75 Questions
What is a fibroadenoma?
A benign breast lesion consisting of fibrotic stroma and glandular tissue
How are complex fibroadenomas different from simple ones?
They are associated with histologic characteristics like cysts greater than three millimeters in diameter, sclerosing adenosis, epithelium calcifications, or papillary changes
What is the likely etiology of benign breast disease like fibroadenomas?
An exaggerated response to normal cyclic hormonal stimuli
Why might a fine needle aspiration be necessary if a mass is found in the breast?
To obtain a sample for cytology and histology evaluation
What is the recommended management approach for breast lesions less than three centimeters?
Yearly imaging and observation
What is the risk of developing malignancy in benign breast disease without atypia if not excised?
1.5 to 3 times increased risk
Which of the following is a possible cause of fibrocystic breast disease?
Sensitivity to methylxanthines
What percentage of women in the United States have some degree of fibrocystic breast disease?
50%
What is the age group where fibrocystic breast disease is more common?
30 to 50 years old
Which of the following may help with non-pharmacologic management of fibrocystic breast disease?
Decrease in dietary fat
What pharmacologic treatment has been shown to be effective for fibrocystic breast disease?
$2000 IUs of vitamin D per day
What is the association between benign breast disease and malignancy?
$30% of all breast cancers develop in women with prior benign breast disease
What is the characteristic feature of intraductal papilloma?
$45% proliferation of the ductal epithelium and myoepithelial cells
What does ductal ectasia often associate with?
Intraductal papilloma
What is the age group among which intraductal papilloma is most common?
35-50 years
What is not known about the etiology of intraductal papilloma?
The age group it affects most
What are the common symptoms associated with multiple papillomas in the breast?
Clusters of papillomas in smaller ducts away from the nipple
What is the recommended diagnostic approach for patients with suspected papillomas in the breast?
Perform a mammogram, possibly an ultrasound or MRI
What type of discharge is typically associated with papillomas in the breast?
Red, rusty, brown, greenish discharge
What is the initial step to take when evaluating a patient with unilateral nipple discharge?
Check a TSH level to rule out hypothyroidism
Which medications may cause bilateral nipple discharge in females?
Hormonal contraceptives and opioids
What benign conditions of the breasts can be caused by trauma or infectious diseases?
Cellulitis and abscesses
What are the screening recommendations for breast cancer according to the American Cancer Society?
Annual screening between 45 and 54, then every 2 years after 55
What is described as malignant neoplasm of the epithelial or stromal cells native to the breast?
Infiltrating ductal carcinoma
Which genes function as tumor suppressor genes and are associated with breast cancer?
BRCA1 and BRCA2
What mutations can lead to cell cycle progression and limitations in DNA repair, contributing to breast cancer?
Mutations in cyclin D1 and c-Myc expression
What percentage of tumors may crosstalk with estrogen receptors and epidermal growth factor receptors, leading to abnormal cellular replication?
Up to 33%
What is described as the most commonly diagnosed cancer for United States women, according to the text?
Breast cancer
What does the US Preventative Services Task Force recommend for women at increased risk for breast cancer?
Risk-reducing medications such as tamoxifen
Why does the American Cancer Society no longer recommend monthly breast self-exams?
They lead to over-imaging and over-diagnosis
What is the recommendation for clinical breast exams according to the US Preventative Services Task Force?
Insufficient evidence to assess clinical benefits and harms
At what age does the US Preventative Services Task Force recommend bi-annual mammograms?
50 to 74
What might a patient with breast cancer describe during a history?
Painful lump in the breast or axilla
What is recommended when visualizing the breast during a physical exam?
Visualize with the patient sitting in supine for skin dimpling
What type of imaging may be necessary to differentiate fluid-filled cysts from solid masses in the breast?
Ultrasound
Which medication requires calcium and vitamin D supplementation along with its use?
Tamoxifen
What is the normal level of CA-125, a tumor marker used to rule out ovarian cancer?
Less than 35 micrograms per milliliter
What is considered the best treatment for prevention of benign ovarian tumors?
Oral contraceptives
At what age does the US Preventative Services Task Force recommend annual mammograms to start?
45
What is the primary role of a thorough history, physical, and physical exam in the diagnosis of benign ovarian tumors?
