Transcript Slide 1

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
insitu
cancinoma
 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
– feeding
 Oophorectomy
 Breast
HRT
HRT
HRT
increase 10 %
> 10 year
increased Risk
(E+P)
HRT
B.C
smaller , less aggressive
HRT
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
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
– cystic lesion
 No screening
( Not micro – Ca )
 Solid
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

Breast implant for rupture

Evaluation in pecroralis
Extensive B-C
 Post lumpectomy bed fibrosis

Dense breast
FNA
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
 Second
common
 < 25 ys . O women
 Palpable
mass smooth
mobile painless
– sono – FNA –
surgery IF :
Large – atypia in FNA –
patient desire
 Mamo
Mastitis
Breast feeding
 Staph – strep
 Continue B-F
 Dicloxacillin 250 mg / QID –
Penicillin G
 If No Better
Biopsy

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

Benign un common ( trauma )

Hard mass – irregular – skin
retraction
Multiple calcification in mamo
 No
increase carcinoma
 Differential
diagnosis
to carcinoma
Nipple discharge
10-15%
Benign 2.5- 3 % malignant
(milky – green – bloody –
serous cloudy – purulent )
bilateral unilateral
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
 Mastectomy

Breast conservation therapy
 Chemotherapy
-
High dose chemotherapy
-
Neoadjuant chemotherapy
- Radiation
–therapy
– directed therapy
 Breast reconstruction
 Stage
Special Issur
 Hereditary
B-Ca
 Chemo Prevention