Module 3 (a) Breast Health Flashcards
1
Q
Breast Cancer Screening
A
- GOLD standard screening tool — Mammography
- Ultrasound
- Useful in young women
- Detects cystic vs solid masses
- Diagnóstico Vs screening
2
Q
Breast Cancer Screening
-High Risk Patient
A
- Contrast enhanced Mammography — Any high risks test are done in CONJUNCTION w/ mammography
- MRI
- High sensitivity but low specificity for breast cancer — can lead to further testing (biopsy)
- Requires dye injection with gadolinium — can leave deposits in the brain
3
Q
Benign Breast Disease
-Non-proliferative Lesions
A
- Fibrocystic changes, cysts, fibrosis, adenosis, lactational adenomatosos
4
Q
Benign Breast Disease
-Proliferative Lesions w/out Atypia
A
- Fibroadenomas, epithelial hyperplasia, sclerosis’s adenosis, complex sclerosis lesions (radial scar), papillomas
- Epithelial hyperplasia and sclerosing adenosis — Incidental findings
- Papillomas — May be symptomatic w/ yellow serous nipple discharge — Excision if discharge is present **
- Radial Scar — Often incidentally found on mammography, may mimic malignancy — Managed by breast surgeon
5
Q
Benign Breast Disease
-Proliferative Lesions WITH Atypia
A
- Atypical ductal hyperplasia, atypical lobular hyperplasia, flat epithelial atypia, LCIS
6
Q
Benign Breast Disease
-Mastodynia
A
- Breast pain, mastalgia
7
Q
Benign Breast Disease
-FIbroEpithelial Lesions
A
- Fibroadenoma (Most Common) — Round, oval, non-tender, firm, well circumscribed — ALWAYS BENIGN
- Phyllodes Tumor — Very similar to fibroadenoma; however, may grow rapidly**
—Most often benign, but rarely malignant
8
Q
Benign Breast Basses
-Cyst
A
- Often VERY TENDER, round, smooth soft and mobile
9
Q
Benign Breast Disease
-Lipoma
A
- Soft, Nintendo’s, will not be visualized on mammography
2. LIpoma will NOT be visualized on mammography
10
Q
Benign Breast Disease
-Galactocele
A
- Milk filled cyst, generally happen during or just after lactation
11
Q
Benign Breast Disease
-Hamartoma
A
- Firm, non-tender, often be an incidental diagnosis
12
Q
Benign Breast Disease
-Fat Necrosis
A
- Firm, I’ll-defined, non-tender, non-mobile — Post trauma like an MVA
13
Q
Proliferative Disease w/ Atypia
A
- Flat epithelial atypia, atypical lobular hyperplasia, atypical ductal hyperplasia, LCIS
- All of the above have a HIGH Increased risk for breast Cancer
- These women should be managed in a high risk breast cancer clinic ** — Counsel on breast cancer risk
-Increased Surveillance (Mammogram + MRI etc)
-Chemoprevention w/ tamoxifen, raloxifene or aromatase Inhibitor ** Not Managed in Primary Care
—These meds lower risk of CA up to 50%
14
Q
Breast Pain (Mastalgia, Mastodynia)
A
- Very common
- RARELY a presenting sign of breast cancer - Reassurance
- Treatment 1st line*
- Warm compress/Cold compress
- Anti-inflammatories / Acetaminophen
- Diclofenac gel topically - Symptomatic treatment, eliminate underlying cause and aggravating factors
- Supportive bra
- Breast imaging
15
Q
Breast Pain (Mastalgia, Mastodynia) -Types of Pain
A
- Cyclic Breast pain — correlated to menstrual cycle
- Non-cyclic breast pain — burning, localized, stabbing pain — r/t breast surgery or
- Extra-mammary pain — located outside of the breast — Trauma, nerve pain, Costochondritis
16
Q
Breast Pain
-Continued 1st line treatment options
A
- Change hormonal medications — HRT, Contraception — lower estrogen meds
- Caffeine abstinence — no data can trial but coffee is OKAY
- Evening primrose oil — controversial
- Vitamin E
17
Q
Breast Pain
-REASSURANCE?
A
- Breast Pain is rarely a presenting finding of breast cancer**
18
Q
Breast Key Health
-Red Flags
A
- Fixed, irregular, solid mass on examination
- Lymphadenopathy on exam or imaging
- Bloody nipple discharge
- Diffuse erythema with peau dórange of the skin which does not respond to antibiotics
- Flaking, scaly skin of the nipple which does not respond to topical treatments
19
Q
Paget’s Disease
A
- Cancer of the nipple
2. Typically starts with changed of the nipple and spares the areola — Skin punch biopsy
