Chapter 32 Benign Breast Disease and Breast Cancer

Question 1

breast cancer is the most common malignancy in women in the US (except for skin cancers), representing approximately ___ of female cancers

Answer 1

30%

Question 2

a woman has 1 in 8 chance 12% of developing invasive breast cancer over her lifetime. despite its incidence, the cause of breast cancer is unknown

Answer 2

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Question 3

in addition to breast cancer, 50% of women will have benign breast lesions over their lifetime

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Question 4

prolactin - involved in milk production

oxytocin from the posterior pitutiary causes

Answer 4

milk letdown

Question 5

most organizations support routine clinical breast evaluation every 1-3 years for all women above age 20.

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Question 6

after age 40, clinical brast evaluation should be done__

Answer 6

annually

Question 7

breast self-awareness

Answer 7

encourages women to become familiar with their breasts and to report any changes from baseline.

Question 8

current mammogram screening guidelines by the ACS include mammogram every year starting at age 40 continuing for as long as a woman is in good heatlh. there is no agreed upon consensus of an upper age limit at which mammogram screening can be stopped

Answer 8

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Question 9

BRCA1 or BRCA2 gene mutation, a first degree relative (mother, sister, dauther) with either mutation and those deemed to be at high risk based on a validated risk assessment tool )Gail/Claus model)

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Question 10

or who have a hereditary syndrome associated with multiple cancer diagnoses (Li Fraumeni, LynchII syndrome)

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Question 11

moderate risk: personal hx of breast cancer or its precursor lesions, or those who have dense breast tissue on mammogram

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Question 12

mammogram starting 5-10 years before the age of the youngest cancer diagnosis in the family

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Question 13

women at highest risk for breast cancer might also have interval breast MRIs along with the annual screening mammogram

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Question 14

breast pain (mastalgia, mastodynia) common complaint 65%. cyclic 67% or noncyclic 33%

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Question 15

breast pain can be normal physiologic response to

Answer 15

hormone fluctiations. or it can be pathologic response to trauma or malignancy.

Question 16

only 1-7% of women with breast pain will have underlying malignancy

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Question 17

vast majority of breast pain is benign and can be treated with oral and topical Nsaids , a supportive bra/sports bra, diet and lifestyle changes (decrase caffeine intake and smoking), and use of warm and cool compresses and massage.

Answer 17

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Question 18

many women will require a decreased dose or discontinuation of OCP and HRT in order to relieve their breast pain

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Question 19

danazol is the only medication approved by FDA to treat mastalgia

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Question 20

as many as 50-80% of women will have nipple discharge. vast majority of nipple discharge is due to normal physiology or benign processes, and only 5% is associated with underlying malignancy

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Question 21

most concerning discharge is

Answer 21

spontaneous bloody or serosanguineous, unilateral, persistent, from a single duct, and associated with a mass.

bilateral, nonbloody, multiductal secretion is usually benign regardless of color.

Question 22

most common cause of bloody nipple discharge is an

Answer 22

intraductal papilloma

Question 23

galactorrhea is associated with

Answer 23

pregnancy, ptiutiary adenomas, hypothyroidism, ,stress, and medications such as ocps, antihypertensives, and psychotropic drugs

Question 24

women with associated masses should have ultrasound <30, mammogram >30

Answer 24

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Question 25

up to 10-15% of new breast cancers are not sen or detected via mammography. a suspicious mass should never be dismissed just because the mammogram is negative. the most common causes of breast masses are fibroadenomas and breast cysts.

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Question 26

malignant masses are classically

Answer 26

single, firm, nontender, and immobile with irregular borders.
lumph nodes are worrisome if larger than 1cm, fixed, irregular, firm , or multiple.

Question 27

any palpable mass/ abnormality seen on radiologic imaging should be evaluated with mammography and biopsied to obtain a pathologic diagnosis.

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Question 28

if a palpable cystic mass is found on examination and confirmed on ultrasound, it can be drained and sampled for diagnosis using needle aspiration

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Question 29

the cyst should be exicsed if bloody

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Question 30

when a palpable solid mass is found on exam and confirmed with ultrasound or mammogram, a tissue sample should be obtained for diagnosis.

Answer 30

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Question 31

when a palpable solid mass is found on exam and confirmed with ultrasound or mammogram, a tissue sample should be obtained for diagnosis.

Answer 31

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Question 32

2/3 of tumors in reproductive age women are benign. whereas 1/2 of palpable masses in perimenopausal women and the majority of lesions in postmenopausal women are malignant

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Question 33

fibrocystic change of the breast due to exaggerated stromal response to hormones and growth factors. it typically presents as painfulb reast masses that are often multiple and usually bilateral. in the absence of atypical hyperplasia, fibrocystic change is NOT associated with increased cancer risk

Answer 33

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Question 34

dx of fibrocystic changes

Answer 34

breast welling, pain, tenderness

Question 35

treatment of fibrocystic disease:

Answer 35

reduction of caffeine, tea, and chocolate. avoiding trauma and wearing a support bra may also help decrease pain associated with fibrocystic change.

