Term
| why have rates of breast CA not improved since the 1950s? |
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Definition
| people are still not being screened to the level which would decrease incidence |
|
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Term
| what is the prognosis for early breast CA? |
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Definition
|
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Term
| what is the incidence of invasive breast CA in the US? |
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Definition
| 1 in 8 women in the US will develop invasive breast CA |
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Term
| what benign findings can mimic breast CA? |
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Definition
| cyst, fibroadenoma, mastitis, gynecomastia, and supernumerary breast |
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Term
| how does mammography compare w/US in terms of diagnosing lesions? |
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Definition
| mammography: good for diagnosing solid lesions. US: good for diagnosing fluid-filled lesions. |
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Term
| what characterizes cysts a benign finding of the breast? |
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Definition
| cysts are *most common in younger pts. they can be aspirated to dx/tx. US is also a good diagnostic modality for most cysts, which appear homogeneously dark (no septae, etc). however, there are complex cysts which may be a little harder to dx, as they appear more cloudy (contain some blood, septae, etc) and the index of suspicion goes up a little for these. |
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Term
| how is a breast cyst aspirated? |
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Definition
| the cyst needs to be palpated first, then a breast aspirator is used w/one hand (for even pressure) and the other hand holds the breast. |
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Term
| why does mammography not work as well for younger pts? |
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Definition
| mammography works b/c older breasts have more fatty tissue which shows up as black and any fibrous lesions show up as white. in younger breasts, which are more generally fibrous, atypical fibrous tissue just blends in on a mammogram. |
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|
Term
| how will a cyst feel on palpation? |
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Definition
| well-circumscribed and mobile (may come and go in association w/periods, diet, etc). fixed lesions are more concerning. |
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Term
| what is the second most common breast lesion in younger pts? what characterizes it? |
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Definition
| fibroadenomas - which are solid and do not come and go, but they are mobile. these lesions demand some kind of imaging to r/o malignancy and should appear well circumscribed on such. if there is doubt of benignity on imaging, a bx will then be required. on US, fibroadenomas will have acoustic shadowing due to their solid nature. |
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Term
| what are giant fibroadenomas? |
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Definition
| a subclass of adenoma which affects pts 12-16 y/o. 1% contain a malignancy, so they should be removed. the breast tissue is compressed by giant fibroadenomas and should return to normal shape once the lesion is removed (should allay cosmetic concerns). |
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Term
| what can mastitis mimic? how is it differentiated? |
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Definition
| inflammatory breast CA, both of which affect young women. mastitis should resolve with tx in a week or so, so if it doesn't - need to r/o malignancy. |
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Term
| what is a supernumerary breast? |
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Definition
| a relatively common lesion which can be misdiagnosed as a lipoma - but is actually composed of breast tissue and will therefore give symptoms w/periods or pregnancy. there is potential for supernumerary breasts to develop a malignancy just as w/any other breast tissue. these usually develop along the milk line. there may also be just a supernumerary nipple which would then mimic a mole. |
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Term
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Definition
| enlargement of breast tissue in males, sometimes associated w/H2 antagonists or prostate problems. |
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Term
| what are important elements of the hx to r/o breast CA? |
|
Definition
| gender, age, fam hx (both mother/father's side), genetics (BRCA1/2), hx of hyperplasia on bx, nulliparous (longer unopposed estrogen drive), OCPs (slight increase in breast CA risk), and obesity |
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Term
| what is the first question before checking a woman for breast CA? |
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Definition
| "do you do your own self-exams?" if they say no - impress upon them the importance of doing so. tell them just to worry about monitoring changes, not to focus on what exactly they are feeling. |
|
|
Term
| what is the anatomy of the breast? |
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Definition
| septated lobules over a muscle tissue (which may mimic a lesion). |
|
|
Term
| what 2 planes is a breast palpated in? |
|
Definition
| standing up and lying down. |
|
|
Term
| what is hand placement in a breast exam? |
|
Definition
| the hand should be flat, pushing the breast against the chest wall or your other hand (need to have a background). |
|
|
Term
| where are common places to miss breast CA? |
|
Definition
| the nipple-areolar complex and inframammary fold |
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|
Term
| what needs to be checked nodally w/a breast exam? |
|
Definition
| the axillary nodes, clavicular, and internal mammary chain of lymph nodes |
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|
Term
| why should self-breast exams be performed in a mirror? |
|
Definition
| so that changes in skin contour/color/venous pattern may be seen |
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|
Term
| is breast dyssymmetry indicative of malignancy? |
|
Definition
| no - this is more common than not |
|
|
Term
| what diagnostics are used to work up a suspicious breast lump? |
|
Definition
| mammogram, US, MRI (if mammogram is hard to read), and bx/aspiration |
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|
Term
| how can you help prepare a pt for her first mammogram? |
|
Definition
| warn her that it will be uncomfortable (requires a large amount of compression) |
|
|
Term
| what is the BI-RADS classification? |
|
Definition
| a rating 1-5 for mammograms, which increases w/perceived likelihood of malignancy. however - a BI-RADS of "0" just means inconclusive, not benign (requires other images). BI-RADS 1: normal (uncommon), 2: finding benign (more common), 3: probably benign, 4: probably malignant, 5: malignant. BI-RADS 3-4 requires more diagnostics. |
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|
Term
| what are macrocalcifications associated with? |
|
Definition
|
|
Term
| what are microcalcifications associated with? what does this require (b/c palpation may not be sufficient)? |
|
Definition
| malignancy - esp in clusters/swirls, so it requires more of a workup such as: a compression mammogram, stereotactic bx, US-guided bx, and needle localization bx (needle hooks it on x-ray, then incision is made to cut out hooked lesion). |
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Term
| what is an extended radical mastectomy? |
|
Definition
| removal of the breast, pectoralis major/minor, and all axillary/internal mammary nodes - not done any more b/c of morbidity/mortality associated w/just the procedure. |
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|
Term
| what is a radical mastectomy? |
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Definition
| removal of the breast, pectoralis major/minor, and all axillary mammary nodes |
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|
Term
| what is a modified radical mastectomy? |
|
Definition
| removal of the breast, pectoralis minor, and all axillary mammary nodes |
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|
Term
| what is a simple mastectomy? |
|
Definition
| removal of just the breast tissue |
|
|
Term
| what is a partial mastectomy? |
|
Definition
| removal of just the lesion (if this is an entire quadrant of the breast - quadrantectomy) |
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|
Term
| what is a sentinel node bx? |
|
Definition
| sample the first node draining the breast, if it is positive for CA - then remove all the nodes. otherwise, the nodes are left in. |
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