Lecture 15B Problems of the breast Flashcards
The best time to perform breast self-examination (BSE) is _
About 5 to 7 days after menstruation stops - physiologic alternations in breast size and activity are at their minimum level.
Breast cancer screening recommendations
- Breast self-examination (BSE) monthly starting in the 20s.
- Clinical breast examination (CBE) about every 3 years for women in their 20s and 30s and every year for women age 40 and over.
- Screening mammogram every 1 to 2 years after 40 years of age.
Breast self-examination (BSE) procedure
- The woman uses her finger pads to palpate for lumps or thickening. A firm ridge in the lower curve of the breast is normal.
- An up-and-down or vertical line pattern is best while moving the fingers across the breast.
- Go up to the collarbone and down to the ribs and from the underarm on the side (tail of Spence) to the middle of the chest.
- Also examine breast appearance in front of a mirror, looking for: dimpling of the skin, changes in the nipple, redness, or swelling.
Nonproliferative lesions
Cysts, papillary apocrine change, epithelial calcifications (on mammography), hyperplasia of the usual type - these do not increase risk for breast cancer.
Proliferative lesions without atypia
Intraductal papilloma, moderate hyperplasia, sclerosing adenosis, radial scar, fibroadenomas - these do increase risk for breast cancer, about 1.5 to 2 times.
Fibrocystic change
- The most common benign breast problem; characterized by lumpiness, with or without tenderness, in both breasts.
- Most significant contributing factor: A woman’s normal hormonal variation during her monthly cycle.
- Symptoms (bilateral lumpiness, with dull, heavy pain, fullness, tenderness - often in the UOQs) usually develop about a week before menstruation begins and subside about a week after menstruation ends.
- Physical examination may reveal excessive nodularity. Cysts are soft, well differentiated and movable.
Diagnosis of fibrocystic change
- Ultrasonography to determine if the lump is fluid filled or solid. If fluid filled - aspiration.
- If solid, and women is older than 35 - mammography.
- If solid, regardless of age - fine needle aspiration (FNA).
- After FNA, in certain cases in order to obtain more tissue - core biopsy.
- Dietary changes and vitamin supplements (E and B6) may help to manage.
Mastalgia
- Breast pain - usually not a symptom of breast cancer.
- Occurs in many women at some time in their reproductive years but especially the perimenopausal years.
- Symptom investigation: Cyclic vs. noncyclic and diffuse vs. local.
- Diagnosis: Serum prolactin and hCG levels in premenopausal women, ultrasound, mammography, aspiration and biopsy for cysts.
Idiopathic (spontaneous, unknown cause) breast pain is usually treated with _
NSAIDs.
Fibroadenoma
- The single most common solid mass of the breast and the most common type of tumor seen in the adolescent population.
- Discrete, usually solitary lumps less than 3 cm in diameter, round and movable, unilateral, nontender - does not increase in size in response to the menstrual cycle (in contrast to fibrocystic cysts).
- May slowly increase in size over time or during pregnancy; may decrease in size as a woman ages.
- Diagnosis by mammography, ultrasonography, MRI, FNA.
- Dietary changes and hormonal therapy have no effect.
Mammary duct ectasia
- Characterized by dilated ducts, acquired nipple inversion, pain, redness, greenish or black nipple discharge; most commonly presents during middle age in women who are still menstruating.
- Associated with smoking and diabetes.
- Dilated, thickened ducts with fibrotic stroma, rupture, and leakage of secretion into surrounding tissue that results in inflammation and fat necrosis. Fever may occur.
- Mass behind nipple that is firm, nonmobile and irregular, unilateral, pain, burning, itching, thick and sticky discharge.
Galactorrhea
- Bilaterally spontaneous, milky, sticky discharge; a normal finding during pregnancy; otherwise occurs due to elevated prolactin levels.
- Diagnostic tests: Prolactin level (do not draw directly after a breast exam, sexual activity, or exercise), thyroid profile, pregnancy test.
Intraductal papilloma
- Benign condition of the terminal nipple ducts that causes unilateral, spontaneous discharge that is serous, serosanguineous, or bloody.
- Diagnostic tests: Ductogram, mammography, core biopsy to rule out malignancy.
- Nonpalpable, unilateral, serous or bloody discharge.
Macro- and microcalcifications
Accumulations of minerals, usually calcium, in the breast. Microcalcifications are more concerning and require a biopsy. Macrocalcifications are associated with normal breast aging and do not require a biopsy.
Fibrocystic changes in the breast most often appear in women in their 20s and 30s. Although the cause is unknown, an imbalance of estrogen and progesterone may be the cause. The nurse who cares for this client should be aware that treatment modalities are conservative. Which proven modality may offer relief for this condition?
Diuretic administration. [Diuretic administration plus a decrease in sodium and fluid intake are recommended. Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced.]
