Clinical Correlation: Breast Exam (11/3)

Question 1

Lymphatic tissue drainage

Answer 1

90% ipsilateral axilla
10% internal thoracic nodes

1st site of metastasis usually

Question 2

Epidemiology

Answer 2

1/8 lifetime risk for women

Most common cancer among women, 2nd leading cause of cancer deaths (lung)

Question 3

BRCA1 and BRCA2

Answer 3

Family hx of breast/ovarian cancer
5-10% risk BRCA1 or BRCA2 gene (autosomal dominant)
1 - 65% BC by 70
2 - 45% risk

Question 4

USPSTF: Mammography

Answer 4

Before 50 - individual decision w/ patient context
50-74 q2 years
Over 75 - unsure

Question 5

USPSTF: BSE

Answer 5

Recommends against

Question 6

USPSTF: CBE beyond mammography, >40yo

Answer 6

Evidence insufficient

Question 7

USPSTF: MRI instead of mammography

Answer 7

Unsure

Question 8

AAFP Guidelines

Answer 8

Recognize that recommendations do not end screening in women 40-49, just need individualized care
Guidelines similar to USPSTF (q2years mamm 50-74, not BSE, unsure 75

Question 9

ACS Guidelines

Answer 9

40-44 choice to start annual
45-54 yearly
55

Question 10

Is Mastalgia risk factor?

Answer 10

No

Question 11

Cyclic vs noncyclic breast pain

Answer 11

Cyclic: Diffuse, bilateral, radiates to axilla (around luteal phase - increased water in stroma)
Non: Unilateral or focal
Focal merits evaluation w/ diagnostic imaging

Question 12

nipple discharge

Answer 12

color, number of ducts, bilateral/unilateral, associated with mass
benign in 97% cases

Question 13

Physiological Discharge

Answer 13

Physiologic: 1yr after breast feeding, endocrinopathy, meds/drugs

Bilateral, multiple ducts, associated with nipple stimulation/breast compression, milky white

Question 14

Pathological Discharge

Answer 14

Spontaneous, unilateral, bloody, serous, clear or associated with mass
Intraductal papilloma, ductal ectasia, carcinoma, infection
mammography and subareolar US
Cytology

Question 15

Benign masses

Answer 15

Discrete margins, no skin changes, smooth, soft to firm and mobile
i.e. fibroadenoma, cysts

Question 16

Malignant masses

Answer 16

Hard, immobile, fixed, poorly defined margins - imaging warranted

Question 17

Biopsy of breast masses

Answer 17

fine needle aspiration, US-guided core needle biopsy, excisional