Onello: Breast Diseases Flashcards
milk line
accessory nipples develop along here
polymastia
extra breast
polythelia
multiple nipples
amastia
abscence of breat nipple and possibly pectoralis
thelarche
breast development
age of thelarche
AA 12.1
caucasians-12.6
MC of gynecomastia in boys
NORMAL development d/t hormonal changes
no pubic hair
I
straight hair extending between labia
II
pubic hair increased in quantitiy, darker, typical female triangle
III
pubic hair more dense, curled, adult distribution
IV
abundant, adult pattern hair that can extend onto medial aspect of thigh
V
who breastfeeds more?
wealthier
more educated
caucasian
non smoker
how long should you breast feed
exclusive for 6 mos
continue for 1 year
why do many women stop breast feeding
insufficient milk supply
key cultural pt about breastfeeding
breastfeeding is a social behavior–we fail/learn how to breastfeed from those around us
common problems encountered during breastfeeding
does NOT fit western lifestyle
hard time feeding after maternity leave
not EASY thing
environmental contaminants in human breast milk
foods- chemicals
hygiene- lotion
pesticides/herbicides
pharmacologic contaminants in breast milk
OTC
prescription
key questions to ask during a breast exam
duration change over time relationship to menses- PERIODS STARTING EARLY, MENSES ENDING LATE nipple discharge presence of pain family hx- BRCA1, MATERNAL gyne-endo hx- NULLIPAROUS, 1ST CHILD AFTER 30, RADIATION EXPOSURE previous cyst aspirations hx of atypical breast hyperplasia
increases risk of breast cancer
nullparious
OR
if 1st child born after 30, radiation
clinical breast exam
inspect breasts seated and supine skin changes palpate entire area of breast nipple discharge supraclavicular/axillary lymph areas cofirm a palpable mass? be aware of normal structures that "mimic"
ideal time in pre-meopausal to do a breast exam
1st week post menses
MASS:
smooth
mobile
well demarcated
Reassuring
**cancer usually DOESN’T HURT
Mass: firm ill defined margins irregular fixed
worrisome
does breast cancer hurt?
not usually
lump/contour change–> cancer pulls the breast
skin tethering
nipple inversion
ulceration
nipple SCALING> Paget disease of the breast
edema/peau d/orange
Worrisome findings on a breast exam
do we recommend self breast exams?
Not recommended
peau d orange is usually a sign of
inflammatory breast cancer
most common complaints (pain, nipple discharge, skin changes, bresat lumpts) are…
BENIGN
BENIGN
freely moving and painless*
hyperplastic process of a single duct
10% disappear spontaneously
fibroadenoma
why does cystosarcoma phylloides need histological differentiation
25% are malignant
common infection caused by staph/strep
often requires I and D
and Abx
abscess
what do you do w/ a breast cyst
aspirate> release fluid
often curative
trauma may cause peripheral calcifications in the breast
how shoiuld you tx?
what should you consider?
watchfull waiting unless infected
physical abuse?
lumpy bumpy breasts
discrete masses
usually bilateral
increase in size/tenderness prior to menses
fibrocystic changes
thick, grey, black discharge
mammary duct ectasia
wart like growth in lining of mammary duct near nipple
+
Serous+/- BLOODY discharge
in 45-50 year old
intra-ductal papilloma
surgically remove it
should be done for any PALPABLE LESIONS
FNA
core needle bx
excisional bx
suspicious masses on imaging that should be biopsied
- needle localization
2. stereotactic bx
is a breast exam alone sufficient to reliably make a final dx when a breast mass is detected?
NO!
how should women <30 be evlauated
NOT mammograms
use US
1st line after breast exam?
mammography
when should you do mammogram?
controversial
after 50 annually
should you do a mammo in a pt w/ implants?
you bet
do most women w/ breast cancer have RFs?
NO
3/4 dont!
**possibly related to lifetime estrogen exposure
RF for bresat cacaner?
DCIS/LCIS age YOUNGER menarche first live birth AFTER 30 relatives w/ BC WHITE
