Normal and Abnormal Breast Exam (Wootton)

Question 1

__1__ is responsible for growth of adipose tissue and lactiferous ducts.

__2__ is responsible for stimulation of lobular growth and alveolar budding.

Answer 1

1) Estrogen

2) Progesterone

Question 2

Early __1__ and late __2__ are risk factors for breast cancer.

Answer 2

1) Menarche (age <12)

2) Menopause (age >55)

Question 3

Is nulliparity or multiparity considered a risk factor for breast cancer?

Answer 3

Nulliparity

Question 4

Recent and long-term use of ____ is considered a risk factor for breast cancer.

Answer 4

Oral contraceptives

Question 5

What is able to detect lesions about two years before they become palpable.

They are best used in women of what age?

Answer 5

1) Mammography

2) 40 years and older

Question 6

Ultrasonography is useful in evaluating inconclusive mammogram findings and are best used in women of what age?

It allows differentiation between what lesions?

Answer 6

1) Younger than 40

2) Cystic vs solid lesions

Question 7

MRI is a useful adjunct to diagnostic mammography in suspicious masses and should be used in women at high risk for breast cancer like?

Answer 7

BRCA carriers

Question 8

Fine Needle Aspiration Biopsy with a 22-24 gauge needle is useful in determining ____ vs ____ mass.

Answer 8

Solid versus cystic

Question 9

With Fine Needle Aspiration Biopsy what type of fluid needs to be sent for cytology and patients needs a diagnostic mammogram/ultrasound?

Answer 9

Bloody fluid

Question 10

If cyst reappears or does not resolve with aspiration what should be done?

Answer 10

1) Mammogram/ultrasound

2) Perform biopsy

Question 11

What biopsy uses a large needle (14-16 gauge) to get tissue from larger solid masses?

Answer 11

Core Needle Biopsy

Question 12

Mastalgia (breast pain) that is cyclic starts at the __1__ of the menstrual cycle and ends after __2__.

Answer 12

1) Luteal phase

2) Onset of menses

Question 13

What are some extramammary causes of mastalgia?

Answer 13

1) Chest wall trauma
2) Shingles
3) Fibromyalgia

Question 14

The only FDA approved treatment for mastalgia in benign breast disease is?

Answer 14

Danazol

Question 15

What are some considerations for symptoms relief in mastalgia treatment?

Answer 15

1) Properly fitting bra
2) Weight reduction
3) Decrease caffeine intake
4) Vitamin E supplementation
5) Primrose oil

Question 16

Non-spontaneous, non-bloody (can be clear, green or yellow) and bilateral nipple discharge is most consistent with __1__ or __2__.

Answer 16

1) Fibrocystic changes

2) Ductal ectasia

Question 17

Milky discharge common with childbearing but may indicate __1__ or __2__.

Answer 17

1) Hyperprolactinemia

2) Hypothyroidism

Question 18

What type of nipple discharge should you consider cancer until proven otherwise?

Answer 18

Bloody

Question 19

Bloody nipple discharge should raise concern for __1__ or __2__.

Answer 19

1) Intraductal carcinoma

2) Invasive ductal carcinoma

Question 20

What features of breast masses should raise concern for malignancy?

Answer 20

1) Greater than 2cm in size
2) Immobility
3) Skin dimpling/retraction/color changes

Question 21

What non proliferative benign breast mass is characterized by lobular growth with increased number of glands?

Answer 21

Adenosis

Question 22

What is the most common benign tumor in female breast?

It usually presents in what age group?

Answer 22

1) Fibroadenomas

2) Late teen/early 20s

Question 23

What is characterized as a solid, rubbery, mobile and typically solitary mass?

Answer 23

Fibroadenomas

Question 24

What is characterized as a cystic dilation of duct filled with milky fluid that occurs near time of lactation?

Answer 24

Galactocele

Question 25

What proliferative benign breast mass without atypia is characterized by overgrowth of the cells that line the ducts?

Answer 25

Epithelial hyperplasia

Question 26

What proliferative benign breast mass without atypia is characterized by increased fibrosis within the breast lobules?

Answer 26

Sclerosing adenosis

Question 27

What proliferative benign breast mass without atypia is characterized by tubules trapped in a dense stoma surrounded by radiating arms of epithelium?

Answer 27

Complex sclerosing lesions (radial scar)

Question 28

What proliferative benign breast mass without atypia is characterized by intraductal growths, cause serous or serosanguinous discharge, and are typically seen in women 30-50 years of age?

Answer 28

Papillomas

Question 29

Breast masses due to proliferative lesions with atypia occur when malignant cells replace the normal epithelium lining the __1__ or __1__.

What are examples of these?

Both are treated with excision and then followed with administration of?

Answer 29

1) Ducts or lobules
2) Lobular carcinoma in situ and Ductal carcinoma in situ
3) SERM

Question 30

Majority of breast cancer occurs in women above what age?

What race has the greatest risk?

Answer 30

1) After 50

2) Caucasian

Question 31

What genes have a key connection to breast cancer?

Which one can cause breast cancer in men?

Answer 31

1) BRCA 1 and 2

2) BRCA 2

Question 32

Why are overweight patients at an increased risk for breast cancer?

Answer 32

Due to the increased conversion of androstenedione to estrone

Question 33

What makes up 70-80% of all breast cancers and are most common in women in their 50s?

Where do they spread to?

Answer 33

1) Ductal

2) Regional nodes

Question 34

What makes up 5-15% of breast cancers and are more likely to be multifocal and/or bilateral?

Answer 34

Lobular

Question 35

What disease presents as superficial skin lesions at the nipple and make up about 3% of breast cancers?

Answer 35

Paget’s disease

Question 36

What makes up 1-4% of breast cancers and presents with swelling and redness of underlying skin and induration of surrounding tissues?

Answer 36

Inflammatory breast cancer

Question 37

What is one of most important indicators of prognosis of breast cancer?

Answer 37

The stage at diagnosis

Question 38

Receptor status of what receptors should be assessed in addition to staging to determine prognosis?

Which has the worse prognosis and is found in 20-30% of invasive cancers?

Answer 38

1) Estrogen receptors
2) Progesterone receptors
3) Her2/neu receptors (worse prognosis)

Question 39

What are surgical options for breast cancer treatment?

Answer 39

1) Lumpectomy with radiation

2) Mastectomy

Question 40

Hormonal therapy such as using tamoxifen in premenopausal women are ____, which reduces risk of cancer in the contralateral breast as well.

Answer 40

Estrogen antagonists

Question 41

What type of drugs are Arimidex and Femara?

They prevent the production of what in postmenopausal women?

Answer 41

1) Aromatase inhibitors

2) Estrogen

Question 42

Trastuzumab (Herceptin) acts on protein made by ____ receptors.

Answer 42

Her2/neu