Health Assessment and Breast Exam Guidelines

Health Assessment

• Assess onset of breast disorders and social history, including length of time and medication use.
• Observe for signs like masses, pain, swelling, redness, skin changes, and nipple discharge.
• Conduct clinical breast exams every three years for women aged 20-30, and monthly for post-menopausal women.

Self-Breast Exam Guidelines

• Optimal time for self-exam is 5-7 days post-menses; report any abnormalities to healthcare provider.
• Begin annual breast exams and mammograms at age 40; women aged 40-44 may begin earlier if desired.

Inspection and Palpation

• Inspect skin for color, venous prominence, thickening, and edema; erythema can indicate malignancy.
• Edema and sluggish skin texture suggest blockage of venous drainage; evaluate for any ulcerations or discharge.
• Paget's disease presents with erythematous nipple and areola; common in men.
• "Peau d’orange" is a classic sign of advanced inflammatory breast disorder.
• Tail of Spence, an axillary extension of breast tissue, is a common site for tumors and must be examined.

Mammography

• Mammography is the gold standard for detecting non-palpable lesions and diagnosing palpable masses, effective for lesions <1 cm.
• Begin mammography screening at least 10 years before the age at which a relative was diagnosed, or at age 45.
• Two views of each breast are standard, with exams lasting 15-30 minutes.
• Young women and those on hormone therapy may pose diagnostic challenges due to breast tissue density.

Other Diagnostics

• Ultrasonography helps differentiate between fluid-filled cysts and other lesions; dark appearance denotes cysts.
• Galactography aids in assessing nipple discharge and solitary dilated ducts.
• MRI is valuable for multifocal or multicentric tumors, assessing response to treatment.
• Fine Needle Aspiration (FNA) provides histopathologic analysis using a small gauge needle.
• Core Needle Aspiration offers more definitive tissue samples via a larger gauge needle.

Benign Conditions

• Mastalgia can be cyclical or non-cyclical, often linked to hormonal changes or trauma.
• Cysts are fluid-filled sacs typically found in women aged 30-55; may cause tenderness.
• Fibroadenomas are benign, firm, round, movable tumors, common but non-tender.
• Benign proliferative breast conditions, while non-malignant, elevate breast cancer risks.

Breast Malignancy

• Ductal Carcinoma in situ (DCIS) is characterized by malignant proliferation within milk ducts without invasion, recognizable on mammograms by calcifications.
• Early treatment may involve mastectomy; breast conservation is possible based on individual cases.
• Key risk factors for breast cancer include early menarche, genetic predispositions (BRCA1/2), obesity, late menopause, and excessive alcohol intake.

Protective Factors

• Chemoprevention options like tamoxifen and raloxifene can reduce cancer risk.
• Regular physical activity, breastfeeding, and full-term pregnancies before age 30 are beneficial.
• Long-term monitoring through mammograms and MRIs is essential; prophylactic mastectomy can be discussed.

Clinical Manifestations and Staging

• Initial signs of breast cancer include fixed, hard lumps with irregular borders, and advanced cases may show skin dimpling or ulceration.
• Common metastasis locations are the bones and lymph nodes, with distant spread frequently impacting lungs, liver, and brain.
• TNM staging describes tumor size, lymph node involvement, and metastasis extent.

Prognosis and Surgical Management

• Prognosis correlates with tumor size and lymph node spread; smaller tumors have better survival rates.
• Modified radical mastectomy involves removing breast tissue and lymph nodes, often followed by drain care.
• Total mastectomy includes removal of the entire breast and surrounding tissues.

Post-operative Management and Education

• Essential to educate patients on drain care, signs of complications like lymphedema, hematoma, and the importance of self-care post-surgery.
• Limit weight-lifting to 5-10 lbs until medically cleared; provide support for emotional adjustment and practical aspects such as driving and self-care abilities.

Radiation and Chemotherapy

• External beam radiation is typically administered for six weeks, with side effects such as fatigue and skin irritation.
• Chemotherapy may be adjuvant and uses agents like cyclophosphamide and taxanes; common side effects include nausea, fatigue, and hair loss.
• Neutropenia management includes medications like filgrastim to boost white blood cells.

Reconstruction and Recurrent Cancer Management

• Reconstruction can improve body image post-mastectomy; discuss options with plastic surgeons.
• Manage recurrent cancer by assessing prognosis and treatment strategies, including hormonal therapy and palliative care.

