Lecture 5: Normal and Abnormal Breast Exam

Question 1

How do estrogen and progesterone affect the growth of the breast tissue?

Answer 1

• Estrogen is responsible for growth of adispose tissue and lactiferous ducts
• Progesterone is responsible for stimulation of lobular growth and alveolar budding

Question 2

What are some of the risk factors for breast cancer?

Answer 2

• High breast tissue density
• Early menarche (age <12)
• Late cessation of menses (age >55)
• No term pregnancies
• Never breastfed
• Recent and long-term use of OC’s
• Postmenopausal obesity

Question 3

A palpable mass of the breast will almost always get what type of evaluation?

Answer 3

Biopsy (FNA/core/excisional)

Question 4

Mammograms are best in women of what age; how often?

Answer 4

40 years and older; annually

Question 5

What type of breast imaging allows for differentiation between cystic vs. solid lesions as well as visualizing solid tissue within or adjacent to a cyst that may be malignant?

Answer 5

Ultrasonography

Question 6

When is ultrasonography useful in examination of the breast?

Answer 6

• Useful in evaluating inconclusive mammogram findings
• Best for evaluating young women (<40) and others w/ dense breast tissue
• Allows to differentiate between cystic vs. solid lesions as well as show solid tissue within or adjacent to a cyst that may be malignant
• Used for guidance when performing core needle biopsies

Question 7

When is MRI useful for evaluating the breasts?

Answer 7

• As adjunct to diagnostic mammography in suspicious masses
• Post-cancer diagnosis for further evaluation of staging
• Used w/ implants
• Women at high risk for breast cancer like BRCA carriers

Question 8

Which technique is useful in determining if a breast mass is solid vs. cystic?

Answer 8

Fine needle aspiration biopsy

Question 9

What is the next best step if fine needle aspiration of a breast mass contains bloody vs. clear fluid?

Answer 9

• Clear fluid needs no further evaluation
• Bloody fluid sent for cytology and pt neds a diagnostic mammogram/ultrasound

Question 10

What is the next best step if a breast cyst reappears or does not resolve with aspiration?

Answer 10

Perform diagnostic mammogram/ultrasound and perform biopsy

Question 11

What is core needle biopsy of the breast used for; how many samples taken?

Answer 11

• Used to get tissue from larger solid masses for diagnosis
• 3-6 samples about 2cm long are obtained

Question 12

What are the 3 categories of benign mastlagia (breast pain)?

Answer 12

• Cyclic = starts at luteal phase of menstrual cycle and ends after onset of menses
• Noncyclic = tumors, mastitis, cysts; can be assoc. w/ some meds (anti-depressants/hypertensives, hormonal meds (OCP’s))
• Extramammary = chest wall trauma, shingles, fibromyalgia

Question 13

What is the only FDA approved treatment for benign mastalgia (breast pain) and what are the AE’s?

Answer 13

• Danazol
• AE’s = menstrual irregularities, benign intracranial HTN, alters blood sugar, deepens voice, unusual hair growth and weight gain

Question 14

What are some recommendations for symptom relief of benign mastalgia?

Answer 14

• Properly fitting bra
• Weight reduction
• Exercise
• ↓ caffeine intake
• Vit E supplementation and evening of primrose oil

Question 15

Non-spontaneous, non-bloody (can be clear, green or yellow) and bilateral nipple discharge is most consistent with what?

Answer 15

Fibrocystic changes or ductal ectasia

Question 16

Bloody nipple discharge is considered what?

Answer 16

CANCER until proven otherwise!

Question 17

Which benign process of the breast can produce bloody nipple discharge?

Answer 17

Intraductal papilloma

Question 18

How is bloody nipple discharge evaluated clinically?

Answer 18

Breast ductography and requires ductal excision

Question 19

What are some characteristics of a breast mass that would be a concern for malignancy?

Answer 19

• >2 cm in size
• Immobility w/ poorly defined margins
• Firmness
• Skin dimpling/retraction/color changes
• Bloody nipple discharge
• IPSILATERAL lymphadenopathy

Question 20

What is the most common benign tumor in female breast; when does it arise?

Answer 20

• Fibroadenoma = solid, rubbery, mobile and typically solitary
• Usually in late teens and early 20’s

Question 21

Which type of benign breast mass is an intraductal growth typically seen in women 30-50 y/o and causes serous or serosanguinous discharge?

Answer 21

Papillomas

Question 22

How are LCIS and DCIS of the breast treated?

Answer 22

Both w/ excision and then followed with SERM tx

Question 23

Which ethnicity has greater risk of breast cancer?

Answer 23

Caucasian women

Question 24

70-80% of all breast cancers are what type?

Answer 24

Ductal

Question 25

Which type of breast cancer is more likely to be multifocal and/or bilateral?

Answer 25

Lobular

Question 26

Using the Gail Model-Breast Cancer risk tool, which women are considered high risk and how should they be managed?

Answer 26

• Women w/ 5-year risk of 1.7% or more
• Counseled on prophylactic therapy (chemoprevention, mastectomy, oophorectomy)

Question 27

What should be used in addition to staging for the treatment of breast cancer?

Answer 27

Receptor status - estrogen and progesterone (positive finding)

Question 28

Which 2 surgical options for breast cancer have equivalent outcomes?

Answer 28

• Lumpectomy w/ radiation
• Mastectomy

Question 29

Which drug can be used for Her2/neu-positive breast cancers; but what are the AE’s?

Answer 29

• Trastuzumab
• AE’s: heart failure, respiratory problems, serious allergic rxns

Question 30

What is the recommended timeline for treatment follow-up for breast cancer; when do the majority of reoccurrences happen?

Answer 30

• During the first 2 years after diagnosis = every 3-6 months
• Annually after first 2 years
• Most reoccurrences happen within first 5 years after tx