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| Presenting Complaints | |
| Breast lump | 65% |
| Breast pain | 15% |
| Tender lumpiness | 8% |
| Nipple discharge | 5% |
n = 1445
Mastalgia
Cyclic or non-cyclic
Diffuse or localize
Rx reassurance
Rx pain management
intermittent analgesia
Rx Danazol
Fibrocystic changes of the breast are physiologic = normal
Nipple discharge
Breast Cancer - 2006
ACS 2006 estimates
| Invasive Gynecologic Cancer - 2006 | ||
| Type | New Cases | Deaths |
| Breast | 178,700 | 43,500 |
| Corpus uteri | 36,100 | 6,300 |
| Ovary | 25,400 | 14,500 |
| Cervix uteri | 13,700 | 4,900 |
| Vulva | 3,200 | 800 |
| Vagina/Others | 2,000 | 600 |
| ACS 2006 estimates | ||
| Breast lesions by age/years - range and frequency | ||
| Range | Frequency | |
| Fibroadenoma | 10 to 80 | 20-25 |
| Fibrocystic/cyst | 25 to 65 | 40-45 |
| Invasive cancer | 20 to 90 | 60-65 |
Invasive breast cancer incidence
112:1 ratio women to men
|
Risk of developing invasive breast cancer |
|
| By age | Odds |
| 25 | 1: 29,608 |
| 30 | 1: 2,525 |
| 35 | 1: 622 |
| 40 | 1:217 |
| 45 | 1: 93 |
| Risk of developing invasive breast cancer | |
| By age | Odds |
| 50 | 1:50 |
| 55 | 1:33 |
| 60 | 1:24 |
| 65 | 1:17 |
| 70 | 1:14 |
| Risk of developing invasive breast cancer | |
| By age | Odds |
| 75 | 1:11 |
| 80 | 1:10 |
| 85 | 1:9 |
| "Lifetime" | 1:8 |
Screening Mammography Guidelines
Began annual screening mammography at age 40
American Cancer Society
American College of Radiology
2006
Balanced Budget Act of 2006
Medicare:
Annual mammogram for all women age 40 & older no deductible (waived)
Screening Mammography Guidelines
1st degree relative with invasive breast cancer
Begin annual screening mammography ten years before the age at which the relative with Br CA was diagnosed
Informal consensus NIH 2006
| Screening Sensitivity for Breast Cancer | |
| Mammography* | 85% |
| Clinical Breast Examination | 64% |
| Breast self-examination | 25% |
*90% specificity
ACS 2006
The paramount purpose of clinical breast examination is the detection of a dominant breast mass
Palpable dominant breast mass
A distinct three dimensional mass which is different from the rest of the breast tissue and from the other breast tissue
Breast mass Diagnostic Triad
Breast fine-needle aspiration
With an adequate cell sample, FNA yields a specific cytologic diagnosis in 90% of palpable breast masses
Reliability of Breast Diagnostic Triad
False negative rate 2:1000
CA with all three Dx benign
n= 1151CAs
About the same as for Bx
Reliability of breast FNA cytology
False positive rate 2:1000
Mostly atypical fibroadenomas or areas of Rx radiation