Question 36

breast fibroadenomas are benign tumors with glandular and stromal components. most masses are 1-5cm in diameter. lesions > 5cm are termed giat fibroadenomas. in these cases, __should be ruled out

Answer 36

cytosarcoma phyllodes

Question 37

fibroadenomas most common benign tumors of the breast. more common than breast cysts in women younger than 25 years. rarely occur and often regress after menopause

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Question 38

diagnosis of fibroadenomas:

Answer 38

palpated on Physical exam, round, well circumscribed, mobile, firm lesions that are rubbery and nontender. classic fibroadenoma in a woman less than 30 years old may be the only solid breast mass that does not require tissue diagnosis.

Question 39

cytosarcoma phyllodes - rare variant of fibroadenoma and involve epithelial and stromal proliferation
dx: large, bulky, mobile mass that is painless. mass is large 4-7cm, smooth, and well circumscribed and is characteraized by rapid growth. most lesions are benign; however, some physicians consider cytosarcoma phyllodes a low grade malignancy. few tumors do develop true sarcomatous potential. core needle biopsy is the preferred method for diagnosis but should be strongly correlated with clinical suspicion

Answer 39

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Question 40

intraductal papilloma: benign, solitary lesion that involes epithelial lining of lactiferous ducts. it is the most common cause of bloody nipple discharge in the absence of a concurrent mass.

Answer 40

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Question 41

mammary duct ectasia - causes dilated mammary ducts. commonly occurs at or after menopause, but is also a cause of breast mass in adolescents.
dx: nipple discharge, noncyclic breast pain, nipple retraction, subareolar masses. discharge is multicolored, sticky, originating from multiple ducts, and often bilateral pt should have what

Answer 41

mammogram and excisional bx to r/o carcinoma

Question 42

risk of getting breast cancer increases with

Answer 42

age

Question 43

4/5 women are with breast cancer and are above age 50

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Question 44

breast cancer is leading cause of death in US women aged 40-59

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Question 45

risk factor: increasing age

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Question 46

having one affected first degree family member increases the patient’s risk by nearly 2 times.
having two first degree family members increase a patient’s risk by nearly 3 times

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Question 47

prevention fo breast cancer: early pregnancy, prolonged lactation, chemical/surgial sterilization, exercise, abstinence from alcohol, and low fat diet help prevent breast cancer.

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Question 48

tamoxifen - selective estrogen receptor modulator (SERM) is effective in suppressing the development of breast cancer. by binding to Estrogen receptor, tamoxigen completely inhibits estrogen binding and thereby blocking stimulation of breast cancer cells.

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Question 49

tamoxifen currently used as adjuvant therapy in pts with early stage, surgically treated, ER positive breast cancer and has been shown to decrease rate of recurrent BCA by 40% and breast cancer mortality by 35%

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Question 50

breast cancer metastacizes to

Answer 50

bone, liver, lung, pleura, brain, lymph nodes

Question 51

benign intraductal papilloma is most common cause of __

Answer 51

bloody nipple discharge

Question 52

dcis (15%) is PREINVASIVE diseasE and is treated with lumpectomy and radiation therapy
LCIS (4%) treated with observation and possible tamoxifen to prevent subsequent invasive breast cancer

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Question 53

INVASIVE BREAST CANCER:
infiltrating ductal carcinoma (76%) and infiltrating lobular carcinoma (8%) treated with lumpectomy and radiation / modified mastectomy with equal risk of recurrence and survival in properly selected patients

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Question 54

standard adjuvant treatment for women with positive lymph nodes is combination chemotherapy

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Question 55

all hormone receptor positive patients should receive hormone therapy aimed at suppressing estrogen, and thereby suppressing stimulation of cancer ells. this is most commonly achieved with tamoxifen (an etrogen agonist/antagonist) or aromatase inhibitors (letrozole, anastrazole), which have antiestrogen activity.

Answer 55

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Question 56

intraductal papilloma is most cmomon cause of bloody nipple discharge. second most common cause is invasive papillary breast cancer. fibrocystic breast change, fibroadenoma, and cystosarcoma phyllodes typically present as painful and nonpainful breast masses

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Question 57

radiation therapy is necessary for all patients who undergo conservative therapy. breast reconstruction should be considered when a large mass is removed from the breast as it carries significant psychosocial benefits.

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Question 58

estrogen/progesterone-receptor positive tumors should be treated with an antiestrogen agent or aromatase inhibitor following surgical resection. postmenopausal women with ER+ and PR+ should be first reated with an aromatase inhibor like letrozole with hormone receptor positive cancers. tamoxifen is first line hormone therapy for premenopausal women. trastuzmab is amonoclonal antibody for adjuvant treatment in tumors that are her2/neu positive

Answer 58

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