e.naghshineh m.d1 in the name of god breast disease
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E.Naghshineh M.D 2
- Most common cancer in women- Lifetime risk of breast cancer: 12.5% (1 in 8)- Lifetime risk of death :3.6% (1 in 28 )
- Decrease if : screening- ( G.P ) or ( ob . Gyn )
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Risk factors
- Age (most important)-family history ( BRCA1 – BRCA 2 ) 5-10 % all breast cancer .
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- personal history Atypical Ductal hyperplasia
Atypical lobular Hyperplasia
Lobular carcinoma insitu
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Contra lateral breast cancer 0.5-1% /year
Ipsilateral recurrence (lumpectomy –Radiation ) 10 % or more in 10 year
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Age at first pregnancy (<30 yrs---30%, <20 yrs---50%)
breast – feeding (>24 months)
Bilateral oophorectomy
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-HRT HRT increase risk ( 10 %) HRT > 10 year increased Risk (E+P: highest risk) HRT smaller , less aggressive Breast cancer, lower mortalityHRT Not recommended for primary nor secondary prevention of heart disease
Not recommended for prevention of osteoporosis
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-prior exposure to radiation therapy
-7-10 yrs after radiotherapy-breast cancer risk in 40
years: 35%
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Alcohol (dose dependent)
-BRCA1 , BRCA 2 -45 % Early onset in Breast cancer
-90 % hereditary Ovarian cancer
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History & Physical
Exam Family History MenarchePrevious pregnancies Breast – feeding HRT
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Breast self Examination•Bilateral Exam after menses & before ovulation
•Supraclavicular -axilla
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Inflammatory appearance After Antibiotic therapy: Biopsy
Mammography (screening & fallow up )
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Mammography Screen of Asymptomatic patient Diagnose of breast cancer in
early stage mediolatenal Oblique (MLO),
Craniocaudal(CC) views Radiation Dose<0.1 Rad per study
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Negative mammogram not R/O Breast cancer
False Negative 10-15% If clinically positive Biopsy Screening mammography at 40 years 20-30 % Mortality
After 40 years: every 1-2 yrs
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BI-RADS CLASSIFICATION
0:Need Additional imaging evaluation Assessment is incomplete1:Negative2:Benign finding3:Probably benign finding Short interval follow-up suggested4:Suspicious abnormality Biopsy should be considered5:Highly suggestive of malignancy Appropriate action should be taken
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Breast ultrasoundD.Dx of Solid from cystic lesion
Guide for biopsyNo screening use( Not micro-calcification Dx)
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MRI•No role in cancer screening•High sensitivity(86-100%)•Low specificity(37-97%)•Expensive
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MRI Rupture of Breast implant pectoralis extension in
extensive breast cancer Post lumpectomy fibrosis Dense breast screening ?
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FNA Palpable thickening – mass DDx solid & cystic mass 21-25 needle,10 cc,3cc False negative 3-35% Atypical cells Biopsy False positive < 0.1 %
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Fibrocystic
change Most common Benign
breast disease 20-50 year Mastodynia – bilateral –
pre menstrual phase DDx: neuralgia, myalgia,
chronic costochondritis
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Fibro
Adenoma Second common Most common < 25 ys
Smooth, mobile, painless, Palpable mass
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Dx:-Physical exam -sonography –Mammography - FNA- Surgery if : Become Larger – atypia in FNA – patient desire
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Mastitis Breast feedingStaph Oreos – strep Continue Breast feedingTx:Dicloxacillin– Penicillin G If not cure: Biopsy R/O inflammatory carcinoma
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Ductectasia Pre-post menopause Hard erythematous mass adjacent to the areola with burning . itching – sensation of pulling in the nipple area .
Tx: Excisional Biopsy
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Multiple calcification in mammography
No increase risk of breast cancer
DDx : carcinoma
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Nipple
discharge 10-15% Benign, 2.5- 3 % malignant(milky – green – bloody – serous- cloudy – purulent ) bilateral- unilateral
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If nipple discharge : •Unilateral•Single duct•Menopause •Mass increase risk of cancer
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Ductal carcinoma Paget Disease Lobular carcinoma insitu Invasive ductal carcinoma Infiltrating lobular carcinoma Inflammatory carcinoma Metastases from
Extramammary tumors (lung,ovary,uterus,…)
Pathology
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