Breast surgery

Question 1

What is the routine screening for breast cancer in the UK?

Answer 1

Women aged 50-70 years old are routinely invited for breast cancer screening involving mammograms every 3 years.

Question 2

How should a new, unexplained breast lump be managed in a woman over 30 years old?

Answer 2

Referral to the breast clinic using a suspected cancer pathway (2-week wait referral).

Question 3

Once in the breast clinic, how should a decision between mammogram and ultrasound be made?

Answer 3

US are more suitable for younger women (<35y) because their breast is denser.
Mammogram would be more appropriate after the age of 35 years.

Question 4

What are the four instances in which prophylactic mastectomy should be carried out?

Answer 4

1. Strong family history of breast cancer
2. Presence of inherited mutations in one of two breast cancer susceptibility genes (BRCA1 and BRCA2)
3. Previous cancer in one breast
4. Biopsies showing lobular carcinoma in situ and/or atypical hyperplasia of the breast

Question 5

What is duct ectasia and what are its symptoms?

Answer 5

Duct ectasia refers to dilatation of the large and intermediate breast ducts and it’s suggested by a green or brown nipple discharge.
The subareolar mammary ducts become chronically inflamed, dilated and scarred, resulting in a mass under/behind the nipple.
Duct ectasia is associated with smoking.

Question 6

What are symptoms associated with duct papilloma?

Answer 6

Nipple bleeding

Question 7

What are symptoms associated with ductal fistula?

Answer 7

Abnormal communication between a mammary duct and the skin surface, usually near the areola and is suggested by discharge from para-areolar region.

Question 8

What are symptoms associated with non-cyclical mastalgia?

Answer 8

Defined as pain that does not coincide with the menstrual cycle. Occurs around 30 to 50 years of age. It is usually unilateral and localised to one part of the breast, and described as having a burning or stabbing pain.

Differenciates from fibroadenoma or cyst, since there is no lump.

Question 9

What are symptoms associated with periductal mastitis?

Answer 9

Occurs when the ducts under the nipple become inflamed and infected. It presents with periareolar inflammation, nipple retraction at the site of the diseased duct, with greenish discharge from the nipple. Ocasionally, a mass may be palpable.
Smoking is one of the risk factors.
It’s considered a subclass of duct ectasia, the main difference is that periductal mastitis has a mass that develops around the nipple.
It’s a benign disease, but due to similar clinical features, it’s common for women to be referred to breast clinics to exclude cancer.
Treated with antibiotics, and if left untreated may develop into an abscess.