Female health assessment

Question 1

Risk factors for females

Answer 1

are 100x more likely to develop breast cancer than males

risk increases with age-especially for invasive breast cancers

5-10% thought to be hereditary BRCA1 and BRCA2 genes

if a woman’s father or brother had breast cancer risk is increased

Question 2

Race risk factors

Answer 2

White women are at greatest risk for diagnosis of breast cancer

black women are at a greater risk for dying of breast cancer

Question 3

Non-modifiable Risk factor

Answer 3

if you had breast cancer there is an increased risk of having it again in the same or other breast

denser breast has increased risk

early menstruation (before age 12) or later menopause (older than 55)

previous chest radiation for therapy (before age 40)

Question 4

Modifiable Risk Factors

Answer 4

having no children or giving birth to first child after 30 years of age

Question 5

Recent oral contraceptive use

Answer 5

risk declines to normal after 10 years of non use

breast cancer

Question 6

Use of menopausal combined HRT

Answer 6

Both estrogen and progesterone

risk is highest in the first 2-3 years

risk reduces to normal after 2-3 years without therapy

Question 7

No history of breast feeding

Answer 7

reduces the lifetime number of menstrual cycles

Question 8

alchohol consumption

Answer 8

2-5 drinks per day

Question 9

Excessive weight or obesity

Answer 9

due to increased fat tissue after menopause increasing estrogen levels

Question 10

Weight gain as adult female

Answer 10

no increased risk if there was weight gain in childhood

Question 11

Limited Physical Activity

Answer 11

exercise should be 1.25 to 2.05 hours of brisk walking at least 5 days per week

Question 12

Dim light at night

Answer 12

even dim light at night wile sleeping has shown to speed growth of human breast cancer tumors and make tumors resistant to tamoxifen

Question 13

current research

Answer 13

night work shifts

exposure to second hand smoke

diet and vitamin intake

Question 14

Disease of nuns

Answer 14

a lot of nuns would get breast cancer so it was called nuns disease

nuns don’t have children and pregnancy reduces a woman’s total number of periods

scientists think having more period related hormones raise the chances of getting breast cancer

Question 15

Average risked woman

Answer 15

woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation (BRCA) and has not had chest radiation therapy before the age of 30

Question 16

Mammograms

Answer 16

women between 40 and 44 have the option to start screening with a mammogram every year

women 45 to 54 should get mammograms every year

women 55 and older can switch to a mammogram every other year or choose to continue yearly mammograms. Screening should continue

clinical breast exams are not recommended for breast cancer screening among average-risk women at any age

Question 17

Lumps

Answer 17

lumps may be present with benign breast conditions like fibrocystic breast disease, fibroadenomas or malignant tumors

Question 18

Premenstrual breast lumpiness

Answer 18

are lumpiness and soreness that subsides after the end of the menstrual cycle indicates benign breast disease (fibrocystic breast disease)

Question 19

Redness, warmth, or dimpling of breasts

Answer 19

redness and warmth indicate inflammation

dumping or retraction of the nipple or fibrous tissue may indicate breast cancer

Question 20

Size change or firmness of the breast

Answer 20

any recent increase in the size of one breast may indicate inflammation, pregnancy, lactation or abnormal growth

Question 21

Pain and tenderness of the breast

Answer 21

are common in fibrocystic breasts, especially just before and during menstruation

also true for patient taking oral contraceptives

Question 22

Symptoms of Fibrocystic Breasts

Answer 22

Breast pain or tenderness

lumps or areas of thickening

lesions feel like multiple, smooth, well-dilneated tiny pebbles under the skin

fluctuating size of breast lumps

green or dark non bloody nipple discharge

changes in both breast

Question 23

Fibrocystic changes

Answer 23

do not increase a woman’s risk of breast cancer

breast examinations and mammography becomes more difficult to interpret with. cysts presence so early cancerous lesions may be missed

