MLA Breast Flashcards
Which benign breast disorder is characterised as a well-circumscribed mobile breast lump?
Fibroadenoma
What is the age threshold for a diagnostic mammogram?
> 35 years of age
What is the most common benign breast lump in women aged 20-30 years?
Fibroadenoma
What is the first line of imaging for patients with a fibroadenoma (<35 years)?
Breast ultrasound
What is the first line management for fibroadenoma?
Reassurance - will spontaneously reduce in size
What are the surgical indications for fibroadenoma management?
Size >3 cm and symptomatic
Which benign breast disorder is associated with nipple discharge and retraction?
Duct ectasia
What is a significant risk factor for duct ectasia?
Smoking
What is mammography finding is observed in patients with duct ectasia?
Microcalcifications
What is the symptomatic management for duct ectasia?
Warm compress and supportive bra
What is the breast cancer referral indications for suspected cancer?
- Unexplained breast lump with or without pain in >30 years of age.
- Nipple changes of concern (in one nipple only e.g., discharge, retraction) in >50 years of age.
Which genes are associated with an increased predisposition to developing breast cancer?
(BRCA1, BRCA2 or TP53)
FHx of breast cancer in a first-degree relative <x years warrants screening?
<40 years
What pre-operative investigation is performed in patients with suspected breast cancer?
Axilla ultrasound
What is performed in in patients with breast cancer + axillary lymph node involvement?
Axillary node clearance
What is performed if axilla ultrasound demonstrates no lymph node involvement in patients with breast cancer?
Sentinel lymph node biopsy
What are the indications for a mastectomy?
Central tumour
Multifocal tumour
Large lesion in small breast
DCIS >4 cm
Pregnancy
What is offered post-wide local excision of the breast to reduce cancer recurrence?
Whole beast radiotherapy
What neoadjuvant endocrine therapy is offered to pre-menopausal women with Oestrogen receptor positive breast cancer?
Tamoxifen
What neoadjuvant endocrine therapy is offered to post-menopausal women with Oestrogen receptor-positive breast cancer?
Anastrozole (aromatase inhibitor)
What adverse effects are associated with tamoxifen?
Increased risk of thrombosis, and endometrial cancer; pregnancy
The risk of which cancer is increased in tamoxifen use?
Endometrial cancer
Pregnancy should be be attempted until how many months following tamoxifen discontinuation?
> 2 months
What is the main adverse effect associated with aromatase inhibitor?
Osteoporosis
What neoadjuvant therapy is prescribed to patients that are HER-2 positive?
Trastuzumab
What is the most common type of breast cancer?
Invasive ductal carcinoma
Which cancer does ‘no special type’ refer to?
Invasive ductal carcinoma
What are the main risk factors associated with invasive ductal carcinoma?
- Hormone exposure – Early menarche, late menopause, late 1st live birth; nulliparity OCP/HRT –i.e degree of unopposed oestrogen exposure.
What forms part of the triple assessment?
- Examination and history
- Imaging
- Biopsy
What prognostic index s used to stage primary breast cancer prognosis?
The Nottingham Prognostic index
What is the NHS breast screening programme?
Mammogram every 3 years for women aged 50-71 years of age.
Which breast malignancy is associated with Eczematoid changes of the nipple?
Paget’s disease of the nipple
What is the classic presentation of an intraductal papilloma?
Bloody or clear nipple discharge
What benign breast disease condition is characterised by cyclical breast lumpiness according to the menstrual cycle?
fibrocystic breast disease
Which breast disease can exhibit both benign and malignant characteristics?
Phyllodes tumour
What is revealed on fine needle aspiration of a breast cyst?
Straw-coloured fluid
What is a mimicker of breast cancer and typically occurs following trauma?
Fat necrosis
What is the most common cause of infective mastitis?
Staph aureus
What are the symptoms of a breast abscess?
- Fever/general malaise.
- A painful swollen lump in the breast, redness, heat, and swelling of the overlying skin.
- Lump may be fluctuant with skin discolouration.
What is the first line management for lactational mastitis?
Reassurance – CONTINUE breastfeeding (including from the affected breast)
- Provide analgesia e.g., paracetamol and ibuprofen.
What are the indications for prescribing antibiotics in mastitis?
Empirical: 500 mg flucloxacillin 500 mg QDS 10-14 days (alternative – erythromycin 250-500 mg)
* Nipple fissure that is infected
* Symptoms have not resolved/worse after 12-24 hours despite effective milk removal
* Breast milk culture is positive
What is the first line management for a breast abscess?
Urgent referral to breast surgeon for diagnostic ultrasonography.
* Ultrasound-guided needle aspiration + culture of fluid.
* Advice to continue breastfeeding.