Health Assessment

• Assess patients' general health and onset of breast disorder.
• Collect social history and recent testing results.
• Inquiry into medications and symptoms: masses, pain, swelling, redness, nipple discharge.

Guidelines for Breast Examination

• Best time for self-breast exam for women of childbearing age is 5-7 days post-menses.
• Report abnormalities to healthcare provider promptly.
• Clinical breast exams recommended every three years for ages 20-30; monthly for post-menopausal women.
• Annual breast exams and mammograms starting at age 40.

Inspection and Palpation Techniques

• Skin inspection should include checking for color changes, venous patterns, thickening, and edema.
• Erythema may signify benign local inflammation or malignancy.
• Prominence of veins can indicate increased blood supply due to tumors (angiogenesis).
• Ulcerations or rashes require further evaluation for malignancy.
• Classic sign of an inflammatory breast disorder is peau d’orange (skin resembling orange peel).
• Tail of Spence, area extending into the axilla, must be palpated as it's a common tumor site.

Mammography

• Gold standard for detecting non-palpable lesions; effective for masses <1 cm.
• Begin screening mammograms at age 45; younger if family history is present.
• Procedure takes 15-30 minutes and requires two views of each breast.
• Tissue density can make diagnosis challenging in younger women or those on hormones.
• Involves radiation exposure and may cause mild pain.

Other Diagnostics

• Ultrasonography distinguishes fluid-filled cysts from other lesions, appearing dark on imaging.
• Galactography diagnoses nipple discharge issues through injected radiopaque material.
• MRI useful for assessing multifocal cancers and response to chemotherapy.
• Fine Needle Aspiration (FNA) provides a histopathologic analysis via a small gauge needle.
• Core Needle Aspiration offers a more definitive tissue core biopsy using a larger needle.

Benign Conditions

• Mastalgia (breast pain) can be cyclical or non-cyclical, often linked to hormonal changes.
• Breast cysts are fluid-filled sacs common in women aged 30-55.
• Fibroadenomas are firm, mobile, benign tumors, typically non-tender.
• Benign proliferative breast disorder can increase breast cancer risk despite being non-malignant.

Breast Malignancy Overview

• Ductal Carcinoma in situ (DCIS) is characterized by malignant cells in ducts without surrounding tissue invasion and appears as calcifications on mammograms.
• Surgical options may include mastectomy for their treatment.
• Risk factors include early menarche, family history, obesity, and genetic mutations like BRCA1 and BRCA2.

Protective Factors

• Chemoprevention methods such as tamoxifen and raloxifene reduce cancer risk.
• Regular physical activity, breastfeeding, and early pregnancy may lower risk.
• Long-term surveillance and prophylactic mastectomy are considered in high-risk individuals.

Clinical Manifestations of Breast Cancer

• Tumors often present as hard, fixed masses with irregular borders.
• Advanced signs include peau d’orange, nipple retraction, and skin ulceration.
• Common metastasis sites include bones and axillary lymph nodes.

Staging and Prognosis

• Staging is determined by tumor size (T0-T4), lymph node involvement (N0-N3), and metastasis (M0-M1).
• Smaller tumors and lack of lymph node involvement correlate with better prognosis; 5-year survival rates significantly drop with advanced stages.

Surgical Management

• Modified radical mastectomy involves the removal of breast tissue and axillary lymph nodes.
• Total mastectomy encompasses all breast and surrounding tissue.
• Post-operative care includes monitoring for potential complications like lymphedema and infection.

Post-operative Education

• Educate patients on drain care and self-monitoring for complications.
• Emphasize arm exercise, lifting restrictions, and signs of infection.
• Swelling, pain, and bruising may indicate hematoma; seromas require drainage.

Chemotherapy Management

• Common side effects include nausea/vomiting, bone marrow suppression, and hair loss.
• Medications like ondansetron and filgrastim support symptom management.
• Emphasize oral hygiene for mucositis and dietary adjustments.

Reconstruction

• Discuss body image, emotional impact, and surgical options for breast reconstruction.
• Procedures may involve tissue expanders or implants and require comprehensive pre-surgical discussions with patients.

This quiz explores key concepts in health assessment related to breast disorders, including clinical examination practices, self-breast exam guidelines, and awareness of symptoms. Participants will learn about the importance of regular screening and recognizing potential signs of breast health issues.