Question 24

Breast self examination

Answer 24

(BSE) is discouraged by some organizations while other organizations remain neutral

for high risk individuals, BSE is an option starting in their 20s

Question 25

Breast Self Awareness

Answer 25

has replaced BSE

becoming familiar with appearance, feel and shape of one’s breasts and nipples

research has shown that BSE plays a small role in finding breast cancer

but some women feel comfortable doing BSE

Question 26

How to BSE

Answer 26

woman should self examine monthly and the best time to do so is right after menstrual period when the breasts are smaller and least congested

pregnant or menopausal women should select a familiar date to examine each month

they will get to know their own breast normal variation and emphasize the absence of lumps

Question 27

Early detection

Answer 27

early detection of breast cancer is important; if cancer is not invasive, survival rate is close to 98%

majority of breast lumps are benign

Question 28

Breast Assessment inspection

Answer 28

position patient with hands over head

when patients lift arms, the breast should move symmetrically

patient should place hands on hips and push hands together to contract pectorals muscle

large women should lean forward in sitting or standing positions and perform these maneuvers. This helps to reveal subtle breast or nipple asymmetry

Question 29

Inspect size and symmetry

Answer 29

a recent increase in the size of one breast may indicate inflammation or an abnormal growth

Question 30

inspect color and texture

Answer 30

redness is associated with breast inflammation

a pigskin-like or orange-peal appearance results from edema this is seen with metastatic breast cancer

Question 31

Inspect superficial venous pattern-observe visibility

Answer 31

a prominent venous pattern may occur as a result of increased circulation due to malignancy

asymmetric venous pattern may be due to malignancy

Question 32

Peau d’orange skin around areolas

Answer 32

associated with carcinoma may be first seen in the areola

Question 33

Red scaly

Answer 33

crusty areas may appear with Paget disease

Question 34

Inspect the nipples

Answer 34

A recently retracted nipple that was previously inverted suggest a malignancy

any type of spontaneous discharge should be referred to further evaluation

Question 35

Inspect for retraction and dimpling

Answer 35

dimpling or retraction is usually caused by a malignant tumor that is attached to the breast tissue and muscles

as the muscle contracts, it draws the breast tissue and skin with it, causing dimpling or retraction

Question 36

Thickening of the tissues

Answer 36

may occur with an underlying malignant tumor

Question 37

Painful breast

Answer 37

may be indicative of fibrocystic breasts specially right after menstruation

pain may also occur with a malignant tumor

Question 38

Heat in the breasts

Answer 38

heat in the breasts of a woman who has not just given birth or who is not lactating indicates inflammation

Question 39

Masses in breast

Answer 39

malignant masses or tumors are most often found in the upper outer quadrant of the breast

these masses are generally hard, immobile and fixed to surrounding skin and soft tissue with poorly defined or irregular margins

Question 40

Documenting a breast lump

Answer 40

Size in cm, shape (round, discoid, regular or irregular), consistency(soft, firm, or hard), mobility, degree of tenderness, and location (quadrant or clock methods)

Question 41

Breast masses

Answer 41

Fibroadenomas, Milk cysts, lipomas

Question 42

Fibroadenomas

Answer 42

usually 1-5 cm

round or oval, mobile, firm, solid, elastic, contender

single or multiple benign masses found in one or both breast

Question 43

Milk cysts

Answer 43

(galactocele)

sacs filled with milk

may become infected and turn into an abscess

occurs in breastfeeding or recently given birth

Question 44

Lipomas

Answer 44

collection of fatty tissue that may also appear as a lump

Question 45

Common causes of nipple discharge

Answer 45

Pregnancy, lactation, hypothyroidism, pituitary adenoma, oral contraceptives, antihypertensives, and tranquilizers

Question 46

Nipple discharge

Answer 46

bloody, greenish or clear

clear discharge from only one nipple is highly suspicious for malignancy

Question 47

Mastitis

Answer 47

a disorder of lactating females

develops from a pathogen from the infant’s nose or pharynx that invades breast tissue through a fissured or cracked nipple

breast will appear tend, hard, swollen and warm

Question 48

Fibroadenomas

Answer 48

Lesions are lobular, ovoid or round

are firm, well defined, seldom tender

usually single lesions that can move when palpated

usually located in the upper outer quadrant of the breast

rarely associated with cancer

Question 49

Fibroadenomas stats

Answer 49

account for 50% of all breast biopsies

most common in women ages 15-25 years

rarely associated with cancer

Question 50

Breast cancer for men

Answer 50

account for 1% of all cases

symptoms for men is a painless, firm, subareolar breast mass

most common in older men, but it can occur at any age

treatment involves surgery to remove the breast tissue

mortality for men is higher because men are less likely to assume a lump in breast cancer which causes delay in seeking treatment

