Breast cancer Breast cancer -most common

-Second common ( Death )

- 211300 new case ( 2003 ) diagnosed

- Lifetime Risk 2.5 % ( 1-8 )

- Lifetime risk death 3.6 % ( 1-28 )

-Decrease if : ( screening )

- ( G.P ) or ( ob . Gyn ) ( screening )

Risk factor

- Age -family history ( BACA1 – BRCA 2 )

5-10 % all breast cancer .

+ personal history Atypical Ductal hyperplasia Atypical(lobular Hyperplasia ) Lobular cancinoma insitu

Contra lateral breast 0.5-1%

Ipsilateral recurrence

(lumpectomy –Radiation )

10 % in 10 year

Reproduction history Early menarche Late menopause Nulliparity

Age at first pregnancy

Breast – feeding Oophorectomy

HRT HRT increase 10 % HRT > 10 year increased Risk (E+P) HRT smaller , less aggressive B.CHRT No primary ( No secondary prevention of heart disease) Not recommended for prevention of

osteoporosis

Perior exposure to radiation

therapy

Other factor Jewish Black women Japanese Asian

Alcohol BRCA1 BRCA 2 45 % Early onset in B-C

90 % hereditary Ov – Ca

History & Ph – E History & Ph – E History Menarche Breast – feeding HRT

Trauma Surgery nipple discharge B-S Examination Bilateral Ex after means before ovulation

Supra clavicular - axilla Inflammatory appearance

After Antibiotic Biopsy If Biopsy benign mass R/O

Malignancy . Mammography(screening )

Mammography Screen of Asymptomatic patient

MLO(mediolatenal Oblique , Cranio cudal )

Dose 0.1 Rad per study ( 0.025)

Chest X Ray 0.025 Rad per study .

Negative mamo not R/O B-C False Negative 10-15% If clinically positive ( Biopsy ) Screening mamo 40 years

20-30 % Mortality After 40 years 1-2

Breast ultrasound + MRI

Solid – cystic lesion No screening

( Not micro – Ca )

Unltrasound cam complement mamo in a young pa with dense Breast

MRI No role in breast cancer screening

sensitivity 86-100 %

specifity 37-97 %

MRI MRI Breast implant for rupture Evaluation in pecroralis

Extensive B-C Post lumpectomy bed fibrosis

Dense breast

FNAFNA Palpable thichening – mass

21-25 needle 10 cc False negative 30-35% Atypical cell Biopsy False positive < 0.1 %

Fibrocystic change Most common Benign B.D 20-50 year Mastalgia – bilateral –

pre menstrual

Treatment

Fibro Adenoma Fibro Adenoma Second common < 25 ys . O womenPalpable mass smooth mobile painless

Mamo – sono – FNA – surgery IF :

Large – atypia in FNA – patient desire

Mastitis Mastitis Breast feeding Staph – strep Continue B-F Dicloxacillin 250 mg / QID –

Penicillin G If No Better Biopsy

Ductectasia Ductectasia Pre-post menopause Hard erythomatous mass

adjacent to the areola with burning . itching – sensation of pulling in the nipple area .

Excision Biopsy

Fat Necrosis Fat Necrosis Benign un common ( trauma ) Hard mass – irregular – skin

retraction

Multiple calcification in mamo

No increase carcinoma Differential diagnosis to carcinoma

Nipple discharge Nipple discharge 10-15% Benign 2.5- 3 % malignant

(milky – green – bloody – serous cloudy – purulent ) bilateral unilateral

Breast cancer Breast cancer

+ neutral History

Pathology Ductal carcinoma Paget Disease Lobular carcinoma insitu Invasive dactal carcinoma Infiltrating lobular carcinome Inflammatory carcinoma Metastases from Extramammoy trauma

Treatment Treatment Mastectomy Breast conservation therapy

Chemotherapy

- High dose chemotherapy - Neoadjuant chemotherapy

- Radiation –therapy

Stage – directed therapy Breast reconstruction

Special IssurSpecial IssurHereditary B-CaChemo Prevention