Transcript IN THE NAME OF GOD

Breast Disease
Dr.F Behnamfar MD
Introduction
 Early detection is improved by risk assessment, breast
examination, and screening mammography
 The most common benign breast problem include
fibrocystic change and mastalgia, best treated by
reassurance
 Spontaneous unilateral bloody discharge requires
histologic evaluation but usually is caused by benign
condition
 Benign Breast disease is a complex entity of its own with a
range of physiologic changes and clinical manifestations
that have an impact on a woman health
Detection
 Nipple discharge
 Breast mass
 Breast pain
 Association of symptoms with menstrual cycle
 Change in breast shape ,size or texture
 Previous breast biopsies
Risk factors for breast cancer
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Increasing age
Age of menarche<12
Menopause>55
Nuliparity or first pregnancy after 30
Family hx especially premenopausal or bilateral
disease
Number of first degree relatives with breast cancer
Family hx of male breast cancer
BRCA1,BRCA2 positive
Other malignancies
Physical Exam
Breast cancer usually is asymptomatic and is discovered
only by physical exam or screening mammography
 Inspection
Symmetry
contour
skin appearance
erythema
skin dimpling
nipple retraction
 Palpation
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Entire breast
axillary and supraclavicular area
Temprature
Texture
tickness of skin
generalized or focal tenderness
Nodularity
Density
Assymetry
dominant masses
nipple discharge
Breast Self Examination
 Most breast cancers are detected by women themselves
 Teach SBE early so that it becomes habitual
Essential components of SBE
Seven P:
position
palpation,
pad of fingers,
pressure,
perimeter ,
pattern of search
patient education
Breast Self Examination
 Premenopausal, monthly 7-10 days after onset of
menarche
 Post menopausal, specific calendar date monthly
Breast Imaging
 Screen film mammography, best method
 Digital: lower radiation, optimal view, higher detection rate
 Slow growing cancers ,identified 2years before being
palpated
Indications
 Screen
 Evaluate mass
 Baseline
 Search for occult cancer in metastatic disease
 Before cosmetic operations
 Monitor breast cancer patients
Mamography
 Calcification distribution
 Number of calcifications
 Description of calcification
 Mass margin and shape
 Density and associated findings
Mamography
 Mamography is never a substitute for biopsy when a dominant or
suspicious mass is present
Senitivity 75%
Specificity 92.5%
 Purpose ,detection of<1CM tumors
 20-30%mortality decreased >50 Y
 10-50% mammo detected cancers not palpable
American geriatric society,
 annual or at least biennual mamography up to 75 y and then
every 2-3 y
 Earlier for high risks
Ultrasosograghy
 Ultrasosograghy :Dense Breast, Lactation, Pregnancy,
Age <30,ambigous mamography
 FNA: palpable lesion or under sonography
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High accuracy ,low false negative(10-15%) and rare false
positive,
if clinic or Xray suspicious for malignancy, core needle or
excisional biopsy
Core needle ,more tissue, ER-PR
For nonpalpable mass, uder sono or mammo guide
Open Biopsy
 Small mass: excision
 Large mass: FNAC or Core needle