Breast lump

Question 1

Breast lump:

Answer 1

Screening mammograms 50 - 74yo

• most benefit 60 - 69yo
• overdiagnosis and over investigation occurs in 40 - 49yo

Question 2

Breast lump:

What counts as hormonal breast changes?

Answer 2

• Clinically round/oval, firm/smooth/rubbery, mobile, tender lump
• most likely a fibroadenoma
• usually in 21 - 25yo age group

Question 3

Breast lump:

Determining breast cancer risk category?

Answer 3

Moderate Risk:
-FDR with breast cancer < 50yo = can choose screening mammogram from 40yo or start at 50yo

High Risk:

• elevated ovarian cancer risk
• relatives with bilateral breast cancer or breast cancer <40yo
• Ashkenazi jew

Question 4

Breast lump:

Breast cancer clinical symptoms?

Answer 4

lump
nipple discharge
Peau d Orange
rash
nipple retraction

Question 5

Breast lump:

Breast cancer evidence based preventative strategies?

Answer 5

• physical activity
• adequate folate
• mediterranean diet
• normal BMI when post menopausal
• lower alcohol consumption

Question 6

Breast lump:

Approach?

Answer 6

*≤35yo or pregnant = USS
>35yo = mammogram

1) If no lump or suspected fibroadenoma - review immediately after next period and mammogram if due
2) Regardless of clinically benign examination or inconclusive examination refer for mammogram and USS (+/- FNA/core biopsy)
3) Suspicious lump = immediate referral AND investigations

Question 7

Breast lump:

Nipple discharge approach?

Answer 7

<60yo AND bilateral discharge/expression = review in 3 months

> 60yo OR unilateral = imaging and referral