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9 Cards in this Set
- Front
- Back
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Describe the overall approach to the patient presenting with a breast mass.
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1) History
2) Physical examination 3) Relative imaging and referral |
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Provide an overview of a focused history for a woman presenting with a breast mass.
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CURRENT SITUATION 2) Associated symptoms of the breast: pain, skin changes, nipple eversion, nipple secretions 3) Constitutional symptoms: energy, appetite, fever/chills, weight loss PROFILE (essentially looking for risk factors) Family history: presence of a first degree relative with breast CA Habits: smoking, ETOH intake Medical history, including menstrual history, obstetrical history, medications, and allergies |
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What are the risk factors for breast cancer?
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FAMILY HISTORY
First-degree relative only DEMOGRAPHIC RISK FACTORS Female sex Age White BEHAVIOURAL RISK FACTORS ETOH intake (in a dose-dependant manner) Current smoking MEDICAL RISK FACTORS Prolonged estrogen exposure: early menarche, late menopause, nulliparity or late age at first pregnancy, HRT |
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Provide an overview of a focused physical exam for a woman presenting with a breast mass.
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1) Wash hands 2) Anthropometrics 3) Blood pressure 4) Inspection of the breasts: skin changes, scars, asymmetry, nipple eversion 5) Palpation: one hand stabilizes the breast while the other palpates. Use the pads of the fingers and a circular motion (superficial, medium, deep) 6) Regional lymph node examination |
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What features on physical examination are consistent with malignancy?
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Mass is firm, fixed, with irregular borders
Associated skin changes Regional lymphadenopathy |
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How would you approach selecting an imaging modality for a woman with a breast mass?
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Mammography is the first diagnostic image that should be obtained in a woman with a breast mass.
1) ALL women with a suspicious mass should undergo diagnostic mammogram. Ultrasonography can be performed as an ADJUNCT to mammography. 2) In young women (<30) that have a mass with NO concerning features, ultrasonography alone can be used instead of mammography. |
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Why is mammography a sub-optimal modality in women <30? Give two reasons.
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1) Young breasts are hypersensitive to radiation and exposure should be avoided if possible.
2) The sensitivity of mammography DECREASES in denser breasts. Young women have denser breasts. |
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Give a differential diagnosis for a breast mass.
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Breast masses can be benign or malignant.
Benign: Fibroadenoma (solid mass in a young woman) Cyst Fibrocystic changes Galactocele (in breast feeding women) Fat necrosis |
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Describe your management of a patient with a breast mass with features consistent with cancer.
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Perform ALL of the above:
Diagnostic mammography Diagnostic ultrasonography with core biopsy Referral to general surgeon. |
