Breast Cancer

Question 1

What are risk factors?

Answer 1

Genetic BRCA 1/2 mutation
Family History
Menstrual- early menarche, late menopause
Reproductive- nulliparity or late 1st pregnancy
Hormonal e.g. COCP or Combined HRT

Question 2

What are clinical features?

Answer 2

Breast lump- painless, hard, tethered
Axillary lymphadenopathy
Nipple changes
Skin changes- dimpling, puckring, peau dorange

Question 3

What is the referral criteria for2WW?

Answer 3

Breast lump aged >30
Unexplained axillary lump >30
Age >50 with unilateral nipple changes
Peau d’orange or other suspicious skin changes
<30 with lump non urgent referral

Question 4

What assessment is required?

Answer 4

Tripple assessment
1) History and exam
2) Imaging
-<40 then US
>40 then mammogram
3) Biopsy

Question 5

What is the management?

Answer 5

Surgery
- wide local excision
-mastectomy
- lymph node biopsy

Chemo/Radio
- for adjuvant settings

Hormonal therapy
- Tamoxifen ER+ve, premenopausal
- Aromoatase inhibitors (postmenopausal)

Biologicals
- Trastuzumab for HER 2+ve
– cardiotoxic need ECHo before during and after

Question 6

What is the screening process?

Answer 6

Women aged 50-70 mammogram every 3 years

Specialist referral if any of the following
- 1st degree relative with BC <40
- 1st degree male relative with BC
- 1st degree relative with bilateral BC (first <50)
- One BC and one ovarian cancer in family
- 3 1st/2nd relatives with BC at any age

Question 7

What are features of breast cyst?

Answer 7

Smooth fluid filled
Painful
Size varies with cycle

Question 8

What are features of fibroadenoma?

Answer 8

Discrete
rubbery
Non tender
Highly mobile

Question 9

What are features of fat necrosis?

Answer 9

Obese women
Often occurs post trauma

Question 10

What are features of breast abscess?

Answer 10

Painful lump associated with fever, malaise
Occurs mainly during breast feeding