Breast referral and assessment

Question 1

what are the referral pathways for breast screening

Answer 1

• NHS breast screening
• Symptomatic pathway

Question 2

NHS breast screening programme

Answer 2

Age 50-70 yrs
3 yearly
Mammogram
Recall for bx if concern

Question 3

Symtomatic Pathway

Answer 3

2WW referral
New breast Sx
Triple assessment clinic

Question 4

Breast Screening aim

Answer 4

Early identification & Dx
Improved long-term outcomes
Improve prognosis

Question 5

who is high risk breast screening for

Answer 5

BRCA gene mutation
FMHx of breast ca
Mantle radiotherapy

Question 6

what is performed in high risk breast screening

Answer 6

Mammogram
MRI
Mx of risk
-Surveillance
-Medication
-Surgery

Question 7

what is the gold standard assessment of a breast complaint

Answer 7

Triple assessment

Question 8

CIP

What does a triple assessment involves

Answer 8

1.Clinical: Hx and examination
2.Imaging: USS / Mammogram
3.Histological Dx: core-cut bx / fine needle aspiration cytology

Question 9

what is the accuracy of triple assessment in Dx of breast ca

Answer 9

95%

Question 10

Breast Hx taking

Answer 10

other breast Sx / breast Hx
FMHx
Mentrual / obstetric Hx
PMHx
DH

Question 11

Most common PC in the breast

Answer 11

breast lump

Question 12

How many quadrants is the breast divide into

Answer 12

4

Question 13

what are the four locations of the breast divided into

Answer 13

upper outer
upper inner
lower outer
lower inner

Question 14

what is the axillary extension of the breast called

Answer 14

Axillary tail

Question 15

what are the four main Hx questions re: breast lump

Answer 15

Chronicity
Location
Size
Tender

Question 16

At which location is breast ca most likely to be found on the breast

Answer 16

upper outer quadrant

Question 17

Mamamogram indications

Answer 17

1. > 40 years
2. Ca is identified on USS breast
3. > 6mth since last mammogram

Question 18

USS breast indications

Answer 18

1. Any age
2. Focus Ix - (NOT for screening)
3. for discrete clinical abnormalities (lump / nodularity / nipple changes)

Question 19

Define Tomosynthesis

Answer 19

3D Mammography using low-dose X-rays

Question 20

Tomosynthesis indications

Answer 20

• diagnosing dense breasts, small tumors

Question 21

Breast MRI indications

gandolinium contrast

Answer 21

• High risk screening (BRCA mutation)
• Inconclusive mammogram / USS
• Gold standard for implant rupture
• Good for lobular breast ca

Question 22

Tissue sampling types

Answer 22

Biopsy – core / vacuum / punch
FNAC (fine needle aspiration cytology)
Nipple cytology

Question 23

FNAC Fine Needle Aspiration Cytology

Answer 23

Aspiration of cells from the mass - can identify malignant cells but no histology

Question 24

what is the difference btwn Bx and FNAC

Answer 24

Bx: Actual tissue of the mass
FNAC: cells from mass

Question 25

Assessment grading

Answer 25

1: Normal 2: Benign 3: Probably Benign 4: Probably malignant 5: Malignant

Question 26

what does a full breast asssessment include

Answer 26

1. Triple assessment 2. Grading 1-5 **(Clinical / Imaging / Histology)**

Question 27

Breast pathway

Answer 27

1.Screening or Symptomatic **(Clinical)** 2. **Imaging** 3. **Histology** (FNAC / Bx) 4. MDT + Tx plan 5. Further Ix: CT CAP staging, Bone scan (met), MRI, further Bx

Question 28

Breast 2WW referral criteria

Answer 28

- age 30 or > w/ unexplained breast lump - age 50 or > w/ unilateral nipple changes

Question 29

when would family history warrant referral to secondary care?

Answer 29

- Breast cancer in a **first-degree male** relative of **any age** - Breast cancer in a first-degree relative **under the age of 40** - Bilateral breast cancer in a first-degree relative under the age of 50 - Breast cancer in two first-degree relatives