Breast Disorders - Chapter 139 PDF

Chapter 139 Breast Disorders  Risk Assessment  The evaluation of breast complaints is common— complaints include  Breast pain, breast masses, and nipple discharge  Evaluation should include risk factors for breast disease.  Risk groups  Family Hx/Gen...

Chapter 139 Breast Disorders  Risk Assessment  The evaluation of breast complaints is common— complaints include  Breast pain, breast masses, and nipple discharge  Evaluation should include risk factors for breast disease.  Risk groups  Family Hx/Genetic, reproductive/hormonal, proliferative benign breast disease, and mammographic density  Risk reduction  Prophylactic mastectomy  Chemoprevention  Screening Recommendations  In 2015, the US Preventive Services Task Force (USPSTF) recommendation for screening mammography for women aged 50 to 74 years of age  Evidence to continue screening women after age 75 was inconclusive  USPSTF screening recommendations for women aged 40 to 49 continue to be individualized based on the risks and benefits  There is strong evidence to suggest that mammography is most useful in women aged 50 to 65 years and that mammography remains the best method for breast cancer screening among average-risk patients.  BSE is individualized decision.  Definition  Breast pain, often referred to as mastalgia or mastodynia, is the most common breast problem encountered in primary care and surgical practices.  Mastitis refers to inflammation of the breast tissue.  Galactorrhea or milky discharge is associated with pituitary adenomas or hypothyroidism.  Breast masses  Ninety percent of breast masses are caused by benign lesions such as cysts, fibroadenomas, and fibrocystic changes.  Clinical Presentation  Puerperal mastitis is typically unilateral and may occur any time during lactation.  Fevers, chills in mastitis  Paget’s disease manifests clinically as a unilateral, well-demarcated, erythematous, scaly plaque first appearing on the nipple and subsequently spreading to the areola.  Reports of palpable masses  Physical Exam and Diagnostics  History and physical exam  Family history, surgical history, medications  Breast exam  Skin exam  Diagnostics  Mammogram  Ultrasound  Serum prolactin  Management  Based on the underlying condition  May involve:  Pharmacotherapy (antibiotics for mastitis)  Lifestyle (e.g., dietary changes)  Surgical intervention  Ongoing surveillance as indicated