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Phase 3a Gynaecology > Breast screening and anatomy > Flashcards

Breast screening and anatomy Flashcards

1
Q

Which is the most common female cancer in the UK?

A

Breast cancer

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2
Q

Which cancers in females are the biggest cause of death?

A
  1. lung cancer

2. breast cancer

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3
Q

What is improved survival of breast cancer due to?

A

New chemotherapy agents
Tamoxifen (for treatment of ER+ cancer)
NHS Breast screening programme

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4
Q

What is the lifetime risk of diagnosis of breast cancer?

A

1 in 9

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5
Q

Is breast cancer commoner in older pts or younger pts?

A

Risk of getting breast cancer increases with age so more common in older pts

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6
Q

What are the risk factors for breast cancer development?

A
  • BRCA 1 and 2 gene carriers
  • HRT
  • moderate-high alcohol consumption
  • nulliparous
  • not breast feeding
  • radiotherapy treatment <35yrs old esp to chest
  • Li Fraumeni syndrome (a syndrome that predisposes to a lot of cancers)
  • alcohol consumption
  • oral contraceptive use
  • obesity - post menopausal
  • dense breast tissue
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7
Q

How doess breast feeding reduce the risk of breast cancer?

A

breast feeding suppresses the proliferation of breast tissue

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8
Q

What age group of women are normally invited for breast cancer screening and how often?

A

50-70
Every 3 years

After the age of 70, can request to have breast screening

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9
Q

What does breast cancer screening involve?

A

Mammography- (X-ray)

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10
Q

What proportion of women will be recalled after their breast cancer screening mammography and what is done in clinic?

A

5%

They will have an USS of their breast and a biopsy if necessary

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11
Q

What proportion of women who are recalled have breast cancer?

A

1 in 4

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12
Q

What are the 4 stages of the breast cancer screening programme?

A
  1. Invitation
  2. Screening mammography
  3. Assessment - 5% recalled, USS, biopsy
  4. Results, surgery and further treatment
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13
Q

What features on mammorgram would lead to a pt being recalled?

A
  • mass: poorly defined or well defined or spiculate (star-shaped)
  • microcalcification
  • parencymal deformity or distortion
  • assymetric density
  • enlarged axillary lymph nodes
  • skin thickening
  • clinical recall - if pts reports that she has a lump when she goes for her mammogram
  • technical recall - haven’t got a good enough image
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14
Q

How do we grade lesions on mammorgrams?

A 
1 - normal: no abnormality
2 - benign: 
3 - indeterminate 
4 - probably malignant 
5 - almost certainly malignant
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15
Q

What methods are used to help breast surgeons localise lesions easily during surgery?

A

Wire localisation - inserting a wire under USS guidance

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16
Q

What is ductal carcinoma in situ and how does it look on mammorgraphy?

A

It is a precancerous stage

New microcalcification

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17
Q

What screening test is used in high risk pts groups with BRCA 1 and 2 genes or strong FH or history of radiotherapy and from what age are those with BRCA genes tested?

A

MRI with contrast to assess enhancement

From age 30

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18
Q

What proportion of breast cancers are picked up by mammography?

A

95%

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19
Q

What are the advantages and disadvantages of breast cancer screening?

A

Adv:

  • Identifies breast cancer earlier, so increases survival
  • node positivity rates lower
  • picks up DCIS (ductal carcinoma in situ) which is asymptomatic and pre-cancerous and can be removed
  • Reduces chance of needing a mastectomy or chemotherapy

Disadv:

  • overdiagnosis of cancers that may have not progressed
  • Anxiety when recalled
  • discomfort/pain during mammogram
20
Q

When is mammography used other than in the breast screening programme?

A

To characterise or further assess symptomatic abnormalities

Follow-up and surveillance of women who have been treated for breast cancer

21
Q

What are the two main types of views obtained in mammography?

A

Mediolateral oblique

Craniocaudal

22
Q

Which areas of the breast should the MLO view contain to be considered adequate?

A

Pectoral muscle at least to the level of the nipple
The inframammary fold
Lower axilla

23
Q

Which areas of the breast should the CC view contain to be considered adequate?

A

Retromammary fat space

24
Q

When is MRI used for assessment?

A

Screening high risk women e.g. genetic mutations, following radiation therapy for previous lymphoma

Assessing for recurrence after breast cancer surgery

Detecting suspected multifocal breast carcinoma

Assessing chemotherapy response for breast cancer

Assessment of breast implant integrity or the presence of suspected malignancy in women with breast implants

25
Q

How does breast tissue density affect the sensitivity of a mammogram?

A

Increased breast density makes it harder to pick up breast cancers on mammogram

26
Q

How are symptomatic women assessed ie those that don’t necessarily present through screening?

A

Patient age <35 years: Clinical examination and ultrasound as first line

Patient aged ≥35 years: Clinical examination and mammogram as first line with ultrasound later

27
Q

What are the name of the glands in the breast?

A

Mammary glands

28
Q

What are the two regions of the breast?

A

Circular body

Axillary tail - upper part of the breast that leads into the axilla

29
Q

What is the pigmented area of the breast called?

A

The areola

30
Q

What is the nipple composed of?

A

Smooth muscle fibres

31
Q

What is the areolar surface composed of?

A

Sebaceous glands

32
Q

What do the mammary glands consist of?

A

Ducts and lobules

33
Q

How many lobules (lobes) are there in each breast?

A

15-20

34
Q

What is the name of the duct that drains each of the lobules of the breast?

A

Lactiferous duct

35
Q

What does each lobule consist of?

A

Many alveoli which are made up of many acini (ductules)

36
Q

What is the name given to the tissue that surrounds the mammary glands and what type of tissues does it consist of?

A

Connective Tissue Stroma

Consists of fatty and fibrous tissue

37
Q

What does the fibrous stroma condense to form?

A

suspensory ligaments (of Cooper)

38
Q

What is the function of the suspensory ligaments?

A

Attach and secure the breast to the dermis and underlying pectoral fascia

Separate the secretory lobules of the breast

39
Q

What structure does the base of the breast lie on?

A

Pectoral fascia of the pectoralis major muscle

40
Q

What is the connective tissue between the breast and the pectoral fascia called?

A

Retromammary space

41
Q

Which artery supplies the medial aspect of the breast?

A

The internal thoracic artery (also called the internal mammary artery)
It is a brach of the subclavian artery

42
Q

What are the names of the veins that drain the breast?

A

axillary veins

internal thoracic veins

43
Q

What are the names of the groups of lymph nodes that drain the breast?

A

Working roughly from the neck down:

Supraclavicular nodes 
Infraclavicualr nodes 
Interpectoral nodes 
Axillary nodes 
Internal mammary nodes
44
Q

Is dense breast tissue commoner in younger or older women?

A

younger women - the tissue becomes more fatty as we age

45
Q

How does the breast tissue change during the menstrual cycle?

A

Proliferation after ovulation until the start of menstruation
Involution after menstruation starts

46
Q

Why do we not screen pts over the age of 70 routinely?

A

As it is not cost effective

May pick up small cancers in frail older women who may have not been harmed by it

Phase 3a Gynaecology (13 decks)

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