Breast Pathology Overview Flashcards

E - refer to hospital immediately
- this is likely to be an abscess due to presence of trauma + systemic symptoms
- there is a hard lump with red skin that feels hot to touch
- it is common to have abscesses following trauma as there is an entry point for bacteria
- need to refer to hospital immediately as the abscess needs drainage

D - reassure her, encourage milk expression and arrange a follow-up the next day
- this is lactational mastitis
- a blocked duct has led to inflammation of the skin and pain
- encourage milk expression as this works to try and unblock the duct
- this is common in new mums who may have a bad breastfeeding technique due to lack of experience
- want to follow-up the next day to ensure it has not become worse, otherwise she would need to go to hospital
C - co-amoxiclav
- this is non-lactational mastitis
- an abscess is starting to form
- she doesn’t currently have one as she has no systemic symptoms
- the piercing is a new foreign body that the breast is reacting to to cause mastitis
- lack of hygiene increases risk
- this is treated with co-amoxiclav
What are the 4 most common differentials in a younger woman presenting with a breast lump?
- benign cystic change
- fibroadenoma
- cyst
- carcinoma
When taking a breast lump history, what 7 areas need to be covered in order to narrow the differentials?
- age of patient
- time
- trauma
- pain (if present and location)
- risk factors
- FLAWS
- changes to the breast in any way (nipple, skin, etc.)
Why is it important to estabilish age to narrow breast lump differentials?
- as age increases, the concern about carcinoma increases
- younger people are more likely to have benign changes as their breasts are still developing

What are the more common causes of breast lumps in <30 and 30-45 year olds?
Patients < 30:
- benign cystic change
- abscess
- normal lumpy breast
- mastitis
- galactocoele
Patients 30-45:
- benign cystic change
- abscess
- cyst
- carcinoma

What are the more likely causes of a breast lump in 45-60 year olds and those >60?
Patients 45-60:
- abscess
- cyst
- carcinoma
- duct ectasia
Patients > 60:
- carcinoma

How can time be used to narrow the differentials of a breast lump?
Which questions can be asked to help with this?
-
abscesses and cysts appear rapidly
- i.e. they can appear overnight
- fibroadenomas and carcinomas take time to form
- benign cystic changes will fluctuate with periods
Questions to ask:
- When did you notice the lump?
- How long has the lump been there for?
- Does the lump change with your periods?
What 2 conditions that cause breast lumps are associated with trauma?
-
fat necrosis tends to only happen with seatbelt trauma
- sore breast following minor car accident/trauma is likely to be fat necrosis
-
diagnostic trauma can lead to abscess formation
- e.g. after biopsy / needle aspiration
- needle punctures the breast, creating an entry point for bacteria

How can seatbelt trauma lead to fat necrosis?
- if you crash into something whilst driving, you will lean forwards into the seatbelt
- this puts a lot of pressure on the breast
- if fat cells become damaged then necrosis can occur
- a sore breast following a minor car accident is likely to be fat necrosis
How can pain be used to narrow the differentials for a breast lump?
- carcinomas do not typically present with pain
- painful lumps include:
- benign cystic change
- acute mastitis
- abscess
- +/- cysts
What type of breast changes are shown here?

- peu d’orange
- inverted nipple
- bloody discharge
- scaling of the nipple
- milky discharge
- breast erythema
- palpable breast lump
What skin signs are more likely to point towards cancer and which are more likely to be due to inflammation?
Cancer:
- peau d’orange
- dimpling of skin
- ulceration
Inflammation / Infection:
- erythematous skin
- warm to touch
What nipple changes are more likely to be cancer?
Cancer:
- inversion of the nipple
- scaling of the nipple
- bloody discharge
- itching / irregular appearance
Benign:
- serous discharge
- milky discharge
- green-brown discharge
What characteristics of the texture of a breast lump raise suspicion of malignancy?
What is considered to be more benign?
Cancer:
- a solitary, hard lump
- it is irregular and immobile
- it has indistinct borders
- can you feel all the way around the outside?
- or does it feel more irregular and like it is stuck to a muscle or the skin?
Benign:
- multiple breast lumps
- rubbery/lax
- smooth
- mobile
- distinct borders
What are other concerning signs associated with a breast lump that point towards carcinoma?
-
new lymphadenopathy
- ask about new lumps appearing in the axilla or by the clavicles
- fixation / tethering to the skin or underlying muscle
What features of FLAWS are present in breast pathology other than carcinoma?
- acute mastitis and abscess may present with fever and lethargy
- there will not be any weight loss or appetite changes

In general, what are “good” and “bad” risk factors for breast carcinoma?
- “bad” risk factors are anything that increases oestrogen exposure
- “good” risk factors are anything that decreases oestrogen in the body
What are examples of risk factors for breast carcinoma?
- risk factors include anything that increases oestrogen exposure
- e.g. taking any form of oral contraceptive pill
- family history of first degree relative with cancer
- increasing age
-
obesity
- fat cells can convert some hormones into oestrogen
- obesity naturally increases the amount of oestrogen in the body
- being biologically female
- caucasian
- ionising radiation
- smoking
What are positive risk factors for breast carcinoma that indicate reduced risk?
-
decreased oestrogen exposure
- being pregnant
- having young children
- starting period at a later age
- having no family history of cancer
- young age
- decreased ionising exposure
- non-smoking
Why is it important to ask someone about when they started and stopped (if relevant) their periods?
- the longer period of time that someone has periods for, the more oestrogen cycles occur over their life time
- this increases oestrogen exposure
- starting periods at a later age is associated with decreased oestrogen exposure
When examining a breast lump, what mnemonic can be used to remember all the aspects that need to be commented on?
Straps Need Tightening
- Size
- Shape
- Skin
- Nodes
- Nipple
- meNstruation
- Tethering
- Tenderness
- Temperature
- Trauma
- Texture
- Time

What are the alveoli of the breast?
Where are they found?
- the alveoli are contained within lobules
- they are surrounded by fat
- they produce the milk, which travels through the lactiferous ducts
- the lactiferous ducts form lactiferous sinuses, which lead to the nipple
























