Clinical Correlation: Breast Exam (11/3) Flashcards Preview

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Flashcards in Clinical Correlation: Breast Exam (11/3) Deck (17)
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1

Lymphatic tissue drainage

90% ipsilateral axilla
10% internal thoracic nodes

1st site of metastasis usually

2

Epidemiology

1/8 lifetime risk for women
Most common cancer among women, 2nd leading cause of cancer deaths (lung)

3

BRCA1 and BRCA2

Family hx of breast/ovarian cancer
5-10% risk BRCA1 or BRCA2 gene (autosomal dominant)
1 - 65% BC by 70
2 - 45% risk

4

USPSTF: Mammography

Before 50 - individual decision w/ patient context
50-74 q2 years
Over 75 - unsure

5

USPSTF: BSE

Recommends against

6

USPSTF: CBE beyond mammography, >40yo

Evidence insufficient

7

USPSTF: MRI instead of mammography

Unsure

8

AAFP Guidelines

Recognize that recommendations do not end screening in women 40-49, just need individualized care
Guidelines similar to USPSTF (q2years mamm 50-74, not BSE, unsure 75

9

ACS Guidelines

40-44 choice to start annual
45-54 yearly
55

10

Is Mastalgia risk factor?

No

11

Cyclic vs noncyclic breast pain

Cyclic: Diffuse, bilateral, radiates to axilla (around luteal phase - increased water in stroma)
Non: Unilateral or focal
Focal merits evaluation w/ diagnostic imaging

12

nipple discharge

color, number of ducts, bilateral/unilateral, associated with mass
benign in 97% cases

13

Physiological Discharge

Physiologic: 1yr after breast feeding, endocrinopathy, meds/drugs

Bilateral, multiple ducts, associated with nipple stimulation/breast compression, milky white

14

Pathological Discharge

Spontaneous, unilateral, bloody, serous, clear or associated with mass
Intraductal papilloma, ductal ectasia, carcinoma, infection
mammography and subareolar US
Cytology

15

Benign masses

Discrete margins, no skin changes, smooth, soft to firm and mobile
i.e. fibroadenoma, cysts

16

Malignant masses

Hard, immobile, fixed, poorly defined margins - imaging warranted

17

Biopsy of breast masses

fine needle aspiration, US-guided core needle biopsy, excisional