Exam 3 Flashcards
Breast cancer is the most common new cancer case in the U.S., at ___% of new cases.
29
What is the probability of developing breast cancer for females?
1 in 8
What is the highest cause of death by cancer for women in the U.S.?
Lung cancer (26%) - breast is second at 14%
Describe the probability of developing breast cancer with age.
Increases as age increases (from 1 in 1,681 at age 20 to 1 in 27 at age 70)
What are risk factors for breast cancer?
- Being a woman
- Increasing age
- Race/ethnicity
- Personal or family history of breast cancer
- Menstrual/pregnancy ihistory
- Prior abnormal biopsies
- Prior ionizing radiation
- Dense breast tissue
Discuss the incidence of breast cancer with age.
Increases with age until age 80, then it drops off or levels out
Breast cancer is most common in which ethnicities?
Most common in white and African American populations; mortality rate is highest in African American population
What is the greatest risk factor for breast cancer?
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
The vast majority of breast cancer is ___ (familial, hereditary, sporadic).
Sporadic (70-80%)
What increases risk for breast cancer 2-3 fold with respect to menstrual cycle and pregnancy history?
- Early menarche (<12)
- Delayed menopause (>55)
- First live birth after age 30
- No children
Where is the majority of breast tissue found?
Upper outer quadrant
What is the age range for mammograms suggested by USPSTF?
50-74, ever 2 years
True or false - negative imaging rules out cancer.
False
What are the exceptions to the rule that a biopsy is required for all lumps?
- Simple cyst on ultrasound
- Young woman with known fibroadenoma
- Breast mass is clinically stable for >2 years
What are retraction signs?
Dimpling, changes in contour, and retraction or deviation of the nipple (caused by shortening of fibrotic tissue seen in breast cancer)
What is skin dimpling?
Dimpling of the skin seen when the patient’s arm is at rest, during special positioning, and on moving or compressing the breast
What is the peau d’orange sign?
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
What are abnormal contours?
Variations in the normal convexity of each breast
What is Paget’s disease of the nipple?
Uncommon form of breast cancer that starts as a scaly, eczema-like lesion that may weep, crust, or erode
What are the three common breast masses?
- Fibroadenoma (benign tumor)
- Cysts
- Cancer
Discuss the usual age of the three common breast masses.
Fibroadenoma: 15-25, but up to 55
Cysts: 30-50, regress after menopause except with estrogen therapy
Cancer: 30-90 (most common over 50)
Discuss the number of masses seen in the three common masses.
Fibroadenoma: usually single, may be multiple
Cysts: single or multiple
Cancer: usually single
Discuss the shape of the three common masses.
Fibroadenoma: round, disclike, lobular
Cysts: round
Cancer: irregular or stellate
Discuss the consistency of the three common masses.
Fibroadenoma: usually firm, may be soft
Cysts: soft to firm, usually elastic
Cancer: firm or hard
Discuss the delimitation of the three common masses.
Fibroadenoma: well-delineated
Cysts: well-delineated
Cancer: poorly-delinated
Discuss the mobility of the three common masses.
Fibroadenoma: very mobile
Cysts: mobile
Cancer: may be fixed to skin or underlying tissues
Discuss the tenderness of the three common masses.
Fibroadenoma: usually non-tender
Cysts: often tender
Cancer: usually non-tender
Discuss the retraction signs of the three common masses.
Fibroadenoma: absent
Cysts: absent
Cancer: present
Lymphatics from most of the breast drain toward the ___.
Axilla
Of the axillary lymph nodes, which are palpable most frequently?
Central nodes
The channels from these three lymph nodes drain into the central nodes.
- Pectoral nodes (anterior)
- Subscapular nodes (posterior)
- Lateralnodes
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.
4; 5; 11
5-year survival rates for breast cancer range from ___% for local disease to ___% for metastatic disease.
98; 23
Milky discharge unrelated to a prior pregnancy and lactation is ___. What causes it?
Non-puerperal galactorrhea; hypothyroidism, prolactinoma, drugs that are dopamine agonist
Spontaneous unilateral bloody discharge from 1 or 2 ducts warrants further evaluation for which issues?
Intraductal papilloma, ductal carcinoma in situ, or Page’s disease of the breast.
Which types of multiductal discharge are usually benign?
Clear, serous, green, black, or non-bloody
What suggests recurrence of breast cancer?
Masses, nodularity, and change in color or inflammation, especially in the incision line
