Disorders of the Breast ppt

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which hormones are chiefly responsible for milk production and release in the breast?

Progesterone and Luteinizing Hormone

Prolactin and Oxytocin (correct)

Follicle Stimulating Hormone and Insulin

Estrogen and Testosterone

What should primary care providers NOT do when managing breast care?

Refer patients for imaging when necessary

Perform chemotherapy regimens (correct)

Conduct thorough patient histories

Educate patients on breast disorders

Which of the following statements about breast anatomy is accurate?

Fatty tissue largely replaces breast tissue with age. (correct)

Milk is produced only in the major ducts.

The axillary nodes drain lymph from the contralateral breast.

Alveoli do not play a role in milk storage.

What is the recommended frequency for clinical breast exams in adults?

Annually during well-exams Signup and view all the answers

Which patient action is NOT recommended in breast preventative care?

Ignoring changes in breast tissue Signup and view all the answers

What role does Oxytocin play during and shortly after labor?

Facilitates milk 'let down' into the ducts Signup and view all the answers

Which aspect of patient care is a physician assistant expected to perform in breast care?

Educate patients on biopsy types Signup and view all the answers

What is typically a benign breast condition that does not have potential for malignancy?

Fibroadenoma Signup and view all the answers

What is indicated by a BI-RADS category of IV on a mammogram report?

Suspicious findings indicating a referral is necessary Signup and view all the answers

Which of the following factors significantly increases breast cancer risk?

Family history of breast cancer in first-degree relatives Signup and view all the answers

What is the primary purpose of performing Eklund views during mammography?

To better visualize breast tissue in women with implants Signup and view all the answers

What is the recommended interval for screening mammography in women aged 40-50?

Every other year Signup and view all the answers

In the management of breast presentations, what is the first step when there's a palpable breast lump?

Image the breast Signup and view all the answers

What is the main usefulness of breast ultrasound in women under 30 with a palpable mass?

Differentiating cystic from solid masses Signup and view all the answers

What is the immediate imaging technique ordered after a breast surgical procedure, like an excisional biopsy?

Diagnostic mammogram of the affected side Signup and view all the answers

What signifies a Cat 0 in BI-RADS mammogram reporting?

Needs additional imaging for clarification Signup and view all the answers

Which of the following is NOT a contraindication for mammography?

Family history of breast cancer Signup and view all the answers

What should be done if an MRI or ductogram is indicated but there's need for specialist referral?

Consult the specialist before ordering imaging Signup and view all the answers

What is one primary responsibility of a physician assistant in patient care related to breast health?

Educate patients on various biopsy types and expectations Signup and view all the answers

Which factor is involved in the involution process of breast tissue with age?

Decrease in breast tissue and replacement by fatty tissue Signup and view all the answers

Which option accurately describes the role of oxytocin during breast milk delivery?

Facilitates the release of milk into the ducts Signup and view all the answers

What is a common misconception about the primary care provider's responsibilities in breast cancer management?

They should perform lab procedures related to diagnosis Signup and view all the answers

What is a typical component of a clinical breast exam (CBE) conducted annually?

Thorough physical examination of breast tissue for abnormalities Signup and view all the answers

What percentage of breast cancers diagnosed are related to inherited factors, particularly BRCA 1 and 2 mutations?

5-10% Signup and view all the answers

Which risk factor is significantly associated with decreased breast cancer risk in women?

Regular physical activity of at least 3 hours per week Signup and view all the answers

What is considered the most significant risk factor for developing breast cancer after being female?

Age Signup and view all the answers

Which symptom is most commonly reported as a presenting complaint in breast cancer cases?

Painless breast lump Signup and view all the answers

Which factor is associated with BRCA mutations in family history?

Bilateral breast cancer in older women Signup and view all the answers

In which breast quadrant are approximately 60% of breast cancers located?

Upper outer quadrant Signup and view all the answers

Which model is one of the best tools for calculating breast cancer risk?

Gail-NCI Model Signup and view all the answers

Which of the following is NOT a typical sign of breast cancer?

Well-defined, smooth breast masses Signup and view all the answers

What is the primary clinical characteristic of Ductal Carcinoma In Situ (DCIS)?

The basement membrane is intact Signup and view all the answers

What does a higher T number in the TNM staging system indicate?

Larger tumor size or wider spread Signup and view all the answers

Which treatment approach is not considered a primary therapy for breast cancer?

Dietary changes Signup and view all the answers

Which type of breast cancer is characterized by cancer cells invading lymph ducts and blood vessels?

Invasive Lobular Carcinoma Signup and view all the answers

What is a primary goal of treatment for Stage IV breast cancer?

To relieve symptoms and improve quality of life Signup and view all the answers

In which situation is a sentinel node biopsy typically indicated?

When no cancerous lymph nodes are present Signup and view all the answers

Which is considered an advantage of modified radical mastectomy over lumpectomy?

Reduced risk of radiation exposure Signup and view all the answers

What entails the adjuvant systemic therapy for breast cancer?

Treatment aimed at minimizing recurrence risk post-surgery Signup and view all the answers

What is a significant drawback associated with a modified radical mastectomy?

Potential for altered body image and psychological effects Signup and view all the answers

Who plays a crucial role in making decisions about breast cancer treatment options?