Question 51

Invasive Ductal Carcinoma

Answer 51

this is the most common breast cancer representing 85% of all cases

more likely for women>60 years of age

it spreads rapidly to axillary and other lump nodes

Question 52

Symptoms Invasive Ductal Carcinoma

Answer 52

A palpable lump or mass in a breast or underarm area

thickened or dimpled breast skin

redness or rash on breast skin

swelling of one breast

unusual pain in one breast

dimpling around a nipple

inward turning of nipple

nipple discharge

other changes in the size, shape, contour or feel of a breast that differ form what you normally experience

Question 53

Invasive Lobular Carcinoma

Answer 53

it accounts for 10% of all cases of breast cancer

it peaks in women aged to 40 to 50 years old

the tumor is frequently located in the upper outer quadrant of the breast

not discovered until the cancer is advanced so the prognosis is often poor

Question 54

Stages of invasive lobular carcinoma

Answer 54

at its earliest stages, may cause no signs and symptoms. As it grows larger, it may cause:

• area thickening in part of the breast
• new area of fullness or swelling in the breast
• a change in the texture or appearance of the skin over the breast, such as dimpling or thickening
• a newly inverted nipple

less likely than other forms of breast cancer to cause a firm or distinct breast lump

Question 55

Inflammatory Breast Cancer

Answer 55

a rare type of breast cancer (1-5% of cases) that develops rapidly

IBC tends to occur in younger women (younger than 40 years of age)

more common among women who are overweight or obese

can be confused with a breast infection, which is a more common cause of breast redness and welling

often not decide on a mammogram / associated with a poor prognosis

Question 56

Symptoms of inflammatory breast cancer

Answer 56

include breast swelling, purple or red color of the skin, and dimpling or thickening of the skin of the breast

lump is not felt even if it is there

Question 57

Paget Disease

Answer 57

a rare from of breast cancer that originates in the nipple

usually starts as a red, granular or crusted, scaly lesion on the nipple or areola

the lesion may ulcerate and cause erosion of the nipple

unilateral and is seen with menopausal women

underlying lump is usually present and nipple is usually destroyed

Question 58

Metastasis Assessment Bones

Answer 58

severe, worsening pain

swelling

bones that are prone to breakage and fracture

Question 59

Metastasis Assessment Brain

Answer 59

Recurrent, progressively worsening headache

vision problems

seizures

vomiting or nausea

Question 60

Metastasis Assessment Liver

Answer 60

Yellow appearance of the skin

rash or itchy skin

abdominal pain, loss of appetite

Question 61

Metastasis Assessment Lungs

Answer 61

Persistent cough

difficulty breathing

chest pain

Question 62

Lymphedema

Answer 62

refers to swelling that generally occurs on one of the arms or legs

often caused by the removal of or damage to the lymph nodes as part of cancer treatment

it results from a blockage in the lymphatic system, which is part of the immune system

the blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling

no cure, but it can be managed with early diagnosis and diligent care of the affect limb

Question 63

Reducing the risk of lymphedema

Answer 63

Protect the arm or leg

Rest the arm or leg while recovering

avoid heat on the arm or leg

elevation of affected limb above the level of the heart

avoid anything that can contract affected limb

keep it clean and watch for changes or breaks that could lead to infection

Question 64

Protect the arm or leg

Answer 64

avoid injury to the affect limb, Cuts, scrapes, and burns can invite infection. Avoid medical procedures such as blood draws in the affect limb

Question 65

Rest the arm or leg while recovering

Answer 65

After cancer treatment, exercise and stretching are encouraged

but avoid strenuous activity until recovered from surgery or radiation

Question 66

Avoid heat on the arm or leg

Answer 66

Don’t apply ice or heat, such as with heating pad, to the affected limb

also protect the affected limb from extreme cold