Breast Lumps and Physiological Changes

Question 1

Are breast lumps a common presenting complaint?

Answer 1

Yes

Question 2

What is true of most breast lumps?

Answer 2

They are benign

Question 3

Why are breast lumps important psychologically?

Answer 3

They cause anxiety amongst patients due to risk of malignancy

Question 4

When does NICE recommend referral for breast lumps?

Answer 4

Consideration for referral for all unexplained breast lumps

Question 5

What does the urgency of referral depend on with breast lumps?

Answer 5

Age and other features

Question 6

How quickly do most breast clinics aim to see women referred with breast symptoms?

Answer 6

Within 2 weeks, whether referred under breast cancer pathway or not

Question 7

What are the features of a benign mass, broadly speaking?

Answer 7

• 3D
• Mobile and smooth
• Regular borders
• Solid or cystic in consistency

Question 8

What are the features of a malignant mass, broadly speaking?

Answer 8

• Firm in consistency
• Irregular borders
• May be fixed to underlying skin or soft tissue
• May be skin changes or nipple retraction

Question 9

Is it possible to make an accurate diagnosis on the basis of examination alone?

Answer 9

Not always

Question 10

What is the result of it not always being possible to make an accurate diagnosis based on breast examination alone?

Answer 10

All unexplained lumps should be referred for assessment

Question 11

What can benign breast disease be divided in to histologically?

Answer 11

3 groups

Question 12

What is the purpose of the histological classification of benign breast disease?

Answer 12

Provides an idea regarding potential future cancer risk

Question 13

What histological classifications can benign breast disease be divided into?

Answer 13

• Non-proliferative disorders
• Proliferative disorders without atypixa
• Atypical hyperplasia

Question 14

How is non-proliferative breast disease linked with cancer?

Answer 14

It conveys no increased risk of cancer

Question 15

How are proliferative disorders without atypica related to breast cancer?

Answer 15

Mild to moderate increased risk

Question 16

How is atypical hyperplasia related to cancer?

Answer 16

There is a substantial increase in risk

Question 17

When do physiological changes in breast occur?

Answer 17

• Puberty
• During pregnancy
• During menstural cycle
• Menopause

Question 18

What is the first obvious sign of puberty in girls?

Answer 18

Breast enlargement

Question 19

How might breast buds initially appear?

Answer 19

Unilateral

Question 20

What is pubertal breast development known as?

Answer 20

Thelarche

Question 21

What is isolated premature thelarche?

Answer 21

Where breasts develop occur in girls <3 years

Question 22

What can happen to the breasts in isolated premature thelarche?

Answer 22

They can spontaneously regress

Question 23

What causes isolated premature thelarche?

Answer 23

Maternal oestrogen in the early months

Question 24

What happens to breast development following isolated premature thelarche?

Answer 24

There is fairly static breast development before true puberty eventually occurs at the normal time

Question 25

Is isolated premature thelarche a benign or malignant condition?

Answer 25

Benign

Question 26

What factors confirm a diagnosis of isolated premature thelarche?

Answer 26

* Absence of other signs of puberty * Normal growth with appropriate bone age * Minimal increase in breast tissue over time * Appropriate uterine dimensions for age, with normal endometrial echo and no vaginal bleeding

Question 27

How is isolated premature thelarche managed?

Answer 27

Unless there are features of precocious puberty, e.g. premature pubic hair, then reassurance is the only management required

Question 28

How common is breast development in boys during puberty?

Answer 28

Very common, occuring in nearly half

Question 29

What happens over time when boys develop breasts during puberty?

Answer 29

It usually disappears on it's own over a year or two

Question 30

What is a very common occurence in the premenstural phase?

Answer 30

Some degree of tenderness and nodularity

Question 31

What proportion of mensturating women experience cyclical mastalgia?

Answer 31

2/3

Question 32

What happens to cyclical mastalgia as menstruation starts?

Answer 32

It rapidly resolves

Question 33

What conditions should be excluded when a patient presents with suspected cyclical mastalgia?

Answer 33

* Infection * Pregnancy * Malignancy

Question 34

What normal changes happen to the breast during pregnancy and breast-feeding?

Answer 34

* Tenderness, discomfort, and pain * Increase in size * Areolar and nipple changes * Leaking of colostrum or milk

Question 35

What areolar and nipple changes may occur in pregnancy?

Answer 35

* Darkening of colour * Enlargement of nipples * Enlargement of Montgomery glands on the areola

Question 36

What are the signs of pathology during pregnancy and breastfeeding?

Answer 36

* Sore and cracked nipples * Thrush * Engorgement