Normal and Abnormal Breast Exam (Wootton) Flashcards
__1__ is responsible for growth of adipose tissue and lactiferous ducts.
__2__ is responsible for stimulation of lobular growth and alveolar budding.
1) Estrogen
2) Progesterone
Early __1__ and late __2__ are risk factors for breast cancer.
1) Menarche (age <12)
2) Menopause (age >55)
Is nulliparity or multiparity considered a risk factor for breast cancer?
Nulliparity
Recent and long-term use of ____ is considered a risk factor for breast cancer.
Oral contraceptives
What is able to detect lesions about two years before they become palpable.
They are best used in women of what age?
1) Mammography
2) 40 years and older
Ultrasonography is useful in evaluating inconclusive mammogram findings and are best used in women of what age?
It allows differentiation between what lesions?
1) Younger than 40
2) Cystic vs solid lesions
MRI is a useful adjunct to diagnostic mammography in suspicious masses and should be used in women at high risk for breast cancer like?
BRCA carriers
Fine Needle Aspiration Biopsy with a 22-24 gauge needle is useful in determining ____ vs ____ mass.
Solid versus cystic
With Fine Needle Aspiration Biopsy what type of fluid needs to be sent for cytology and patients needs a diagnostic mammogram/ultrasound?
Bloody fluid
If cyst reappears or does not resolve with aspiration what should be done?
1) Mammogram/ultrasound
2) Perform biopsy
What biopsy uses a large needle (14-16 gauge) to get tissue from larger solid masses?
Core Needle Biopsy
Mastalgia (breast pain) that is cyclic starts at the __1__ of the menstrual cycle and ends after __2__.
1) Luteal phase
2) Onset of menses
What are some extramammary causes of mastalgia?
1) Chest wall trauma
2) Shingles
3) Fibromyalgia
The only FDA approved treatment for mastalgia in benign breast disease is?
Danazol
What are some considerations for symptoms relief in mastalgia treatment?
1) Properly fitting bra
2) Weight reduction
3) Decrease caffeine intake
4) Vitamin E supplementation
5) Primrose oil
Non-spontaneous, non-bloody (can be clear, green or yellow) and bilateral nipple discharge is most consistent with __1__ or __2__.
1) Fibrocystic changes
2) Ductal ectasia
Milky discharge common with childbearing but may indicate __1__ or __2__.
1) Hyperprolactinemia
2) Hypothyroidism
What type of nipple discharge should you consider cancer until proven otherwise?
Bloody
Bloody nipple discharge should raise concern for __1__ or __2__.
1) Intraductal carcinoma
2) Invasive ductal carcinoma
What features of breast masses should raise concern for malignancy?
1) Greater than 2cm in size
2) Immobility
3) Skin dimpling/retraction/color changes
What non proliferative benign breast mass is characterized by lobular growth with increased number of glands?
Adenosis
What is the most common benign tumor in female breast?
It usually presents in what age group?
1) Fibroadenomas
2) Late teen/early 20s
What is characterized as a solid, rubbery, mobile and typically solitary mass?
Fibroadenomas
What is characterized as a cystic dilation of duct filled with milky fluid that occurs near time of lactation?
Galactocele
What proliferative benign breast mass without atypia is characterized by overgrowth of the cells that line the ducts?
Epithelial hyperplasia
What proliferative benign breast mass without atypia is characterized by increased fibrosis within the breast lobules?
Sclerosing adenosis
What proliferative benign breast mass without atypia is characterized by tubules trapped in a dense stoma surrounded by radiating arms of epithelium?
Complex sclerosing lesions (radial scar)
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?
Papillomas
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?
1) Ducts or lobules
2) Lobular carcinoma in situ and Ductal carcinoma in situ
3) SERM
Majority of breast cancer occurs in women above what age?
What race has the greatest risk?
1) After 50
2) Caucasian
What genes have a key connection to breast cancer?
Which one can cause breast cancer in men?
1) BRCA 1 and 2
2) BRCA 2
Why are overweight patients at an increased risk for breast cancer?
Due to the increased conversion of androstenedione to estrone
What makes up 70-80% of all breast cancers and are most common in women in their 50s?
Where do they spread to?
1) Ductal
2) Regional nodes
What makes up 5-15% of breast cancers and are more likely to be multifocal and/or bilateral?
Lobular
What disease presents as superficial skin lesions at the nipple and make up about 3% of breast cancers?
Paget’s disease
What makes up 1-4% of breast cancers and presents with swelling and redness of underlying skin and induration of surrounding tissues?
Inflammatory breast cancer
What is one of most important indicators of prognosis of breast cancer?
The stage at diagnosis
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?
1) Estrogen receptors
2) Progesterone receptors
3) Her2/neu receptors (worse prognosis)
What are surgical options for breast cancer treatment?
1) Lumpectomy with radiation
2) Mastectomy
Hormonal therapy such as using tamoxifen in premenopausal women are ____, which reduces risk of cancer in the contralateral breast as well.
Estrogen antagonists
What type of drugs are Arimidex and Femara?
They prevent the production of what in postmenopausal women?
1) Aromatase inhibitors
2) Estrogen
Trastuzumab (Herceptin) acts on protein made by ____ receptors.
Her2/neu
