Breast Lumps and Physiological Changes Flashcards
Are breast lumps a common presenting complaint?
Yes
What is true of most breast lumps?
They are benign
Why are breast lumps important psychologically?
They cause anxiety amongst patients due to risk of malignancy
When does NICE recommend referral for breast lumps?
Consideration for referral for all unexplained breast lumps
What does the urgency of referral depend on with breast lumps?
Age and other features
How quickly do most breast clinics aim to see women referred with breast symptoms?
Within 2 weeks, whether referred under breast cancer pathway or not
What are the features of a benign mass, broadly speaking?
- 3D
- Mobile and smooth
- Regular borders
- Solid or cystic in consistency
What are the features of a malignant mass, broadly speaking?
- Firm in consistency
- Irregular borders
- May be fixed to underlying skin or soft tissue
- May be skin changes or nipple retraction
Is it possible to make an accurate diagnosis on the basis of examination alone?
Not always
What is the result of it not always being possible to make an accurate diagnosis based on breast examination alone?
All unexplained lumps should be referred for assessment
What can benign breast disease be divided in to histologically?
3 groups
What is the purpose of the histological classification of benign breast disease?
Provides an idea regarding potential future cancer risk
What histological classifications can benign breast disease be divided into?
- Non-proliferative disorders
- Proliferative disorders without atypixa
- Atypical hyperplasia
How is non-proliferative breast disease linked with cancer?
It conveys no increased risk of cancer
How are proliferative disorders without atypica related to breast cancer?
Mild to moderate increased risk
How is atypical hyperplasia related to cancer?
There is a substantial increase in risk
When do physiological changes in breast occur?
- Puberty
- During pregnancy
- During menstural cycle
- Menopause
What is the first obvious sign of puberty in girls?
Breast enlargement
How might breast buds initially appear?
Unilateral
What is pubertal breast development known as?
Thelarche
What is isolated premature thelarche?
Where breasts develop occur in girls <3 years
What can happen to the breasts in isolated premature thelarche?
They can spontaneously regress
What causes isolated premature thelarche?
Maternal oestrogen in the early months
What happens to breast development following isolated premature thelarche?
There is fairly static breast development before true puberty eventually occurs at the normal time
Is isolated premature thelarche a benign or malignant condition?
Benign
What factors confirm a diagnosis of isolated premature thelarche?
- 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
How is isolated premature thelarche managed?
Unless there are features of precocious puberty, e.g. premature pubic hair, then reassurance is the only management required
How common is breast development in boys during puberty?
Very common, occuring in nearly half
What happens over time when boys develop breasts during puberty?
It usually disappears on it’s own over a year or two
What is a very common occurence in the premenstural phase?
Some degree of tenderness and nodularity
What proportion of mensturating women experience cyclical mastalgia?
2/3
What happens to cyclical mastalgia as menstruation starts?
It rapidly resolves
What conditions should be excluded when a patient presents with suspected cyclical mastalgia?
- Infection
- Pregnancy
- Malignancy
What normal changes happen to the breast during pregnancy and breast-feeding?
- Tenderness, discomfort, and pain
- Increase in size
- Areolar and nipple changes
- Leaking of colostrum or milk
What areolar and nipple changes may occur in pregnancy?
- Darkening of colour
- Enlargement of nipples
- Enlargement of Montgomery glands on the areola
What are the signs of pathology during pregnancy and breastfeeding?
- Sore and cracked nipples
- Thrush
- Engorgement
