1. Breast cancer -most common -Second common ( Death ) - 211300 new case ( 2003 ) diagnosed - Lifetime Risk 2.5 % ( 1-8 )

2. - Lifetime risk death 3.6 % ( 1-28 ) - Decrease if : ( screening ) - ( G.P ) or ( ob. Gyn ) ( screening )

3. Risk factor - Age -family history ( BACA1 – BRCA 2 ) 5-10 % all breast cancer.

4. + personal history  Atypical Ductal hyperplasia  Atypical(lobular Hyperplasia )  Lobular cancinoma insitu

5.  Contra lateral breast 0.5- 1%  Ipsilateral recurrence (lumpectomy –Radiation ) 10 % in 10 year

6. Reproduction history  Early menarche  Late menopause  Nulliparity

7.  Age at first pregnancy  Breast – feeding  Oophorectomy

8. HRT  HRT increase 10 %  HRT > 10 year increased Risk (E+P)  HRT smaller, less aggressive B.C  HRT No primary ( No secondary prevention of heart disease) Not recommended for prevention of osteoporosis

9. Perior exposure to radiation therapy

10. Other factor  Jewish  Black women  Japanese  Asian

11.  Alcohol  BRCA1 BRCA 2 45 % Early onset in B-C 90 % hereditary Ov – Ca

12. History & Ph – E  History  Menarche  Breast – feeding  HRT

13.  Trauma  Surgery  nipple discharge B-S Examination  Bilateral Ex after means before ovulation

14.  Supra clavicular - axilla  Inflammatory appearance After Antibiotic Biopsy  If Biopsy benign mass R/O Malignancy.  Mammography(screening )

15. Mammography  Screen of Asymptomatic patient  MLO (mediolatenal Oblique, Cranio cudal )  Dose 0.1 Rad per study ( 0.025) Chest X Ray 0.025 Rad per study.

16.  Negative mamo not R/O B-C  False Negative 10-15%  If clinically positive ( Biopsy )  Screening mamo 40 years 20-30 % Mortality  After 40 years 1-2

17. Breast ultrasound + MRI  Solid – cystic lesion  No screening ( Not micro – Ca )

18.  Unltrasound cam complement mamo in a young pa with dense Breast

19.  MRI No role in breast cancer screening sensitivity 86-100 % specifity 37-97 %

20. MRI  Breast implant for rupture  Evaluation in pecroralis Extensive B-C  Post lumpectomy bed fibrosis  Dense breast

21. FNA  Palpable thichening – mass 21-25 needle 10 cc  False negative 30-35%  Atypical cell Biopsy  False positive < 0.1 %

22. Fibrocystic change  Most common Benign B.D  20-50 year  Mastalgia – bilateral – pre menstrual  Treatment

23. Fibro Adenoma  Second common  < 25 ys. O women  Palpable mass smooth mobile painless

24.  Mamo – sono – FNA – surgery IF : Large – atypia in FNA – patient desire

25. Mastitis  Breast feeding  Staph – strep  Continue B-F  Dicloxacillin 250 mg / QID – Penicillin G  If No Better Biopsy

26. Ductectasia  Pre-post menopause  Hard erythomatous mass adjacent to the areola with burning. itching – sensation of pulling in the nipple area.  Excision Biopsy

27. Fat Necrosis  Benign un common ( trauma )  Hard mass – irregular – skin retraction

28. Multiple calcification in mamo  No increase carcinoma  Differential diagnosis to carcinoma

29. Nipple discharge  10-15% Benign 2.5- 3 % malignant (milky – green – bloody – serous cloudy – purulent ) bilateral unilateral

30. Breast cancer + neutral History

31. Pathology  Ductal carcinoma  Paget Disease  Lobular carcinoma insitu  Invasive dactal carcinoma  Infiltrating lobular carcinome  Inflammatory carcinoma  Metastases from Extramammoy trauma

32. Treatment  Mastectomy  Breast conservation therapy  Chemotherapy

33. - High dose chemotherapy - Neoadjuant chemotherapy - Radiation –therapy

34.  Stage – directed therapy  Breast reconstruction

35. Special Issur  Hereditary B-Ca  Chemo Prevention