Lecture 36 - Breast Pathology Flashcards
Breast screening programme
designed to detect cancer at its earliest stages
Invite women between the ages of 50-70
Age extension 47-73
Mammography main tool
What is a fibrocystic change
Fibrocystic breast disease is a noncancerous condition in which a woman has painful lumps in her breasts.
Over 50 percent of women will develop fibrocystic breast disease at some point in their lives.
Prevalence of a fibrocystic change
Some studies indicate that the lifetime prevalence of FBC may be as high as 70% to 90%
Except for patients with a strong family history of breast cancer, where the risk is 2-fold, non-proliferative lesions have no increased risk
What is a fibrocystic disease
Different benign changes seen in the breast including apocrine change, usually type ductal hyperplasia and sclerosing adenoids.
Can form a lump, can be associated with calcium, can mimic cancer, is a common incidental finding
Can cause discomfort related to the menstrual cycle.
Shares same risk factors as breast cancer
Fibroadenoma
common
usually occur in women - ages of 10 and 40 years
Most common breast mass in the adolescent and young adult population
Incidence decreases after 40 years
Diagnosis of a fibroadenoma
Usually found as a lump
Very round on x-ray or may need ultrasound to find it in young people
These are not fixed/tethered and does not cause skin dimpling
Epidemiology of Breast cancer
vary about 5-fold around the world
increasing in regions that until recently had low rates of the disease
Risk factors are linked to oestrogens
Risk is increased by early menarche, late menopause, and obesity in postmenopausal women
high concentrations of endogenous oestradiol are associated with an increase in risk
Childbearing reduces risk, with greater protection
What effect does OCP and hormonal therapy for menopause have on risk of breast cancer?
Increase in breast cancer risk, appears to diminish once use stops
Effect of alcohol on breast cancer
increases risk
Genetic mutations on breast cancer
increases risk but only accounts for a minority of cases
What is DCIS
ductal carcinoma in situ
Stage of cancer before it invades and is a factor of time
Pure DCIS cannot produce a metastasis
Has the potential to progress to invasion if left
what is DC NST
Ductal carcinoma of no special type
Learning points for breast cancer?
Does it clinically seem like cancer, look like cancer radiology/pathology
If the triple assessment is followed this should not happen.
what is the triple assessment for breast cancer?
Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. Together they give sensitivity of 99%.
What would a pathology report tell you about a malignancy
In situ or invasive Type Grade Size Vascular invasion. Nodal status Relationship to margins ER, PR and HER2 status
