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Breast cancer is the most common form of cancer in women. There are 200,000 new cases of breast cancer each year, resulting in 47,000 deaths per year. The lifetime risk of breast cancer is one in eight for a woman who is age 20. For patients under age 60, the chance of being diagnosed with breast cancer is 1 in about 400.
The etiology of breast cancer
remains unknown, but two breast cancer genes have
been cloned-the BRCA-1 and the BRCA-2 genes. Only 10% of all of the breast
cancers can be explained by mutations.
Estrogen stimulation is an important promoter of breast cancer, and, therefore,
patients who have a long history of menstruation are at increased Breast Cancer
Chemotherapy Mastectomy risk. Early menarche and late menopause are risk factors for
breast cancer. Late age at birth of first child or
nulliparity also increase the risk of breast cancer.
Family history of breast cancer in a first degree relative and history of benign breast disease also increase the risk of breast cancer.
The use of estrogen replacement therapy or oral contraceptives slightly increases the risk
of breast cancer. Radiation exposure and alcoholic beverage consumption also increase the risk of breast
cancer.
| Recommended Intervals for Breast Cancer Screening Studies | |||
| Age <40 yr | 40-49 yr | 50-75 yr | |
| Breast Self-Examination | Monthly by age 30 | Monthly | Monthly |
| Professional Breast Examination | Every 3 yr, ages 20-39 | Annually | Annually |
| Mammography,
Low Risk Patient |
Annually | Annually | |
| Mammography,
High Risk Patient |
Begin at 35 yr | Annually | Annually |
The history should assess the length of time that the
Breast Cancer Chemotherapy Mastectomy mass has been present, associated pain
(especially if cyclical), any change in size, and the color and quantity of any
discharge.
B. The results of, and time since, the last clinical breast examination and the last
mammogram should be recorder.
Physical Examination
The patient should be examined
while sitting up with arms first at her side and then behind her head, this facilitates
examination of the breast contours and allows visualization of nipple inversion or
tethering.
Examine for dimpling, asymmetry, lumps, thickened areas, or shape or contour. The
nipples should be compressed to identify any discharge and both axillae should be
palpated. Masses should be assessed for multiple components, mobility, and cystic or solid
qualities. A drawing should be made of any irregularities or masses.
The patient should also be examined in the supine position with her arms up and
<30 Years Old. The
common causes are fibroadenoma, papillomatosis, abscess (especially if lactating), and fat
necrosis.
30-50 Years Old. Common causes include fibrocystic mastopathy, cancer, fatty
lobule, or cystosarcoma phylloides.
Older than 50. Breast cancer is the primary diagnosis, followed by fibrocystic
mastopathy, fat necrosis, and cyst.
Breast nodules should be assessed
by physical exam, mammography, and aspiration biopsy. Each test taken individually has a
significant false negative rate. However, taken together, the tests have a B. If the
clinical exam, mammography, and fine-needle aspiration biopsy are benign, open biopsy is
usually not
Mammography is usually not clinically appropriate for patients under 35 years of
age For this group, the double test of physical examination and cytologic
examination.
An ultrasound of the breast may sometimes be obtained to determine if the mass
is cystic or solid. If the lesion is cystic, no further management is necessary,
or the fluid can be removed.
Fine-Needle Aspiration Biopsy (FNAB)
The skin is prepped with alcohol and the lesion is immobilized with the nonoperating hand. A 10 mL syringe, with a 18 to 22 gauge needle, is introduced in to the central portion of the mass at a 90° angle. When the needle enters the mass, suction is applied by retracting.
Cyst Aspiration. If the physical characteristics (or ultrasound) support the diagnosis of a cyst, needle aspiration may be done. Using the same technique as for FNAB, the cyst fluid.
Treatment