breast cancer -most common -second common ( death ) - 211300 new case ( 2003 ) diagnosed - lifetime...
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Breast cancer Breast cancer -most common
-Second common ( Death )
- 211300 new case ( 2003 ) diagnosed
- Lifetime Risk 2.5 % ( 1-8 )
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- Lifetime risk death 3.6 % ( 1-28 )
-Decrease if : ( screening )
- ( G.P ) or ( ob . Gyn ) ( screening )
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Risk factor
- Age -family history ( BACA1 – BRCA 2 )
5-10 % all breast cancer .
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+ personal history Atypical Ductal hyperplasia Atypical(lobular Hyperplasia ) Lobular cancinoma insitu
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Contra lateral breast 0.5-1%
Ipsilateral recurrence
(lumpectomy –Radiation )
10 % in 10 year
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Reproduction history Early menarche Late menopause Nulliparity
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Age at first pregnancy
Breast – feeding Oophorectomy
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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
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Perior exposure to radiation
therapy
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Other factor Jewish Black women Japanese Asian
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Alcohol BRCA1 BRCA 2 45 % Early onset in B-C
90 % hereditary Ov – Ca
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History & Ph – E History & Ph – E History Menarche Breast – feeding HRT
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Trauma Surgery nipple discharge B-S Examination Bilateral Ex after means before ovulation
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Supra clavicular - axilla Inflammatory appearance
After Antibiotic Biopsy If Biopsy benign mass R/O
Malignancy . Mammography(screening )
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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 .
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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
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Breast ultrasound + MRI
Solid – cystic lesion No screening
( Not micro – Ca )
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Unltrasound cam complement mamo in a young pa with dense Breast
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MRI No role in breast cancer screening
sensitivity 86-100 %
specifity 37-97 %
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MRI MRI Breast implant for rupture Evaluation in pecroralis
Extensive B-C Post lumpectomy bed fibrosis
Dense breast
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FNAFNA Palpable thichening – mass
21-25 needle 10 cc False negative 30-35% Atypical cell Biopsy False positive < 0.1 %
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Fibrocystic change Most common Benign B.D 20-50 year Mastalgia – bilateral –
pre menstrual
Treatment
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Fibro Adenoma Fibro Adenoma Second common < 25 ys . O womenPalpable mass smooth mobile painless
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Mamo – sono – FNA – surgery IF :
Large – atypia in FNA – patient desire
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Mastitis Mastitis Breast feeding Staph – strep Continue B-F Dicloxacillin 250 mg / QID –
Penicillin G If No Better Biopsy
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Ductectasia Ductectasia Pre-post menopause Hard erythomatous mass
adjacent to the areola with burning . itching – sensation of pulling in the nipple area .
Excision Biopsy
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Fat Necrosis Fat Necrosis Benign un common ( trauma ) Hard mass – irregular – skin
retraction
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Multiple calcification in mamo
No increase carcinoma Differential diagnosis to carcinoma
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Nipple discharge Nipple discharge 10-15% Benign 2.5- 3 % malignant
(milky – green – bloody – serous cloudy – purulent ) bilateral unilateral
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Breast cancer Breast cancer
+ neutral History
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Pathology Ductal carcinoma Paget Disease Lobular carcinoma insitu Invasive dactal carcinoma Infiltrating lobular carcinome Inflammatory carcinoma Metastases from Extramammoy trauma
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Treatment Treatment Mastectomy Breast conservation therapy
Chemotherapy
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- High dose chemotherapy - Neoadjuant chemotherapy
- Radiation –therapy
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Stage – directed therapy Breast reconstruction
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Special IssurSpecial IssurHereditary B-CaChemo Prevention