Conditions of the Breasts and Axilla

Question 1

What age group is most susceptible to breast cancer?

Answer 1

50-70

Question 2

What are the risk factors for developing breast cancer?

Answer 2

Gender
Increasing Age
Nulliparity, first pregnancy over the age of 30, menarche< 12 years, menopause >55
Family hx of breast cancer ( greater if relative was first degree and menopause)
Obesity, high-fat diet, sedentary lifestyle
BRCA 1/2 gene mutation
>5 year hormone replacement, > 10 year oral contraceptive pill
Excessive Alcohol use; 2-3 servings per day

Question 3

What are the major types of breast cancer?

Answer 3

Non-Invasive
Ductal Carcinoma in Situ: cannot penetrate basement membrane; non-palpable, mammogram
Lobular Carcinoma in Situ: completely contained within breast lobule, rubbery and ill defined, non-palpable, mammogram

Invasive
Inflammatory Carcinoma: Ductal Carcinoma that invades into dermal lymphatics, most aggressive
Invasive Ductal Carcinoma of the Breast: infiltrates thoracic fascia to become fixed to chest wall; cooper ligaments
Invasive Lobular Carcinoma

Paget’s disease of the nipple
Inflammatory breast cancer IBC

Question 4

What are the early signs of breast cancer?

Answer 4

Unilateral, solitary, firm to hand, fixed and non-tender lump in the breast

Question 5

What are the later signs of breast cancer?

Answer 5

Erythema over the area
Local edema in breast and/or arm
Fixation of the part of the breast to chest wall
LAO: Left Anterior Oblique
Skin or nipple retraction/inversion
Orange Peel Skin
Nipple Discharge

Question 6

How is breast cancer diagnosed?

Answer 6

Biopsy of suspicious breast lesion

Question 7

What is the DDX for breast cancer?

Answer 7

Fibroadenoma, fat necrosis, fibrocystic breast changes, intraductal papilloma, Paget’s disease of the nipple

Question 8

What carbohydrate antigen is associated with breast cancer?

Answer 8

CA 27-29

Question 9

What is the most common benign breast tumor in women?

Answer 9

Fibroadenoma

Question 10

What does a fibroadenoma feel like?

Answer 10

Non-tender, firm, smooth, rubbery, mobile, well-circumscribed

Question 11

How is fibroadenoma diagnosed?

Answer 11

Core or excisional biopsy

Question 12

Does having a fibroadenoma increase your risk for breast cancer?

Answer 12

Yes, 1.5-2 times more likely

Question 13

What are the possible risk factors for fibrocystic breast?

Answer 13

Women of reproductive age: mostly age 25 through menopause
Hormone imbalance: estrogen dominance
Methylxanthine use: Coffee, tea, and chocolate
High or low iodine in the diet

Question 14

What are signs and symptoms of fibrocystic breasts?

Answer 14

1) Generalized premenstrual breast tenderness and lumpiness
2) Often Bilateral
3) Multiple nodules and palpable lumps
4) Monthly increase in breast pain or lumpiness from mid-cycle (ovulation) to just before period
5) May regress during pregnancy
6) Symptoms improve with onset of menses

Question 15

How are fibrocystic breasts diagnosed?

Answer 15

Clinical breast exam on physical exam; followed by ultrasound and/or mammogram, biopsy if necessary

Ultrasound distinguish the difference between fluid-filled cyst and solid masses

Question 16

What’s in the DDx for fibrocystic breasts?

Answer 16

Fibroadenoma
Intraductal Papilloma
Fat Necrosis
Carcinoma

Question 17

A deficiency in what mineral is associated with fibrocystic breasts?

Answer 17

Iodine

Question 18

What herb might be indicated in fibrocystic breast disease?

Answer 18

Phytolacca Americana

Question 19

What part of the breast does Paget’s disease of the breast affect?

Answer 19

Nipple and ducts (an intraductal carcinoma)

Question 20

What are the signs and symptoms of Paget’s Disease?

Answer 20

1) Eczema-like rash on and around the nipple
2) Unilateral
3) Palpable
4) Nipple retraction

Question 21

What population is at risk for Paget’s disease of the breast?

Answer 21

Affects Postmenopausal women; poor prognosis

Question 22

What do you do when, during the clinical breast exam, you find an eczematous rash on the nipple of a postmenopausal woman?

Answer 22

Order a mammogram and biopsy

Question 23

What are the symptoms of mastitis?

Answer 23

Unilateral localized breast pain
Tenderness
Erythema
Heat and Hardness of the breast
Possible fever, chills
Malodorous breast milk, feels worse with nursing

Question 24

What causes mastitis?

Answer 24

Usually S.aureus infection of the breast

Question 25

What predisposes a woman to get mastitis?

Answer 25

Bacteria from baby’s mouth entering milk duct through cracks in nipple

Question 26

What kind of nipple discharge is seen with mastitis?

Answer 26

Creamy purulent discharge

Question 27

What herbs are used for mastitis?

Answer 27

Baptisia tinctoria (internal)
Berberis aquifolium (topical and internal)
Echinacea spp. (internal)
Hydrastis canadensis (topical and internal)
Phytolacca Americana (topical and internal)
Symphytum officinalis (topical)

Question 28

What homeopathic remedy would you consider for mastitis especially if the pain radiates from nipple outward and is right sided?

Answer 28

Phytolaca

Question 28

What are some causes of gynecomastia?

Answer 28

Low testosterone
Excess estrogen exposure
Drugs
Idiopathic

Question 28

What are some of the causes of low testosterone in men?

Answer 28

Kleinfelter’s Syndrome
Pituitary Syndrome
Anorchia
Orchitis
Renal Failure
Aging
Obesity

Question 29

What are the various causes of estrogen exposure in men?

Answer 29

Exogenous estrogen exposure
Obesity leading to aromatization

Question 30

What drugs can cause gynecomastia in men?

Answer 30

Spironolactone
Testosterone inhibitors used for prostate cancer
Methyldopa and isoniazid
Tricyclic antidepressants and diazepam
Marijuana and heroin
Calcium Channel Blockers and ACE inhibitors
Estrogen or Anabolic Steroids