Breast Diseases and Disorders

Breast Diseases

• Breast patients make up 15% of new referrals to general surgical outpatient clinics.
• Breast cancer has been increasing over the years.

Breast Evaluation

• Any mass within the breast is considered cancer until proven otherwise.
• Triple assessment includes:
  • Clinical assessment (history and examination)
  • Radiological assessment (mammography)
  • Cytological/histological assessment

Clinical Assessment

• History taking includes:
  • Menses history
  • Family history
  • Trauma history
• Examination includes:
  • Inspection for asymmetry
  • Palpation of the breast and axilla

Radiological Assessment

• Mammography is used for screening, but only for women above 35 years old.
• Abnormalities on a mammogram include:
  • Irregular masses
  • Microcalcification
• Annual mammography is recommended starting at 40 years of age.

Cytological/Histological Assessment

• Fine needle aspiration cytology (FNAC) may be used to diagnose breast cancer.

Benign Breast Diseases

• Most common causes of breast problems in women include:
  • Breast feeding
  • Oral contraceptives
  • Hormonal changes
  • Trauma (fat necrosis)

Breast Cancer

• Risk factors for breast cancer include:
  • Family history
  • Delayed marriage and childbearing
  • Nulliparity (never been pregnant)
• Signs and symptoms of breast cancer include:
  • Nipple discharge
  • Breast mass
  • Axillary lymph node metastasis### Breast Diseases
• Back pain and fibrocystic breast disease can be signs of breast cancer
• Fibroadenoma is a type of benign breast lesion
• Fracture and metastasis are related to breast cancer

Diagnosis of Breast Cancer

• Mammogram (Mammo) and ultrasound (USS) are used for diagnosis
• MRI with contrast is used for high-risk individuals
• Fine-needle aspiration (FNA) is used for cytological diagnosis
• Core needle biopsy and true cut needle biopsy are used for histological diagnosis
• Incisional biopsy is used for large masses
• Excisional biopsy is used for small masses
• Nonpalpable mammographic abnormalities require biopsy

Benign Breast Diseases

• Infectious and inflammatory breast disease:
  • Cellulitis (mastitis) is common during lactation and treated with antibiotics
  • Breast abscess is a collection of purulent fluid within breast parenchyma and is treated with surgical drainage or aspiration
  • Chronic subareolar abscess is usually due to a sinus tract fistula and is treated with complete excision of the sinus tract
• Benign lesions of the breast:
  • Fibroadenoma is a common benign lesion that is usually treated with excision
  • Fibrocystic breasts are bilateral small scattered cysts that are more common in younger women
  • Mondor's disease is a benign condition characterized by superficial thrombophlebitis

Multidisciplinary Team (MDT)

• A multidisciplinary team consisting of a surgeon, oncologist, radiotherapist, radiologist, and histopathologist is necessary for treating breast cancer cases### Breast Disease and Treatment
• Fibrocystic disease: treated with follow-up, NSAIDs, and excision if size > 2cm or painful
• Phyllodes tumors: usually benign, but borderline and malignant forms exist
• Epithelial hyperplasia: 1.5-3 times higher incidence of breast cancer
• Atypical hyperplasia: 3-6 times higher risk of breast cancer
• Fat necrosis: associated with trauma, clinically mimics breast cancer
• Sclerosing adenosis: benign condition with proliferation of acini in lobules, may result in a breast lump
• Mammary duct ectasia: nipple retraction, circumferential nipple retraction, and bloody nipple discharge are suspicious signs
• Intraductal papilloma: benign, non-cancerous tumor that grows within the milk duct of the breast

Pain and Treatment

• Mastalgia: breast pain, can be cyclic (correlates with menstrual cycle) or non-cyclic
• Treatment for cyclic mastalgia: danazol, bromocriptine, and ammalolinec
• Non-cyclic pain may be caused by chest wall pain, musculoskeletal pain, or other conditions

Study and assess your knowledge of breast diseases and disorders, including symptoms, causes, and treatment options.