7.1 Breast Disease

Question 1

What is mastalgia?

Answer 1

Breast pain

Question 2

What are the clinical presenting features of breast disease?

Answer 2

Physiological swelling
Nodularity
Breast pain - persistent unilateral mastalgia is concerning
Palpable breast lumps
Nipple discharge (including galactorrhoea) - unilateral blood stained is indicative of a malignancy
Breast infection and inflammation, usually associated with lactation

Question 3

What is thelarche?

Answer 3

Breast enlargement, sometimes initially unilateral, is the first obvious sign of puberty in girls (8-13 years of age).Breast buds may initially be unilateral.

Question 4

What is the most common benign breast disorder?

Answer 4

Fibrocystic change

Question 5

How does fibrocystic chance usually present?

Answer 5

Commonly affects women of 20-50 years
Pain and nodularity
Often more sore and painfu leading up to the onset of the period

Question 6

What is the causation of fibrocystic change of breast tissue?

Answer 6

Hormonal changes

Question 7

How does a woman with benign breast disease usually present?

Answer 7

Bilateral symptoms
Symptoms greatest a week before menstration and starts to decrease when it starts
On examination, may have area of nodularity or thickening that is poorly differentiated and often in the upper outer quadrant of the breast
Pain and tenderness of breast

Question 8

What is cyclical mastalgia?

Answer 8

Tenderness and pain in the premenstrual phase of the menstrual cycle
Affects two thirds of menstruating women
Resolves when menstruation starts

Question 9

Most benign lumps will be one of two things. What are they?

Answer 9

Cysts

Fibroadenomas

Question 10

How does a benign mass in the breast usually feel?

Answer 10

Three-dimensional 
Mobile
Smooth 
Regular borders
Solid or cystic consistency

Question 11

How are breast cysts treated?

Answer 11

Examination and referral as difficult to distinguish from tumour
USS
Aspiration if USS shows to be fluid filler

Question 12

What are fibroadenomas?

Answer 12

benign tumours that are common in young women, with incidence peaking at 20-24 years of age.
They are the most common type of breast lesion.
Arise in breast lobules and are composed of fibrous
and epithelial tissue

Question 13

How do fibroadenomas present?

Answer 13

They present as firm, non-tender, highly
mobile palpable lumps, regular borders. Hormones seem to be involved in aetiology, and hormone replacement therapy (HRT) increases the incidence.

Question 14

What is an intraductal papilloma?

Answer 14

A benign growth that occurs within a single milk duct. Can cause discharge, or if it occurs during breast feeding, can block the milk duct, causing swelling and pain as the drainage system is blocked.

Question 15

What is mammary duct ectasia?

Answer 15

Dilation of major ducts in the breast, filled with creamy fluid and periductal inflammation
Can cause nipple discharge, retracted nipple, acute inflammation, recurrent or chronic inflammation with abscess formation

Question 16

How is mammary duct ectasia treated?

Answer 16

Surgical excision of the major duct

Correction of the nipple retraction

Question 17

What causes mastitis?

Answer 17

Breast engorged and drainage not happening during lactation

Staphylococcus infection causing cellulitis and deep infection and may result in abscess.

Question 18

What is mastitis?

Answer 18

Generalised cellulitis of the breast

Question 19

How is mastitis treated?

Answer 19

If occurring during lactation then ensure adequate and regular drainage.
If due to staphylococcus infection then give antibiotics and maybe incision and drainage
If due to streptococcus, it may be more diffuse inflammation anal superficial infection treated with local wound care and antibiotics.

Question 20

How does mastitis present?

Answer 20

Point tenderness
Erythema
Fever
Generally associated with lactation

Question 21

What is periductal mastitis?

Answer 21

Less diffuse mastitis

More specific in location

Question 22

When are people referred via the suspected cancer pathway referral to a specialised breast clinic?

Answer 22

Aged ≥30 and have an unexplained breast lump with or without pain
Aged ≥50 with any of the following symptoms in one nipple only
Discharge
Retraction
Other changes of concern

Question 23

In suspected breast disease patient, which lymph nodes should be examined?

Answer 23

Axillary lymph nodes

Question 24

What is colostrum?

Answer 24

The thin yellow milky fluid secreted by the mammary gland a few days before or after childbirth

Question 25

What is the most common causative organism of acute mastitis?

Answer 25

Staphylococcus aureus