Module 6 Study Guide

Question 1

What are more worrisome findings with nipple discharge?

Answer 1

Spontaneous, unilateral, from a single duct, clear/bloody/serosangenous, associated with a mass, occurs in older women

Question 2

What are less worrisome findings with nipple discharge

Answer 2

Occurs with manipulation or stimulation, bilateral, multiductal, milky, yellow, green, black or brown

Question 3

What is mastalgia?

Answer 3

Breast pain

Question 4

How will you evaluate mastalgia?

Answer 4

Collect a history, complete a clinical breast exam

Question 5

What are the likely causes?

Answer 5

Often cyclical beginning after ovulation and resolving with period. Common with pregnancy. Can be caused by significantly increased caffeine intake. Can be caused by exogenous hormones in hormone therapy (pt may have started it recently). Can also be costocondritis.

Question 6

What diagnostic tests will you do?

Answer 6

Only mammogram or U/S if other symptoms such as a mass are also present.

Question 7

What is the appropriate first-line treatment?

Answer 7

Education. It is typically benign

Question 8

What is the purpose of a clinical breast exam?

Answer 8

To identify or rule out dominant masses and assess for skin and lymph node changes that could indicate malignancy.

Question 9

What are more concerning findings on a clinical breast exam?

Answer 9

Fixed, hard, rough edges

Question 10

What are less concerning findings on a clinical breast exam?

Answer 10

Smooth, mobile, soft, tender

Question 11

At what age is a palpable mass more likely to be breast cancer?

Answer 11

55 y/o

Question 12

What are some skin indicators of breast CA?

Answer 12

Peau d’orange
Inflammation (looks like mastitis without flu symptoms)
Paget’s disease (redenned, sore, flaky nipple that is unresponsive to steroids)

Question 13

What should you do if you find a concerning clinical finding, but the mammogram comes back negative?

Answer 13

Refer/continue work up

Question 14

What are current breast cancer screening recommendations? If they differ, why?

Answer 14

Self Exam: USPSTF, WHO and other suggest AGAINST self breast exam. It is shown not to be affective against breast cancer mortality
Clinical Exam: Clinical breast exam are not useful either. Often result in false positive or negative. ACOG recommends shared decision making for and other suggest AGAINST.
Mammography: Screening mammograms are shown result in overdiagnosis and treatment without significant benefit. There is no mortality reduction overall in screening mammopraphy.
USPSTF: Begin q 2 yr screening at age 50; individual decision about beginning screening prior to age 50 (may benefit starting at 40 if parent, sibling or child affected); no evidence of benefit after age 75
ACS: Begin annual screening at age 45 (may start at 40 if desired). Annual until age 54, then q 2 years.
ACOG: Begin 1-2 year screening at age 50; May start at age 40 if desired. Stop or not at age 75.
Breast Ultrasound: Is not part of screening but is used first line for diagnosis. Can be used adjunctly for screening.

Question 15

What can the falling breast cancer mortality be attributed to?

Answer 15

Improved treatments

Question 16

Why do breast screenings help some women?

Answer 16

Screening helps some women by advancing the time of diagnosis of CA destined to become larger, it more often identified women with small CA that otherwise would never have bothered them

Question 17

Are all breast cancers harder to treat at larger sizes?

Answer 17

No. For some small CA destined to become larger, there may be no benefit from early detection because they are equally treatable at either size

Question 18

What can we say to women who are unsure if they want screening mammography?

Answer 18

Screening mammography is a choice. Women who feel good about screening can feel good about continuing it, those who do not, can feel equally good about not pursuing it

Question 19

Describe the CDC recommendations for HPV vaccination.

Answer 19

Boys and girls who are vaccinated at age 11 to 14 only need 2 doses of vaccine 6-12 months apart, and older teens and adults need all 3. This is because younger teens develop greater immunity from the vaccine than do older teens and young adults. The Gardisil-9 vaccine has now been approved for women and men aged 27 - 45, who need a 3-dose series for full protection like older teens do. Be aware that early intercourse as a risk factor for cervical cancer isn’t the same as societally-defined early intercourse. Early intercourse for cervical cancer risk means within a couple of years of menarche/puberty.

Question 20

What is the purpose of cervical cytology screening today?

Answer 20

To detect precursor lesions that could become cancer if left untreated. Identifying and appropriately treating these pre-malignant lesions before they progress means that, in most cases, invasive cervical cancer can be prevented.