential for a definitive diagnosis

Question 3

What are common areas of breast cancer metastasis?

Answer 3

Common areas of metastasis are regional lymph nodes, lung, skin, bone, liver, and brain

Question 4

What should be assess in a women regarding breast?

Answer 4

Inspect contour, symmetry, skin and nipple changes
To be done during follicular phase of menstrual cycle
Inspect and palpate in upright and supine positions
Document size, location, mobility, and consistency of any palpable breast mass/dense area, nipple discharge, and lymph nodes
Pain is present in

Question 5

What is mastitis?

Answer 5

Inflammation of the breast

Question 6

What is Non-puerpural mastitis?

Answer 6

mastitis in patients that are not lactating; typically in patients that are immunocompromised, radiation therapy, or autoimmune disorder patients

Question 7

What are signs of Puerperal mastitis ?

Answer 7

cracked, abraded, damaged nipples; latch-on/positioning difficulty during feeding, skin disruption, and milk stasis; anything that can block or restrict the breast tissue and lactating ducts

Question 8

Diagnostics for mastitis are?

Answer 8

Milk cultures are warranted with a recurrence or failure of initial treatment
Ultrasound or mammogram
Biopsy because carcinoma and mastitis can coexist
Needle aspiration and culture of areas of inflammation

Question 9

What is the management of mastitis? (non-pharmacological)

Answer 9

Principle is to decrease contributing factors, improve breastfeeding management
Ensure infant continues breastfeeding to avoid milk stasis
Breast massage and pumping
Bed rest
Moist heat to affected breast
Stress management
If a mass is present it must be biopsied
If nipple discharge is suspicious, duct excision

Question 10

What is the management of mastitis? (pharmacological)

Answer 10

Broad-spectrum antibiotics: dicloxicillin or cloxacillin 500 mg PO q6h for 10 to 14 days
NSAIDs for pain and discomfort

Question 11

Antibiotic therapy treatment can lead to what potential complication if reoccurrence of mastitis occurs?

Answer 11

Risk of candida infection in nipple with antibiotic therapy

Question 12

How long does it take for a response treatment of mastitis symptoms with proper interventions in place?

Answer 12

If no response to treatment and care after 48 hours, further diagnostic evaluation is needed

Question 13

What are the ACS (american cancer society) guidelines for breast cancer screening?

Answer 13

women should start getting mammograms at age 45 years instead of 40 and that these screenings may not be needed as often
Women should undergo regular screening mammography starting at age 45 years.
Women aged 45 to 54 years should be screened annually.
Women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually.
Women should have the opportunity to begin annual screening between the ages of 40 and 44 years.
Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
Clinical breast examination for breast cancer screening among average-risk women at any age is not recommended.

Question 14

Invasive breast cancer is often preceded by?

Answer 14

Invasive breast cancer is often preceded by carcinoma in situ (CIS)

Question 15

What are the two types of carcinoma in situ (CIS) of the breast?

Answer 15

lesions of either ductal or lobular distribution

Question 16

Is Ductal carcinoma in situ (DCIS) malignant and how is it treated?

Answer 16

Malignant potential but infrequently disseminates
98% of patients cured with local-regional therapy (total mastectomy or breast-conserving surgery with radiation therapy)

Question 17

Is Lobular carcinoma in situ (LCIS) malignant and how is it treated?

Answer 17

Propensity for bilaterality, multicentricity, and a 25–40% risk of subsequent invasive cancer
Managed with close surveillance, a bilateral mastectomy, or chemoprevention (tamoxifen)

Question 18

What is considered a good prognosis of breast cancer?

Answer 18

DCIS, negative lymph nodes with an invasive tumor size of less than 1 cm in diameter
High-grade tumors: less differentiated = poor prognosis

Question 19

What are signs of breast cancer?

Answer 19

Palpable mass is usually persistent, unilateral, solitary, discrete, firm, irregularly shaped, nontender
Breast distortion and skin changes such as erythema, edema, peau d’orange, dimpling, nipple retraction, or nipple ulceration
Nipple discharge is spontaneous, persistent, unilateral, localized to a single duct, watery or sticky
Malignant lymph nodes are large, firm, or fixed

Question 20

What are differential diagnosis for breasts?

Answer 20

Benign breast masses 
Fibrocystic changes
Fibroadenomas
Hamartomas
Diabetic mastopathy
Intraductal papilloma
Duct ecstasia
Ductal hyperplasia
Sclerosing adenosis
Mastitis