The patient, if competent Signup and view all the answers

Study Notes

Breast Disorders - Primary Care Perspective

Benign vs. Malignant Conditions: Primary care providers need to distinguish typically benign breast conditions from those potentially malignant.
Imaging Needs: Determine which patients require imaging (mammogram, ultrasound) and what type, based on patient concerns and risk factors.
Sampling Requirements: Identify patients needing breast tissue sampling (biopsy). Specify the type of biopsy needed.
Referral Guidelines: Know when and to whom to refer patients for specialized breast care.
Self-Care for Doctors: Understand how to manage patients undergoing breast cancer treatment and surveillance (post-treatment).
PCP Limitations: Chemotherapy regimens and procedures (lab work) fall outside the scope of primary care. Don't interpret diagnostic imaging yourself; always defer to radiology.

Role of Physician Assistants (PAs) in Breast Care

Risk Assessment & Education: Assess breast cancer risk factors and educate patients.
Detailed Histories: Gather detailed patient histories.
Thorough Physical Exams: Perform comprehensive physical breast exams.
Appropriate Referrals: Recommend appropriate imaging and testing.
Patient Education (Biopsy): Explain different biopsy procedures and patient expectations.
Referral Network Knowledge: Know which specialists to refer patients to for proper care.
Specialty-Specific Knowledge: Gain extra knowledge if working in specialties related to breast care, oncology, etc.

Breast Anatomy/Physiology

Milk Production: Breast tissue produces milk for babies. Oxytocin and prolactin are crucial for lactation.
Pregnancy Hormones: Prolactin levels rise during pregnancy and remain elevated until hormones drop post-pregnancy, triggering milk production.
Milk Release: The suckling reflex (nipple stimulation) triggers prolactin elevation & milk release from ducts. Oxytocin facilitates milk "let-down"
Anatomy: Lobes hold the milk; ducts carry milk to the nipple. The breast primarily comprises fat tissue. Lymphatic drainage is crucial.
Supporting Structures: The pectoralis major/minor muscles and latissimus dorsi muscle provide support.
Involution: Breast tissue naturally shrinks and becomes more fatty with age.

Preventative Medicine

Clinical Breast Exams (CBE): Annually or with well-woman exams.
Breast Self-Exams (BSE): Breast awareness, not necessarily monthly checks. (USPSTF guidelines).
Screening Mammography: Bilateral, digital, and 3D are best. Key aspects in mammography include compression, proper positioning, and use of Eklund views (if applicable).

Bi-RADS Mammogram Reporting

Categories: BI-RADS ratings help classify mammogram findings. Cat 0-6 classifications define the severity of abnormalities and need for further procedures.
Benign/Suspicious/Malignant: Categories I-III are often benign; IV and V are suspicious for malignancy; VI indicates known malignancy.
Referral Criteria: When suspicious findings (Cat. IV & V) or further imaging are needed, referral to a specialist is necessary.

Breast Cancer Risk Factors

Age: Older age is a risk factor.
Personal/Family History: Family history of breast cancer, particularly in first-degree relatives (mother, sister, daughter), significantly increases risk. Male breast cancer family history also raises concerns.
Genetic Mutations: BRCA and PALB2 gene mutations are strong risk factors. If a relative has these mutations, genetic counseling and testing are recommended.
Other Factors: Early onset of menstruation, late first pregnancy, benign breast disease, hormone replacement therapy, oral contraceptives, and obesity also increase risk.
High Alert Risk Factors: Extreme concern for individuals with family history of breast cancer (close relatives), BRCA genetic variation, or prior chest radiation.

"High Alert" Risk Factors & Management

High Risk Measures: Annual mammograms with CBE every 6-12 months, genetic counseling/testing if a relative has BRCA mutation, discuss alternating Breast MRIs with a specialist or local radiologist.
Key Concerns: Ensure diligent breast exams & mammography, genetic screening for at-risk individuals, and specialist consultations.

Items Requiring Consideration

Breast Self Exam Findings: Lumps, skin changes, nipple discharge, retraction, changes in breast shape, should prompt investigation.
Physical Exam Findings: Palpable lumps, discharge, retraction, shape changes, skin changes, tenderness, or redness may indicate problems. Be especially wary of red, non-tender tissue.
Abnormal Mammograms/Family History: Abnormal findings and substantial family history necessitate further evaluation.

Breast Imaging (Indications & Contraindications)

Indications: Screening (mammograms, ultrasound) and breast problems; imaging should be performed in all patients.
Contraindications: No absolute contraindications but pregnancy is a relative contraindication to mammography.

Screening Mammography

Frequency: Yearly after age 40, every other year ages 40-49, annual starting at 50, and potentially later, based on individual risk factors.
Imaging Views: Bilateral (both breasts) CC (craniocaudal) and MLO (mediolateral oblique) views are required.
Implants: Mammograms with implants should include Eklund views to see around implant.

Breast Ultrasound

Role in Diagnosis: Breast ultrasound differentiates cystic masses from solid ones, especially useful for younger women. Useful as initial imaging modality for palpable masses below age 30.

Diagnostic Imaging (Mammogram/Ultrasound)

Diagnostic vs. Screening: In a patient with a significant finding or concern, perform a diagnostic mammogram/ultrasound, rather than a screening exam.
One Side Only: If possible, only image the affected breast; however, always screen the unaffected breast to ensure no overlooked earlier issues.

Management of Breast Presentations

General Rule: Image the breast, then sample if necessary for any breast related concern.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz focuses on the essential knowledge for primary care providers regarding breast disorders, including the distinction between benign and malignant conditions, imaging needs, and referral guidelines. It also addresses the role of physician assistants in breast care and patient management during treatment. Enhance your understanding of breast health in the primary care setting.