Clincal Assessment Flashcards
What is the affect of age on developing breast cancer?
Risk of developing breast cancer by:
- age 29 = 1/2900
- age 39 = 1/215
- age 49 = 1/50
- age 59 = 1/22
- age 69 = 1/13
- age 79 = 1/11
What is the lifetime risk of developing breast cancer?
1 in 8
How does parity affect the incidence of breast cancer?
Reduces risk:
- A mother of 5 has half the risk of nulliparous woman.
Younger age at 1st full-term pregnancy also reduces risk:
- If 1st baby at 20, has half risk than if at 30.
By what percentage is the risk of breast cancer lowered for each year of breastfeeding?
4%
What is the significance of breast symptoms that are associated with the menstrual cycle?
Breast symptoms that vary with menstrual cycle are very likely to be associated with benign breast disease.
What affect can taking HRT have on breast disease?
Associated with a 55-100% increase in beast cancer risk compared to never-users.
Both post menopausal and menopausal women taking HRT may extend the age at which they are likely to suffer from benign breast conditions such as cysts.
What do we do with any discharge in examination of the breast?
Send for cytology and microbiology
How do we get a sample of breast lump?
Cystic lumps - aspirated (FNA)
Solid lumps - core biopsy for histology
What imaging does a lady with a breast symptoms get?
If over 35, mammography (X-ray) +- US
If under 35, US
What is the P score?
When a clinical breast examination is performed, the findings are recorded on a diagram and given a P score for the level of suspicion for malignancy.
P1: normal P2: benign P3: uncertain/probably benign P4: suspicious P5: malignant
What is Paget’s disease of the breast?
Eczema-like scaly red rash in skin of the nipple related to an underlying breast malignancy
Where do accessory (supranumerary) nipples occur?
Along the mammary ridge that develops in the embryo along the trunk on either side from the axilla to the groin.
May be just nipples or have associated breast tissue.
May be mistaken for moles, but have characteristic appearance and site and are present from birth.
Relatively common (lily Allen, zac efron)
What are the two views obtained at a mammogram?
Mediolateral oblique (MLO) Craniocaudal (CC)
Mammogram is X-ray of breast.
Why is the breast compressed during mammography?
- To spread out the glandular tissue, reducing the problem if overlapping structures
- To hold the breast still, reducing blurring which may obscure small details
- A breast which is uniformly thin helps to avoid problems with over or under exposure of parts of the image
- Making the breast thinner reduces the radiation received
Why is a mammogram not done on women under 35?
Mammogram is sensitive to density of breasts - much less effective in detecting signs of breast cancer in dense breasts (have a high proportion of fibroglandular tissue compared to fat).
Younger women have denser breasts (and lower incidence of breast cancer) therefore only done over 35 (40 in some units) unless strong clinical suspicion of malignancy.
State four abnormal features that could indicate breast cancer on a mammogram.
Asymmetry - a difference in the pattern of glandular tissue in one breast compared to another.
Architectural distortion - pulling in of breast tissue such that normal pattern of breast tissue is distorted.
Microcalcification - tiny deposits of calcium salts which show up a dense white specks on mammogram.
Mass - space occupying lesion within the breast tissue.
How is the level of concern about the findings of a mammogram scored?
M score:
M1: normal M2: benign M3: probably benign/uncertain M4: suspicious M5: malignant
How much background radiation is a standard mammogram equivalent to?
2 months worth. (Same as flying London to Australia and back)
(CXR is about 2 days worth)
(Skull X-Ray is about 2 weeks worth)
When is ultrasound used in breast assessment?
In women under 35 or in conjunction with mammogram in women older than 35.
Especially effective for investigating focal breast symptoms such as a lump and can be very useful in women with dense breasts.
Ultrasound allows for real time imaging which is very useful when guiding biopsy needle
How is the level of concern about the findings of an ultrasound scored?
U score:
U1: normal U2: benign U3: probably benign/uncertain U4: suspicious U5: malignant
Eg U2 for a well defined mass with a smooth ovoid shape and wider than it is fat. Also v black (indicating fluid rather than liquid).
When is MRI useful in breast assessment?
- identifying abnormalities in younger women with very dense breast tissue
- evaluating the size of breast cancers that are not clearly seen on mammography and ultrasound
- assessment of breast implants
- unable to distinguish between cancerous and benign abnormalities and therefore many false positives and unnecessary biopsies
- unable to identify microcalcifications
(Patient lies on front between two parts so breasts hanging)
What should you tell patients about having MRI breast scan?
- usually need IV contrast during scan
- need to lie on front with breasts hanging through openings on couch
- lasts about 30mins and need to keep still
- scanner is noisy, may be given headphones to wear
- scanner is cylindrical shape and some people may feel claustrophobic
- leave watches and credit cards outside as may stop working
- screen for pacemakers (CI as can malfunction), metal work, 1st trimester of pregnancy
What is sentinel node biopsy?
A technique used to assess lymph node spread - the sentinel node is the first axillary node along the lymphatic chain where lymph drains to first.
Identified by injecting a solution of radioactive isotope technithium and blue dye around nipple/areola tissue and around the canacer itself and then using a hand held counter to see which node has turned most blue. This node can then be removed and sent for histology.
Which score does FNA use?
C score 1-5
1 is insufficient cells for analysis
