Exam 3

Question 1

Breast cancer is the most common new cancer case in the U.S., at ___% of new cases.

Answer 1

29

Question 2

What is the probability of developing breast cancer for females?

Answer 2

1 in 8

Question 3

What is the highest cause of death by cancer for women in the U.S.?

Answer 3

Lung cancer (26%) - breast is second at 14%

Question 4

Describe the probability of developing breast cancer with age.

Answer 4

Increases as age increases (from 1 in 1,681 at age 20 to 1 in 27 at age 70)

Question 5

What are risk factors for breast cancer?

Answer 5

1. Being a woman
2. Increasing age
3. Race/ethnicity
4. Personal or family history of breast cancer
5. Menstrual/pregnancy ihistory
6. Prior abnormal biopsies
7. Prior ionizing radiation
8. Dense breast tissue

Question 6

Discuss the incidence of breast cancer with age.

Answer 6

Increases with age until age 80, then it drops off or levels out

Question 7

Breast cancer is most common in which ethnicities?

Answer 7

Most common in white and African American populations; mortality rate is highest in African American population

Question 8

What is the greatest risk factor for breast cancer?

Answer 8

Previous history of breast cancer; 10 year risk of breast cancer in the contralateral breast is 1% per year pre-menopause and 0.5% per year post-menopause

Question 9

The vast majority of breast cancer is ___ (familial, hereditary, sporadic).

Answer 9

Sporadic (70-80%)

Question 10

What increases risk for breast cancer 2-3 fold with respect to menstrual cycle and pregnancy history?

Answer 10

1. Early menarche (<12)
2. Delayed menopause (>55)
3. First live birth after age 30
4. No children

Question 11

Where is the majority of breast tissue found?

Answer 11

Upper outer quadrant

Question 12

What is the age range for mammograms suggested by USPSTF?

Answer 12

50-74, ever 2 years

Question 13

True or false - negative imaging rules out cancer.

Answer 13

False

Question 14

What are the exceptions to the rule that a biopsy is required for all lumps?

Answer 14

1. Simple cyst on ultrasound
2. Young woman with known fibroadenoma
3. Breast mass is clinically stable for >2 years

Question 15

What are retraction signs?

Answer 15

Dimpling, changes in contour, and retraction or deviation of the nipple (caused by shortening of fibrotic tissue seen in breast cancer)

Question 16

What is skin dimpling?

Answer 16

Dimpling of the skin seen when the patient’s arm is at rest, during special positioning, and on moving or compressing the breast

Question 17

What is the peau d’orange sign?

Answer 17

Thickening of the skin with enlarged pores caused by edema of skin after lymphatic blockade; often seen first in the lower portion of the breast or areola

Question 18

What are abnormal contours?

Answer 18

Variations in the normal convexity of each breast

Question 19

What is Paget’s disease of the nipple?

Answer 19

Uncommon form of breast cancer that starts as a scaly, eczema-like lesion that may weep, crust, or erode

Question 20

What are the three common breast masses?

Answer 20

1. Fibroadenoma (benign tumor)
2. Cysts
3. Cancer

Question 21

Discuss the usual age of the three common breast masses.

Answer 21

Fibroadenoma: 15-25, but up to 55
Cysts: 30-50, regress after menopause except with estrogen therapy
Cancer: 30-90 (most common over 50)

Question 22

Discuss the number of masses seen in the three common masses.

Answer 22

Fibroadenoma: usually single, may be multiple
Cysts: single or multiple
Cancer: usually single

Question 23

Discuss the shape of the three common masses.

Answer 23

Fibroadenoma: round, disclike, lobular
Cysts: round
Cancer: irregular or stellate

Question 24

Discuss the consistency of the three common masses.

Answer 24

Fibroadenoma: usually firm, may be soft
Cysts: soft to firm, usually elastic
Cancer: firm or hard

Question 25

Discuss the delimitation of the three common masses.

Answer 25

Fibroadenoma: well-delineated Cysts: well-delineated Cancer: poorly-delinated

Question 26

Discuss the mobility of the three common masses.

Answer 26

Fibroadenoma: very mobile Cysts: mobile Cancer: may be fixed to skin or underlying tissues

Question 27

Discuss the tenderness of the three common masses.

Answer 27

Fibroadenoma: usually non-tender Cysts: often tender Cancer: usually non-tender

Question 28

Discuss the retraction signs of the three common masses.

Answer 28

Fibroadenoma: absent Cysts: absent Cancer: present

Question 29

Lymphatics from most of the breast drain toward the ___.

Answer 29

Axilla

Question 30

Of the axillary lymph nodes, which are palpable most frequently?

Answer 30

Central nodes

Question 31

The channels from these three lymph nodes drain into the central nodes.

Answer 31

1. Pectoral nodes (anterior) 2. Subscapular nodes (posterior) 3. Lateralnodes

Question 32

Breast cancer occurs in up to ___% of women with breast complains, in approximately ___% of women reporting nipple discharge, and in up to ___% of women specifically complaining of a lump or mass.

Answer 32

4; 5; 11

Question 33

5-year survival rates for breast cancer range from ___% for local disease to ___% for metastatic disease.

Answer 33

98; 23

Question 34

Milky discharge unrelated to a prior pregnancy and lactation is ___. What causes it?

Answer 34

Non-puerperal galactorrhea; hypothyroidism, prolactinoma, drugs that are dopamine agonist

Question 35

Spontaneous unilateral bloody discharge from 1 or 2 ducts warrants further evaluation for which issues?

Answer 35

Intraductal papilloma, ductal carcinoma in situ, or Page's disease of the breast.

Question 36

Which types of multiductal discharge are usually benign?

Answer 36

Clear, serous, green, black, or non-bloody

Question 37

What suggests recurrence of breast cancer?

Answer 37

Masses, nodularity, and change in color or inflammation, especially in the incision line