WH - The Female Breast

Question 1

Where is the breast located?

Answer 1

It lies against the anterior thoracic wall, extending from the clavicle and second rib down to the sixth rib. It extends from the sternum across to the mid axillary line

Question 2

Describe the shape of the breast

Answer 2

The breast is more rectangular than round and has an axillary tail of breast tissue that extends toward the axilla

Question 3

Describe the middle part of the breast

Answer 3

The areola is a pigmented area surrounding the nipple

Question 4

Describe what the breast is made of

Answer 4

The breast is made of adipose tissue with milk glands

Question 5

Describe what is found in the axillary tail and what it does

Answer 5

Lymph glands are found in the axillary tail and are part of the lymphatic system which collects excess fluid in body tissue and returns it to the blood stream and makes immune cells

Question 6

List the concerning findings during a breast exam

Answer 6

Breast lumps, change in shape, nipple discharge, discoloration, change in texture, breast pain, enlarged lymph nodes

Question 7

Describe the most common palpable mass found in the breast of a 15-25 year old

Answer 7

Fibroadenoma; usually fine, round, mobile, tender

Question 8

Describe the most common palpable masses found in the breast of 25-50 year olds

Answer 8

Cysts - Usually soft to firm, round, mobile, often tender;
Fibrocystic changes - nodular, ropelike;
Cancer - Irregular, firm, not clearly delineated from surrounding tissue

Question 9

Describe the most common palpable masses found in the breast of women over the age of 50

Answer 9

Cancer until proven otherwise

Question 10

Describe the most common palpable masses found in the breasts of pregnant/breastfeeding women

Answer 10

Fibroadenomas, cysts, mastitis, cancer

Question 11

Describe a fibroadenoma

Answer 11

A benign tumor made of epithelial cells

Question 12

Describe a cyst

Answer 12

A closed sac that contains fluid or can have solid quantities; only fluid means simple cyst, fluid and solid qualities mean complex cyst

Question 13

Describe fibrocystic disease

Answer 13

Condition marked by palpable lumps in the breast usually associated with pain and tenderness; fluctuates with menstrual cycle and is worse pre-menstrually

Question 14

Describe the proper inspection of the breast

Answer 14

4 things: Asymmetry, Skin changes, Contour changes, Retraction;
4 different positions: Arms at sides, Arms overhead, Arms at hips, Leaning forward

Question 15

What should be asked if nipple retraction/indentation is observed?

Answer 15

Has it always been that way?

Question 16

What does atypical fullness/puckering indicate?

Answer 16

Potential pathology underneath

Question 17

What is the best position for breast palpation?

Answer 17

Supine position

Question 18

What fingers should be used to palpate the breasts?

Answer 18

Finger pads of 2,3,4

Question 19

Describe how palpation should be done

Answer 19

1. Be systematic
2. Can be done in a circular manner or up and down
3. Nipple should be palpated as well (discharge)
4. Remember to palpate the tail of breast and axilla

Question 20

How should physical findings of the breast be described?

Answer 20

The breast is divided into four quadrants based on horizontal and vertical lines which intersect at the nipple. Findings can be localized as the time on the face of a clock. Document size.

Question 21

Give an example of how to document a breast finding

Answer 21

Marble-sized lump in upper outer quadrant about 1 inch from the nipple

Question 22

Describe the quadrants of the breast and the percentage of area they make up

Answer 22

Upper outer quadrant - 50%
Upper inner quadrant - 15%
Lower outer quadrant - 11%
Lower inner quadrant - 6%
Nipple and areola - 18%

Question 23

What is a mammogram?

Answer 23

An x-ray of the breasts

Question 24

Describe how a mammogram works

Answer 24

Breasts are compressed between two plates to flatten the breast tissue

Question 25

Why get a mammogram and how long does it take?

Answer 25

It provides a better image to find abnormalities; it typically takes about 15-20 minutes

Question 26

What will the radiologist look for in a mammogram?

Answer 26

Calcifications; tiny mineral deposits within the breast tissue that appear as white spots on the image; they may or may not be cancerous

Question 27

Describe a macrocalcification

Answer 27

Large calcium deposits most likely caused by aging of the breast arteries, old injuries, or inflammation that are mostly related to non-cancerous conditions

Question 28

About how many women aged 50 or older have macrocalcifications found in their breasts?

Answer 28

about half

Question 29

Describe a microcalcification

Answer 29

Small specks of calcium in the breast that are more concerning than macrocalcifications but still usually do not mean cancer

Question 30

Describe a mass

Answer 30

An important change that can occur with or without calcifications. A mass can represent a cyst, a non cancerous solid tumor, or breast cancer; term used for a new finding

Question 31

Describe density

Answer 31

based on how fibrous, glandular, or fatty the breast is; younger women have denser breasts and it is harder to identify lumps in dense breasts

Question 32

What are the limitations to mammograms?

Answer 32

1. Cannot diagnose breast cancer, only identify findings
2. There may be false positive and false negatives
3. Patients with breast implants need extensive/different testing so it is important to alert the radiologist
4. They do not work as well in younger women due to denser breasts

Question 33

What are the recommendations for mammogram frequency by age in women with an average risk of breast cancer according to the ACS?

Answer 33

Age 40-44 should have the choice to start a mammogram annually;
Age 45-54 should get a mammogram every year;
Age 55+ should switch to getting a mammogram every 2 years or have the choice to continue yearly

Question 34

Under what conditions should breast screenings continue?

Answer 34

As long as the woman is in good health and is expected to live at least 10 years

Question 35

What does the ACS recommend for clinical breast exams (CBE) and breast self exams (BSE)?

Answer 35

They no longer recommend them for women of any age, however patients should know what their breasts feel like and look like to notice if there are any changes

Question 36

Describe a screening mammogram

Answer 36

patient has no symptoms but may have some risk factors

Question 37

Describe a diagnostic mammogram

Answer 37

something has been found by patient or provider that needs diagnosed; based on findings/symptoms

Question 38

What are some risk factors for breast cancer?

Answer 38

Family history, over age 50, female, history of other types of cancer, early onset menses and late onset menopause, no child or first child after the age of 30, dense breasts, genetic mutation

Question 39

How can breast cancer be prevented?

Answer 39

1. regular mammograms
2. regular physical activity
3. Decrease alcohol/smoking

Question 40

What should be done if nipple discharge is found?

Answer 40

Send away to determine what it consists of