1. IN THE NAME OF GOD
BREAST DISEASE
E.Naghshineh M.D

2. Decrease if : screening
Most common cancer in women
Lifetime risk of breast cancer: 12.5% (1 in 8)
Lifetime risk of death :3.6% (1 in 28 )
Decrease if : screening
( G.P ) or ( ob . Gyn ) 6
E.Naghshineh M.D

3. Risk factors - Age (most important) -family history ( BRCA1 – BRCA 2 )
5-10 % all breast
cancer .
E.Naghshineh M.D

4. Atypical Ductal hyperplasia Atypical lobular Hyperplasia
- personal history
Atypical Ductal hyperplasia
Atypical lobular Hyperplasia
Lobular carcinoma insitu
E.Naghshineh M.D

5. Contra lateral breast cancer 0.5-1% /year Ipsilateral recurrence
(lumpectomy –Radiation )
10 % or more in 10 year
E.Naghshineh M.D

6. -Reproduction history Early menarche Late menopause Nulliparity
E.Naghshineh M.D

7. Age at first pregnancy (<30 yrs---30%, <20 yrs---50%)
breast – feeding (>24 months)
Bilateral oophorectomy
E.Naghshineh M.D

8. Not recommended for prevention of osteoporosis
-HRT
HRT increase risk ( 10 %)
HRT > 10 year increased Risk (E+P: highest risk)
HRT smaller , less aggressive Breast cancer, lower mortality
HRT Not recommended for primary nor secondary prevention of heart disease
Not recommended for prevention of osteoporosis
E.Naghshineh M.D

9. -prior exposure to radiation therapy
-7-10 yrs after radiotherapy
-breast cancer risk in 40 years: 35%
E.Naghshineh M.D

10. Other factor Jewish Black women Japanese Asian Diet (animal fat )
E.Naghshineh M.D

11. Alcohol (dose dependent) -BRCA1 , BRCA 2
-45 % Early onset in Breast cancer
-90 % hereditary Ovarian cancer
E.Naghshineh M.D

12. History & Physical Exam
Family History
Menarche
Previous pregnancies
Breast – feeding
HRT
E.Naghshineh M.D

13. Trauma
Surgery
nipple discharge
Breast mass
E.Naghshineh M.D

14. Breast self Examination
Bilateral Exam after menses & before ovulation
Supraclavicular -axilla
E.Naghshineh M.D

15. Inflammatory appearance After Antibiotic therapy: Biopsy
Mammography (screening & fallow up )
E.Naghshineh M.D

16. Mammography mediolatenal Oblique (MLO), Craniocaudal(CC) views
Screen of Asymptomatic patient
Diagnose of breast cancer in early stage
mediolatenal Oblique (MLO), Craniocaudal(CC) views
Radiation Dose<0.1 Rad per study
E.Naghshineh M.D

17. Negative mammogram not R/O Breast cancer False Negative 10-15%
If clinically positive Biopsy
Screening mammography at 40 years % Mortality
After 40 years: every 1-2 yrs
E.Naghshineh M.D

18. BI-RADS CLASSIFICATION
0:Need Additional imaging evaluation
Assessment is incomplete
1:Negative
2:Benign finding
3:Probably benign finding
Short interval follow-up suggested
4:Suspicious abnormality
Biopsy should be considered
5:Highly suggestive of malignancy
Appropriate action should be taken
E.Naghshineh M.D

19. D.Dx of Solid from cystic lesion Guide for biopsy No screening use
Breast ultrasound
D.Dx of Solid from cystic lesion
Guide for biopsy
No screening use
( Not micro-calcification Dx)
E.Naghshineh M.D

20. Ultrasound complement mammography in a young patient with dense Breast
E.Naghshineh M.D

21. MRI No role in cancer screening High sensitivity(86-100%)
Low specificity(37-97%)
Expensive
E.Naghshineh M.D

22. MRI Rupture of Breast implant
pectoralis extension in extensive breast cancer
Post lumpectomy fibrosis
Dense breast screening ?
E.Naghshineh M.D

23. FNA Palpable thickening – mass DDx solid & cystic mass
21-25 needle,10 cc,3cc
False negative 3-35%
Atypical cells Biopsy
False positive < 0.1 %
E.Naghshineh M.D

24. Fibrocystic change Most common Benign breast disease 20-50 year
Mastodynia – bilateral – pre menstrual phase
DDx: neuralgia, myalgia, chronic costochondritis
E.Naghshineh M.D

25. Etiology: ? Methylgesantins cAMP, cGMP increase
No risk for breast cancer
E.Naghshineh M.D

26. Fibro Adenoma Second common Most common < 25 ys
Smooth, mobile, painless, Palpable mass
E.Naghshineh M.D

27. Become Larger – atypia in FNA – patient desire
Dx:
-Physical exam
-sonography
–Mammography
FNA
Surgery if :
Become Larger – atypia in FNA – patient desire
E.Naghshineh M.D

28. Mastitis Breast feeding Staph Oreos – strep Continue Breast feeding
Tx:Dicloxacillin– Penicillin G
If not cure: Biopsy R/O inflammatory carcinoma
E.Naghshineh M.D

29. Ductectasia Pre-post menopause
Hard erythematous mass adjacent to the areola with burning . itching – sensation of pulling in the nipple area .
Tx: Excisional Biopsy
E.Naghshineh M.D

30. Fat Necrosis Benign, uncommon Trauma
Hard mass – irregular - skin retraction
E.Naghshineh M.D

31. Multiple calcification in mammography
No increase risk of breast cancer
DDx : carcinoma
E.Naghshineh M.D

32. Nipple discharge 10-15% Benign, 2.5- 3 % malignant
(milky – green – bloody – serous- cloudy – purulent )
bilateral- unilateral
E.Naghshineh M.D

33. Mass increase risk of cancer
If nipple discharge :
Unilateral
Single duct
Menopause
Mass increase risk of cancer
E.Naghshineh M.D

34. Breast cancer Most common: sup-lat (38.5%)
Most metastases: axilla, same side
E.Naghshineh M.D

35. Pathology Ductal carcinoma Paget Disease Lobular carcinoma insitu
Invasive ductal carcinoma
Infiltrating lobular carcinoma
Inflammatory carcinoma
Metastases from Extramammary tumors (lung,ovary,uterus,…)
E.Naghshineh M.D

36. Treatment Mastectomy Breast conservation therapy Chemotherapy
Radiation therapy
E.Naghshineh M.D

37. E.Naghshineh M.D