Click here to view next page of this article Breast MassesBreast cancer is the most common cancer in women, it affects about 180,000 women per year, it is the second leading cause of cancer death, lung cancer kills more women than breast cancer. When you cite to your patient’s the risk, it is one in eight, unlike one in eleven when I trained 13 years ago, it is one in eight, but it’s for woman living to the age of 85, and be careful to state that clearly to your patient’s breast mass. As you can see, the instance did take a little bit a blipped toward the end of 1980s and early 1990's. I am going to briefly outline the risk factors for breast cancer; age being the number one, incidentally risk factor, but from there, we interrogate out patient’s to look into family history. What are we looking for for family history? We’re looking for multiple affected relatives, early onset defined at age less than 50, bilaterality, any history of ovarian cancer. Diet. We know that Asian women world wide have the lowest instance of breast cancer, and we think it may be diet related, however, will tell you that last year in a major study from the Nurse’s Health group, a study of 80,000 women whom they have we suspect high fat, low fiber is actually an increased risk for breast cancer. Exercise. We know women who exercise frequently decrease their risk for breast cancer, a survey out of Sweden showed that women who are very active at work and at leisure time had a decrease. Breast presentations. These does not duplicate on your hand out, so if you can just fill this in with the presenting symptoms on the left hand column starting with palpable mass, abnormal mammogram, vague nodularity, nipple discharge, breast pain and breast infection, because I am going to speak about each of these entities, but an interesting point that I wanted to make, is that the likelihood of cancer. Let’s move on to some of the presentations, pain, it’s very important when we interview these patient’s to determine if it’s cyclical pain or non-cyclical. If it’s non-cyclical the patient can point point tenderness, it’s persistent throughout the menstrual cycle, she has no history of trauma or changing any kind of her exercise routine and you can’t attribute to some musculoskeletal problem, this could be an early cancer. I have had patient’s say, there is just something funny happening to my breasts. Ultrasound used to be used for differentiating cystic masses, but we’re finding that it can actually look at different types of cancers and early cancers, so it is used, be careful about using just whole breast ultrasound, you will find too many things that you really don’t want to be dealing with. Nipple discharge. I would like to divide those unto two categories, benign features and suspicious features, benign features , if it’s induced, if it’s bilateral, the color is green, gray or brown, these are kind of the normal fibrocystic changes, again changes, not disease of the breast, and those are absolutely normal. Let’s talk a little bit about areolar eczema, another presentation, if have to think about ruling out Paget’s disease, this can be done with a punch biopsy in your offices, a little 4 or 5 mm punch biopsy, a little Novocain and one stitch. Features of Paget’s disease, 60% of patient’s have palpable masses that go along with it, but 40% do not. Areolar eczema will be the only presentation. |