To rule out other causes of abdominal pain
What is the recommended screening tool for ovarian cancer in the general population?
Mammogram
Which condition can cause an elevated CA-125 level, leading to a false positive result?
All of the above
What is one of the symptoms associated with an acute presentation of ovarian cancer?
Nausea, vomiting, and decreased oral intake
Which diagnostic test is NOT recommended as a screening tool for ovarian cancer?
CA-125 level
What should women with a family history placing them at high risk for ovarian cancer be referred to?
Genetic counselor
What percentage of stage one ovarian cancers may have a falsely negative CA-125 level?
50%
Which tumor markers are better indicators for mucinous tumors?
CA 19-9 and CEA
What is NOT recommended for screening asymptomatic women at low to average risk for ovarian cancer?
(Mammogram)
What are the recommended diagnostics for nonepithelial tumors?
(Inhibin A/B, HCG, AFP, LDH)
What is one of the symptoms associated with a subacute presentation of ovarian cancer?
Bloating and sense of abdominal fullness
What is one of the physical exam findings associated with confirmed or suspected ovarian cancer?
Cachectic appearance
What is the indication for genetic testing if a patient has a triple negative ER or PR or HER2?
Age above 50
What is the relative risk associated with hormone replacement therapy during peri menopause?
2.1 to 4.0
What should be considered for annual MRI beginning at age 30 for patients with a 20 to 25% lifetime risk of breast cancer?
Family history of radiation exposure
Under what condition would a male patient need to have annual mammograms?
History of male breast cancer
What is the criteria for additional risk evaluation or gene testing related to the age of onset for breast cancer?
Breast cancer at any age and one or more family members with breast cancer at 50 or less years of age
What is the indication for genetic testing if a patient has two breast cancer primaries?
$ ext{BRCA}$ mutation
Which factor increases breast cancer risk for 10 years after discontinuation of medication?
$ ext{Hormone replacement therapy}$ during peri menopause
What would indicate the need for genetic testing if present in a patient's family history?
$ ext{Dermatologic manifestations}$ in family members
What is a risk factor that increases lifetime risk of breast cancer by 15 to 20%?
$ ext{Dense or unevenly dense breasts}$
What type of family history would indicate the need for annual MRI beginning at age 30?
$ ext{First degree relative with BRCA mutation history of radiation, age 10 to 30 years}$
What is a risk factor that increases lifetime risk of breast cancer by 1.1 to two?
$ ext{Diethylstilbestrol exposure}$
Who plays a huge role in the prevention of any type of cancer according to the text?
Primary care providers
What is the most common type of ovarian cancer?
Epithelial ovarian cancer
What is the leading cause of gynecologic related deaths in women?
Ovarian cancer
What is the recommended non-pharmacologic management of benign ovarian tumors?
Laparoscopic surgery
What is the age group in which half of all Epithelial Ovarian Cancer (EOC) cases are diagnosed?
Over 65
Which genetic syndrome increases the risk for colorectal, endometrial, stomach, small bowel, breast, pancreas, and ovarian cancers?
Lynch syndrome
Which factor is NOT associated with an increased risk of ovarian cancer?
Infertility
What can decrease the risk of ovarian cancer by 20% with five years of use and 50% with 15 years of use?
"Use of oral contraceptives"
"Multiparity", "breastfeeding", and "tubal ligation or hysterectomy" are considered to:
"Reduce the risk of ovarian cancer"
"Prophylactic oophorectomy" is advised for mutation carriers after childbearing is completed by the age of:
35
"CA-125 level measurement and transvaginal ultrasound every six to 12 months" is recommended for which group of patients?
"Women with family history of hereditary ovarian cancer syndrome"
"Aspirin and NSAIDs" are believed to have a protective effect against ovarian cancer, but this is:
Controversial
What should individuals and families with familial cancer syndromes undergo?
Genetic counseling
Explore the non-pharmacologic management of benign ovarian tumors such as laparoscopic surgery and the use of oral contraceptives or estrogen therapy for physiologic cysts in premenopausal women. Learn about the diagnosis and treatment of ovarian cancer, including malignancies of the ovary surface epithelium, germ, or stromal cells.
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