Bates/Lecture

Question 1

What breast mass is common between ages 15-25 during puberty and young adulthood?

Answer 1

Fibroadenoma

Question 2

How does a fibroadenoma present?

Answer 2

Round, disc-like, or lobular usually single, but may be multiple mass that may be soft, but usually firm that is well delineated and very mobile, non-tender without retraction sign

Question 3

What breast mass is common between ages 30-50 that repress after menopause except with estrogen therapy?

Answer 3

Cyst

Question 4

How does a cyst present?

Answer 4

Single or multiple round mass that is soft to firm, usually elastic, well delineated, mobile, often tender, without retraction sign

Question 5

What breast mass is seen between the ages of 30-90, but most common over the age of 50?

Answer 5

Breast cancer

Question 6

How does breast cancer present?

Answer 6

Usually single mass with an irregular or stellate shape that is firm or hard, not clearly delineated from surrounding tissues, fixed to skin or underlying tissue, usually non-tender, retraction sign may be present

Question 7

Fibrosis that is caused by shortening of the tissue that produces dimpling, changes in contour, and retraction deviation of the nipple on the breast

Answer 7

Retraction signs

Question 8

What are some causes of retraction signs?

Answer 8

Breast cancer, fat necrosis, and memory duct ectasia

Question 9

What position should the patient be in to look for skin dimpling?

Answer 9

Arms at rest, during special positioning, and on moving or compressing the breast

Question 10

What are the retraction signs?

Answer 10

• Skin dimpling
• Abnormal contouring
• Nipple retraction/deviation
• Edema of the skin
• Pagets disease of the nipple

Question 11

What produces edema of the skin?

Answer 11

lymphatic blockage

Question 12

What sign is seen with edema of the skin?

Answer 12

peau d’orange sign: thickened skin with enlarged pores usually seen first in the lower portion of the breast or areola

Question 13

What is seen with abnormal contours?

Answer 13

Any variation in the normal convexity of each breast compared one side with the other. Special positioning may be useful

Question 14

What is a retracted nipple?

Answer 14

Flattened or pulled inward that may also be broadened and feels thickened

Question 15

What can happen if nipple involvement is radially asymmetric?

Answer 15

It may deviate in a different direction from its normal counterpart, typically toward the underlying cancer

Question 16

Uncommon form of breast cancer that starts as a scaly, eczema like lesion that may weep, crust, or erode with possible breast mass

Answer 16

Paget’s disease of the nipple

Question 17

What can Paget’s disease present with?

Answer 17

invasive breast cancer or ductal carcinoma in situ

Question 18

When to suspect Paget’s disease?

Answer 18

persisting dermatitis of the nipple and areola

Question 19

What is the lifetime risk of breast cancer?

Answer 19

1 in 8!

Question 20

What is the most important risk factor with breast cancer/

Answer 20

AGE!

Question 21

Other risk factors for breast cancer?

Answer 21

• family history
• breast tissue density
• biopsy showing atypical hyperplasia
• Unopposed estrogen exposure (e.g. early menarche, late menopause, no pregnancies)
• radiation to chest wall

Question 22

What percentage of women with breast cancer have no identifiable risk factors?

Answer 22

> 50%

Question 23

What is important to know with a family history of breast CA?

Answer 23

Age of diagnosis

Question 24

What screening is done for a young patient with increased risk factors for breast cancer?

Answer 24

Start screening early - usually 10 years prior to the age that the family member was diagnosed - MRI every other year with mammograms in off years

Question 25

Diagnostic testing for a patient below 30 years old with nipple discharge/breast mass

Answer 25

Start with ultrasound only because younger breast tissue is more dense and harder to see things on mammogram

Question 26

Diagnostic testing for a patient over 30 years old with nipple discharge/breast mass

Answer 26

Ultrasound and mammogram usually ordered

Question 27

What age range do you start mammography?

Answer 27

40-50 years old - usually annually

Question 28

Risks of mammograms

Answer 28

False positives, over diagnosis

Question 29

When can you chose to stop giving patients mammograms for screening?

Answer 29

If life expectancy is less than 10 years

Question 30

What gene mutations can you suspect with breast cancer?

Answer 30

BRCA1 & BRCA2

Question 31

What can a positive family history for BRCA1 & BRCA2 include?

Answer 31

- 1st degree relative w/ breast CA BEFORE age 50 - ≥2 individuals in same lineage w/ breast CA - 1st degree relative w/ ovarian CA

Question 32

Recommendations for CBE

Answer 32

20-40 years old, every 2-3 years | >40, annually

Question 33

What are you looking for in CBE?

Answer 33

- Lump - Pulled in nipple - Dimpling - Dripping - Redness/rash - Skin changes

Question 34

What lymphatics should be palpated during CBE?

Answer 34

Infraclavicular, supraclavicular, and central deep axilla

Question 35

How should the patient be positioned on the table for inspection of the breasts?

Answer 35

Patient seated

Question 36

4 positions that the patient needs to be in during breast inspection

Answer 36

- Arms at sides - Arms over head - Hands pressed against hips - Leaning forward

Question 37

What position on the table should the patient be in during palpation?

Answer 37

Patient supine

Question 38

Where are 60% of breast cancers found?

Answer 38

Upper outer quadrant

Question 39

What characteristics do you need to describe if you find a breast mass/lump?

Answer 39

- location (by quadrant or clock, w/ centimeters from nipple) - size - shape - consistency - tenderness - mobility