Breast Lump

Question 1

In a women under the age of 30, what is/are the investigation(s) of choice for a palpable breast lump?

Answer 1

Diagnostic Ultrasound +- U/S-guided biopsy

Question 2

In a women over the age of 30, what is/are the investigation(s) of choice for a palpable breast lump?

Answer 2

Ultrasound and mammography with imaging guided biopsy.

Question 3

Generally speaking, which BIRADS categories are considered benign and which require further monitoring or investigation?

Answer 3

BIRADS 1-3 —> likely benign
BIRADS 4-6 —> likely or confirmed malignancy

Question 4

Which risk factors identify a woman as being at higher risk of breast cancer that requires earlier screening programs?

Answer 4

Family history of breast cancer before the age of 50 or ovarian cancer at anytime, known personal or familial genetic syndrome such as BRCA1, BRCA2, previous history of chest radiation therapy before the age of 30.

Question 5

At what age should breast cancer screening begin for a woman at average risk of breast cancer?

Answer 5

50 years of age until age 74.

Question 6

What is the screening interval for women at average risk of breast cancer?

Answer 6

2 years (2-3 years dependent on province)

Question 7

What is the role of breast self-exam is breast cancer screening?

Answer 7

There isn’t any, has not shown to provide mortality nor morbidity benefits, and increases the likelihood of invasive testing showing benign lesions.

Question 8

In what context is a breast self-exam recommended?

Answer 8

Women who have previously had breast cancer and have not had double mastectomy, breast self-exam in this case is important and is part of surveillance rather than screening.

Question 9

What questions are important to ask on history regarding a breast lump.

Answer 9

1- Course/progression over time?
2- Fluctuations with menstrual cycle?
3- Associated pain?
4- Overlying skin changes (erythema, discolouration, pear d’orange) or nipple inversion
5- Nipple discharge
6- Recent Breast trauma

Question 10

What are non-modifiable risk factors for breast cancer?

Answer 10

Sex -> Female
Age >40
Family history of breast or ovarian cancer
Family history of BRCA1 or BRCA2 in a patient who has not had genetic testing.
Prolonged endogenous estrogen
Therapeutic chest radiation exposure prior to age 30

Question 11

What conditions cause prolonged endogenous estrogen exposure?

Answer 11

1- Early menarche prior to age 12
2- Late menopaus greater than age 55
3- Nulliparity
4- Hormone therapy greater than 5 years

Question 12

What are the modifiable risk factors associated with breast cancer?

Answer 12

Ethanol intake
Smoking
Obesity in post-menopausal women** (may be modifiable or not)

Question 13

In what age groups are screening mammograms warranted?

Answer 13

Age 50-74

Question 14

Are screening mammograms indicated in women between the ages of 40 and 49?

Answer 14

No.

Question 15

What lifestyle interventions can a person undertake to reduce their risk of breast cancer?

Answer 15

1- Reduce Alcohol intake
2- Quit smoking
3- increase physical activity
4- optimize weight loss.

Question 16

What are some worrying features for a breast lump on palpation?

Answer 16

Hard
Matted
Irregular
Non-mobile

Question 17

What features are most suggestive of a fibroadenoma and in which population is it likely to occur?

Answer 17

A firm, rubbery, well-circumscribed and mobile mass in a woman <30 years old.

Question 18

True or False- Axillary lymphadenopathy or edema of the arm is likely consistent with a benign breast lesion?

Answer 18

False- any axillary lymphadenopathy or edema of the arm is ALWAYS concerning for malignancy and requires investigation.