Normal and Abnormal Breast (Wootton) Flashcards
Progesterone is responsible for the growth of what in the breast?
stimulation of lobular growth and alveolar budding
Estrogen is responsible for the growth of what in the breast?
growth of adipose tissue and lactiferous ducts
Embryological origin of breast tissue?
modified sebaceous gland
Polythelia
extra nipples
Polymastia
accessory breast
What are the two most common breast complaints?
breast pain and a mass
What are some risk factors for breast cancer?
age (increases); hx of atypical hyperplasia; breast tissue density; first degree relative with breast/ovarian cancer; early menarche; late cessation of menses; nulliparity; height (tallness); long term use of OTC
Physical exam of the breast
examine BOTH breast; examine axilla and chest wall; palpable masses always get a biopsy
Mammography
detects lesions 2 years before they’re palpable; best in women 40+ (less dense); c/l breast should be images at the same time
What is considered a suspicious finding on a mammogram?
densities and calcifications
What category is considered “suspicious” in BI-RADS
category 4
Category 1 in BI-RADS
what you want to see; negative; essentially 0% likelihood of malignancy
Category 5 in BI-RADS
high suggestive of malignancy; >95% likelihood
When should you consider an ultrasound?
young women under 40 yrs; patients with dense breast tissue; guidance when performing core needle biopsies
When should you consider a MRI?
after a suspicious mass is seen on mammogram; post cancer diagnosis; patients at high risk for breast cancer (BRCA carriers)
When should you do a fine needle biopsy?
need to determine solid vs cystic mass clear fluid needs NO further evaluation; bloody fluid need diagnostic mammogram/US
When should you get a core needle biopsy?
larger needle used to get larger solid mass for diagnosis; will need local anesthesia
Cyclic mastalgia
breast pain that starts at the luteal phase of the menstrual cycle and ends onset of menses
Noncylic mastalgia
breast pain not associated with the menstrual cycle; includes tumors mastitis and cysts
Extramammary mastalgia
breast pain due to chest wall trauma, shingles or fibromyalgia
What is the only FDA approved treatment for benign breast disease?
Danazol; Wootton never prescribed b/c unpleasant side effects; deepens voice, unusual hair growth and weight gain
Milky discharge with childbearing
may indicate hyperprolactinemia (look for anterior pituitary tumor) or HYPOthyroidism or related to meds (OTC/psychotropics)
Bloody nipple discharge
considered cancer until proven otherwise; concerned for intraductal or invasive ductal carcinoma; could be benign intraductal papilloma; required evaluation with breast ductography and requires ductal excision
Required workup on patients presenting with bloody nipple discharge
considered cancer until proven otherwise; required evaluation with breast ductography and requires ductal excision
What are some of the concerns for malignancy in breast masses?
if greater than 2cm
immobile
firmness
skin dimpling/retraction/color changes
bloody nipple discharge
ipsilateral lymphadenopathy
Which category of benign breast mass carries the highest risk for malignancy?
Proliferative with atypia
What are the 4 non proliferative benign breast masses?
- Fibrocystic change
- Lactactional adenomas
- Fibroadenomas
- Galactocele
What is the most common benign tumor in the female breast?
Fibroadenoma; seen in late teens early 20s; solid, rubbery, mobile, typically solitary (one)
Galactocele
cystic dilation filled with milky fluid; occurs near time of lactation; typically can be needle aspirated
What are the 4 proliferative without atypia benign breast masses?
- epithelial hyperplasia
- sclerosing adenosis
- complex sclerosing lesion (radial scar)
- papillomas
What are the 2 proliferative with atypia benign breast masses?
- Lobular carcinoma in situ (LCIS) - not a precursor to breast cancer BUT a risk factor to it
- Ductal carcinoma in situ (DCIS) - women are at increased risk for developing invasive disease or reoccurrence DCIS
How are LCIS and DCIS treated?
Both treated with excision and then followed with treatment with SERMs
What is a woman’s lifetime risk for developing breast cancer?
1:8
What is a woman’s lifetime risk for dying from breast cancer?
1:39
What is a man’s lifetime risk for breast cancer?
1:883
Rick factors for developing breast cancer?
black women under the age of 45 yrs; family hx and genetics (BRCA); radiation exposure
Gail Model-Breast Cancer Risk
falsely elevated in patients with multiple breast biopsies
What is one of the most important indicators of prognosis in breast cancer?
the stage at diagnosis; SCREENING is important
Which breast malignancy disease has the best 5 year relative survival rate?
a localized disease (99%)
What is considered a positive finding indicating a better prognosis in breast cancer?
estrogen and progesterone
What is considered a bad finding indicating a worse prognosis in breast cancer?
Her2/neu (oncogene)
