Normal and Abnormal Breast (Wootton)

Question 1

Progesterone is responsible for the growth of what in the breast?

Answer 1

stimulation of lobular growth and alveolar budding

Question 2

Estrogen is responsible for the growth of what in the breast?

Answer 2

growth of adipose tissue and lactiferous ducts

Question 3

Embryological origin of breast tissue?

Answer 3

modified sebaceous gland

Question 4

Polythelia

Answer 4

extra nipples

Question 5

Polymastia

Answer 5

accessory breast

Question 6

What are the two most common breast complaints?

Answer 6

breast pain and a mass

Question 7

What are some risk factors for breast cancer?

Answer 7

age (increases); hx of atypical hyperplasia; breast tissue density; first degree relative with breast/ovarian cancer; early menarche; late cessation of menses; nulliparity; height (tallness); long term use of OTC

Question 8

Physical exam of the breast

Answer 8

examine BOTH breast; examine axilla and chest wall; palpable masses always get a biopsy

Question 9

Mammography

Answer 9

detects lesions 2 years before they’re palpable; best in women 40+ (less dense); c/l breast should be images at the same time

Question 10

What is considered a suspicious finding on a mammogram?

Answer 10

densities and calcifications

Question 11

What category is considered “suspicious” in BI-RADS

Answer 11

category 4

Question 12

Category 1 in BI-RADS

Answer 12

what you want to see; negative; essentially 0% likelihood of malignancy

Question 13

Category 5 in BI-RADS

Answer 13

high suggestive of malignancy; >95% likelihood

Question 14

When should you consider an ultrasound?

Answer 14

young women under 40 yrs; patients with dense breast tissue; guidance when performing core needle biopsies

Question 15

When should you consider a MRI?

Answer 15

after a suspicious mass is seen on mammogram; post cancer diagnosis; patients at high risk for breast cancer (BRCA carriers)

Question 16

When should you do a fine needle biopsy?

Answer 16

need to determine solid vs cystic mass clear fluid needs NO further evaluation; bloody fluid need diagnostic mammogram/US

Question 17

When should you get a core needle biopsy?

Answer 17

larger needle used to get larger solid mass for diagnosis; will need local anesthesia

Question 18

Cyclic mastalgia

Answer 18

breast pain that starts at the luteal phase of the menstrual cycle and ends onset of menses

Question 19

Noncylic mastalgia

Answer 19

breast pain not associated with the menstrual cycle; includes tumors mastitis and cysts

Question 20

Extramammary mastalgia

Answer 20

breast pain due to chest wall trauma, shingles or fibromyalgia

Question 21

What is the only FDA approved treatment for benign breast disease?

Answer 21

Danazol; Wootton never prescribed b/c unpleasant side effects; deepens voice, unusual hair growth and weight gain

Question 22

Milky discharge with childbearing

Answer 22

may indicate hyperprolactinemia (look for anterior pituitary tumor) or HYPOthyroidism or related to meds (OTC/psychotropics)

Question 23

Bloody nipple discharge

Answer 23

considered cancer until proven otherwise; concerned for intraductal or invasive ductal carcinoma; could be benign intraductal papilloma; required evaluation with breast ductography and requires ductal excision

Question 24

Required workup on patients presenting with bloody nipple discharge

Answer 24

considered cancer until proven otherwise; required evaluation with breast ductography and requires ductal excision

Question 25

What are some of the concerns for malignancy in breast masses?

Answer 25

if greater than 2cm
immobile
firmness
skin dimpling/retraction/color changes
bloody nipple discharge
ipsilateral lymphadenopathy

Question 26

Which category of benign breast mass carries the highest risk for malignancy?

Answer 26

Proliferative with atypia

Question 27

What are the 4 non proliferative benign breast masses?

Answer 27

1. Fibrocystic change
2. Lactactional adenomas
3. Fibroadenomas
4. Galactocele

Question 28

What is the most common benign tumor in the female breast?

Answer 28

Fibroadenoma; seen in late teens early 20s; solid, rubbery, mobile, typically solitary (one)

Question 29

Galactocele

Answer 29

cystic dilation filled with milky fluid; occurs near time of lactation; typically can be needle aspirated

Question 30

What are the 4 proliferative without atypia benign breast masses?

Answer 30

1. epithelial hyperplasia
2. sclerosing adenosis
3. complex sclerosing lesion (radial scar)
4. papillomas

Question 31

What are the 2 proliferative with atypia benign breast masses?

Answer 31

1. Lobular carcinoma in situ (LCIS) - not a precursor to breast cancer BUT a risk factor to it
2. Ductal carcinoma in situ (DCIS) - women are at increased risk for developing invasive disease or reoccurrence DCIS

Question 32

How are LCIS and DCIS treated?

Answer 32

Both treated with excision and then followed with treatment with SERMs

Question 33

What is a woman’s lifetime risk for developing breast cancer?

Answer 33

1:8

Question 34

What is a woman’s lifetime risk for dying from breast cancer?

Answer 34

1:39

Question 35

What is a man’s lifetime risk for breast cancer?

Answer 35

1:883

Question 36

Rick factors for developing breast cancer?

Answer 36

black women under the age of 45 yrs; family hx and genetics (BRCA); radiation exposure

Question 37

Gail Model-Breast Cancer Risk

Answer 37

falsely elevated in patients with multiple breast biopsies

Question 38

What is one of the most important indicators of prognosis in breast cancer?

Answer 38

the stage at diagnosis; SCREENING is important

Question 39

Which breast malignancy disease has the best 5 year relative survival rate?

Answer 39

a localized disease (99%)

Question 40

What is considered a positive finding indicating a better prognosis in breast cancer?

Answer 40

estrogen and progesterone

Question 41

What is considered a bad finding indicating a worse prognosis in breast cancer?

Answer 41

Her2/neu (oncogene)